“Supporting doctors and other health care professionals change the way they work is critical to improving quality and spending our healthcare dollars more wisely,” said Secretary Burwell in a press release. “These awards will give patients more of the information they need to make informed decisions about their care and give clinicians access to information and support to improve care coordination and quality outcomes.”

The investment aims to provide the tools and support needed to improve quality of care for patients as an overall shift to reward value rather than volume in healthcare. The Transforming Clinical Practice Initiative is one of the largest federal investments designed to support doctors and other clinicians in all 50 states through collaborative and peer-based learning networks;  meaning, learning from one another’s successes or failures.

The Community Health Center Association of Connecticut (CHCACT) is one of the organizations selected to receive the funds –  $17.25 million to provide technical assistance support to help clinicians at  health centers  in Connecticut with the tools, information, and network support they need to improve quality, increase patient access, and spend health care money more wisely.

Evelyn Barnum, CHCACT’s CEO, said in a press release that the program will “focus on improving health outcomes for three conditions common to health center patients: asthma, diabetes and hypertension. Overall, CHCACT expects this investment to improve the health of FQHC patients while saving over $38 million in the health care system.”

Congratulations to CHCACT and all of the other awardees!

To learn more about the Transforming Clinical Practice Initiative and the other awardees, visit the initiative website.

Did your health center or PCA receive funds under this initiative? We want to hear from you! Let us know in the comments below and we will feature you in a future blog post.

“Many insured and uninsured women throughout the state of Nevada feel they don’t have access to breast cancer screenings because of the travel needed just to get screened and don’t feel they can take the time away from family and work,” said  Colleen Petrosky, Mammovan Manager.  “The Mammovan is helping to reach these women and provide hope and support as well as follow-up and referrals when needed.   We know prevention is the best protection and we hear stories from our returning women whose lives were saved because of their Nevada Health Services Mammovan visit.”

About one in 8 women will develop breast cancer in her lifetime and early screenings can make the difference between life and death.

Throughout the month of October–Breast Cancer Awareness Month–we’ll be featuring health centers and people who are waging the battle against breast cancer. If you have a story to share, please tell us and we’ll write about it on this blog.

“We’re building a mindset of comprehensive care with primary care and behavioral health providers,” Parinda Khatri, PhD, a clinical psychologist and CCO at CHS tells reporter John Commins. “We believe strongly in access. We say there’s no wrong door,” she says. “People can come through the primary care door and they will be asked about their behavioral health status, they will get behavioral health screenings.

She goes on to describe how the therapists are trained to ask if a new patient has a primary care provider. If not, then the goal of CHS is to be that patient’s medical home and stand ready to talk to him or her about health and how they’re functioning in life. If a patient feels they have a behavioral health issue, at the point of care a behaviorist is brought to them. Whether the issue is substance misuse, depression, smoke cessation, stress management — if there is a request for help it is available on site. No navigating a complex healthcare maze of different providers in different places — at CHS it’s all under the same roof and designed to ensure the patient gets the help they need as soon as they need it. Best of all, the providers, whether it is the doctor or therapist, are all communicating with each other about the patient’s needs.

This seems like a common sense approach, unfortunately, it is not a commonplace approach in healthcare — unless of course one happens to visit a Community Health Center.

Paul Kaye, MD, of HRHCare at the NCQA Gala in Washington, D.C.

Deb Murph, CEO of Cherokee Health Systems at the NCQA Gala in Washington, D.C.

We are so proud of our friends at HRHCare (Hudson River HealthCare) in New York and Cherokee Health Systems  (CHS) in East Tennessee. Both health centers were  honored this week in Washington, D.C, by the National Committee for Quality Assurance (NCQA) at their 25th Anniversary Gala.  NCQA is a private, nonprofit organization dedicated to improving healthcare quality.

“As we celebrate our own 40th Anniversary this year, HRHCare is so proud to be recognized as a lead organization providing high quality health care for all by the NCQA during their 25th Anniversary celebration,” said Anne Kauffman Nolon, MPH, President and CEO of HRHCare in a press release. “Having achieved Level 3 PCMH status from the NCQA is a testament to the mission of HRHCare to provide outstanding, compassionate care to the patients we serve.”

