Expanding Primary Care Access through Federally Qualified Health Centers and Rural Health Clinics

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Expanding Primary Care Access through Federally
Qualified Health Centers and Rural Health Clinics

• Strengthening the Healthcare Safety Net in
  Missouri

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Background

• 1/14/05 Initiative Proposal form developed, to
  address access to care through the support of
  FQHCs
• Program and Grants Committee of MFH Board of
  Directors directed staff to research the
  potential mechanisms in developing an initiative
• Staff researched the activities of other
  Foundations concerning Improving Access to
  Care/Strengthening Safety Net Approaches
• Staff held discussions w/ Missouri Primary Care
  Association and the Primary Care Resource
  Initiative for Missouri (PRIMO) to support Health
  Centers using a collaborative approach

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Why Support Federally Qualified Health Centers?

• FQHCs
• Located in Medically Underserved Areas/Serve
  Medically Underserved Populations (in MO, 58.4
  are 100 FPL and Below, 35.8 are uninsured, and
  53.1 are minorities)
• Provide comprehensive primary health care
  services, referrals, case management,
  transportation, etc.
• Provide services to all individuals regardless of
  inability to pay
• Offer Sliding Scale Fees Based on Income
• Majority of Board of Directors are patients of
  heath clinics/centers
• Have diverse funding mechanisms that strengthens
  sustainability

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Approaches to Supporting Expanded Access

• Maine Health Access Foundation (Maine Access
  Project) Worked w/ Maine PCA to provide TA for
  grant writing
• Health Care Foundation of Greater Kansas City
  Safety Net Care Initiative
• California Endowment Access to Health Services
• Healthcare Georgia Foundation Expanding Access
  to Primary Health Care
• Sunflower Foundation (Kansas) Health Care
  Access
• Missouri Foundation for Health Areas of
  Interest 1. Strengthening the Healthcare Safety
  Net and 2. Improving Access to Care
• 7/21/05 Board of Directors issued 3.5 Million
  Challenge to preserve safety net in St. Louis
  Region

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Approaches to the Initiative

• 3 Main Focus Areas
• 1. Services Expansion Support new or expanded
  mental health, substance abuse, or oral health
  services
• 2. New Access Points Support for a new
  organization or an existing health center to open
  a new site
• 3. Expanded Medical Capacity Increase an
  existing health centers ability to serve more
  people at existing sites
• Other Considerations
• Information Technology
• Networking Grants

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Initiative and Phase 1 Goals

• Overall Initiative Goal
• Strengthen the health care safety net
• Expand access to primary care services
• Phase 1 Goal
• Support FQHCs efforts to further strengthen the
  healthcare safety net
• Improve access to care by providing funding in 3
  areas

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Phase 1 and 2 Development

• Phase 1 developed with the participation of the
  MO Primary Care Association and MDHSS Office of
  Rural and Primary Care
• Focus on FQHCs located in MFH Service Region
  (excluding St. Louis City and County)

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Primary Care update 2006-2007

• August 2005 Presentation to Joint
  PGC/Strategic Planning Committees
• March 2006 - Received BOD approval for
  multi-phased initiative
• Two rounds of funding for Phase 1 to support
  FQHCs (2006 2007)
• Phase 2 focus on rural health clinics

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Rural Health Clinic Development

• Staff Research
• Engaged Missouri Association of Rural Health
  Clinics (MARHC)
• Talked with a number of key leaders in rural
  health

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Rural Health Clinics

• The RHC program was established in 1977 to
  address an inadequate supply of physicians who
  serve Medicare and Medicaid beneficiaries in
  rural areas.
• The RHC program is the largest (based on of
  clinics) primary care service delivery program in
  rural underserved communities in the country
• Approx. 300 rural health clinics in MO, approx. ½
  of which are non-profits
• MO has an Association of Rural Health Clinics
  that serves as a key voice on behalf of rural
  health clinics
• Currently only ½ of the rural health clinics in
  MO are members of the MO Association of Rural
  Health Clinics

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Why Support Rural Health Clinics?

• Rural Health Clinics
• Receive cost-based reimbursement from
  Medicaid/Medicare
• Located in areas designated as rural and
  medically underserved
• Staffed substantially by Nurse Practitioners and
  Physician Assistants

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Missouri Association of Rural Health Clinics

• Non-profit corporation founded in 2000 to serve
  as a voice for rural health clinics in MO
• Works with State and National agencies to
  promote, protect, and expand the rural health
  clinic program
• Works conjunctly with the Natl Assoc. of Rural
  Health Clinics
• Currently has volunteer Board, with no dedicated
  full time staff

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Barriers to Identifying Rural Health Funding Needs

• Rural health clinic data such as and location
  of clinics in MO patient info (such as payor
  mix, utilization, and demographics) is
  unavailable
• MARHC and other key stakeholders were unable to
  identify potential funding needs across all
  eligible applicants
• MFH Staff unable to determine how to make the
  most impact with its funding

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Proposed Plan

• The Primary Care Team would not recommend direct
  funding to rural health clinics
• Instead, we recommended providing funding to
  provide capacity building/strategic planning
  services in order to strengthen the MO
  Association of Rural Health Clinics
• This will allow the Association to serve as a
  collective voice for RHCs and would help
  strengthen and support the rural health
  infrastructure in MO
• MFH will contract with a consultancy firm to
  provide strategic planning/capacity building
  services over a 2-year period.

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Proposed Plan cont

• Goal of MFH that when the MARHC project is
  concluded
• Able to provide clear presentation on status of
  RHCs as well as recommendations to MFH as to how
  RHCs can be strengthened through targeted
  projects
• Is a central address for rural health clinics
  across MO seeing support, information, and
  resources
• Has a professional model sustainable through
  membership support and other reliable funding
  sources and
• Is a central voice/advocate for rural health
  clinics on health care policy

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Future Steps

• Expanding Primary Care team will continue to work
  with the consultant hired to build capacity for
  the association over the next 2 years
• Team continues to formulate goals for the next 8
  years
• Innovative Funding Opportunities (IF)
• 13 Million in support to local health departments
  for HIT and other infrastructure needs

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HIT Support

• MFH does not directly fund solely HIT programs,
  rather HIT is usually part of the over program of
  the applicant or grantee.
• Telemedicine
• Telepsychiatry
• Conversations on HIT
• its on MFHs Rader

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Any QuestionsThank You!