Zucconi.aafp slc 2013


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Nick Zucconi's presentation on HRSA, Health Centers & Managing Workforce Challenges

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  • In the past few years, health centers have also achieved significant growthOverall, since the beginning of 2009, health centers have increased the total number of patients served 17.1 million to 21.1 million annually.Health centers have furthered their national impact not only in terms of increased numbers of patients served, but also by adding sites and creating essential jobs within their communities. In fact, health centers have added more than 25,200 jobs over the last three years.
  • HRSA-funded health centers, as a whole now constitute one of the largest primary care networks in the country – a true national presence
  • Ensuring an appropriate and adequate health care professional workforce is challenging on many levels and health centers are not an exception here. Some of the major issues we face are workforce recruitment and retention, too few people and those we have need help, geographic and specialty maldistribution, and competing priorities for providers and patients.
  • All of our efforts aimed at meeting these challenges are framed by our quality strategy. Our goals are consistent with the triple aim of better care, healthy people and communities, and affordable care. In achieving our strategic goals BPHC’s focus continues to be on positioning health centers within the larger national goal of moving towards a truly Integrated Health System-one in which coordination and integration of patient information and services among and across Health Centers and other community-based health care providers is the norm-and not the exception. In order to get to this point, we must continue to strengthen the Health Center Program’s foundation of Access.And of course, we want this to be access to Comprehensive Services-the full scope of high quality primary health services, including dental, behavioral health, and enabling services. Once we have assured access and comprehensive services, we can move upwards towards implementing Integrated Services by assuring health center patients have a true patient-centered medical home that ultimately, is part of an overall more effective Integrated Health System.All HRSA/BPHC quality related activities are IMPLEMENTED through one or several of the FIVE elements or mechanisms across the top of the slide (published policies, funding opportunities, Onsite TA Visits, etc.) in order to support and promote the PRIORITIES AND GOALS on the RIGHT.  Our five priority quality goals are interrelated and all have an impact on workforce and patient’s ability to be receive the right care at the right time:Implementation of QI/QA SystemsAdoption and Meaningful Use of EHRsPatient-Centered Medical Home RecognitionImproving Clinical OutcomesWorkforce/Team-Based Care
  • Electronic Health Records adoption and Patient-centered Medical Home recognition which are key transformative tools in realizing the HRSA goals of increased quality, improved access to care, and reduced health disparities. Slide Data Notes:Clinical Performance Measure and EHR Implementation Data are from the 2012 UDS.PCMH Recognition Data:NCQA Data is as of 8/13 and includes those recognized in the HRSA PCMHHI and those who sought recognition independently. Accreditation Data is as of 8/1/13 (provided quarterly) % of PCMHHI participants is based on the % of grantees that have been moved forward to NCQA to receive recognition. NCQA recognized grantees at the site level, Accreditation recognizes the entire organization.
  • Even before ARRA and Meaningful Use, HRSA has viewed HIT as central to quality improvement in health centers, and has been encouraging them to adopt and use health IT for quality improvement and cost efficiencies since the 1990’s.We see HIT as a key transformative tool in supporting and realizing the HRSA and Health Center Program goals of increased quality, improved access to care, and reductions in health disparities.It is no surprise therefore that health centers remain national leaders in electronic health records adoption and service delivery transformation.BPHC’s 2012 goal is to have at least 50% of grantees with EHR adopted at all sites and in use by all providers – and we have already well surpassed this internal goal.As an example, let’s look at the statewide of EHR adoption in CO – 79% of health centers in CO have implemented EHR at all of their sites and 21% have implemented EHR at some sites.
  • PCMH recognition is also an HHS level priority and in support of this BPHC has set a related 2013 goal to have 25% of grantees with at least one site recognized: As of August, 2013, 29% of all grantees have achieved PCMH Recognition. For comparison, 59% of health centers in CO are participating in one of the HRSA PMCH initiatives and 65% have achieved PCMH recognition (some health centers may have achieved recognition outside of a HRSA-sponsored initiative)While PCMH adoption is a newer area for all primary care providers-we are pleased at the swift adoption and increase in efforts across the Health Center Program. 
