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NACHC Policy & Issues Forum Plenary Session – PCA/HCCN...Primary Care Association, Health Center...
Transcript of NACHC Policy & Issues Forum Plenary Session – PCA/HCCN...Primary Care Association, Health Center...
NACHC Policy & Issues Forum Plenary Session – PCA/HCCN
March 2019
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HRSA Strategic Goals
Goal 1 Improve access to quality health care and services
Goal 2 Foster a health care workforce able to address current and emerging needs
Goal 3 Enhance population health and address health disparities through community partnerships
Goal 4 Maximize the value and impact of HRSA programs
Goal 5 Optimize HRSA operations to enhance efficiency, effectiveness, innovation, and accountability
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Addressing HHS and HRSA Priorities Rural
Health
Opioids & Substance
Use Disorder
Value Based Care
Oral Health
Childhood Obesity
Ending the HIV
Epidemic
Maternal Mortality
Health Workforce
Health Technology
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FY 2019 New Funding Opportunities
Integrated Behavioral
Health Services Expansion
$200 million
New Access Points
$50 million
Oral Health Infrastructure
$76 million
Quality Improvement
$100 million
Health Center Controlled Networks
$42 million
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Investing in Substance Use Disorders and Behavioral Health Care
• Substance Abuse Service Expansion (SASE) Awards •$94M – 217 awards 2016• Access Increases for Mental Health and Substance Abuse Services (AIMS
Awards) • $200M - 1,174 awards 2017• Substance Use Disorder and Mental Health Services Awards •$350M – 1,232 awards 2018• Integrated Behavioral Health Service (IBHS) Awards •$200M - 1,375 awards2019
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SUD-MH Triannual Progress Report Data Data Elements UDS (2017) September to
December 2018 Progress Report Data
Substance Use Disorder Patients Visits
168,5081,227,629
212,418 748,497
Mental Health Services PatientsVisits
2,049,1949,876,669
1,115,977 3,369,651
Medication Assisted Treatment (MAT) ProvidersPatients
2,97364,597
4,877 54,642
Use of Telehealth for Substance Use Disorder and/or Mental Health Services – Number of Health Centers 315* 356* 2017 UDS did not have a specific category for health centers to note the use of telehealth for SUD services, so this data only represents use of telehealth for mental health services. The 2018 UDS has added a question to capture health center use of telehealth for SUD services.
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FY 2020 Budget Request
• Funding Level • Mandatory: $4.0 Billion
Discretionary: $1.626 Billion
• Mandatory Cliff • FY 2020 and FY 2021
• Proposed New Spending • Ending the HIV Epidemic
Initiative
President’s Budget:
$5.6 billion
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Ending the HIV Epidemic: A Plan for America
Diagnose All people living with HIV (PLWH) as early as possible after transmission
Treat HIV rapidly and effectively to achieve sustained viral suppression
Prevent People at highest risk of HIV with PrEP and prevention education
Respond Rapidly and effectively to clusters and outbreaks of new HIV infections
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Ending the HIV Epidemic: Health Center Program
• Nearly 2 million HIV tests conducted annually
• More than 165,000 patients with HIV receive medical care services at health centers, including many sites co-funded by the Ryan White HIV/AIDS Program
• More than 600 health centers purchase Pre-Exposure Prophylaxis (PrEP) through the 340B Program
• FY 2020: $50 million to support increased outreach, testing, care coordination, and HIV prevention services, including PrEP, in targeted counties/cities and States.
