CREATION OF LARGE
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CREATION OF LARGE FQHC SYSTEMS PowerPoint PPT Presentation


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CREATION OF LARGE FQHC SYSTEMS. ACCESS History… Founded as FQHC in 1991. FY 1994 9 sites 100,000 primary care visits 35,000 unduplicated patients including 13,000 HMO patients 150 staff $12 million in revenues on $20 million budget Single hospital operating relationship

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CREATION OF LARGE FQHC SYSTEMS

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Creation of large fqhc systems

CREATION OF LARGE FQHC SYSTEMS


Access history founded as fqhc in 1991

ACCESS History…Founded as FQHC in 1991

FY 1994

  • 9 sites

  • 100,000 primary care visits

  • 35,000 unduplicated patients including 13,000 HMO patients

  • 150 staff

  • $12 million in revenues on $20 million budget

  • Single hospital operating relationship

  • 40% operating deficit off-set by $8 million operating grant by affiliated hospital

  • Served small geographic area –primarily South and West sides of Chicago

  • Medical only model

  • Defunding notification by Bureau of Primary Health Care


Access history cont

ACCESS History cont..

FY 2004

  • 43 sites (does not include all original 9 sites)

  • 460,000 + primary care visits

  • 150,000 unduplicated patients including almost 39,000 HMO patients

  • 600 staff

  • $65 million in revenues

  • Small operating surplus

  • Multiple hospital relationships

  • Metropolitan-wide including 11 suburban sites

  • Comprehensive primary care model with specialty services and wide array of behavioral health and “wrap-around”services

  • Added teaching programs

  • JCAHO accredited

  • Largest FQHC in U.S.

  • Participant in “Best Practices” FQHC forum identified by BPHC


Access history cont1

ACCESS History cont..

Turnaround Strategies

  • Implemented basic management and financial systems

  • Adjusted provider and ancillary support staff to match volume and increase productivity

  • Redesigned service delivery model to reduce encounter costs by 27% since FY 1994 while simultaneously expanding ancillary services and improving quality of care.

  • Secured local, state and federal grant support as well as private philanthropic funds

  • Grew to respond to need, increase revenues and achieve economies of scale

  • Developed incentive system for staff at all levels in organization based on financial performance


Fqhc history

FQHC History

  • Originated out of “War on Poverty” of the 1960s and 1970s.

  • Response to lack of primary care access and lack of community control over health services.

  • Two major guiding principles:

    • Access regardless of ability to pay

    • Patient/community governed

  • Historically small and single site operations

    • Some struggle to remain fiscally viable in evolving/competitive environments

    • Trend is toward larger and multi-site operations.

    • Handful of “super” FQHCs of large systems with 250,000+ medical visits

  • President Bush’s major health care initiative goal is to double number of FQHC users and sites


Fqhc benefits

FQHC Benefits

  • Enhanced Medicaid and Medicare fee-for-service reimbursements

  • Enhanced reimbursement for Medicaid HMO and Medicare HMO patients (state specific)

  • Access to federal BPHC Section 330 funding

  • Access to reduced drug costs through 340(b) program

  • If directly federal funded, then free malpractice coverage through Federal Tort Claims Act (FTCA)

  • Safe-harbor provision through new Medicare legislation

  • Brought stability to safety net system through increased revenues and decreased costs


Major fqhc regulations

Major FQHC Regulations

  • Autonomous Board and management

  • Provide services to whole life-cycle (pediatric to geriatric)

    • Including dental, mental health and pharmacy (may be referred)

  • Board cannot be subsidiary of parent Board

  • 51% of Board must be patients of FQHC and reflective of patient population

  • Of the remaining 49% of Board members:

    • No more than 50% can make more than 10% of income from health care

    • Must be representative of community at large

  • Majority of providers must be employees of FQHC

  • Must be not-for-profit

  • Be located in a designated medically underserved area or serve a designated medically underserved population.


Access statistics

ACCESS Statistics

  • 150,000 users with 460,000+ medical visits

  • 60% African American, 35% Latino, 4% White, 1% Other

  • FY’04 Budgeted Visits:

    • 44% Medicaid fee-for-service

    • 24% Uninsured

    • 17% HMO (60% Medicaid, 40% Commercial)

    • 9% Commercial

    • 6% Medicare

  • FY’04 Budgeted Revenues:

    • 55% patient revenues (78% Medicaid, 10% Medicare, 7% Self-pay, 5% Commercial)

    • 28% HMO capitation (67% Medicaid and 33% Commercial)

    • 17% other (local, state and federal grants; health system grants: rent: private funding etc.)


Fqhc benefits to access

FQHC Benefits to ACCESS

  • Enhanced Medicaid rate 4x non-FQHC rate in Illinois = $14.75 mil/yr

  • Medicaid HMO wrap-around payment = $3.25 mil/yr

  • Enhanced Medicare rate 1.3x non-FQHC rate = $750,000/yr

  • Malpractice savings = $4 mil/yr (no tail costs)

  • Federal 330 Grant = $4.5 mil/yr

  • 340(b) saves ACCESS about 28% on prescriptions for HMO members

    • Helps patients save 53% on prescriptions compared to retail


Recommendations

Recommendations

  • Single corporate entity with multiple sites to achieve scale to impact problem and to leverage funder, government, insurer, payors and hospital relationships

  • Owned and operated by private entity with public/hospital funding

    • Autonomy and nimbleness are critical

  • Managed by staff with strong ambulatory, primary care experience

    • Cannot be operated/staffed like hospital settings

  • Representation of hospitals and government on Board

  • Hospital and public grants executed through contractual arrangements and/or affiliation agreements.

  • Develop secondary level of care relationships

    • Including for the uninsured


Access senior management team

ACCESS Senior Management Team

Mike Savage

CEO

[email protected]

773.257.6307

Dr. Dan Mukundan

Medical Director

[email protected]

773.257.6025

Donna Thompson

COO

[email protected]

773.257.6219

Eduardo V. de Jesus

CFO

[email protected]

773.257.5643

Steven Glass

V.P. External Affairs

[email protected]

773.257.5099

Warren Brodine

Director-Strategic Initiatives

[email protected]

773.257.5362


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