Introduction to the Community

Health Center System

NWRPCA Spring Primary Care Conference

Seattle, WA – May 18, 2014

Seth Doyle

Community Health Improvement Program, NWRPCA

1

Overview of Session

History – Current Initiatives

Federal Structure

Region X

Health Center Data

Health Center Program Requirements

Support System

2

Origins of the Community Health Center

Movement

Migrant Health Act (1962)

Migrant Health Branch

War on Poverty (1965)

Office of Economic Opportunity (OEO)

Neighborhood Health Center Demonstration Projects

VISTA

Head Start

Job Corps

3

Origins of the CHC Movement Cont’d

Community-Oriented Primary Care

Civil Rights

Political/Economic

Empowerment

Educational Opportunity

Social Change

4

Health Center Consolidation Act

Health Center Consolidation Act

§330 of the Public Health Service Act

Community 330(e)

Migrant 330(g)

Homeless 330(h)

Public housing 330(i)

Department of Health and Human Services (HHS)

Health Resources and Services Administration (HRSA)

Bureau of Primary Health Care (BPHC)

5

Growth & Expansion

Bush Administration Health Center Initiative Investment doubles

630 New Health Centers or Satellite Clinics

570 Expanded Health Centers

Additional 6 million patients served

6

The American Recovery and Reinvestment Act

ARRA allocates $2 billion specifically for health center

infrastructure and operations

More than 2.7 million new patients served

More than 1.5 million new uninsured patients served

More than 10,000 health center jobs added in 2009

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The Patient Protection and Affordable Care Act

ACA provides $11 billion in funding over the next 5 years

$9.5 billion for:

New health center sites in medically

underserved areas

Expansion of

preventive/primary

health care services

$1.5 billion for major

construction/renovation

projects

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Outreach & Enrollment

$150 million new funding for Health Centers in

FY 13 + $6.4M to PCAs to support O/E efforts

Assist 3.7 million Americans with enrollment

Hire 3,000 new outreach and eligibility workers

Develop culturally/linguistically appropriate materials

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US Department of

Health & Human Services

Sylvia Mathews Burwell ?

Health Resources and Services

Administration

Mary Wakefield, Ph.D, R.N.

Bureau of Primary Health Care

Bureau of Primary Health Care

Office of the Associate Administrator

Associate Administrator

Deputy Associate Administrator

Chief Medical Officer

Office of

Administrative

Management

Office of Policy and

Program

Development

Office of Quality

and Data

Office of National

Assistance and

Special Populations

Northeast Division

Central Southeast

Division

North Central

Division

Southwest

Division

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Jim Macrae

Tonya Bowers

Seiji Hayashi

Tracy Orloff Margaret Davis

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Region X

90 Health Center Grantees (as of 02/13)

Alaska = 25

Idaho = 11

Oregon = 29

Washington = 25

Over 590 sites (2013)

Serve over 1.3M people (2013)

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Health Centers Nationwide In 2012:

1,198 Grantees (48% rural)

Employing 148,245 FTEs

21.1 million patients (59% female):

• Medical services: 18.03 million (85%)

• Dental services: 4.33 million (21%)

• Mental health care: 1.04 million (5%)

• Vision services: 346,000+ (2%)

• Enabling services: 1.97 million (9%)

HRSA 2012 Uniform Data System (UDS)

Mountain Family Health Center, CO

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Health Centers Nationwide In 2012:

Patient Demographics*

22.9%

57.1%

36.0%

92.6%

Region X Health Centers in 2012:

HRSA 2012 Uniform Data System (UDS) 17

best served in language other than English (LOTE)

racial/ethnic minority

uninsured

at/below 200% poverty level

Utah Navajo Health System, Utah Region X

LOTE Patients 22%

Racial/Ethnic Minority 50%

Uninsured 37%

<= 200% Poverty Level 93%

*Percentages

are of known,

not of total

Health Centers Nationwide In 2012:

Special Populations Patients

Migrant & Seasonal Farmworkers Pts: 903,089 (4.3%)

Homeless Pts: 1,121,037 (5.3%)

School-Based Health Center Pts: 434,833 (2.1%)

Veteran Pts: 251,188 (1.2%)

Region X Health Centers in 2012:

HRSA 2012 Uniform Data System (UDS)

Region X

MSFW Patients 122,173 (9%)

Homeless Patients 115,268 (8%)

SBHC Patients 23,571 (2%)

