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NACHC UPDATE National Association of Community Health Centers Health Choice Network 20th Annual Education Session and Health Care Quality Institute Saturday June 28, 2014. 2011 B iggest Internal C hallenges ???. To integrate with other providers (including other CHCs)

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NACHC UPDATE

National Association of Community Health Centers

Health Choice Network20th Annual Education Session and Health Care Quality InstituteSaturday June 28, 2014

2011 b iggest internal c hallenges
2011 Biggest Internal Challenges ???
  • To integrate with other providers (including other CHCs)
  • To coordinate patient care to assure sharing of clinical data/information.
  • To coordinate service delivery and match capacity while linking patients with enabling services.
  • Re-engineering our health center operations (data and insurance focused)
  • Workforce (all levels)
2011 biggest external c hallenges
2011: Biggest External Challenges ???

External Challenges

Greatest Challenges: Appropriations and Medicaid

today s agenda
TODAY’S AGENDA
  • The Environment for Health Centers
  • Federal Policy Update:
  • Medicare PPS
  • Health Center Transformation
  • Questions?
the environment
THE ENVIRONMENT

The Environment in Washington – the BAD

  • Political Polarization
  • ACA is as divisive as ever
  • “Must-pass” bills pass, but not much else
  • Heightened scrutiny of federal programs
  • Budget caps and future funding uncertainty
the environment1
THE ENVIRONMENT

The Environment in Washington – the GOOD

  • Bipartisan support for Health Centers’Program, Model and Mission
  • Both sides looking for solutionsin the health care arena
  • Health Centers are at the center of the conversation
health centers in a post aca world
HEALTH CENTERS IN A POST-ACA WORLD
  • Access to primary care is vital for cost savings and improved outcomes (Transformation)
  • Increased demand, among newly insured and uninsured (MA experience)
  • Federal support, through 330 grant and Medicaid payment, crucial to model of care
  • We will have to advocate louder than ever
  • New funding essential for base grant adjustments, expanded capacity, service expansion, new access points
  • Since ACA, funding comes two ways:
health center funding streams since aca enacted
HEALTH CENTER FUNDING STREAMS – SINCE ACA ENACTED

DISCRETIONARY

  • Annual, up to Congress to determine amount
  • Prior to ACA, the only funding for CHC program
  • Cut in 2011, backfilled with mandatory funds
  • Currently $1.5 billion (FY14)

MANDATORY

  • Required spending, unless Congress changes the law
  • Special Fund created in ACA to boost Health Center Capacity
  • Currently 2.2 billion (FY14)
  • Expires in FY2016 (more on that in a moment)
health centers funding cliff
HEALTH CENTERS FUNDING CLIFF
  • Mandatory funding expires at the end of FY15
  • Without action by Congress, up to 70% cut to Health Center grants
  • NHSC, THCs in same position (though ALL mandatory)
fixing the cliff our plan
FIXING THE CLIFF – OUR PLAN
  • Extends, grows mandatory funding
  • $20b over 5 years
  • Grow from current 22m patients to 35m
  • Continue funding for NHSC, Teaching Health Centers
  • Message: Act Now!
the cliff key points
THE CLIFF – KEY POINTS
  • This is real. Health Centers have had success in gaining new funding, but even our biggest champions can’t predict the outcome here.
  • Estimate the impact. What would a 70% cut to your grant mean in your community, to your patients?
  • Raise the drumbeat for a fix. We have a long fight ahead, but our best hope is the understanding that this is a “must-do”.
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ADVOCACY: THE BOTTOM LINE

HEALTH CENTERS SUCCESS - OUR COLLECTIVE FUTURE - DEPEND ON THE STRENGH OF OUR ADVOCACY.

  • Local connections are the key to policy change – build relationships and demonstrate impact over time
  • Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center
  • The challenges and opportunities ahead are huge. Let’s take them on TOGETHER.
  • Campaign Website: www.saveourchcs.org
medicare pps game changer
Medicare PPS – GAME CHANGER!
  • Greatest opportunity to mover into Medicare ever!
  • The PPS base rate for October 1, 2014, through December 31, 2015, is $158.85 (roughly a 35% increase)
  • Transition to new FQHC PPS begins on the 1stday of cost reporting period on or after 10/1/14 (updated annually)
    • Increased rates for new patients: can bill for subsequent illness/injury visits and mental health visits on same day
  • FQHCs must now use “G” Codes and must create appropriate charges for the new codes
  • Do your charges reflect your real costs?
medicare pps cont
Medicare PPS cont….
  • When was the last time your FQHC reviewed your charges?
    • Cost of care isn’t decreasing
    • Do nothing? - THIS RULE HURTS! – Medicare rate may go down
    • Rule will have HUGE impact on sliding fee scale policies if it isn’t reviewed and adjusted on a regular basis
  • Huge potential for Medicare Advantage Plans!
  • NACHC will be rolling out national trainings shortly
      • First trainings to focus on Sept, Oct, Nov due dates - 150 CHCS, Jan - >300 CHCs
transformation vc 2
Transformation – VC2
  • VC2 – A vision started by NACHC Chair Dr. Gary Wiltz
  • Strategy to enhance CHC capacity in transformation and a means to cope with the enormous shifts we are now facing.
    • EHRs: Identify needed performance improvements, implement solutions, and measure the effects of those solutions.
      • clinical quality, cost control, operational effectiveness, financial performance, and patient experience.
    • Develop systems integrated with other providers in the community.
    • Provide organization-wide focus and team training
    • A continual performance strategy, “This is how we do business.”
    • Create system to share proven ways to improve quality and lower cost.
    • Disseminate methods to all health centers
transformation
Transformation
  • It is all up to the Health Centers, HCCNs and PCAs
    • NACHC can’t lead this – its all local/regional
      • Convener, collect and spread
  • HCCN’s are the key to success!
    • Health Choice Network is a best practice model!
      • OCHIN and Clinical Informatics tools
      • Medicare ACOs
      • Managed care products
  • ACA changed everything for health care delivery (more business less politics)
    • Local, regional and state work will dominate for business success
    • PCAs and HCCNs must work together
the future
The Future
  • Health Centers are one of the critical pieces of health care delivery moving forward
    • ACA provided unparalleled growth and opportunities
      • Capital
      • Growth
      • Medicaid Expansion and Marketplace Exchanges
      • Medicare PPS
  • Health Centers must start taking risk – more business thinking less grant dependence
    • NACHC tools (ACO/IPA toolkits)
today
Today
  • NACHC must work closer with HCCNs and PCAs recognizing the new roles we are now have
    • Ohio
  • We must continue to advocate for our cause
    • The Primary Care Cliff is real!
    • Never forget FY’11 - $600M decrease
slide21

NATIONAL HEALTH CENTER WEEK

Invite Your Members of Congress to Visit During NHCW – August 10th-16th

More info updated regularly at www.healthcenterweek.org

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QUESTIONS and CONTACT INFO

QUESTIONS?

Shawn K. FrickAssociate Vice President, PCA & Network Relations National Association of Community Health CentersDirect:301-347-0447E-Mail: sfrick@nachc.com