  • Finally - the most important impact of the Health Center Program is of course to improve the health outcomes of health center patients. Utilizing the key transformative quality tools of electronic health records and the patient-centered medical home model-we must work towards achieving goals of improved performance for all health centers on these HRSA/BPHC Required Clinical Performance Measures reported annually in UDS.Let me first focus on how the HRSA/BPHC Required Clinical Performance Measures compare to current national averages as well as to Healthy People 2020 goals. Hypertension Control: The HP2020 goal is that at least 61% of hypertensive patients have their BP under control. Nationally, across the US, only 44% of hypertensive patients actually have their BP under control while nationally, across all health centers, the average rate of hypertension control is 64%, which is slightly higher than the HP2020 goal. So health centers are doing better than the US in general, and many health centers are already achieving the HP2020 goal.Specifically, in 2012, 59% of all health centers already met or exceeded the Healthy People 2020 goal for hypertension. Diabetes Control: The HP2020 goal is that at least 85% of diabetic patients have hemoglobin levels under 9%. Nationally, across the US, 84% of diabetic patients are under control. This one of the hardest of the clinical performance measures to move, and nationally, across all health centers, the average rate of diabetes control is 70%, which is both below the HP2020 goal and national averages.Given these challenges, only 11% of all health centers met or exceeded the HP 2020 goal for diabetes in 2012.Early Entry into Prenatal Care: The HP2020 goal is that at least 78% of pregnant women will receive prenatal care beginning in the first trimester. Nationally, across the US, about 71% of percent of women delivering a live birth received prenatal care beginning in the first trimester (2007 data) while nationally, across all health centers, the percentage of pregnant women receiving early prenatal care is 70%, just slightly below the national average. Clearly there is room for improvement both nationally and across the Health Center Program in order to achieve the HP2020 goal of 78%. However it is important to note that, 37% of all health centers already met or exceeded the Healthy People 2020 goal for early entry into prenatal care in 2011. Low Birthweight: The HP2020 goal is to reduce the rate of low birthweight nationally to 7.8%. Currently, across the US, nearly 8.2% of babies are born at low birthweight, while across all health centers, the low birthweight rate is quite a bit lower at 7.8%, So not only are health centers already doing better than the US at reducing poor birth outcomes, on average the program has also already exceeded the HP2020 goal.Specifically, an impressive 61% of all health centers already met or exceeded the Healthy People 2020 goal for reductions in low birthweight in 2012.The right side of the graph shows the percentage of health centers in CO meeting or exceeding HP 2020 goals in these 4 areas (HTN control, DM control, early entry to prenatal care, and LBW).
  • We know that all this work can’t be done alone and encourage health centers to collaborate with national, state, and local partners in leveraging partnerships to achieve mutual goals. Health centers are involved with many different national initiatives with the White House (National HIV/AIDS strategy, Let’s Move), and other federal agencies (Million Hearts Initiative , CDC, National Prevention Strategy, Text4baby) etc. Health centers also partner with PCAs, PCOs, and state Medicaid offices as well as local partners such as health center controlled networks (HCCN), other safety net providers, hospitals, and community based organizations.
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  • Zucconi.aafp slc 2013

    1. 1. HRSA , Health Centers, and Managing Workforce Challenges November 2, 2013 Nick Zucconi Deputy Regional Administrator U.S. Department of Health and Human Services Health Resources and Services Administration Office of Regional Operations, Denver
    2. 2. HRSA Priorities  Strengthen the Primary Care Workforce to Better Meet the Health Needs of the Nation  Improve Access to High Quality Primary Care Services, Integrated with Public and Population Health  Strengthen HRSA’s Organizational and Technology Infrastructure, Workforce, and Workplace Climate
    3. 3. HRSA”s Regional Offices
    4. 4. The People We Serve • About 16,750 safety net providers participate in the 340B drug discount program. • Over 500,000 people living with HIV/AIDS receive Ryan White services. Two-thirds are racial or ethnic minorities. • 34 million women, infants, children, and adolescents benefit from maternal and child health programs. • More than 8,650 National Health Service Corps clinicians are working in underserved areas. • 19.5 million patients served through health centers.
    5. 5. HRSA in Colorado • In fiscal year 2012, HRSA awarded $153M to 45 grantees – 59% = Primary Care – 19% = Ryan White HIV/AIDS – 12% = Maternal and Child Health – 7% = Health Professions – 2% = Rural Health – <1% = Clinician Recruitment – <1% = Health Care Systems
    6. 6. Health Center Fundamentals 1. Located in or serve a high need community (designated Medically Underserved Area). 2. Governed by a community board composed of a majority of patients representing the population served. 3. Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) to promote access to care. 4. Provide services available to all with fees adjusted based on ability to pay. 5. Meet federal program requirements regarding administrative, clinical, and financial operations.
