HRSA Bureau of Primary Health CarePolicy/Program Development Update & Value-Based Care

South Carolina Primary Care Association Annual Meeting

October 12, 2019CAPT Morrisa Rice, PhDTeam Lead, Office of Southern Health Services, Southeast DivisionBureau of Primary Health Care (BPHC)

Overview

• Funding and supporting access to care updates

• Policy updates

• Other program updates

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Health Center Program 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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National Presence: Approximately 12,000 Service Delivery Sites

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South Carolina Presence: Approximately 222 Health Center Service Delivery and Look-Alike Sites

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Bureau of Primary Health Care 2022: Strategic Shifts

Compliance-oriented grant maker Primary health care leader1

Health Centers as independent entities Health Centers as interconnected entities 2

Interventions that address immediate medical needs Continuous community-oriented, comprehensive care3

Siloed functions Collaborative model4

Separate data tools Integrated systems that inform decision-making5

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Integrated Care at Health Centers

Primary Care

Mental Health

Oral HealthVision

Substance Use Disorder

Prevention and Treatment

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Funding and Supporting Access to Care

2018 UDS Highlights

Source: Uniform Data System, 2018

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FY 2019 Funding Opportunities

Integrated Behavioral

Health Services Expansion

$200 million1,208 awards

Quality Improvement

$100 million

New Access Points

(competitive)

$50 million~75 awards at

$650K each

Oral Health Infrastructure(competitive)

$76 million~250 awards at

$300K each

Health Center Controlled Networks

(competitive)

$42 million49 awards

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Notices of Funding Opportunities

• State and Regional Primary Care Association (PCA) Cooperative Agreements Approximately $57.5 million for 52 PCAs Eligible applicants: organizations that can provide training and technical assistance (T/TA) to

organizations that have or are seeking Health Center Program funding or look-alike designation Two-phase application process: Phase 1 due November 8 to Grants.gov,

Phase 2 due December 10 to HRSA EHBs Expected awards: June 2020

• National Health Center Training and Technical Assistance Partners Cooperative Agreements (NTTAP) Approximately $22 million for 21 NTTAPs Eligible applicants: entities that can provide T/TA to organizations that have or are seeking Health

Center Program funding or look-alike designation Two-phase application process: Phase 1 due November 15 to Grants.gov,

Phase 2 due December 17 to HRSA EHBs Expected awards: June 2020

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Ending the HIV Epidemic: A Plan for America Sign up for initiative updates at HIV.gov

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Ending the HIV Epidemic: Health Center Program Funding

• Primary Care HIV Prevention (PCHP) Supplemental Funding $50 million for HRSA-funded

health centers in the identified geographic areas

Eligible applicants: dually funded (BPHC and RWHAP) health centers or health centers with MOUs with RWHAP sites

Expected release: Fall, 2019 Expected awards:

Early Calendar Year 2020

PCHP OBJECTIVES

Engage new and existing patients to identify those

at risk for HIV

Increase patients tested for HIV

Increase patients who receive prevention

education and clinically-indicated PrEP

Increase linkage to HIV treatment

Enhance/Establish partnerships to support HIV prevention activities

Within 8 months of award add at least 0.5 full-time equivalent personnel to

identify and support PrEP patients

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Policy Updates

Compliance Resources and Tools

Compliance Manual BBA updates (8/2018)

Conditions library BBA updates (8/2018)

Site Visit Protocol (SVP) BBA and other updates (9/2018)

SVP Updates (3/2019)

Compliance Manual DRAFT updates for commentFall 2019 (anticipated)

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Continuous Compliance: Results

Fewer conditions

Faster resolution of conditions

Fewer one-year project periods

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Continuous Compliance: FY 2019 Service Area Competition Applications

Source: HRSA Electronic Handbooks

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Continuous Compliance: CY 2019 Operational Site Visits (OSVs)

Source: HRSA Electronic Handbooks (Date Range 1/22/2019-6/24/2019)

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Service Area Request for Information (RFI)

Preliminary Takeaways• Nearly 600 comments received• Feedback across all areas of consideration• Nature of comments from partial review:

• No clear consensus• Concerns about the impact of criteria on the ability of health centers to specialize

in serving unique patient populations requiring a specific type of culturally competent care

• Concerns that criteria could be impacted by factors outside health centers’ control (e.g., local market conditions, movement of patient populations)

• Concerns about impacts of a “one size fits all” approach (e.g., on rural areas) • Detailed feedback on service area criteria as well as new criteria that might be

considered

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Service Area Policy Development Timeline

