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CREATION OF LARGE FQHC SYSTEMS

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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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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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