Zucconi.aafp slc 2013

HRSA , Health Centers, and Managing

Workforce Challenges

Nick ZucconiDeputy Regional Administrator

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Office of Regional Operations, Denver

November 2, 2013

HRSA Priorities

Strengthen the Primary Care Workforce to Better Meet the Health Needs of the Nation

Improve Access to High Quality Primary Care Services, Integrated with Public and Population Health

Strengthen HRSA’s Organizational and Technology Infrastructure, Workforce, and Workplace Climate

HRSA”s Regional Offices

The People We Serve

• About 16,750 safety net providers participate in the 340B drug discount program.

• Over 500,000 people living with HIV/AIDS receive Ryan White services. Two-thirds are racial or ethnic minorities.

• 34 million women, infants, children, and adolescents benefit from maternal and child health programs.

• More than 8,650 National Health Service Corps clinicians are working in underserved areas.

• 19.5 million patients served through health centers.

• In fiscal year 2012, HRSA awarded $153M to 45 grantees– 59% = Primary Care– 19% = Ryan White HIV/AIDS– 12% = Maternal and Child Health– 7% = Health Professions– 2% = Rural Health– <1% = Clinician Recruitment– <1% = Health Care Systems

HRSA in Colorado

1. Located in or serve a high need community (designated Medically Underserved Area).

2. Governed by a community board composed of a majority of patients representing the population served.

3. Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) to promote access to care.

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

5. Meet federal program requirements regarding administrative, clinical, and financial operations.

Health Center Fundamentals

Health Center Program National Grantee Overview-CY

2012

• 1,198 Grantees with 8,900+ Service Sites

• 83.8 Million Patient Visits • Over 148,000 Staff • 10,400+ Physicians• 7,500+ NPs, PA, & CNMs

Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks

21.1 Million Patients• 93% Below 200% Poverty • 36% Uninsured • 62% Racial/Ethnic Minorities• 1,121,037 Homeless Individuals• 903,089 Farmworkers• 219,220 Residents of Public Housing

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Under 511%

5 to 1213%

13 to 178%

18 to 2410%

25 to 6451%

65 & up7%

Grantees Serve All Ages

Medicaid38%

Medicare6%

Other Public Insurance3%

Other 3rd Party7%

Self-Pay6%

State / Local/Other

17%

BPHC Grants18%

ARRA Grants2% Other Federal Grants

3%

Grantees Revenue Sources

Health Center Program Growth:

National Impact 2008 - 2012

2008 2009 2010 2011 2012 17,000,000

18,000,000

19,000,000

20,000,000

21,000,000

22,000,000 Patients

2008 2009 2010 2011 20127000

7500

8000

8500

9000

9500

10000Sites

2008 2009 2010 2011 2012 100,000

110,000

120,000

130,000

140,000

150,000

160,000 Jobs

2008 2009 2010 2011 2012 Growth from 2008-

2012 (% Increase)Patients17,122,535 18,753,858 19,469,467 20,224,757 21,102,391 3,979,856 (23.2%)

Sites 7,518 7,892 8,156 8,501 8,979 1,461 (19.4%)Jobs 113,059 123,012 131,660 138,403 148,245 35,186 (31.1%)

Source: Uniform Data System, 2008-2012 and HRSA Electronic Handbooks 8

Health Center ProgramNational Presence – July

2013

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Health Center Program Colorado Overview-CY 2012

Source: Uniform Data System, 2012, Service Sites: HRSA Electronic Handbooks

494,000 Patients• 95% Below 200% Poverty • 38% Uninsured • 64% Racial/Ethnic Minorities• 30,500 Homeless Individuals• 13,250 Farmworkers• 2,000 Residents of Public Housing

18 Community Health Centers• 152 Service Sites • In 2012, Colorado CHCs provided more than 2

million medical, dental, and mental health visits • Colorado CHCs care for:

• 1/3 of all Medicaid enrollees• 1/4 of all Children’s Health Insurance Program

(CHIP) enrollees • 1/3 of all the state’s low-income uninsured

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Summary of Major Issues

• Workforce recruitment and retention• Too few people; those we have, need

help• Geographic and specialty

maldistribution • Competing priorities for providers &

patients

What are the challenges?

What We Do NowQuality Strategy

1. Implementation of QI/QA SystemsAll Health Centers fully implement their QI/QA plans

2. Adoption and Meaningful Use of EHRs

All Health Centers implement EHRs across all sites & providers

3. Patient-Centered Medical Home Recognition

All Health Centers receive PCMH recognition

4. Improving Clinical OutcomesAll Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure

5. Workforce/Team-Based CareAll Health Centers are employers/providers of choice and support team-based care

Priorities & Goals

ACCESS

COMPREHENSIVE SERVICES

INTEGRATED SERVICES

INTEGRATED HEALTH SYSTEM

Better Care Healthy People & Communities Affordable ⃘ ⃘Care

1. Programs/Policies

2. Funding

3. Technical Assistance

4. Data/Information

5. Partnerships/Collaboration

Strategy Implementation

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Current Program Impact: Key National Indicators