Release RFIApril 2019

60-Day Feedback Period

Summer 2019

Overview of public feedback

Fall 2019

Draft policy, as appropriateWinter 2020

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Other Program Updates

PCAs: Supporting State/Regional Value Transformation

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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Linking Grant Funding to Performance

Define value and performance specific to the

Health Center Program

Quantify ROI with transparent measures and

risk adjustment

Measureperformance using UDS

and other standard data sources

Incentivizeperformance with grant

funding

Value: How well a health center impacts the health of their patients and community to improve the health of the nation’s underserved populations

Performance: How well a health center fulfills its unique role in the health care ecosystem by providing comprehensive, high quality care to underserved populations

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Value Based Grant Funding Activities

Share your feedback: hcperformance@hrsa.gov

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Value-Based Health Center Performance Domains

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Measures Under Consideration

Financial Management

• Revenue• Net Patient Revenue• Percent Medicaid• Percent Medicare• Percent total margin• Two year change in

total margin

Admin Operations

• Growth in FTE• Growth in visits• Growth in patients• Visits/FTE• Visits/Day• Percent support staff• Percent

administrative and facility staff

• NHSC vacancies (tenure measure)

• Grant conditions

Clinical Quality

• UDS clinical quality process and outcome measures

Access

• Market Penetration• Patient Targets• PCMH• Health Center

Availability (total weekly hours, operations schedule, calendar schedule)

• Comprehensive Services

• Enabling Services (visits and FTEs)

• Patients• Visits• FTEs

Population Health Management

• Data not currently available – future UDS measures?

Non-UDS Measures in bold

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Considerations for Risk Adjustment

• Social determinants of health (SDOH)• Patient acuity• Special populations served

Patients

• Volume/size• Urban/rural• Revenue/payer mix• Provider and staffing mix

Health Centers

• Relative unmet need• Area morbidity/mortalityService Area

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Other Considerations

Lessons learned from value-based care delivery and state payment models

Patient targets and QIAs

Maturity models and UDS modernizations (and patient-level data)

Ongoing feedback

Share your feedback: hcperformance@hrsa.gov

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Value Based Grants Made in Improving Quality

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New Funding/Payment ModelsRecognizing that there is variability in health center performance across domains, we will work to support health centers where they are and rethink how we invest to be most meaningful for their success.

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Workforce Well-Being and Burnout

• Nearly half of physicians, nurses and other health care providers report experiencing job burnout1

• Highest rate of burnout is among rural clinicians2

• Survey of Family Physicians ABFM recertification candidates: 24.5% burnout3

Female sex and age significantly associated with burnout Broader scope of family practice is protective against burnout4

• Medical trainees experience higher rates of depression and burnout than similar age individuals pursuing different careers5

• Burnout can take many forms, including emotional exhaustion, depersonalization, and a low sense of personal accomplishment at work and can lead to depression/suicidality

Prevalence of burnout among board-certifiedfamily physicians by sex and age

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What Health Centers Can Do

• Establish workforce well-being1 as a strategic priority with leadership and staff engagement led by a wellness champion2.

• Practice facilitative leadership and enhance communication between senior leadership and health center staff and providers.

• Conduct organizational assessments3 to identify workflow inefficiencies and inform workforce engagement and burnout prevention strategies and measure4 impact of interventions.

• Promote flexibility in scheduling for work-life balance5 and provide time for staff to focus on areas of interests (e.g., teaching, quality improvement, clinical focus interests).

• Improve efficiency6 (e.g., workflow redesigns) and reduce clerical burden (e.g., Electronic Health Record [EHR] entries) through targeted quality improvement7 projects tailored to staff concerns.

• Provide time and support for self and team care8; increase staff capacity and expertise to care for complex patients9.

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Health Center Program Resources

• Website: https://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

• Health Center Program Support: https://bphccommunications.secure.force.com/ContactBPHC/BPHC_Contact_Form HRSA Electronic Handbooks (EHBs) questions/issues FTCA inquiries

• National Cooperative Agreements and Primary Care Associations: https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/

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Thank You!

CAPT Morrisa Rice , PhDTeam Lead, Office of Southern Health Services, Southeast DivisionBureau of Primary Health Care (BPHC)Health Resources and Services Administration (HRSA)

mrice@hrsa.gov

(301) 443-6838

bphc.hrsa.gov

Sign up for the Primary Health Care Digest

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