Geographic Hotspots
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Health Centers: Ending the HIV Epidemic Flowchart
Targeted health centers Serve the identified counties and states
Testing Link to prevention and care
HIV+
Engage and Treat
Retain
Viral suppression
HIV- PrEP
Respond rapidly to detect and respond to growing HIV clusters and prevent HIV infection (CDC)
High risk referrals of new patients (CDC, S/LHDs)
Health center in reach to identify high-risk current patients
Diagnose all people as early as possible after infection
Treat the infection rapidly and effectively to achieve viral suppression
Prevent people at risk using potent and proven prevention interventions, including medication that can prevent HIV
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BPHC 2022: Strategic Shifts
Compliance-oriented grant maker Primary health care leader 1
Health Centers as independent entities Health Centers as interconnected entities 2
Interventions that address immediate medical needs Continuous community-oriented, comprehensive care 3
Siloed functions Collaborative model 4
Separate data tools Integrated systems that inform decision-making5
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Service Area Request for Information: Areas of Consideration for Public Comment
How can HRSA better maximize impact of Health Center Program expansion?
Unmet need
Proximity
Reasonable boundaries
Other providers
Demonstrated capacity in current area
Patient representation
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Uniform Data System (UDS) Modernization Initiative
Reduce Reporting Burden • Automate data submission, provide
enhanced UDS reporting capabilities, promote transparency and integrate stakeholder feedback.
Measure Impact • Improve UDS data‘s ability to support
quality improvement by collecting patient level data to better reflect medical and social complexity and unique aspects of care delivery in health centers.
Promote Transparency • Provide an open transparent decision-
making process on UDS changes such as measure selection, information technology, and reporting improvements.
Modernizing Data Collection & Utilization
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Continuous Compliance: Operational Site Visits
CY 2018 OSVs • Number of Visits: 547
• Number and Percent demonstrating full compliance: 131 / 24%
• Number and Percent with Conditions: 416 / 76%
CY 2019 OSVs • Number of Visits (through March 15): 43
• 88% (7/8) of health centers completing CRO* demonstrated 100% compliance through the process
*Compliance Resolution Opportunity
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Continuous Compliance: FY 2019 SAC/RD Application Reviews
• Number of Applications with a 3-year Project Period: 470 • Without External Correspondence: 310 • With External Correspondence: 160
• Number of Conditions resolved in CRO: 428
• Number of Applications with a 1-year Project Period: 6
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Continuous Compliance: Conditions
• Number of CY 2018 90-Day Conditions: 2,464
• Number of conditions that progressed to 60-Days: 336
• Number of conditions that progressed to 30-Days: 14
Top 5 Conditions (64% of conditions placed)
1. Sliding Fee Discount Program
2. Clinical Staffing
3. Board Authority
4. Billings and Collections
5. Contracts and Sub awards
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Continuous Compliance: Health Center Profile Compliance Status Updates Health Center Profile City, State
3-year project/designation period; end date June 30, 2021
Service Area Map Total Patients Served: 10,000
• NEW: Project/designation period length and end date
• NEW: Operational Site Visit badge to recognize successful demonstration of compliance
• NEW: 90-day conditions (in addition to 60-day, and 30-day conditions)
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Provider and Staff Satisfaction Survey • High and increasing rates of burnout
among clinicians and trainees • ½ of physicians and nurses1
• Highest among rural clinicians2
• Related Factors • Workload/job demands • Efficiency and resources • Meaning of work • Culture and values • Control and flexibility • Social support/community • Work life integration
1 https://nam.edu/initiatives/clinician-resilience-and-well-being/ 2 https://www.ahrq.gov/professionals/clinicians-providers/ahrq-works/burnout/index.html
Provider/staff satisfaction affects their well-being, quality of care, patient safety, and satisfaction
• Medical errors • Suboptimal patient outcomes • Provider/staff turnover • Recruitment/retention • Productivity loss
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HCCNs: The Road Ahead
1. Enhance the Patient and Provider Experience • Patient Access • Patient Engagement • Provider Support
2. Advance Interoperability • Data Protection • Health Information Exchange • Data Integration
3. Use Data to Enhance Value • Data Analysis • Social Risk Factor Intervention
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Looking Ahead: Draft PCA Framework for FY 2020
1. Accelerate Value-Based Care Delivery
2. Increase Access to Comprehensive Primary Health Care
3. Strengthen the Health Center Workforce
4. Enhance Health Center Emergency Preparedness
5. Advance Health Center Clinical Quality and Performance
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