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Health Care Reform. Our State: Problems and Perceptions State Medicaid: Issues and Direction A Case for Federal Reform Community Health Centers. NICHOLAS. MC-. CUMBER-. CRACKEN. LAND 1. MUA/P and HPSA Designations. Shortage Designation Legend

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Health Care Reform

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Health care reform

Health Care Reform

  • Our State: Problems and Perceptions

  • State Medicaid: Issues and Direction

  • A Case for Federal Reform

  • Community Health Centers


Health care reform

NICHOLAS

MC-

CUMBER-

CRACKEN

LAND

1

MUA/P and HPSA Designations

Shortage Designation Legend

Medically Underserved Area or Population (MUA/P)

Health Professional Shortage Area (HPSA)

Both MUA/P and HPSA

KENTON

BOONE

CAMPBELL

BRACKEN

PENDLETON

GREENUP

GALLATIN

GRANT

MASON

LEWIS

WOOD-

CARROL

ROBERTSON

Boyd

TRIMBLE

OWEN

HARRISON

FLEMING

CARTER

HENRY

OLDHAM

ROWAN

BATH

SCOTT

ELLIOT

BOURBON

FRANKLIN

LAWRENCE

SHELBY

MONTGOMER

JEFFERSON

FAYETTE

MENIFEE

JOHNSON

CLARK

FORD

MORGAN

MARTIN

SPENCER

ANDERSON

FORD

POWELL

JESSAMINE

MAGOFFIN

BULLITT

WOLFE

FLOYD

MEADE

MERCER

MADISON

NELSON

ESTILL

WASHINGTON

LEE

GARRARD

BREATHITT

PIKE

BRECKINRIDGE

HANCOCK

HARDIN

BOYLE

HENDERSON

JACKSON

OWSLEY

KNOTT

MARION

DAVIESS

LARUE

LINCOLN

PERRY

ROCKCASTLE

WEBSTER

UNION

MCLEAN

GRAYSON

TAYLOR

LETCHER

HART

CASEY

CLAY

OHIO

Leslie

LAUREL

GREEN

CRITTENDEN

PULASKI

EDMONSON

HOPKINS

HARLAN

MUHLENBERG

BUTLER

ADAIR

METCALFE

KNOX

LIVINGSTON

RUSSELL

CALDWELL

BARREN

BELL

WARREN

WHITLEY

LYON

WAYNE

CHRISTIAN

LYON

CUMBER-

LAND

BALLARD

ALLEN

MCCREARY

LOGAN

MONROE

CLINTON

TODD

SIMPSON

TRIGG

CARLISLE

MARSHALL

GRAVES

HICKMAN

CALLOWAY

FULTON

Designations as of March 2009


Health care reform

Cunningham, Peter J., and Laurie E. Felland, Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007,

Tracking Report No. 19, Center for Studying Health System Change, Washington, D.C. (June 2008).


Health care reform

What Do People Say?


Health care reform

STATE OF THE STATEMedicaid growth and cost is unsustainable.New leadership gets it! They understand the Big Picture and see how the parts fit together.Trying to move Medicaid from an entitlement program to a program that will improve the health of a population.Using Stimulus, HITECH and MTG funding to move changes in Medicaid and the health of the StateFocus on Medical Home and outcomes


Health care reform

THE CASE FOR REFORM AT THE FEDERAL LEVELACCESS⎯MILLIONS OF AMERICANS LACK COVERAGECOST⎯ GROWTH IN HEALTH CARE SPENDING IS UNSUSTAINABLE FOR FAMILIES, BUSINESSES, AND THE FEDERAL GOVERNMENTQUALITY⎯ POOR RETURN ON OUR HUGE INVESTMENT


Health care reform

PROBLEMSThere is no health care system. It is a business enterprise.We have a series of silos.Accountability is limited. It has about the same controls as Wall Street.


Health care reform

SOCIETIAL DECISIONAs a society we have decided that education is a right. We have not made a decision whether health care is a right or a privilege.LESSONS LEARNED AND UNLEARNEDWhat we are learning as a society is that education is a key to our economic success. What we have not learned is that a well educated and healthy workforce is the true key to our future.


