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The Health Center Program

Judith Steinberg, MD, MPHChief Medical OfficerBureau of Primary Health Care (BPHC)Health Resources and Services Administration (HRSA)

MassLeague of Community Health CentersCommunity Health Institute, 2017

May 3, 2017

Mission

Improve the health of the nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

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Key Strategies

Increase access to primary health

care services

Modernize primary care infrastructure and systems

Improve health outcomes

Promote performance-

driven, innovative

organizations

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Increase Impact of Health Center Program

Increase AccessNational Impact

Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates

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Increase AccessNational Impact

Source: Uniform Data System, 2015. National Data: U.S. Census Bureau, 2015 Population Estimates

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Increase AccessProgram Growth

Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015.

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17

18

19

20

21

22

23

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25

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Mill

ion

s

Patients

2008 2010 2013 2015Growth from 2008-2015

(% Increase)

Patients 17,122,535 19,469,467 21,726,965 24,295,9467,173,411 (41.9%)

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Increase AccessProgram Growth

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1000

1050

1100

1150

1200

1250

1300

1350

1400

1450

1500Grantees

2008 2010 2013 2015Growth from 2008-2015

(% Increase)

Grantees 1,080 1,124 1,202 1,375295

(27.3%)

Source: Uniform Data System, 2008-2015. HRSA Electronic Handbooks, 2008-2015.

Modernize and Improve Primary Care Delivery

EHR Adoption

No EHR2% Some

Sites6%

All Sites

92%

2015

Patient Centered Medical Home

Source: Uniform Data System, 2010 and 2015. AIU = Adoption, Implementation, Upgrade.

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Over 1,020 (74%) of health centers are participating in Health Center

Controlled Networks

No PCMH

Recognition

32%

PCMH

Recognized

68%

2016

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Improve Health Outcomes and Reduce Health Disparities

Perinatal Measures

8.0%17.6%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

NationalEstimates

UDS 2015

Low Birth Weight Babies

71.0%273.0%

60.0%

65.0%

70.0%

75.0%

80.0%

NationalEstimates

UDS 2015

Patients Entering Prenatal Care in the First Trimester

Source: 1National Vital Statistics Report. Birth: Final Data for 2014. Vol. 64, No 12, December 23, 2015.2National Vital Statistics Report. Expanded Data from the New Birth Certificate, 2008. Vol. 59, No.7, July 27, 2011.

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Improve Health Outcomes and Reduce Health Disparities

Chronic Disease Management

53.0%1

63.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

National Average UDS 2015

Adults with Hypertension whose Blood Pressure is Under Control

54.4%2

70.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

National Average UDS 2015

Diabetic Patients whose Diabetes is Under Control

Source:1NCHS Data Brief. Hypertension Prevalence and Control Among Adults. No. 220, November 2015.2National Committee on Quality Assurance. The State of Health Care Quality 2014.

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Improve Health Outcomes and Reduce Health Disparities

Preventive Services

68.4%1

71.6%2

77.5%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

HP2020 Baseline National Average UDS 2015

Percentage of Children Ages 19-35 Months who Receive Immunizations

Source:1National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2012.2National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS, 2014.

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Colorectal Cancer (CRC) Screening: 80% by 2018 Public Health Campaign

CRC Screening by PCMH National Partnerships

• National Colorectal Cancer Roundtable TA resources

1. EHR Best Practice Workflow and Documentation Guide

2. 80% by 2018 Communications Guidebook to reach the unscreened

3. American Cancer Society CRC Health Center Learning Collaborative in New England and West Virginia

38.7%

32.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

CRC ScreeningRates

PCMH

No PCMH

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Promote Innovative Organizations

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Integrate with Primary Care:

Focus Area FundingOpportunity

Awards Amount

BehavioralHealth

Mental Health Service

Expansion

433 $105.8 M

Substance Use

Substance Abuse Service

Expansion

271 $94 M

Oral Health Oral Health Service

Expansion

420 $155.9 M

HIV/Public Health

Partnerships for Care

22 $30 M

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Successes:

