Dr. Afshan Nuri Baig, Chief Medical Officer of Clinicas de Salud del Pueblo, presents “Affordable Care Act from the Clinical Perspective” at the AHF ACA Workshop. About the Event: To help those in Imperial County prepare for how the Affordable Care Act will impact work the community, Alliance Healthcare Foundation hosted a workshop on Sept. 11, 2013 at the San Diego Gas & Electric Renewable Energy Resource Center in Imperial County. In this workshop, we explored Covered California enrollment with an overview of multiple health plans and eligibility, discussed the community clinic perspective, and considered its potential impact on the underserved in Imperial County. This workshop was free and included a healthy lunch for all attendees. Watch the complete event here: http://www.youtube.com/playlist?list=PL-CwI2rkvFSV1_XYs45kGqdJj_R-jfXHP

1. Afshan N. Baig, M.D., F.A.A.P.
Chief Medical Officer
Clinicas De Salud Del Pueblo, Inc.
ACA from the Clinical Perspective

2. Introduction
For more than 45 years, health centers have
delivered comprehensive, high-quality preventive
and primary health care to patients regardless of
their ability to pay. During the at time, health
centers have become the essential primary care
medical home for millions for Americans including
some of the nation’s most vulnerable populations.
With a proven track record of success, health
centers will play a key role in implementation of the
Affordable Care Act.

3. The Essential Role
 Health Centers  Will play an essential
Role in implementation
of ACA
 Those who emphasize
coordinated primary and
preventive services or a
“medical home” that
promotes reductions in
health disparities for
low-income
individuals, racial and
ethic minorities, rural
communities and other
underserved
populations.

4. The Affordable Care Act and Health
Centers
Delivery of Care: Increased
Access to Health Services
Health Centers, supported
by the Health Resources
and Services
Administration
(HRSA), treated
approximately 21 Million
people in 2012
One out of every 15 people
living in the U.S. now relies
on a HRSA-funded clinic
for primary care
Health Centers are an
integral source of local
employment and economic
growth in many
underserviced and low-
income communities.
65
and
up
7%
under
5
11%
5 to
12
13%
13 to
17
8%
18 to
24
10%
25 to
64
51%
Series 1 7 11 13 8 10 51
Column1
0
10
20
30
40
50
60

5. The ACA: Essential Role of
Community Health Centers
 The Affordable Care Act established the
Community Health Center Fund that provides $11
billion over 5 a year for the
operation, expansion, and construction of health
centers throughout the Nation
 $9.5 billion is targeted to:
 Support ongoing health center operation.
 Create new health center sites in medically underserved
areas.
 Expand preventive and primary health care services
, including oral health, behavioral health, pharmacy, and /or
enabling services, at existing health center sites.

6. The ACA: Essential Role of
Community Health Centers
 $1.5 billion will support major construction and
renovation projects at community health centers
nationwide.

7. ACA and Health Centers
 FY 2012
 Health Center New
Access points –
 Health Center Capital
Development- Building
Capacity Program:
 129 million was
awarded to establish
219 health center new
access points across
the country.
 629 million was
awarded to 171
organizations for new
large
renovation, expansion
or construction projects
to improve health center
capacity to provide
primary and preventive
health services to
underserved
populations. Grants are
expected to expand

8. ACA and Health Centers
 Health Center Capital
Development –
Immediate Facility
Improvement
Program:
 99 million was
awarded to 227
organizations for new
construction and
renovation projects to
help support health
center efforts to
address immediate
facility needs within
existing sites that are
providing primary and
preventive health
services.

9. ACA and Health Centers
FY 2013, through the ACA, the Health Center
Program will award the following new funding
Health Center Controlled
Networks:
 18 million was awarded
in December 2012 to 37
network organizations
to support the adoption
and meaningful use of
EHR’s, and the other
HIT to improve quality in
health centers. These
networks must include
at least 10 Health
Center Program
grantees and overall will
provide support to more
than 600 health centers
nationwide.

10. ACA and Health Centers
FY 2013, through the ACA, the Health Center
Program will award the following new funding
 Health Center Outreach
and Enrollment
Assistance
supplemental funding
opportunity:
 HRSA awarded 150
million in early July to
1,159 health centers in
support of outreach and
enrollment activities
nationwide. The
outreach efforts are to
be in line through
Insurance
Marketplaces, Medicaid
or the Children’s Health
Insurance Program, as
well as other federal
efforts such as the
Navigator program, as
well as state consumer
assistance efforts.

11. ACA and Health Centers
FY 2013, through the ACA, the Health Center
Program will award the following new funding
 Health Center New
Access Points:
 19 Million will be
awarded to help
establish 25 new
health center access
points. Grants will
support new full-time
service delivery sites
for provision of
comprehensive
primary and
preventive health care
services. HRSA
anticipates

12. ACA and Health Centers
FY 2013, through the ACA, the Health Center
Program will award the following new funding
 School-Based Health Center
Capital Program
** Create new School-based HC
sites in medically underserved
areas; and
** Expand preventive and primary
health care services at existing
school-based health center
sites.
Hoping to serve an addition
875,000 through the use of
SBHCC
 ACA authorized a new program
and appropriated 200 million in
funding from 2010 to 2013 to
address significant and pressing
capital needs to improve
delivery and support expansion
on services at school-based
health centers. HRSA awarded
these funds under SBHCC
program in FY 2011,2012 and
2013 to 470 school-based
health Center programs

13. Coverage Breakdown

14. Current eligibility categories & income
standards
 Infants and children (ages 0-19), up to: 250% FPL
 $28,725/year for an individual
 $58,875/year for a family of4
 Pregnant women up to: 200% FPL
 $22,980/year for an individual
 $47,100/year for a family of 4
 Seniors and persons with disabilities up to: 133% FPL
 $15,282/year for an individual
 Parents with dependent children up to: 100% FPL
 $11,170/year for an individual
 $23,550/year for a family of 4

15. Essential Health Benefits
 Ambulatory patient
services
 Emergency services
 Hospitalization
 Maternity and Newborn
Care
 Mental health and
substance use disorder
services, including
behavioral health
treatment
 Rehabilitative and
habilitative services (e.g.
physical therapy and
occupational
therapy, speech
 Laboratory Services
 Preventative and
wellness services and
chronic disease
management
 Pediatric
services, including dental
and vision care
 Prescription drugs

16.  Transitions of care – hospital to ED to primary care
medical home
 Prevention of chronic disease - promoting effective
prevention strategies and evidence-based treatment
of chronic disease
 Patient centered care and engaging patient and
families in care
 Improved patient experience
 Reduced hospital readmissions and ED utilization
 Improved care coordination across the continuity of
care - promoting effective communication and
coordination of care across providers
 Increased focus on measurement and improvement
of clinical outcomes
 Meaningful use of health information technology –
for example, use of technology to identify high
utilizers of care to target cost effective interventions

17. Effect on our population
The Law will help the issue of disparities in access
to care.
 Increase access to quality affordable health
coverage.
 Invest in prevention and wellness and give
individuals more control over their care.
 Latinos suffer from certain illnesses at higher
levels than other groups.
 E.g. Obesity, Diabetes heart disease, Cervical
cancer screening.
 Only 46.5 of Latinos received Colorectal cancer
screening compared to 59.9 non Latinos.

18. Resources
 Council of Community Clinics
 HRSA – www.hrsa.com