The secret formula to their success?  Plan. Do. Study. Act. If you want to know what these words have to do with healthcare delivery, watch this great video by NCQA about HRHCare and see how this organization  isn’t afraid to try out bold ideas.

Paul Kaye, MD, Executive Vice President of Practice Transformation at HRHCare, accepted award on behalf of HRHCare at the NCQA Gala. Previously serving as Chief Medical Officer of HRHCare for 21 years, Dr. Kaye was instrumental in helping HRHCare achieve Level 3 PCMH recognition.  Some 22 HRHCare Health Centers now hold the highest PCMH status of Level 3, a recognition that establishes HRHCare as a medical home that focuses care coordination and communication to transform primary care into what patients need and want it to be.

HRHCare started nearly 40 years ago. Founded in 1975 to provide care to the medically underserved population of Peekskill, the health center organization has grown to include 29 health centers delivering care throughout a 10 county region of 135,000 patients with over 1,000 employees and 350 health care practitioners. Their services include adult and pediatric care; obstetrical and gynecological care; family planning; HIV counseling, testing and referral; dental services; mental health counseling; nutrition counseling; podiatry; WIC services; health education; and a full complement of outreach, translation, transportation, benefits counseling and health insurance enrollment assistance.

CHS, which operates in 18 locations around East Tennessee, was also honored for  ground-breaking work using a whole health approach that blends in behavioral health services to address the psychological, social and environmental factors that affect overall health, as described in this NCQA video.  The work they do is especially noteworthy given the challenges of the patient population they serve, which includes migrant farmworkers and a growing homeless population.

We congratulate these leaders in community health!

A recent article in The Herald Mail Media notes that many preventable emergency department visits happen because patients could not access timely primary care.  Access to a primary care provider is indeed a problem in the U.S.  Some 62 million people are at risk for health issues because they do not have access to regular primary care provider, according to NACHC.  Some 43 percent of these medically underserved are low-income people, 28 percent live in rural areas, and many do have insurance, whether it is private coverage or Medicaid.  The real issue is having a regular place to go for care to stay healthy and out of the hospital.  Not having that option for primary care can prove expensive.  Consider this: the average cost per health center medical visit was less than one-sixth the average cost of one ED visit.

To learn more about health centers and their role in reducing hospital ED use read this NACHC fact sheet.

Research demonstrating the value of Medicaid expansion continues to grow. The following is an overview of a recent study that examined how the MetroHealth Care Plus program in Cuyahoga County, Ohio impacted patient care. [Note: Unfortunately, access to the full text of Cebul et al.’s article in Health Affairs requires paid subscription or purchase.]

What is Care Plus?
In February 2013, prior to Ohio’s decision to expand Medicaid, CMS approved a Medicaid waiver that enabled a county-owned hospital (MetroHealth System) and two local FQHCs (Care Alliance and Neighborhood Family Practice) in Cuyahoga County to offer Medicaid-like coverage to residents (ages 18-64) with incomes at or below 133 percent of the federal poverty line. To finance Care Plus, the hospital used the $36 million annual subsidy it receives from Cuyahoga County taxpayers and drew down enhanced federal Medicaid matching dollars.

Over the next 11 months, Care Plus provided coverage to 28,294 patients who were able to receive benefits without co-pays through the program’s defined network, which included the three partner organizations and other community providers (e.g., community mental health centers). Care Plus patients formally transitioned to Ohio’s expanded Medicaid program on January 1, 2014.

What did the study find?
Between 2012 and 2013, Cebul and colleagues found that patients enrolled in Care Plus had better care and health outcomes than those who remained uninsured. For example, the researchers found that, compared to those who were continuously uninsured, Care Plus patients with diabetes improved over 13 percentage points on the diabetes composite standard (a combined metric for assessing quality of diabetes care).

The researchers also found that the total cost of care for patients enrolled in Care Plus was 28.7 percent below the budget cap set by CMS for the program to remain budget neutral.

