missouri primary care association march 2011 missouri primary care association1

Missouri Primary Care AssociationMarch 2011

Missouri Primary Care Association 1

Senate and House approved Continuing Resolution through April 8.

$6.1 billion in cuts◦ $3.5 billion in program reductions◦ $2.6 billion in earmark cuts

No funding cuts to CHCs in Continuing Resolution Uncertainty regarding final budget and cuts –

negotiations behind the scenes


Dedicated Funding for CHCs Total $9.5 billion for operations and expanded

capacity (New Access Points, Expanded Medical Capacity, and Service Expansion)

$1.5 billion for capital improvement projects (new facilities, new equipment, renovation)

Primary Care Provider Capacity $1.5 billion for National Health Service Corps to

train, recruit and retain primary care providers to serve the underserved


Medicaid Expansion for all individuals under 65 at or below 133% of FPL in 2014; many current sliding fee patients will be able to access Medicaid coverage

Private insurance plans in Health Insurance Exchanges will be required to contract with FQHCs and pay cost-based PPS rates. Premium and cost sharing assistance available to individuals between 133%-400% FPL


Preventive services added to FQHC Medicare services and removal of cap on payment for Medicare visits

Funding for teaching FQHCs and FQHC-based residency programs


Medical Home Demonstration: FQHCs become recognized as Patient-Centered Medical Homes. (BPHC Priority)

Accountable Care Organizations: Provider led organization whose members engage in joint decision making, that manages full continuum of care and is held accountable for overall costs and quality of care

FQHC providers receive Medicaid incentives for Meaningful Use of Health Information Technology


Community Health Center model prominent – we must deliver

Focus on Becoming Providers of Choice Anticipate increased demand for services Patient Satisfaction with Care Experience is

Critical as is Patient Retention and Outreach Provider Recruitment and Retention is Critical


CHCs should Pursue Patient Centered Medical Home (PCMH) Recognition

Focus on Operational Excellence, Effective and Efficient Operations

Fully Implement Electronic Medical Records (EMRs) and Participate in Health Information Exchanges (HIEs)

Improve Quality and Be Transparent Enhance External Communications and Advocacy


Bring Clinical, Quality, and HIT together◦ Finish Data Warehouse to enable accurate, reliable,

timely quality measures reporting◦Statewide Quality Improvement Effort◦Meaningful Use Incentives

Arcadia Solutions is consultant Actively working with 16 of 23 FQHCs 17 measures reported for 7 FQHCs


Operating Board Appointed by MPCA Board of Directors◦Clinical Provider Staff◦Quality Improvement Staff◦HIT Staff

Staffed by MPCA Center for Quality Meets Quarterly Determines Priorities for MOQuIN


Arcadia Solutions Proprietary & Client Confidential

MPCA Strategic Vision

11

Own your data…Own your future.

Meaningful Use may not achieve all of your organizational goals.

Missouri Primary Care Association

16 FQHCs participate at present 10 measures for diabetes and cardiovascular

disease Combination of reporting from patient registries,

EMRs, and manual chart audits Transitioning to use of MOQuIN data warehouse

and reporting to satisfy state contract requirements


ARRA HITECH HIT Innovation and Implementation

Special Congressional Initiative Missouri HIT Assistance Center


MPCA is partner and contractor Funding supports MPCA providing technical

assistance to Health Centers to achieve Meaningful Use of HIT and receive incentive payments

No cost to Health Centers Work is coordinated with Arcadia Solutions in

tandem with MOQuIN


Arcadia Solutions Proprietary & Client Confidential16

Meaningful Use Incentives

Calendar YearFirst Calendar Year in which the EP Receives and Incentive

PaymentCY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016* $8,500 $8,500 $8,500 $8,500 $8,500 $21,2502017 $8,500 $8,500 $8,500 $8,500 $8,5002018 $8,500 $8,500 $8,500 $8,5002019 $8,500 $8,500 $8,5002020 $8,500 $8,5002021 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Eligible professionals can receive up to $63,750 over six years.

Missouri Primary Care Association

Health Home Initiative PRIMO Revamped Health Insurance Exchange Legislation and

Implementation


1. Ignorance is not Bliss: too many people don’t know who we are

2. Nearly 100 New Members of Congress and 80 members of the Missouri Legislature know little or nothing about Health Centers

3. State and Federal Deficit Reduction Efforts: we are now big enough to matter

4. The Appearance of Power is Power5. Elected officials fear the voters more than ever

(See #2)


◦ Grassroots advocacy is about one thing – building power.

◦ Power is not measured by the number of advocates we have on a list.

◦ Power is not measured by the number of small (or even large) victories we win every now and then.

◦ Power must be measured by our ability to successfully advance our own agenda and to make it unthinkable that any other political or special interest would ever want to take us on.


Health Center Expectations (PIN 98-23) FTCA (PIN 11-01) Corporate Compliance (HIPAA) Meaningful Use

20Missouri Primary Care Association

Community-Oriented Primary CareFoundation for CHC movementaccessible first contact care, or serving as the entry

pointa continuous relationship with patients over time;comprehensive carecoordination of care

Care Modelfocuses on “system changes intended to guide quality

improvement and disease management activities” for chronic illness.


Joint Principles of the Patient-Centered Medical Home

Developed and Adopted March 2007

Personal Physician Physician Directed Medical Practice Whole Person Orientation Care is Coordinated and/or Integrated Quality and Safety Enhanced Access Payment Reform


Centers for Medicare and MedicaidHealth Resources and Services Administration:

Bureau of Primary Health Care (HRSA-BPHC)All CHCs recognized by 2014Awarded contract to National Committee for

Quality Assurance (NCQA) to cover application costs

Insurers-Private and PublicMedical Societies Foundations


Provides an excellent review of the organization’s :◦ Quality Improvement Programs◦ Care Coordination- Both internal and external◦ Community Linkages and access to specialty

care◦ Policies and procedures ◦ Corporate compliance◦ Data extraction/reporting◦ Meaningful Use of EMR


NCQA developed a set of standards and a 3-tiered recognition process program) to assess the extent to which health care organizations are functioning as medical home

Recognition requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place

Recognition is offered at three levels:Level 1 – basicLevel 2 – intermediateLevel 3 – advanced


National Committee for Quality Assurance: www.ncqa.org/tabid/631/Default.aspx

The Joint Commission: www.jointcommission.org/accreditation/pchi.aspx

Primary Care Development Corporation of New York: www.pcdc.org/resources/patient-centered-medical-home

Patient-Centered Primary Care Collaborative: www.pcpcc.net/content/patient-centered-medical-home

Commonwealth Fund: Safety Net Medical Home Initiative: www.qhmedicalhome.org/safety-net/change-concepts.cfm

Improving Chronic Illness Care: www.improvingchroniccare.org/index.php?p=Patient-Centered_Medical_Home&s=224 American College of Physicians: www.acponline.org/running_practice/pcmh/


Susan Wilson- [email protected] Angela Herman- [email protected] Danny O’Neill- [email protected]

Missouri Primary Care Association3325 Emerald LaneJefferson City, MO 65109-6879(573) 636-4222www.mo-pca.org


missouri primary care association march 2011 missouri primary care association1

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