Quality Improvement Efforts in Community Health Centers

Health Centers – Key Characteristics

Federally Qualified Health Centers (FQHCs), free clinics, nurse-run clinics, public hospitals, and others all make up the safety net in terms of health care for the un- and underinsured. Today’s discussion will refer to FQHCs when talking about “community health centers” or “health centers”.

 Location in

high-need areas

 

Comprehensive

health and related services (especially ‘enabling’ services) Open to all residents,

regardless of ability to pay

, with charges prospectively set based on income  Governed by

community boards

, to assure responsiveness to local needs  Held to strict

performance/accountability standards

for administrative, clinical, and financial operations

Find a community health center at: http://ask.hrsa.gov/pc/

Characteristics of Health Center Patients

   

Health Care Home for 16 Million Americans

 1 of 5 Low-income Uninsured Persons (6.4 million)   1 of 9 Medicaid/CHIP Recipients (5.7 Million) 1 of 4 Low-Income Children (5.9 million) 1 of 5 Low-Income Births (400,000) 1 of 10 Rural Americans (7.9 Million) 1 of 7 People of Color (10.2 Million) 800,000 Farm workers, 800,000 Homeless Persons

State-by-State Data can be found at

http://www.nachc.com/research/ssbysdat.asp

The Effectiveness and Cost Effectiveness of Health Centers

 Average total yearly cost per health center patient is $475, compared to the mean per person expenditure for office-based medical provider service = $737  Health centers reduce unnecessary hospital admissions and specialty care referrals  Save Medicaid at least 30% = $3 billion saved in state/federal spending ($1.2 billon for states)  Increased health center usage reduces non-urgent ER usage and could save up to $6 billion  Health centers’ $7 billion budgets produce nearly $20 billion in overall economic output for communities 

America’s Health Centers: Making Every Dollar Count

( http://www.nachc.com/research/Files/Cost%20Effectiveness%20Fact%20S heet.pdf

) 

Access to Community Health and Wasted Expenditures on Avoidable Emergency Room Visits: Summary of Findings, 2006

http://www.nachc.com/research/files/2006Datasummary.pdf

Federal and State Policy Support for Community Health Centers



Appropriations

( http://www.nachc.com/advocacy/2007_approps.asp

) 

Medicaid and Medicare

( http://www.nachc.com/advocacy/cmsreghome.asp#recent ) 

FTCA Coverage

( http://www.nachc.com/hco/ftcamrm.asp

) 

State Support for Health Centers

( http://www.nachc.com/advocacy/Files/state policy/State%20Policy%20Report%2013.pdf

) 

Health Information Technology

( http://www.nachc.com/research/files/CHC%20HIT%20survey%20fac t%20sheet.pdf

)

Major Challenges Affecting Health Centers in How Health Care is Covered



Growth in Uninsured:

continue to be the largest and fastest-growing group of health center patients 

Decline in Charity Care:

reductions by private providers by managed care 

Reduction in primary care providers

more nurses : there is a continuing growing trend of less providers moving into the primary care sector, coupled with the growing need for 

Loss of Medicaid and Other Public Funding:

severe “Deficit Reduction” cuts by states and now Congress 

Changing Nature of Insurance Coverage:

Since the release of

Crossing the Quality Chasm: The IOM Health Care Quality Initiative

pay for performance) from the Institute of Medicine (IOM), the health care system has shifted the focus of delivery systems, accrediting bodies, and payors to evaluate and align cost with quality of care (e.g.,

Clinical Quality: Where We Are Today

National Health Disparities Collaboratives -

National initiative aimed at improving health outcomes for chronic conditions among the medically vulnerable, particularly minorities.

Results:

 Low birth weight rates for health center women are comparable to the Nation's, yet health center women are more likely to be at greater risk, and the national disparity in rates between African American & others is reduced by 50% for African American women served by health centers.  Health center Medicaid beneficiaries are 22% less likely to be hospitalized for potentially avoidable conditions than beneficiaries who obtain care elsewhere.

 The cost of treating health center Medicaid recipients is 30-34% less than the cost for beneficiaries receiving care elsewhere; 26-40% lower for prescription drugs; 35% lower for diabetics, and 20% lower for asthmatics.

Health Centers Excel at Reducing Health Disparities

Decline in Hispanic/White Disparity for Early Prenatal Care Based on Proportion of States’ Low-Income Population Served by CHCs 20 17.5

15.3

15 13.5

10 5 0 ≤ 10% 10-20% ≥ 20% Decline in Black/White Disparity for Overall Mortality Per 100,000 Based on Proportion of States’ Low-Income Population Served by CHCs 300 286.0

250 217.0

200 166.5

150 100 50 0 ≤ 10% 10-20% ≥ 20 % Pct. Served by CHCs

Source: Shin, P., Jones, K. and Rosenbaum, S.

Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities.

GWU CHSRP. September 2003

Clinical Quality: Where We Are Today

Up-To-Date Pap Tests by Race: Health Center Women Exceed National Health Interview Survey Comparison Group and Healthy People 2000 Objectives All Women Hispanic White Non-Hispanic Black Non-Hispanic Other Healthy People 2000 Objective

0 20 40 60

65.8

88.5

75.1

72.9

85.7

79.6

84.8

94.3

81.9

89.3

85

80 100

Clinical Quality: Where We Are Today

Collaborative Results • Over 250,000 health center patients in a registry; over 150,000 patients have a self-management goal • Over 50% of patients in the Diabetes collaborative have had at least two HbA1c tests per year 90% of patients with hypertension have had at least two blood pressure exams per year • 50% of patients with hypertension have a blood pressure reading of less than 140/90 - the national average is 20% • 90% of patients with severe asthma are on the proper medication

Clinical Quality: Where We are Going

NACHC can play several vital roles for health centers in the evolving “quality dialogue”, including:  Influence health center leaders at every turn to make quality and safety a strategic and operational emphasis at their centers, making it part of the organizational culture, and reinforcing it as their fiduciary responsibility to their communities.

 Provide sources and technical assistance for health centers and networks on best practices, models, and strategies that work.  Identify lead performers (internally and externally) and develop ways to link health centers to work with them.  Support health centers by being the source of information they need to know and can trust and more importantly prevent ‘information overload’ by keeping it simple, aligned, consistent, and uniform.

Vision for the Future of Health Centers

•

Grow health centers

to become the health care home for all 51 million un-served Americans •

Share, and disseminate data on health center results

in performance and quality improvement, both in terms of statistical analysis and third party evaluations of health center performance, to bolster case for continued support and expansion of health centers •

Reform health professions programs

to promote Primary Care careers, diversity, and service in underserved areas via health centers

Vision for the Future of Health Centers

•

Preserve the Medicaid guarantee of coverage

income, elderly & disabled Americans for low •

Wire every health center

technology for complete health information •

Lead the way

to a high-performing health system as indicated by a set of clinical primary care performance measurements •

Play a central role in emergency preparedness,

at the local, state and national levels