HIPAA, Abuse

1
People Caring for people since 1970
Community Health Centers SeniorCare
Center Focus on Mission, Quality, Community
Service, and Innovation
2
People Caring for people since 1970
Statement of Mission Community Health Centers We
believe that quality health care for everyone in
our community is a fundamental right. Our
mission is to ensure this right SeniorCare
Center To promote and sustain the independence of
seniors wishing to remain in the community
3
People Caring for people since 1970

• Who we are
• Services we provide
• Where we are located
• Patients we serve
• How we are funded

4
Who we are..

• Piedmont Health Services operates six federally
  qualified community health centers and one
  SeniorCare center in Caswell, Alamance, Orange,
  and Chatham counties

5
Who we are..

• Community Health Centers
• Grant-Supported Federally Qualified Health
  Centers are public and private non-profit health
  care organizations that meet certain criteria
  under the Medicare and Medicaid Programs of the
  Social Security Act and receive funds under the
  Health Center Program.
• Community Health Centers serve a variety of
  underserved populations and areas.

6
Who we are..

• What is a Health Center?
• community-based
• patient-driven
• serving populations with
• limited access to health
• care

7
Who we are..

• Health Center Fundamentals
• Located in or serve a high need community
  (designated Medically Underserved Area or
  Population).
• Governed by a community board composed of a
  majority (51 or more) of health center patients
  who represent the population served.
• Provide comprehensive primary health care
  services
• as well as supportive services (education,
  translation
• and transportation, etc.) that promote access to
  
• health care.
• Provide services available to all with fees
  adjusted
• based on ability to pay.
• Meet other performance and accountability
• requirements regarding administrative, clinical,
  
• and financial operations.

8
Community Health Centers North Carolina and
Nationally

• Spread across 50 states and all U.S. territories,
  there are 1,200 Community Health
  Centers nationally
• Providing vital primary care to 18 million
  Americans with limited financial resources.
• There are 27 federally qualified community health
  centers (FQHC) in North Carolina.
• Health centers focus on meeting the basic health
  care
• needs of their individual communities. Health
  centers
• maintain an open-door policy, providing
  treatment
• regardless of an individuals income or
  insurance
• coverage.

9
Who we are..

• Piedmont Health SeniorCare (PHSC)
• The model is centered on the belief that elderly
  with chronic health care needs and their families
  are best served in their homes and communities
  whenever possible. PHSC is an alternative to
  nursing home care and will enable seniors to
  remain in their homes in Alamance and Caswell
  counties.

10
Who we are..

• PHSC offers an innovative, financially viable
  option for community-based, comprehensive long
  -term care for the nursing-home eligible
  population. It builds on existing community
  services, to offer a full-continuum of care by an
  interdisciplinary care team in collaboration with
  patients and their loved ones.

11
Who we are..

• PHSC Efficacy and Outcomes
• PACE participants have
• lower rates of nursing home and in-patient
  hospital utilization
• higher utilization of ambulatory services
• better health status and higher quality of life
• lower mortality rates
• increased benefits for those with the highest
  levels of impairment
• PACE hospitalization rates lt ½ rate of older
  adults with similar disability levels

12
Community Based and Mission Driven

• Accreditations and Affiliations
• Accredited by the Joint Commission on
  Accreditation of Healthcare Organizations
  (JCAHO). Only 25 of all community health
  centers in the country are JCAHO accredited. We
  are part of that group and one of the first
  community health centers to receive this
  accreditation.
• Member of the Institute for Healthcare
  Improvement - The Institute for Healthcare
  Improvement (IHI) is an independent not-for-profit
  organization helping to lead the improvement of
  health care throughout the world.  Founded in
  1991 and based in Cambridge, Massachusetts, IHI
  works to accelerate improvement by building the
  will for change, cultivating promising concepts
  for
• improving patient care, and helping health care
• systems put those ideas into action. Piedmont
• joined this organization in 2008.