• Hiring BH staff

• Staff training/education

• Policies/procedures

• Huddles for team based care

• Integrating EHR

• Expanding into addiction services

Challenges:

• Recruitment/retention BHCs

• Lack of desired competencies for BHI

• Lack of bilingual staff

• Partnering with professional schools

• Mental health stigma

• Lack of resources re: autism

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Behavioral Health Integration

RESOURCE: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)Health Center Depression Screening Innovation CommunityMonthly roundtable discussionsResources, webinars, direct TA

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Substance Abuse Service Expansion (SASE)

• Progress at 9 months: • 92% have at least one provider with Drug Addiction Treatment Act

(DATA) Waiver

• 50% have increased the number of providers with DATA Waiver

• 67% increase in DATA Waivers

• 15,000 patients received MAT

• Resources:• Opioid Addiction Treatment ECHO

• Substance Abuse Warmlines

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Facilitators• Language interpretation

• SBIRT integrated in EHR

• Shared medical appointments for transitional age youth

• Support groups for young adults

• Use of telemedicine

Challenges• Recruitment/retention

• DATA waiver training not widely available for NPs and PAs

• State regulatory restrictions on MAT

• Coordinating and managing workflow for MAT

• Coordinating with internal and external partners

• Confidentiality and release of records from external treatment facilities

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Substance Abuse Service Expansion

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Behavioral Health and Substance Abuse Services Integration

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0

500,000

1,000,000

1,500,000

2,000,000

2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

er o

f Pa

tien

ts

Years

Health Center Mental Health and Substance Use Patients 2007-2015 (UDS)

• Mental health patients increased by 19% from 2014 to 2015

• Mental health personnel increased by 22% from 2014 (6,372 FTEs) to 2015 (7,780 FTEs)

• Depression screenings and follow up for patients increased by nearly 12%from 2014 (38.8%) to 2015 (50.6%)

38.8%

50.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

2014 2015

DepressionScreening

Oral Health Integration

Investments to Increase Access to Oral Health:

• Oral Health Services Expansion (OHSE) • $156 Million supporting 420 Health Centers

• 1,600 new dentists, dental hygienists, assistants, technicians to serve nearly 785,000 new patients

• Increase access to oral health care services and improve oral health outcomes

• Oral Health T/TA National Cooperative Agreement (NCA)• National Network for Oral Health Access (NNOHA)

• T/TA for health centers to provide new high quality oral health services, enhance quality of oral health services, report on oral health care quality

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Oral Health Integration

• 90% health centers provide preventive dental services either directly or via contract

• In 2015, 13.2M dental visits were provided with an increase of 42% since 2010

• 5.2M dental patients were served in 2015 with an increase of 38% since 2010

• 4,108 dentists and 1,921dental hygienists work at health centers

• HRSA UDS Dental Sealant Measure in 2015, achieved 42.4%, exceeding HP2020 goal of 28.1%

Source: HRSA Uniform Data System (UDS)

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0

2

4

6

8

10

12

14

2010 2011 2012 2013 2014 2015

Mill

ion

Health Center Dental Patients and Visits from 2010-2015

# of Patients

# of Visits

UDS 2015 Dental Sealants Measure

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Numerator 121,312

Denominator 285,799

% 42.5%

25.5

42.5

0

5

10

15

20

25

30

35

40

45

HP2020 Baseline UDS 2015

Dental Sealants Measure, %

HP2020 Goal – 28.1

Percentage of children, age 6-9 years of age, at moderate to high caries risk, who received a dental sealant on a first permanent molar during the measurement period.

