The High Performing FQHC of Tomorrow: Expanding the Mission Through Margin
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Presented by Don McDaniel at NACHC FOM/IT Conference
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The High Performing FQHC of Tomorrow: Expanding the Mission Through Margin
- 2. Agenda Megatrends Market Forces Implica4ons 1
- 3. Backdrop FQHCs have been protected—Market forces are drawing them into healthcare economy Market—Tidal Wave that Affects FQHCs How is the high-performing FQHC to respond? 2
- 4. Megatrend 1: Public Sector Challenges 131% 191% 72% 127% 212% 17% 38% 54% 13% 28% 43% 0% 50% 100% 150% 200% 250% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Health Insurance Premiums Workers' ContribuIon to Premiums Workers' Earnings Overall InflaIon SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2014. Bureau of Labor StaOsOcs, Consumer Price Index, U.S. City Average of Annual InflaOon (April to April), 1999-2014; Bureau of Labor StaOsOcs, Seasonally Adjusted Data from the Current Employment StaOsOcs Survey, 1999-2014 (April to April). AND 3
- 9. EXPANDING COVERAGE FOR LOW-INCOME RESIDENTS Expanding Coverage ........28 Considering Expansion..........4 Not Expanding Coverage at This Time.........19 Medicaid Reform State Elements of MA Reform Oregon 16 Coordinated Care OrganizaOons Global Payments with 2% withhold paid on quality metrics 11 of 15 received full payments in 2013 Arkansas Purchasing silver level coverage on the exchanges for Medicaid recipients, pueng the risk on the commercial insurers rather than the State Vermont Medical homes and accountable care are integral 80% of Vermont’s primary care pracOces are NCQA PCMH cerOfied. State organizes care coordinate groups within the community New York DSRIP Approach to Medicaid reform; expects $6 billion in incenOve payments Montefiore’s Care Management programs are viewed as model Where the States Stand on Medicaid Expansion 27 States, DC, Expanding Coverage–December 17, 2014 Notes: Based on literature review as of 12/17/14. All policies subject to change without noOce. HHs has announced that states can obtain a waiver to use federal funds to shim Medicaid-eligible residents into private health plans. The District of Columbia plans to parOcipate in Medicaid expansion and will operate its own exchange. Learn more about ACA implementaOon at advisory.com/daily-briefing ©The Advisory Board Company 8
- 11. FighIng Over the Same Turf: The Hospital Is Not Your Friend!! 33.4 31.2 30.9 33.1 35.2 35.1 218.7 301.3 414.3 521.4 585.4 651.4 1985 1990 1995 2000 2005 2010 1985 1990 1995 2000 2005 2010 Although inpaOent volumes have recovered since dipping In the 1980s some experts expect admissions to stagnate as the delivery system shims towards outpaOent care ADMISSIONS In millions OUTPATIENT VISITS In millions Source: American Hospital Associa4on Hospital Sta4s4cs MODERN HEALTHCARE GRAPHIC 10
- 12. FQHC Equals Triple Aim 93% 99% 84% 91% 86% 90% 47% 59% 44% 57% 37% 51% 0% 20% 40% 60% 80% 100% Health Centers Perform Beoer on Ambulatory Care Quality Measures than Private PracOce Physicians Private PracOce Physicians Health Centers No electrocardiogram screening in low-risk paOents No use of benzodiazepines in depression Blood pressure screening ß-Blocker use in coronary artery disease Aspirin use in coronary artery disease Ace inhibitor use in congesOve heart failure Note: StaOsOcally Significant at 0.05 level. Based on 2006-2008 NaOonal Ambulatory Medical Care Survey (NAMCS) Source: Goldman, L.E., Chu, P.W., Tran, H., Stafford, R.S. 2012. Federally Qualified Health Centers and private pracOce performance on ambulatory Care measures. AmericanJournalofPrevenOveMedicine,43(2):142-149. 11
- 13. In 2015, HRSA began giving incen4ves to FQHCs for ranking well on clinical measures compared to other FQHCs in state and in na4on HRSA/CMS are sister organiza4ons in HHS CMS has established value-based payment goals of 50% for 2016 and 80% for 2018 for its programs HRSA and CMS Show Moves to Value 12
- 16. Example #1 – FQHC as part of ACO Health System’s point of view - Reduce readmissions - ED diversion programs - Can’t own FQHC so include FQHC as ACO member Delaware Valley Community Health (FQHC) is member of Delaware Valley ACO (DV-ACO) Milwaukee Health Services, Inc. is part of IPN’s ACO 15
- 17. Example #2 – Medicaid FQHC ACO FQHC Urban Health Network (FUHN) – Twin CiVes, 2013 10 of 12 FQHCs in Twin Ci4es entered ACO 40 sites, 150k pa4ents Believed failure of FQHC coali4on could result in absorp4on by larger health system OR marginaliza4on—moved from “default provider to preferred provider” 16
- 18. Example #3 – Medicare FQHC ACO Family Health ACO—Founded 2014 3 FQHCs in Hudson Valley, NY with 300+ providers Manages diverse popula4on of Medicaid and dually-eligible beneficiaries—Medicare ACO unusual for FQHCs Stemmed from ini4al collabora4on in 2008 with Hudson Informa4on Technology for Community Health (HITCH) to pool resources on cancer screening and diabetes collabora4ves Strong leader who is pioneer in NYC IT circle and US Health IT Policy, NYS HIE 17
- 19. Pros Favorable contract terms with one payer Poten4al to keep current iden4ty Poten4al to tap into sophis4cated back office resources Cons Loss of focus on mission Becoming compe4tors of former partners Poten4ally limi4ng the client base, depending on which payers are accepted Example #4 – Strategic Alignment with Payer 18
- 21. Benchmarks 20
- 22. New World Benchmarks Add new benchmarks around global payment to tradi4onal benchmarks “No outcome, no income” Fundamental shii of focus from Encounter to Covered Lives 21
- 23. New World Benchmarks—FFS vs FFV Metric CHC Nat’l Median (2013) Your FQHC Measures … Your CompeItors Measure … OperaOng Margin 1.2% 1 Yes Yes Days Cash on Hand 47 1 Yes Yes Current RaOo 1.8 1 Yes Yes Cost per paOent $721 2 Yes Yes Revenue per paOent $766 3 ? Yes Expense by disease cohort ? ? Yes Pt saOsfacOon by team/department ? ? Yes Expense per pt by team ? ? Yes Expense by paOent (highest uOlizers) ? ? Yes Sources: 1 T. Skapinsky, Capital Link. June 2015. MPCA Finance & Billing Networks: FQHC Financial & OperaOonal Benchmarking. 2 HRSA, UDS. Accessed Oct. 2015 3 Calculated from: P. Shin, J. Sharac, Z. Barber, S. Rosenbaum, J. Paradise. Kaiser Family FoundaOon, Mar. 2015. Community Health Centers: A 2013 Profile and Prospects as ACA ImplementaOon Proceeds. Value-Based 22
- 25. ImplicaIons for FQHCs Opportuni4es are Endless Think like a Health Plan Drive Business Model Transforma4on Embrace Transparency and Drive Communica4on Seek our VBC Payment Opportuni4es and ac4vely manage cohort popula4ons Never been a BeHer Time to “Do Good and Do Well” 24