    7. 7. Health Center Program National Grantee Overview-CY 2012 21.1 Million Patients • 93% Below 200% Poverty • • • • • Grantees Serve All Ages 36% Uninsured 62% Racial/Ethnic Minorities 1,121,037 Homeless Individuals 903,089 Farmworkers 219,220 Residents of Public Housing 65 & Under 5 up 11% 7% 5 to 12 13% 25 to 64 51% Grantees Revenue Sources ARRA Grants 2% BPHC Grants 18% Other Federal Grants 3% • Medicaid 38% State / Local/Other 17% Medicare 6% Self-Pay 6% Other 3rd Party 7% • • • • 13 to 17 8% 18 to 24 10% 1,198 Grantees with 8,900+ Service Sites 83.8 Million Patient Visits Over 148,000 Staff 10,400+ Physicians 7,500+ NPs, PA, & CNMs Other Public Insurance 3% Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks 7
    8. 8. Health Center Program Growth: National Impact 2008 - 2012 Sites 21 Jobs 10 Thousands 22 Thousands Millions Patients 9.5 160 150 9 140 8.5 130 8 120 7.5 110 7 100 20 19 18 17 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012 Growth from 2008-2012 (% Increase) Patients 17,122,535 18,753,858 19,469,467 20,224,757 21,102,391 3,979,856 (23.2%) Sites 7,518 7,892 8,156 8,501 8,979 1,461 (19.4%) Jobs 113,059 123,012 131,660 138,403 148,245 35,186 (31.1%) Source: Uniform Data System, 2008-2012 and HRSA Electronic Handbooks 8
    9. 9. Health Center Program National Presence – July 2013 9
    10. 10. Health Center Program Colorado Overview-CY 2012 494,000 Patients • 95% Below 200% Poverty • 38% Uninsured • 64% Racial/Ethnic Minorities • 30,500 Homeless Individuals • 13,250 Farmworkers • 2,000 Residents of Public Housing 18 Community Health Centers • 152 Service Sites • In 2012, Colorado CHCs provided more than 2 million medical, dental, and mental health visits • Colorado CHCs care for: • 1/3 of all Medicaid enrollees • 1/4 of all Children’s Health Insurance Program (CHIP) enrollees • 1/3 of all the state’s low-income uninsured Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks 10
    11. 11. What are the challenges? Summary of Major Issues • • • • Workforce recruitment and retention Too few people; those we have, need help Geographic and specialty maldistribution Competing priorities for providers & patients
    12. 12. What We Do Now Quality Strategy Better Care ⃘ Healthy People & Communities ⃘ Affordable Care Strategy Implementation INTEGRATED HEALTH SYSTEM Priorities & Goals 1. Implementation of QI/QA Systems All Health Centers fully implement their QI/QA plans 2. Adoption and Meaningful Use of EHRs All Health Centers implement EHRs across all sites & providers 3. Patient-Centered Medical Home Recognition All Health Centers receive PCMH recognition 4. Improving Clinical Outcomes All Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure 5. Workforce/Team-Based Care All Health Centers are employers/providers of choice and support team-based care 12 1. Programs/Policies 2. Funding 3. Technical Assistance INTEGRATED SERVICES 4. Data/Information 5. Partnerships/Collaboration COMPREHENSIVE SERVICES ACCESS
    13. 13. Current Program Impact: Key National Indicators % of Health Centers with EHR Implementation (2012)  79% have EHRs at all sites used by all providers  11% have EHRs at some sites used by some providers % of Health Centers Achieving Patient-Centered Medical Home Recognition (as of August 2013)  80% of all health centers are participating in Patient-Centered Medical Health Home Initiatives (PCMHHI) and nearly 29% have achieved Patient-Centered Medical Home (PCMH) recognition % of Health Center Meeting/Exceeding Healthy People 2020 Goals (2012):  59% Meet/Exceed Hypertension Control Goal of 61%  11% Meet/Exceed Diabetes Control (HbA1c ≤9) Goal of 84%  37% Meet/Exceed Early Entry into Prenatal Care Goal of 78%  61% Meet/Exceed Low Birthweight Goal of 7.8% Individual health center profiles with performance data are now available to the public on the HRSA web site. See: http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2012 13
    14. 14. Percentage of EHR Adoption by State 2011 Source: Uniform Data System, 2011 14
    15. 15. Health Center EHR Adoption National and Colorado 2012 100% 90% 80% 11% 21% 2015 Goal: 100% of Health Centers use EHR at All Sites 70% 60% 50% 40% 79% 79% 30% 2012 Goal: 50% of Health Centers use EHR at All Sites 20% EHR at Some 10% Sites EHR at All 0% Sites National Source: Uniform Data System, 2012 CO State 15
