Specialty Care Access for FQHCs

1
Specialty Care Access for FQHCs

• Ricci Sanchez, CHE, MBA
• TACHC Annual Conference
• October 28, 2008

2
History

• Public Health Care Studies 2004
• Greater Houston Partnership Public Health Task
  Force
• Save our ERs Coalition Lewin Group Assessment
• Re-visioning the Delivery of Health Care
  Services
• to Uninsured Patients in Harris County

3
History

• Safety Net Primary Care Providers needed
  affordable access to specialty services
• Gateway to Care / HCHD discussions began in late
  2004

4
Lewin Group
Expand Ambulatory Care Capacity
Improve Coordination of Care
Establish Effective Governance
Restructure Public Health Functions
Assure Adequate Financing
Source Lewin Group Report, Harris County
Healthcare Alliance website, 2008
5
Reinvent the Wheel?

• Referral Network Model in Cook County, Illinois
  (Chicago)
• With no example to follow, HCHD set out to
  develop its own agreements (MOUs)
• Implications of the Anti-Kickback Statute

6
Developing the MOUs

• Draft agreements developed
• Multiple meetings with HCHD and FQHCs to review
  draft, answer questions, work out logistics
• Safe Harbor Rule issued and first agreement
  approved in October 2007

7
MOU Approvals

• Referral accepted from first FQHC in March 2008
• Other FQHC MOUs were approved between March
  May 2008
• Referrals are now being accepted from seven
  FQHCs in Harris County

8
Ramping Up
9

• Challenges
• Pre-referral testing not covered
• Procedures are needed that are not considered
  specialty care

• Solutions
• Gateway to Cares
• Provider Health
• Network
• Ongoing dialogue
• regarding service
• gaps new strategies
• to be developed

10

• Challenges
• HCHD Eligibility

• Solutions
• Quad Eligibility System
• implementation in
• January 2009

11

• Challenges
• Capacity / Resource constraints

• Solutions
• New HCHD specialty /
• diagnostic tower slated
• for completion in 2011
• St. Lukes Episcopal
• Health Charities Project
• Safety Net
• Gateway to Cares
• Provider Health
• Network

12

• Challenges
• Increasing numbers of
• uninsured and limited
• funding

• Solutions
• Three Share Program
• subsidized insurance
• product developed
• through the Harris
• County Healthcare
• Alliance

13
One small step for FQHCs, one giant leap for
collaboration