% of Health Centers with EHR Implementation (2012) 79% have EHRs at all sites used by all providers 11% have EHRs at some sites used by some providers

% of Health Centers Achieving Patient-Centered Medical Home Recognition (as of August 2013) 80% of all health centers are participating in Patient-Centered

Medical Health Home Initiatives (PCMHHI) and nearly 29% have achieved Patient-Centered Medical Home (PCMH) recognition

% of Health Center Meeting/Exceeding Healthy People 2020 Goals (2012): 59% Meet/Exceed Hypertension Control Goal of 61% 11% Meet/Exceed Diabetes Control (HbA1c ≤9) Goal of 84% 37% Meet/Exceed Early Entry into Prenatal Care Goal of 78% 61% Meet/Exceed Low Birthweight Goal of 7.8%

Individual health center profiles with performance data are now available to the public on the HRSA web site. See:

http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2012

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Source: Uniform Data System, 2011

Percentage of EHR Adoption by State 2011

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Health Center EHR Adoption National and

Colorado 2012

National CO State0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

79% 79%

11%21%

EHR at Some Sites

EHR at All Sites

2015 Goal: 100% of Health Centers use EHR at All Sites

Source: Uniform Data System, 2012

2012 Goal: 50% of Health Centers use EHR at All Sites

National PCMH RecognitionFY 2013

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2013 Health Center PCMH Recognition

National and Colorado

National CO State0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

80%

59%

29%

65%

PCMHHI Partic-ipantsPCMH Rec-ognized

2013 Goal: 25% of

Health Cen-ters Recog-

nized as PCMH

2014 Goal: 40% of

Health Cen-ters Recog-

nized as PCMH

Data as of August 16, 2013PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC

2012 National and Colorado Health Center Performance and Healthy

People 2020 Goals

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National CO State0%

10%20%30%40%50%60%70%80%90%

100%

59% 59%

11%6%

37%

50%61%

46%

Hypertension ControlDiabetes ControlEarly Entry to Prenatal CareLow Birthweight

Percentage of Health Centers Meeting or Ex-ceeding Healthy People 2020 Goals

2014 Goal: 20+% of Health Centers Meet or Exceed HP 2020 Goals

Source: 2012 UDS and Healthy People 2020

High Low CO State Average

National Average

Diabetes Control 84% 57% 70% 70%Timely entry into Prenatal Care 100% 59% 72% 70%

Hypertension Control 79% 47% 65% 64%

Low Birth Weight 0% 14% 8% 7%

Childhood Immunizations 79% 11% 33% 42%

Cervical Cancer Screening 84% 14% 62% 57%

Asthma Therapy 94% 50% 61% 73%

2012 ColoradoRange of Clinical Performance

Source: Uniform Data System, 2012. 19

Quality Strategy Implementation

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Partnerships/Collaboration• State Partners

• Primary Care Association• Primary Care Office• State Office of Rural Health• Area Health Education Centers


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Primary Care Associations• Colorado Community Health Network (CCHN)

is the membership association for the 18 federally funded Community Health Centers.

• CCHN: 1. Educates policy makers and stakeholders

about the unique needs of CHCs and their patients;

2. Provides resources to ensure that CHCs are strong organizations; and

3. Supports CHCs in maintaining the highest quality care.


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Primary Care Office (PCO)The Colorado State Department of Public Health

and Environment (CDPHE) serves as the Primary Care Office in the State. • Technical Assistance to Organizations and

Communities Seeking to Expand Access to Primary Care for Underserved Populations

• Assessment of Needs and Sharing Data• Workforce Development for the NHSC and

Safety Net and Health Center Network• Shortage Designation Applications and

Updateshttp://www.colorado.gov/cs/Satellite/CDPHE-

PSD/CBON/1251618793013


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State Office of Rural HealthThe Colorado Rural Health Center (CRHC) works with

federal, state and local partners to offer services and resources to rural healthcare providers, facilities and communities:• provides recruitment and retention services and

connects communities with loan repayment options for their providers;

• supplies organizations with funds and equipment, such as workforce-enhancing loan repayment or scholarships; Federally-granted medical equipment; or technical assistance grants to rural hospitals and communities.

• convenes workshops, training programs, and technical assistance to facilities and communities, such as coding, billing, quality improvement, and compliance assistance.

http://www.coruralhealth.org/


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Area Health Education Center The Colorado Area Health Education Centers were

established as an academic-community partnership involving the University of Colorado Denver and six community-based nonprofit regional AHEC offices, each serving a designated region of the state.

The AHEC works to build state-wide network capacity and strengthen academic-community linkages in four areas:• Health Careers and Workforce Diversity• Health Professions Student Education• Health Professions Continuing Education• Public Health and Community Education

http://www.ucdenver.edu/life/services/ahec/Pages/index.aspx

Nick ZucconiDeputy Regional AdministratorHealth Resources and Services

Administration Office of Regional Operations - Denver

[email protected]

mailto:[email protected]

Zucconi.aafp slc 2013

Health & Medicine

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