What supported these outcomes?
In addition to giving patients access to care, Cebul et al. concluded that the program’s defined provider network and delivery system innovations helped to support the quality and cost outcomes. Specifically, all three partner organizations:

• Used the same electronic health records platform;
• Had patient-centered medical home-recognized primary care practices; and
• Publicly reported performance in a regional health improvement collaborative.

The article by Cebul and colleagues was published in July’s Health Affairs issue, which was dedicated to the 50th anniversary of Medicaid. Several articles within the issue feature the substantial role played by health centers. For more information, read our post “Health Affairs’ July Issue Commemorating 50 Years of Medicaid Highlights Significant Role Played by Health Centers.”

July’s Health Affairs issue is dedicated to the 50th anniversary of Medicaid. Unsurprisingly, several articles within this issue feature the substantial role played by health centers, another program celebrating 50 years of service, in providing care to a significant portion of the Medicaid population. In Shin and colleagues’ article discussing the interdependence of the health center and Medicaid programs, the authors review the rich history of the Medicaid-health center relationship while stressing the importance of a continued and evolving partnership. [Note: Unfortunately, access to the full text of Shi et al.’s article requires paid subscription or purchase.]

Authors explain that Medicaid and health centers work together to accomplish a key goal – that is, improving access to quality primary care for otherwise un-served populations – by providing needed sources of primary care and the financing to support and expand it. The article notes that both Medicaid and federal health center grants have helped make health center growth possible by sustaining provided services. Health centers can help Medicaid achieve its growing focus on population health by, for example, serving complex patients with complicated health needs, particularly when other providers are still limiting their participation in Medicaid or not accepting Medicaid patients at all. In addition, health centers provide continuous care even when patients experience interruptions in Medicaid coverage. This is especially important for those with chronic conditions who require consistent and reliable care. Finally, given the substantial reach into underserved communities nationally, leveraging Medicaid-health center partnerships can reach uninsured and other patient populations by ensuring interventions reach all patients. Looking forward, authors state that a more “deliberate” and “purposeful” collaboration between Medicaid and health centers can accelerate advancements in quality and efficiency by sustainably financing accessible health care for underserved patients.

Just as health centers serve a substantial number of patients with Medicaid, they also serve a high proportion—about twice the national rate—of patients with both Medicaid and Medicare. These so-called “dual eligible” patients tend to be highly complex, in poverty, members of racial/ethnic groups, suffer from multiple chronic conditions, and have high rates of preventable hospitalizations and emergency department (ED) visits. Wright and colleagues explore the link between use of health centers and both hospitalizations and ED visits for ambulatory care sensitive conditions among those patients enrolled as dual eligibles. Specifically, they examine rates of these kinds of visits and hospitalizations among dual eligible patients living in Primary Care Service Areas containing a health center, comparing those who sought care at a health center with those who did not. This was done by collecting and analyzing fee-for-service Medicare Part A and Medicare Part B claims data from 2008-2010. Individuals were considered health center users if they had visited a health center one time or more within a year. The authors find that Black and Hispanic dual-eligible health center patients are less likely to be hospitalized for ambulatory-care sensitive conditions when compared to those not seeking care at a health center. However, the same trend is not seen for emergency department visits. Therefore, the authors conclude that strong evidence exists to suggest that health centers help reduce racial and ethnic disparities in hospitalizations for ambulatory care-sensitive conditions among dual-eligible patients and that further efforts are needed to reduce potentially avoidable emergency department visits.

Reading these articles, it is evident that Medicaid and health centers have a rich history that has dramatically and positively altered the way low income individuals are able to receive care. By eliminating barriers to access and removing health disparities at a feasible cost of service, health centers and the Medicaid program have demonstrated a powerful collaboration which must not only continue, but strengthen and evolve over the next 50 years.

NACHC is also currently reviewing several other Proposed Rules with upcoming comment deadlines listed below. Please be on the lookout for more information on our draft comments as the comment deadlines approach.