    16. 16. National PCMH Recognition FY 2013 16
    17. 17. 2013 Health Center PCMH Recognition National and Colorado 100% 90% 80% PCMHHI Participants PCMH 80% 70% 59% 60% 65% 2014 Goal: 40% of Health Centers Recognized as PCMH 50% 40% 30% Recognized 29% 2013 Goal: 25% of Health Centers Recognized as PCMH 20% 10% 0% National Data as of August 16, 2013 PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC CO State 17
    18. 18. 2012 National and Colorado Health Center Performance and Healthy People 2020 Goals 100% Percentage of Health Centers Meeting or Exceeding Healthy People 2020 Goals 90% 80% 70% 60% 61% 59% 59% 50% 50% 37% 40% 30% 20% 10% 11% 6% 46% 2014 Goal: 20+% of Health Centers Meet or Exceed HP 2020 Goals 0% Hypertension Control Diabetes Control National CO State Early Entry to Prenatal Care Low Birthweight 18 Source: 2012 UDS and Healthy People 2020
    19. 19. 2012 Colorado Range of Clinical Performance High Low CO State Average National Average Diabetes Control 84% 57% 70% 70% Timely entry into Prenatal Care 100% 59% 72% 70% Hypertension Control 79% 47% 65% 64% Low Birth Weight 0% 14% 8% 7% Childhood Immunizations 79% 11% 33% 42% Cervical Cancer Screening 84% 14% 62% 57% Asthma Therapy 94% 50% 61% 73% Source: Uniform Data System, 2012. 19
    20. 20. Quality Strategy Implementation Partnerships/Collaboration • State Partners • Primary Care Association • Primary Care Office • State Office of Rural Health • Area Health Education Centers 20
    21. 21. Quality Strategy Implementation Primary Care Associations • Colorado Community Health Network (CCHN) is the membership association for the 18 federally funded Community Health Centers. • CCHN: 1. Educates policy makers and stakeholders about the unique needs of CHCs and their patients; 2. Provides resources to ensure that CHCs are strong organizations; and 3. Supports CHCs in maintaining the highest quality care. 21
    22. 22. Quality Strategy Implementation Primary Care Office (PCO) The Colorado State Department of Public Health and Environment (CDPHE) serves as the Primary Care Office in the State. • Technical Assistance to Organizations and Communities Seeking to Expand Access to Primary Care for Underserved Populations • Assessment of Needs and Sharing Data • Workforce Development for the NHSC and Safety Net and Health Center Network • Shortage Designation Applications and Updates http://www.colorado.gov/cs/Satellite/CDPHEPSD/CBON/1251618793013 22
    23. 23. Quality Strategy Implementation State Office of Rural Health The Colorado Rural Health Center (CRHC) works with federal, state and local partners to offer services and resources to rural healthcare providers, facilities and communities: • provides recruitment and retention services and connects communities with loan repayment options for their providers; • supplies organizations with funds and equipment, such as workforce-enhancing loan repayment or scholarships; Federally-granted medical equipment; or technical assistance grants to rural hospitals and communities. • convenes workshops, training programs, and technical assistance to facilities and communities, such as coding, billing, quality improvement, and compliance assistance. http://www.coruralhealth.org/ 23
    24. 24. Quality Strategy Implementation Area Health Education Center The Colorado Area Health Education Centers were established as an academic-community partnership involving the University of Colorado Denver and six community-based nonprofit regional AHEC offices, each serving a designated region of the state. The AHEC works to build state-wide network capacity and strengthen academic-community linkages in four areas: • Health Careers and Workforce Diversity • Health Professions Student Education • Health Professions Continuing Education • Public Health and Community Education http://www.ucdenver.edu/life/services/ahec/Pages/index.aspx 24
    25. 25. Nick Zucconi Deputy Regional Administrator Health Resources and Services Administration Office of Regional Operations - Denver 303-844-7879 Nicholas.zucconi@hrsa.hhs.gov