Americas Health Centers: Yesterday, Today and Tomorrow

1
Americas Health CentersYesterday, Today and
Tomorrow

• Presentation to TACHC
• 2006 Fall Conference
• Craig A. Kennedy
• National Association of Community Health Centers
• October 17, 2006

2
First, A Quick Check (-up)

• How many have 3 years with CHCs?
• How many 3 PCA Annual Conferences?
• 3 NACHC Meetings (PI, CHI, etc.)?
• How many are CHC Advocates at NACHC?
• A test
• What of Region 8/10 CHC staff/Board members are
  CHC advocates today?
• What of those advocates typically respond to
  Action Alerts

3
Brief History of Health Centers

• Common Roots Turn-of-Century Dispensaries, Milk
  Clinics, Public Health Reforms
• Special Heritage Civil Rights, War on Poverty
  Efforts to Address Needs of Poor Minorities
• Unique Public-Private Partnership Resources
  Directly to Community-Owned Organizations
• Health Centers Two-Fold Purpose -
• Be Agents of Care in Communities With Too Little
  of the Same
• Be Agents of Change, Giving Communities Control
  of their Health Care System

4
Brief History of Health Centers

• Health Centers Five Basic Characteristics -
• Location in high-need areas
• Comprehensive health and related services
  (especially enabling services)
• Open to all residents, regardless of ability to
  pay, with charges prospectively set based on
  income
• Governed by community boards, to assure
  responsiveness to local needs
• Held to strict performance/accountability
  standards for administrative, clinical, and
  financial operations

5
Growth of Health Centers 1970-2005
6
Accomplishments of Health Centers

• Health Care Home for 16 Million Americans
• 1 of 7 Uninsured Persons (6.4 million)
• 1 of 9 Medicaid/CHIP Recipients (5.7 Million)
• 1 of 4 Low-Income Children (5.9 million)
• 1 of 5 Low-Income Births (400,000)
• 1 of 9 Rural Americans (7.9 Million)
• 10 Million People of Color, 750,000 Farmworkers,
  700,000 Homeless Persons

7
Location of Community Health Centers
8
Accomplishments of Health Centers

• Excellent Quality of Care More Effective Care,
  Better Control of Chronic Conditions, Greater Use
  of Preventive Care, Fewer Infant Deaths
• Major Impact on Minority Health Significant
  Reductions in Disparities for Health Outcomes,
  Receipt of Preventive and Condition-Related Care
• Higher Cost-Effectiveness Lower Overall Costs,
  Lower Specialty Referrals and Hospital
  Admissions, Substantial Medicaid Savings
• Significant Community Impact Employment and
  Economic Effects, Contribution to Community
  Well-Being, Development of Community Leaders

9
Recent Recognition of Health Centersby Key
Government Agencies

• IOM recommended health centers as THE model for
  reforming the delivery of primary health care
  (Rapid Advances in Health Reform)
• GAO credited CHCs for Collaboratives success and
  recommended expanding them further
• OMB ranked CHC program 1st among all HHS programs
  and one of the top 10 federal government programs
  for effectiveness

10
Health Centers Provide One-Fourth of All
Ambulatory Care for Uninsured
11
But Millions of Americans Have No Regular Source
of Care

• 35 Million People Have No Regular Source of Care
  (not even a Health Center)
• Half are Uninsured
• 40 percent are Members of Minority Groups
• In 13 states, they number More Than 1 Million
• 47 Million People are Uninsured
• Three-fifths are in Low-Income Families
• One in 3 Latinos is Uninsured

12
Major Challenges AffectingHealth Centers

• Growth in Uninsured Continue to be Largest and
  Fastest-Growing Group of Health Center Patients
• Decline in Charity Care Cutbacks by Private
  Providers Squeezed by Managed Care
• Loss of Medicaid and Other Public Funding Severe
  Deficit Reduction Cuts by States now
  Congress
• Changing Nature of Insurance Coverage Growing
  Shift to Catastrophic/High-Deductible Plans that
  Cover Little or no Preventive/Primary Care

13
Growth in Uninsured PopulationServed by Health
Centers, 1990-2005
Percent Increase
Uninsured Served by Health Centers
(6.4 million 128 increase since 1990)
All Uninsured
(47 million 34 increase Since 1990)
SOURCE Data from 1996-2005 UDS National
estimates from Bureau of the Census.
1990
1995
2000
2005
14
NACHCs Legislative Priorities for 2006

• Reauthorize Health Center 330 law without
  change
• Appropriate at least the Presidents request for
  a 181 million increase in FY2006, plus increases
  for other key programs (eg, NHSC)
• Medicaid reforms must not hurt people or safety
  net providers
• State Flexibility must not violate Congressional
  intent to protect FQHCs and preserve PPS
• Also, revise Medicare FQHC payment cap, make
  FTCA available for volunteers emergencies, and
  allow CHC staff to have FEHBP coverage

15
Reauthorization

• What is it and why is it needed?
• Core features location in area of need, open to
  all, comprehensive services, community-owned and
  operated
• Support for continuation growth
• Who wants to change it?
• Non-community owned providers (faith-based,
  others) who want access to funding, FQHC, FTCA,
  340B, VFC, etc.
• What is the current status?
• House passed straight reauthorization (HR 5573)
  424-3 Senate action pending on similar bill (S
  3771)