• CMS Notice for Comment on the new Essential Community Provider Petition Process (comments due at www.regulations.gov by August 4, 2015) 
• HRSA’s Notice of Proposed Rulemaking on 340B Ceiling Price & Civil Monetary Penalties (comments due at www.regulations.gov by August 17, 2015)
• CMS Notice of Proposed Rulemaking on Medicare Physician Fee Schedule (comments due at www.regulations.gov by September 8, 2015)

As always, we encourage you to review these rules and our draft comments when they are made available. We also encourage you to submit your own comments reflecting your state or local experience. Please feel free to contact Colleen Meiman (cmeiman@nachc.org) should you have any questions about these rules or any other issues for the Regulatory Affairs Department.

• The intersection of the 340 program and Medicaid managed care
• Network adequacy standards for MCOs
• Whether FQHCs can receive state funding for providing outreach & enrollment assistance to Medicaid MCO enrollees.
• States’ responsibility to make wrap-around payments directly to FQHCs
• Credentialing requirements under MCOs
• Value-based purchasing initiatives
• Beneficiary protections

Before submitting these comments to CMS, we welcome your comments on our draft. To ensure NACHC has adequate time to consider your input, please send any feedback to Colleen Meiman (cmeiman@nachc.org), Director of Regulatory Affairs, by Monday July 20.

**Note that the 3-4 highlighted items indicate areas where we are still seeking information ad/or finalizing our recommendations.

In addition, we strongly encourage your organization to submit your own comments on this proposed regulation. Please feel free to adapt or copy the language included in NACHC’s comments to suit your needs; we also encourage you to add examples based on your own experiences.  Note that your comments must be submitted no later than 5 p.m. ET on July 27.  You can submit them electronically by following the “Submit a comment” instructions at http://www.regulations.gov.

If you have any further questions, please contact Colleen Meiman, Director of Regulatory Affairs at cmeiman@nachc.org.

King v. Burwell — Image Credit Ted Eytan

The King v. Burwell Supreme Court decision on Thursday marked a huge victory for ACA proponents. In a 6 -3 ruling, SCOTUS upheld health insurance premiums for eligible individuals in all states—regardless of whether their marketplaces were state or federally-established. The decision was met with both relief and applause by President Obama’s administration. With Congress still without a contingency plan as of Thursday morning, the ruling in favor of Burwell likely saved policymakers from months of legislative chaos, while also preserving health insurance for over 6 million Americans.

With the wait finally over, we are now left to consider what the Court’s recent decision means for the ACA moving forward. This is the last in a series of posts that have examined the case’s details and possible implications leading up to last Thursday’s big decision.

Breaking down the majority opinion

Chief Justice Roberts, joined by Justices Kennedy, Breyer, Ginsburg, Kagan, and Sotomayor, read the opinion confirming the legality of health insurance subsidies across all 50 states. Prior to the decision, many believed the ruling would be decided on the Chevron rule—or namely whether the federal agency (IRS in this case) had made a reasonable interpretation of the statute at hand. Instead, the Court announced the IRS was no health insurance expert and the Court, rather than the IRS, should determine the “correct reading” of the law.

The Court concluded the phrase underlying the whole case, “established by a state,” was indeed ambiguous. However, when read in relation to the ACA as a whole, the Court determined the underlying purpose of the law relied too heavily on the availability of subsidies across all marketplaces for “marketplaces” to be interpreted as solely those “established by a state.” In the majority’s opinion, limiting subsidies to only state-established marketplaces would undermine the entire healthcare system—something Congress would never have intended to do. Chief Justice Roberts synthesized these ideas in his concluding statement:

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.

Understanding the dissent

In a heated dissent, Justice Scalia, on behalf of himself, Justice Thomas, and Justice Alito, declared the Court’s majority decision as “interpretive jiggery-pokery” that omits the plain meaning interpretation of “established by a state.” Justice Scalia accuses the majority of once again rewriting the ACA to save it from its demise. As stated by Justice Scalia, the “opinion changes the usual rules of statutory interpretation for the sake of the Affordable Care Act. That, alas, is not a novelty.”

The dissent goes on to dismiss each of the points presented in the majority opinion; however, the opinions of Justice Scalia are perhaps best be summed up by his new nickname for the ACA: “SCOTUScare.”

What’s next for the ACA?