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Primary Care HIV Integration

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Partnerships for Care (P4C) Health Centers have:

• Improved HIV testing and care capacity

• Established multidisciplinary HIV care teams

• Enhanced EHR and trained HIV care teams

• Developed partnerships with local and state entities

for enabling services and linkage/ re-engagement in

care

1.3 million patients tested for HIV

155,000 HIV patients served at over 630,600 visits

74.7% of HIV patients linked to care

In 2015, HRSA-funded health centers continued working to increase access and improve health outcomes for patients living with HIV

4 State Health Departments in FL, MA, MD, NY

22 Health Centers across the 4 states

One Training and Technical Assistance Contractor

Federal Partners across Department of Health and Human Services

PrEP Service Delivery by Health Centers

• Developed and disseminated HIV PrEP Health Center Technical Assistance Resource

• BPHC supports adopting PrEP into clinical practice for at risk patients as part of routine primary care

• Health Center Program/ Section 330 funding can be used for PrEP, including medication and health center visits for follow-up and related services

• Offered services must be provided in accordance with applicable clinical guidelines regardless of insurance status and/or ability to pay

• Working with partners to support PrEP training and technical assistance

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Public Health and Primary Care Integration

• Emergent public health issues, examples:• Zika virus infection

• Opioid epidemic

• Social Determinants of Health Academy

• Partnership for Care

Health Centers Respond to their Community

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Health Center Workforce

• Health Center Workforce Workgroup

• National Cooperative Agreements:• CHC Inc

• Association of Clinicians for the Underserved

• Collaborations with Bureau of Health Workforce, Federal Office of Rural Health Policy

• FTCA coverage for health center volunteer health professionals

• Telehealth

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Preparing for New Payment and Delivery Models

• Demonstrate impact:• Access

• Quality of care

• Cost-effectiveness

• Population management

• Getting there:• QI, performance management

• Optimization of HIT/HIE

• Expertise with most complex populations

• Care integration

• Addressing social determinants of health

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BPHC Key Strategies Prepare Health Centers

Health Center Controlled Network Accomplishments

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83.8 81.9

63.2

54.7

74.0

28.8

99.0 98.8

73.468.1

97.3

81.2

0

20

40

60

80

100

ONC certifiedEHRs

EPs usingEHRs

EPs attestingto MU

EPs receivingMU payments

HCs meetingat least oneHP2020 goal

HCs withPCMH

recognitionstatus

HCCN Baseline YR 3 Closeout

%

Source: FO HRSA-13-237, HCCN awardees, final report

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Health Information Exchange and Patient Engagement

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57.7

68.0

75.7

86.4

51.3

59.3 57.3

67.3

0

20

40

60

80

100

2014 2015 2014 2015

Health Info Exchange Patient Engagement using HIT

HCCN No Network

%

Source: UDS 2014 and UDS 2015

Looking Ahead

• Priority areas• Opioid epidemic/substance abuse treatment services• Mental health• Childhood Obesity

HRSA/BPHC • Care integration/Social determinants of health• Coordinated strategy to improve diabetes control• Intimate partner violence strategy• UDS Modernization• New Compliance Manual, Change in Scope, Operational

Site Visits• Enhance bi-directional communication with health

center clinicians

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Role of State, Regional, and National Partners

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Local

Regional

Federal

State

Health Centers

PCAs HCCNs

NCAs

BPHC and Federal Partners

Health Center Program Resources

BPHC Helpline: www.hrsa.gov/about/contact/bphc EHB questions/issues FTCA inquiries

BPHC Project Officer: Address specific questions about your health center’s grant or look-alike

designation

National Cooperative Agreements & Primary Care Associations: bphc.hrsa.gov/qualityimprovement/strategicpartnerships

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Website: www.bphc.hrsa.gov Includes many Technical Assistance (TA)

resources

Weekly E-Newsletter: Primary Health Care Digest Sign up online to receive up-to-date

information

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Thank You!

Judith Steinberg, MD, MPH

Bureau of Primary Health Care (BPHC)

Health Resources and Services Administration (HRSA)

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jsteinberg@hrsa.gov

301 594 4110

www.bphc.hrsa.gov

facebook.com/HHS.HRSA@HRSAgov