16
AppropriationsMeasuring Funding Results
17
Medicaid What Did Congress Do?

• The Deficit Reduction Act (DRA) gives states
  broad new flexibility to re-shape Medicaid
• Benefit Flexibility States can enroll most
  beneficiaries in private insurance programs, with
  fewer benefits NOTE The Deal amendment assures
  continued access to FQHCs and payment at PPS
  rates
• Cost-sharing States can increase cost-sharing
  for all above-poverty beneficiaries, and can
  charge premiums deductibles for the first time
• New Waivers States can set up Health
  Opportunity Accounts (HOAs), giving
  beneficiaries a fixed cash account for
  preventive/primary care, with back-up coverage
  only for catastrophic specialty or hospital care
• It also requires states to verify the citizenship
  or legal status of all Medicaid applicants
  beginning July 1, 2006

18
State Flexibility What Does it Mean?

• States can now change their Medicaid programs
  without a waiver, and in most cases without
  legislative action
• In most states, the Governor can change Medicaid
  without asking the legislature for approval
• CMS is actively encouraging states to implement
  Medicaid reform, promising a quick review of
  State Plan Amendments
• This means that there may be NO public notice or
  opportunity to review or comment on proposed
  changes before theyre approved
• CMS is also encouraging states to apply for HOA
  and other waivers, promising quick review
  approval also
• Here, too, there may be little or no opportunity
  to review comment on proposed waivers before
  theyre approved

19
What is NACHC Doing About This?

• NACHC has organized a special program of legal,
  technical, and advocacy assistance to PCAs,
  especially in high-risk states
• Developed distributed special model state
  legislation to make sure that any state Medicaid
  changes are publicly disclosed and reviewed in
  state legislatures
• Identified which of the 50 states currently have
  no legislative oversight of their Medicaid
  programs, and is providing legal technical
  assistance to PCAs in these high-risk states
• Offering strategic advocacy assistance to all
  PCAs that request it
• NACHCs special Partnership for Medicaid will
  continue to fight for Medicaids future
• The Partnership includes public childrens
  hospitals, primary care and minority physician
  groups, nursing homes, the cities and counties,
  and other safety net providers
• It has produced a series of proposals for making
  Medicaid more efficient effective, without
  cutting current eligibility, benefits, or
  provider payment rates
• Working closely with the HHS Medicaid Commission
  to influence its report to Congress, due at the
  end of 2006

20
Other Major Policy Issues

• Increase the Medicare Payment Cap
• 75 of all FQHCs affected, 51M in lost revenues
• Can be fixed administratively, without
  legislation
• Extend FTCA Coverage
• Allow coverage across state lines in emergencies,
  and coverage for providers who volunteer to see
  patients
• Allow CHCs to enroll employees in FEHBP
• Multiple plans, excellent benefits, lower costs,
  but CHCs must pay employer share (75)

21
The Future Our Vision

• Grow health centers to become the health care
  home for all 51 million Americans who need a
  health care home (51/15/15)
• Reform health professions programs to promote
  Primary Care careers, workforce diversity, and
  service to underserved via health centers
• Preserve the Medicaid guarantee of coverage for
  low-income, elderly disabled Americans

22
The Future Our Vision (contd)

• Wire every health center for complete health
  information technology (HIT)
• Lead the way to a high-performing health system,
  grounded in primary care
• Play a central role in emergency preparedness, at
  the local national levels

23
How Health Centers Re-pay the Public Investment

• They reduce hospital and ER use (5.8 fewer admits
  per 1,000 13 - 38 fewer ER visits) for their
  patients
• Their Medicaid patients cost 30 percent less than
  those served by other providers, saving Billions
  of
• Their disparities collaboratives are found to
  reduce health disparities significantly for
  minority patients
• They stand ready to serve more uninsured people
  with limited support (about 500 annually/person)

24
Success (and Our Future) WillDepend on Strength
of Advocacy

• Advocacy is not just a clinical or social work
  act for individual patients, but a responsibility
  of leaders for their communities
• Advocacy involves full participation in groups
  that support your cause (PCAs and NACHC)
• This means organizational membership (dues
  support)
• Also means active individual participation
  (grassroots advocacy with state/federal
  policymakers)

25
Why Care About Advocacy?

• Health centers a remarkable record of
  achievement open access, superior care,
  cost-effectiveness we are part of the SOLUTION
• BUT
• Not enough people know about us our record
• The challenges we face are daunting
• AND
• The only way we can win is to grow our
  Grassroots, (100,000 staff/Board members, 16
  million patients), speak with one voice, make it
  count!

26
What Can You Do to Help?

• Sign up as a Health Center Advocacy Coordinator
  or as an Advocate (go to www.nachc.com for
  details)
• By signing up, you will receive regular updates
  from NACHC and will be notified when action is
  needed
• Get 5 colleagues/friends to do the same
• Invite your Member of Congress and State
  legislators to visit your health center
  (especially during recesses, and National Health
  Center Week, August 5 11, 2007 begin
  preparing NOW!
• Send the message that health centers are part of
  the solution, and ask them to support our efforts
  to do even more!
• Join the National Association of Community Health
  Centers and Your State Regional PCAs

27
NACHC Resources

• Visit our improved, expanded web site
• for more information on all issues,
• for the latest on federal state policy
  developments,
• to sign up as an advocate and send a message to
  your Members of Congress on key Health Center
  issues
• Address is www.nachc.com