Community health centers in kentucky

Community Health Centers in Kentucky


Innovative approaches in healthcare

Innovative Approaches in Healthcare

  • Technology

  • National Quality Initiative


Health care reform

NICHOLAS

MC-

CUMBER-

CRACKEN

LAND

1

Section 330 Health Center Sites by County

with MUA/P and HPSA Designations

Health Center Legend

New Section 330 Health Center sites funded by the ARRA Stimulus Package

Section 330 Health Center Sites by County

(Number of sites in the County is indicated in circle)

Shortage Designation Legend

Medically Underserved Area or Population (MUA/P)

Health Professional Shortage Area (HPSA)

Both MUA/P and HPSA

KENTON

3

BOONE

CAMPBELL

6

GALLATIN

BRACKEN

PENDLETON

1

1

GREENUP

GRANT

MASON

LEWIS

WOOD-

CARROL

2

12

Boyd

TRIMBLE

OWEN

HARRISON

FLEMING

CARTER

1

HENRY

OLDHAM

ROWAN

BATH

SCOTT

ELLIOT

BOURBON

FRANKLIN

LAWRENCE

SHELBY

MONTGOMER

JEFFERSON

FAYETTE

10

MENIFEE

JOHNSON

CLARK

FORD

8

MORGAN

MARTIN

SPENCER

ANDERSON

1

POWELL

JESSAMINE

MAGOFFIN

BULLITT

WOLFE

FLOYD

MEADE

1

MERCER

MADISON

NELSON

ESTILL

WASHINGTON

LEE

GARRARD

1

BREATHITT

2

PIKE

BRECKINRIDGE

HANCOCK

3

1

1

HARDIN

BOYLE

HENDERSON

JACKSON

OWSLEY

KNOTT

MARION

DAVIESS

LARUE

LINCOLN

1

PERRY

ROCKCASTLE

1

6

WEBSTER

UNION

MCLEAN

GRAYSON

TAYLOR

LETCHER

HART

CASEY

CLAY

OHIO

1

1

Leslie

LAUREL

GREEN

CRITTENDEN

PULASKI

2

EDMONSON

HOPKINS

HARLAN

MUHLENBERG

BUTLER

ADAIR

1

METCALFE

1

KNOX

LIVINGSTON

2

1

RUSSELL

1

1

CALDWELL

2

BARREN

BELL

WARREN

1

WHITLEY

LYON

WAYNE

CHRISTIAN

LYON

CUMBER-

LAND

1

BALLARD

ALLEN

MCCREARY

LOGAN

MONROE

CLINTON

TODD

SIMPSON

TRIGG

CARLISLE

MARSHALL

GRAVES

HICKMAN

CALLOWAY

FULTON

2008: 19 grantees with 76 sites in 30 counties

As of March 2009: 20 grantees with 83 sites in 37 counties (The additional sites will be open by July 2009)


What is a health center

What is a Health Center?

  • For more than 40 years, HRSA-supported Health Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations.

  • Health centers are community-based and patient-driven organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those living in public housing.


Health center program fundamentals

Health Center Program 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.

  • Providecomprehensive 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 otherperformance and accountability requirements regarding administrative, clinical, and financial operations.


Health care reform

Technology

Teleradiology

Hospital Portals

Insurance

Internet

Family Med., Pharmacy

PrimaryPlus Flemingsburg

PrimaryPlus Tollesboro

Family Medicine

Other Data Sources

T-1 Voice Data TeleHealth

T-1

T-1 Voice Data TeleHealth

PrimaryPlus Maysville

T-1 Voice Data TeleHealth

OB/GYN, Family Medicine, Pharmacy

T-1 Voice Data TeleHealth

Family Med., Women’s Health, Dental, PT and Fitness Center and Pharmacy

PrimaryPlus Vanceburg

PrimaryPlus Bracken

Family Medicine

T-1 Voice Data TeleHealth

T-1 Video Only

Comprehend

PrimaryPlus Robertson County

University of Louisville

University of Kentucky

Other


Community programs

Community Programs

LIFE STILL ENHANCEMENT ACTIVITY PROGRAM

LEAP

A PERSONAL AND COMMUMITY WELLNESS APPROACH


National quality initiative

National Quality Initiative

Health Disparities Collaborative

THE EXPERIENCE IN CHCs IN

KENTUCKY


How is data being used to impr0ve care in chcs

HOW IS DATA BEING USED TO IMPR0VE CARE IN CHCs


Health care reform

An example is provided by the analysis we performed in linking data on diabetics from Big Sandy’s information system with Medicaid claims data. We accomplished this with the assistance of Artemetrx. We had observed, as stated earlier, that Big Sandy clinicians prescribe 80% of their diabetic patients renal-protective agents. In looking at the Medicaid claims data, however, we find that a full 29% of those patients prescribed such medications never get them filled at a pharmacy. Further analysis of claims data reveals that only 39% of patients prescribed these medications are compliant with the medication at least 75% of the time. With access to this type of information, Big Sandy would be in a position to greatly enhance its already leading edge care management programs.


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