Veteran Patients 24,328 (2%)

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Types of Health Centers Nationwide In 2012:

Community Health Grantees: 1,114 (93%)

Migrant Health Grantees: 166 (14%)

Homeless Health Grantees: 246 (21%)

Public Housing Grantees: 76 (6%)

FQHC Look-Alikes: 93

Region X Health Centers in 2012:

HRSA 2012

Uniform Data

System (UDS)

Region X

Community Health Grantees 85 (94%)

Migrant Health Grantees 24 (26%)

Homeless Health Grantees 19 (21%)

Public Housing Health Grantees 1 (1%)

FQHC Look-Alikes 0

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Health Center Program Fundamentals

1. Located in or serve a high need community

2. Governed by a community board

3. Provide comprehensive primary health care

4. Provide services available to all

5. Meet other performance and accountability requirements

Non-profit private or public community-based, patient-directed organizations

that serve populations with limited access to health care

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19 Key Health Center

Program Requirements

NEED

1 of 19

SERVICES

7 of 19

MANAGEMENT &

FINANCE

8 of 19

GOVERNANCE

3 of 19

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NEED

1. Needs Assessment

SERVICES – Part 1

2. Required and

Additional Services

3. Staffing Requirement

4. Accessible Hours of

Operation/Locations

Program Requirements

Virginia Garcia Memorial Health Center (OR) Mobile Health Clinic

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SERVICES – Part 2

5. After-Hours Coverage

6. Hospital Admitting Privileges and

Continuum of Care

7. Sliding Fee Discounts

8. Quality Improvement/Assurance

(QI/QA) Plan

Program Requirements

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MANAGEMENT & FINANCE – Part 1

9. Key Management Staff

10. Contractual/Affiliation Agreements

11. Collaborative Relationships

12. Financial Management and Control

Policies

Program Requirements

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MANAGEMENT & FINANCE – Part 2

13. Billing and Collections

14. Budget

15. Program Data Reporting Systems

16. Scope of Project

Program Requirements

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GOVERNANCE

17. Board Authority

18. Board Composition

19. Conflict of Interest Policy

Program Requirements

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So…WHY?

Benefits to

Community

Health Home

A Voice

Broader Coverage

Less Costly Care

Benefits to Health Center

$$$$

Malpractice Coverage (FTCA)

PPS for Medicaid

Cost-Based for Medicare

Drug Discounts – 340B

Loan Guarantees

NHSC

National Network

Columbia Valley Community Health (WA) Health Fair 27

Health Center Support System

State & Regional PCAs:

Provide state- and region-wide Training and

Technical Assistance (T/TA)

Additional Support via:

National Cooperative Agreements (NCAs)

Primary Care Offices (PCOs), etc.

BPHC/Project Officer, Contractors/Consultants

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Northwest Regional Primary Care Association

Mission

Northwest Regional Primary Care Association is a

member organization that strengthens community and

migrant health centers in the Northwest by leveraging

regional power and resources on their behalf.

Vision

With the support of NWRPCA, our community health centers will be

exemplary professional homes for their staffs and serve their

communities well.

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Visit www.NWRPCA.org for more information.

National Cooperative Agreements (NCAs)

Training and Advocacy

National Association of Community Health Centers, Inc.

Migrant and Seasonal Farmworker Populations

Farmworker Justice

Health Outreach Partners

Migrant Clinicians Network, Inc.

MHP

National Center for Farmworker Health, Inc.

Homeless Populations

National Health Care for the Homeless Council

Residents in Public Housing

Community Health Partners for Sustainability

North American Management

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National Cooperative Agreements (NCAs)

Asian American, Native Hawaiian, and Pacific Islander

Populations

Association of Asian Pacific Community Health Organizations

Capital Financing

Capital Link, Inc.

Children in Schools

School-Based Health Alliance

Elderly Populations

North American Management

LGBT Populations

The Fenway Institute

Oral Health

National Network for Oral Health Access

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Final Thought

“Civil Rights and the War on Poverty were key to the program’s birth. The

need to care for the underserved is the key to growth. But the real reason

for success has always been the communities’ feeling of ownership over

their centers. That’s what has sustained and nurtured us through it all.”

--Dan Hawkins, Senior Vice President, NACHC

Thank You!

Seth Doyle

Community Health Improvement Program, NWRPCA

206-783-3004 ext. 16

sdoyle@nwrpca.org

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