While the King v. Burwell ruling does not safeguard the ACA from additional legal attacks, it sets the precedent that the ACA is here to stay—at least through the end of President Obama’s second term. The ruling supports Congress’s intent to improve, not hurt, insurance marketplaces with the ACA—making similar court litigation unlikely in the future.

Although some fear the decision for Burwell may discourage states from establishing their own State-based marketplaces, HHS Secretary Burwell has vowed to continue to offer assistance to states wishing to shift towards a State-based marketplace. Burwell admits the administration still “has work to do” to make the ACA better, but remains optimistic on the administration’s chance to “build on the progress” the ACA has made. Following the decision, Burwell announced several new campaigns to improve the law, including a push to expand Medicaid in non-expansion states and reforms to payment systems to reflect quality not quantity of care.

Though the complete repeal of the ACA is unlikely at this point, the topic is almost guaranteed to resurface during the 2016 presidential campaign season. Although the ACA could take a beating during the upcoming race, President Obama remains confident in the future of his signature legislation. In a press conference on Thursday, President Obama heralded the decision remarking that “after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all.” In his own words, it is becoming increasing clearer that “the Affordable Care Act is here to stay.”

 Connect with colleagues, hear about new research, and learn how to implement model practices that enhance capabilities to prepare for, respond to, and recover from disasters and emergencies through a variety of interactive workshops, sessions, and town halls at the 2014 Preparedness Summit.

 The Summit is the premier national conference in the field of public health preparedness. The four-day annual event provides one of the only cross-disciplinary learning opportunities in the field and has evolved over time to meet the growing needs of the preparedness com­munity. A diverse range of attendees includes professionals working in all levels of government (local, state, and federal), emergency management, volunteer organizations, and healthcare coalitions. Each year, attendance at the Summit has continued to grow, and in 2013, the Summit brought 1,741 attendees to Atlanta from nearly every state and several countries.

This year’s Summit will take place April 1—4, 2014 in Atlanta, Georgia. The theme is “Stronger Together: Aligning Public Health and Healthcare Preparedness Capabilities to Protect Our Communities.” Don’t miss out on outstanding learning and networking opportunities during the 2014 Preparedness Summit; register today at www.preparednesssummit.org.

This year’s Summit will take place April 1—4, 2014 in Atlanta, Georgia. The theme is “Stronger Together: Aligning Public Health and Healthcare Preparedness Capabilities to Protect Our Communities.” Join the distinguished list of Preparedness Summit presenters and submit an abstract for the 2014 Preparedness Summit today. Health centers and Primary Care Associations are strongly encouraged to submit an abstract to highlight the strong and proud history of meeting the needs of their communities, before, during, and after emergencies.  Abstracts are being accepted until October 11. Visit www.preparednesssummit.org to learn more.

Way to go, Mass League!

Per FEMA:  NPM is led by FEMA’s Ready Campaign in partnership with Citizen Corps and the Ad Council, and is a nationwide effort encouraging individuals, families, businesses and communities to work together and take action to prepare for emergencies. 2013 marks the 10th anniversary of Ready, a public service advertising media campaign that has garnered in excess of $1billion in donated media placements, over 77 million visitors to its websites and has had in excess of 88 million pieces of preparedness materials requested or downloaded.

 NPM is an opportunity to disseminate emergency preparedness information and host sponsor activities across the country to help Americans understand what it truly means to be ready. This year a new series of public service advertisements (PSAs) were launched as part of the Ready Kids campaign. The TV, radio, outdoor, print and digital PSAs take a humorous approach to emphasize the importance for parents to involve their children in the preparedness process. Through these PSAs, families are provided preparedness conversation starters including: who to call as your out-of-state emergency contact, where to meet if everyone is separated, and what to pack as part of your emergency supply kit. The PSAs direct to the redesigned Ready Kids website where parents can find the resources they need to make preparedness a family year-round family activity. (View PSAs on FEMA’s YouTube Channel: Seat of Your Pants & Not Sharing)

 Social Media: Follow Ready online www.twitter.com/readygov, www.facebook.com/readygov, and www.youtube.com/fema. Learn more about the Ready Campaign at www.ready.gov & Citizens Corps at www.citizenscorps.gov.