Mauda Monger, MPH Delta Region AIDS Education Training Center 2012 Faculty Development Conference LPS Coordinator- Mississippi

 History of CHCs in the United States  Community Health Center defined and types of CHCS  Building collaborations and trainings with Community Health Centers

 First clinics opened in 1965, Boston and 1967 in Mount Bayou, MS (neighborhood clinics)  Were developed to provide health and social services access points in poor and medically underserved communities and to promote community empowerment  Health Centers Consolidation Act of 1996 – Public Service Act (330 funds)

Health centers are community-based and patient-directed organizations that serve populations with limited access to health care.

 Located in or serve a high need community (designated Medically Underserved Area or Population).  Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served.  Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care.

 Provide services available to all with fees adjusted based on ability to pay.

 Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.

 Community Health Center or Health Center: ◦ An outpatient clinic that receives grant funds from the federal government through §330 of the Public Health Service Act (PHSA).

 ◦ Look-alike: An outpatient clinic that meets all requirements to receive §330 grant funds but does not actually receive a grant.

 ◦ Rural Health Clinic: An outpatient clinic that may be for profit, is located in a rural HPSA or MUA, and uses nurse practitioners and physician assistants to provide the majority of care.

 ◦ Tribal or Urban Indian FQHC: An outpatient clinic or program operated by a tribe or tribal organization or by an urban Indian organization.

 Low income  Minorities  Elderly  Young people (16-25)  Children

 Growth in Uninsured: Continue to be Largest Group of Health Center Patients  Decline in Charity Care: Cutbacks by Private Providers Squeezed by Managed Care  Loss of Medicaid and Other Public Funding: Severe “Deficit Reduction” Cuts by States & now Congress  Changing Nature of Insurance Coverage: Growing Shift to Catastrophic/High-Deductible Plans that Cover Little or no Preventive/Primary Care  Shortage of Primary Care Physicians:Growing Demand and Lack of Appeal to U.S. Medical Students is Already Causing Physician Vacancy Rates in Health Centers

 Need 1,843 primary care providers, inclusive of physicians, nurse practitioners, physician assistants, and certified nurse midwives.  1,384 nurses short.

 To reach 30 million patients by 2015, health centers need at least an additional 15,585 primary care providers  Health centers also will need another 11,553 to 14,397 nurses. Health Center Workforce ShortagesSource: NACHC, Robert Graham Center, and The George Washington University School of Public Health and Health Services, Access Transformed: Building A Primary Care Workforce For The 21stCentury, August 2008, www.nachc.com/research.

 ◦ Starting Points Develop a plan   What is it we want from the CHCs?

How are we willing to support them in their efforts?

◦ Learn the role and history of CHCs in your state ◦ Make a connections within the health care organizations that support and or govern the community health centers in your state

 ◦ ◦ ◦ ◦ Establishing relationship with governing bodies (MPHCA) May take a long period of time Attend all functions( meetings, trainings, & conferences) Understand the dynamics Connect with the board, medical directors and lead persons of clinics

 Get educated about HIV/AIDS epi in the state  Provide a safe environment for their community to get information on HIV/AIDS  Offer HIV screening as a part of routine care  Provide information on HIV/AIDS prevention and modes of transmission  ULTIMATELY..provide primary HIV care

 Provide training (onsite and offsite)  Provide resources and links to resources  Provide effective and efficient consultation options  Be a source of technical assistance

     Number of Organizations 21 Number of Delivery Sites 188 Total Patients 314,612 Number Seasonal Farmworker Patients 999 Number Homeless Patients 7,455

Health Center Population At or Below 100% of Poverty Under 200% of Poverty Uninsured Medicaid Medicare Hispanic/Latino African American Asian/Pacific Islander White Rural 72% 94% 43% 30% 9% 3% 65% 1% 34% 71%

 Should be done in person  Should be direct and concise  Use the background data to have a realistic conversation  Demonstrate the true capability of your AETC, don’t oversale what you are able to do

 ◦ ◦ Specialized for community health centers Timing Information  ◦ ◦ Culturally competent Patients Providers  Informative, but not overwhelming  ◦ Should be flexible May be after your normal hrs

 ◦ Make them a priority Assign someone to be their liaison  Continued offering of new trainings and information for all levels of staff  Annual needs assessments

 Finding connections  Answering the push-back  ◦ Ensuring that we have the resources they will need once we get them onboard Specialized attention

 Long process  Requires a plan before the first meeting  Expect difficulty in getting changes/updates in place  They will have a major role in the Affordable Care Act,