13
Community Based and Mission Driven

• We are a private, non-profit health center
  serving our community since 1970
• Prospect Hill, Piedmonts first community health
  center, was also the first community health
  center in North Carolina.
• Some patient families are beginning their fifth
  generation of care at Piedmont Health Services
• Some providers are marking their 100,000th
  patient appointment.

14
Community and Mission Driven

• Piedmont Health Services History
• March 1970 First incorporated as
  Orange-Chatham Comprehensive Health Services, a
  joint venture of the UNC Division of Health
  Affairs a Local Community Action Program
• Late 1970 Opened Prospect Hill Carrboro
  Moncure CHCs
• May 1995 - Name changed to Piedmont Health
  Services, Inc.
• 1996 Opened Charles Drew CHC
• July 2001 Acquired the Scott Clinic
• December 2002 Opened Siler City CHC
• February 2006 Opened a new facility to house
  Siler City CHC
• August 2007 Began conversion to Electronic
  Health Records
• October 2008 PHS Senior Care opens in
  Burlington

15
Community and Mission Driven

• Patients Served (based on 2007 data)
• 35,195 Users
• 102,138 Medical Visits
• 8,731 Dental Visits
• 210, 000 Prescriptions filled
• Employer Status (2009)
• We employ 250 full-time, part-time and PRN
  employees from a wide range of professional
  disciplines to include Physicians, Mid-Level
  Providers, Nurses, Medical Assistants, Registered
  Dieticians, Pharmacists, Pharmacy Technicians,
  Dentists, Dental Hygienist, Dental Assistants,
  Social Workers, and Medical Office Staff.

16
Services We Provide

• Primary Health Care with Wrap-around Services
• Physician and Midlevel Provider medical care
• Dental Services with diagnostic XRAY
• Pharmacy Services onsite
• Lab Services both in-house and Reference
• Social Work Services for any patient
• Women Infants and Children (WIC) and nutritional
  services
• Referrals for Specialty Services
• UNC Collaborative to provide medical home for
  uninsured
• Adult Day Health Center providing all-inclusive
  care for the elderly while allowing them to
  remain in their community and out of the nursing
  home.

17
Where We Are Located
6 centers in 4 counties, providing health care
to more than 35,000 people
18
Services We Provide

• Piedmont Health Services has 6 CHCs Centers
  located in 4 counties

Our designated service area is Almance, Caswell,
Chatham, Lee, Orange, Person and Randolph Counties
19
Patients We Serve
Community Health Centers

• Calendar year 2007

20
Patients We Serve
Patients by Payment Source - Community Health
Centers
50 30 11 7
21
Patients We Serve

• SeniorCare Eligibility Criteria (Who can enroll)
• 55 years of age or older
• Resident of a SeniorCare service area (Alamance
  or Caswell)
• Certified as needing nursing home care
• Able to live safely in the community with the
  services of the SeniorCare program at the time of
  enrollment

22
Community Health
Funding..

• 19 of our Operating Budget is our
• Federal Grant
• FQHC (Federally-Qualified Health Center) Annual
  Grant supports our care for patients who cannot
  pay their full charges

23
Community Health Centers
Funding..

• 81 of our revenue comes from patients
• Sliding Scale (Self-pay) 51
• Medicare 10
• Medicaid 27
• NC Childrens Health Choice Program
• Private Insurance 12
• Other Funding Sources
• Our Sliding Scale patients are North Carolinas
  working poor they pay their bill at a gt90 rate

24
SeniorCare
Funding..

• Managed Care Model
• Monthly capitated payments
• Pooled financing
• Medicare, Medicaid small amount of private pay
• For dually-eligible participants, revenue is
  approximately 2/3 Medicaid 1/3 Medicare
• Medicare capitation rate adjusts for the frailty
  of the PACE enrollees

25
People Caring for people since 1970
Statement of Mission Community Health Centers We
believe that quality health care for everyone in
our community is a fundamental right. Our
mission is to ensure this right SeniorCare
Center To promote and sustain the independence of
seniors wishing to remain in the community