Developing Agendae for Training of CHCs

1. Developing Agendae for Training of CHCs Mauda Monger, MPH Delta Region AIDS Education Training Center 2012 Faculty Development Conference LPS Coordinator- Mississippi

2. Points of Discussion • History of CHCs in the United States • Community Health Center defined and types of CHCS • Building collaborations and trainings with Community Health Centers

3. History of Community Health Centers • First clinics opened in 1965, Boston and 1967 in Mount Bayou, MS (neighborhood clinics) • Were developed to provide health and social services access points in poor and medically underserved communities and to promote community empowerment • Health Centers Consolidation Act of 1996 – Public Service Act (330 funds)

4. What is a community health center? Health centers are community-based and patient-directed organizations that serve populations with limited access to health care.

5. 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.

6. Types of Health Centers • Community Health Center or Health Center: • An outpatient clinic that receives grant funds from the federal government through §330 of the Public Health Service Act (PHSA). • Look-alike: • An outpatient clinic that meets all requirements to receive §330 grant funds but does not actually receive a grant.

7. Types of Health Centers • Rural Health Clinic: • An outpatient clinic that may be for profit, is located in a rural HPSA or MUA, and uses nurse practitioners and physician assistants to provide the majority of care. • Tribal or Urban Indian FQHC: • An outpatient clinic or program operated by a tribe or tribal organization or by an urban Indian organization.

8. Who does the community health center serve? • Low income • Minorities • Elderly • Young people (16-25) • Children

10. Challenges of Health Centers • Growth in Uninsured: Continue to be Largest 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 • Shortage of Primary Care Physicians:Growing Demand and Lack of Appeal to U.S. Medical Students is Already Causing Physician Vacancy Rates in Health Centers

11. Health Center Workforce Shortages • Need 1,843 primary care providers, inclusive of physicians, nurse practitioners, physician assistants, and certified nurse midwives. • 1,384 nurses short. • To reach 30 million patients by 2015, health centers need at least an additional 15,585 primary care providers • Health centers also will need another 11,553 to 14,397 nurses. Health Center Workforce ShortagesSource: NACHC, Robert Graham Center, and The George Washington University School of Public Health and Health Services, Access Transformed: Building A Primary Care Workforce For The 21stCentury, August 2008, www.nachc.com/research.

12. Building Collaborations • Starting Points • Develop a plan • What is it we want from the CHCs? • How are we willing to support them in their efforts? • Learn the role and history of CHCs in your state • Make a connections within the health care organizations that support and or govern the community health centers in your state

13. Developing your plan • Establishing relationship with governing bodies (MPHCA) • May take a long period of time • Attend all functions( meetings, trainings, & conferences) • Understand the dynamics • Connect with the board, medical directors and lead persons of clinics

14. What do I want from these sites? • Get educated about HIV/AIDS epi in the state • Provide a safe environment for their community to get information on HIV/AIDS • Offer HIV screening as a part of routine care • Provide information on HIV/AIDS prevention and modes of transmission • ULTIMATELY..provide primary HIV care

15. What are we willing to do to aid them? • Provide training (onsite and offsite) • Provide resources and links to resources • Provide effective and efficient consultation options • Be a source of technical assistance

16. Mississippi Federally-Supported Health Centers, 2010 • Number of Organizations 21 • Number of Delivery Sites 188 • Total Patients 314,612 • Number Seasonal Farmworker Patients 999 • Number Homeless Patients 7,455

17. Mississippi Federally-Supported Health Centers, 2010 Health Center Population At or Below 100% of Poverty 72% Under 200% of Poverty 94% Uninsured 43% Medicaid 30% Medicare 9% Hispanic/Latino 3% African American 65% Asian/Pacific Islander 1% White 34% Rural 71%

18. Needs Assessment • Should be done in person • Should be direct and concise • Use the background data to have a realistic conversation • Demonstrate the true capability of your AETC, don’t oversale what you are able to do

19. Development of trainings • Specialized for community health centers • Timing • Information • Culturally competent • Patients • Providers • Informative, but not overwhelming • Should be flexible • May be after your normal hrs

20. Maintaining the Bridge • Make them a priority • Assign someone to be their liaison • Continued offering of new trainings and information for all levels of staff • Annual needs assessments

21. Challenges for AETC • Finding connections • Answering the push-back • Ensuring that we have the resources they will need once we get them onboard • Specialized attention

22. Take away points • Long process • Requires a plan before the first meeting • Expect difficulty in getting changes/updates in place • They will have a major role in the Affordable Care Act,

23. Questions…Questions