NACHC Policy & Issues Forum Plenary Session – PCA/HCCN

March 2019

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HRSA Strategic Goals

Goal 1 Improve access to quality health care and services

Goal 2 Foster a health care workforce able to address current and emerging needs

Goal 3 Enhance population health and address health disparities through community partnerships

Goal 4 Maximize the value and impact of HRSA programs

Goal 5 Optimize HRSA operations to enhance efficiency, effectiveness, innovation, and accountability

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Addressing HHS and HRSA Priorities Rural

Health

Opioids & Substance

Use Disorder

Value Based Care

Oral Health

Childhood Obesity

Ending the HIV

Epidemic

Maternal Mortality

Health Workforce

Health Technology

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FY 2019 New Funding Opportunities

Integrated Behavioral

Health Services Expansion

$200 million

New Access Points

$50 million

Oral Health Infrastructure

$76 million

Quality Improvement

$100 million

Health Center Controlled Networks

$42 million

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Investing in Substance Use Disorders and Behavioral Health Care

• Substance Abuse Service Expansion (SASE) Awards •$94M – 217 awards 2016• Access Increases for Mental Health and Substance Abuse Services (AIMS

Awards) • $200M - 1,174 awards 2017• Substance Use Disorder and Mental Health Services Awards •$350M – 1,232 awards 2018• Integrated Behavioral Health Service (IBHS) Awards •$200M - 1,375 awards2019

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SUD-MH Triannual Progress Report Data Data Elements UDS (2017) September to

December 2018 Progress Report Data

Substance Use Disorder Patients Visits

168,5081,227,629

212,418 748,497

Mental Health Services PatientsVisits

2,049,1949,876,669

1,115,977 3,369,651

Medication Assisted Treatment (MAT) ProvidersPatients

2,97364,597

4,877 54,642

Use of Telehealth for Substance Use Disorder and/or Mental Health Services – Number of Health Centers 315* 356* 2017 UDS did not have a specific category for health centers to note the use of telehealth for SUD services, so this data only represents use of telehealth for mental health services. The 2018 UDS has added a question to capture health center use of telehealth for SUD services.

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FY 2020 Budget Request

• Funding Level • Mandatory: $4.0 Billion

Discretionary: $1.626 Billion

• Mandatory Cliff • FY 2020 and FY 2021

• Proposed New Spending • Ending the HIV Epidemic

Initiative

President’s Budget:

$5.6 billion

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Ending the HIV Epidemic: A Plan for America

Diagnose All people living with HIV (PLWH) as early as possible after transmission

Treat HIV rapidly and effectively to achieve sustained viral suppression

Prevent People at highest risk of HIV with PrEP and prevention education

Respond Rapidly and effectively to clusters and outbreaks of new HIV infections

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Ending the HIV Epidemic: Health Center Program

• Nearly 2 million HIV tests conducted annually

• More than 165,000 patients with HIV receive medical care services at health centers, including many sites co-funded by the Ryan White HIV/AIDS Program

• More than 600 health centers purchase Pre-Exposure Prophylaxis (PrEP) through the 340B Program

• FY 2020: $50 million to support increased outreach, testing, care coordination, and HIV prevention services, including PrEP, in targeted counties/cities and States.

Geographic Hotspots

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Health Centers: Ending the HIV Epidemic Flowchart

Targeted health centers Serve the identified counties and states

Testing Link to prevention and care

HIV+

Engage and Treat

Retain

Viral suppression

HIV- PrEP

Respond rapidly to detect and respond to growing HIV clusters and prevent HIV infection (CDC)

High risk referrals of new patients (CDC, S/LHDs)

Health center in reach to identify high-risk current patients

Diagnose all people as early as possible after infection

Treat the infection rapidly and effectively to achieve viral suppression

Prevent people at risk using potent and proven prevention interventions, including medication that can prevent HIV

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BPHC 2022: Strategic Shifts

Compliance-oriented grant maker Primary health care leader 1

Health Centers as independent entities Health Centers as interconnected entities 2

Interventions that address immediate medical needs Continuous community-oriented, comprehensive care 3

Siloed functions Collaborative model 4

Separate data tools Integrated systems that inform decision-making5

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Service Area Request for Information: Areas of Consideration for Public Comment

How can HRSA better maximize impact of Health Center Program expansion?

Unmet need

Proximity

Reasonable boundaries

Other providers

Demonstrated capacity in current area

Patient representation

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Uniform Data System (UDS) Modernization Initiative

Reduce Reporting Burden • Automate data submission, provide

enhanced UDS reporting capabilities, promote transparency and integrate stakeholder feedback.

Measure Impact • Improve UDS data‘s ability to support

quality improvement by collecting patient level data to better reflect medical and social complexity and unique aspects of care delivery in health centers.

Promote Transparency • Provide an open transparent decision-

making process on UDS changes such as measure selection, information technology, and reporting improvements.

Modernizing Data Collection & Utilization

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Continuous Compliance: Operational Site Visits

CY 2018 OSVs • Number of Visits: 547

• Number and Percent demonstrating full compliance: 131 / 24%

• Number and Percent with Conditions: 416 / 76%

CY 2019 OSVs • Number of Visits (through March 15): 43

• 88% (7/8) of health centers completing CRO* demonstrated 100% compliance through the process

*Compliance Resolution Opportunity

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Continuous Compliance: FY 2019 SAC/RD Application Reviews

• Number of Applications with a 3-year Project Period: 470 • Without External Correspondence: 310 • With External Correspondence: 160

• Number of Conditions resolved in CRO: 428

• Number of Applications with a 1-year Project Period: 6

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Continuous Compliance: Conditions

• Number of CY 2018 90-Day Conditions: 2,464

• Number of conditions that progressed to 60-Days: 336

• Number of conditions that progressed to 30-Days: 14

Top 5 Conditions (64% of conditions placed)

1. Sliding Fee Discount Program

2. Clinical Staffing

3. Board Authority

4. Billings and Collections

5. Contracts and Sub awards

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Continuous Compliance: Health Center Profile Compliance Status Updates Health Center Profile City, State

3-year project/designation period; end date June 30, 2021

Service Area Map Total Patients Served: 10,000

• NEW: Project/designation period length and end date

• NEW: Operational Site Visit badge to recognize successful demonstration of compliance

• NEW: 90-day conditions (in addition to 60-day, and 30-day conditions)

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Provider and Staff Satisfaction Survey • High and increasing rates of burnout

among clinicians and trainees • ½ of physicians and nurses1

• Highest among rural clinicians2

• Related Factors • Workload/job demands • Efficiency and resources • Meaning of work • Culture and values • Control and flexibility • Social support/community • Work life integration

1 https://nam.edu/initiatives/clinician-resilience-and-well-being/ 2 https://www.ahrq.gov/professionals/clinicians-providers/ahrq-works/burnout/index.html

Provider/staff satisfaction affects their well-being, quality of care, patient safety, and satisfaction

• Medical errors • Suboptimal patient outcomes • Provider/staff turnover • Recruitment/retention • Productivity loss

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HCCNs: The Road Ahead

1. Enhance the Patient and Provider Experience • Patient Access • Patient Engagement • Provider Support

2. Advance Interoperability • Data Protection • Health Information Exchange • Data Integration

3. Use Data to Enhance Value • Data Analysis • Social Risk Factor Intervention

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Looking Ahead: Draft PCA Framework for FY 2020

1. Accelerate Value-Based Care Delivery

2. Increase Access to Comprehensive Primary Health Care

3. Strengthen the Health Center Workforce

4. Enhance Health Center Emergency Preparedness

5. Advance Health Center Clinical Quality and Performance

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