Insure the Uninsured Project19th Annual ConferenceSacramento Convention CenterFebruary 17, 2015

James W. Hunt, Jr., PhD President & CEO

Changing Our Stripes: Health Centers & Health Care Reform

49 Community Health Centers

300+ sites reflect medical, dental, behavioral health, school-based and social services

889,000 patients (MA population: 6.6 million)

• Provide a broad range of primary & preventive care, including dental, eye and mental health care and other community-based services

• All 49 health centers have either purchased, implemented or are in the process of implementing a certified EHR; all preparing for Meaningful Use

• Support more than 18,000 jobs and generate a total economic impact exceeding $2 billion

• Viewed as Savings Generators not Cost Drivers

• 37 FQHCs have adopted a class-based rate for Medicaid & a negotiated class-based rate for subsidized plans (ConnectorCare)

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Massachusetts Community Health Centers

Early Growth Under State Health Reform

An Archives of Internal Medicine study found that Massachusetts’ federally-funded health centers saw a 31% increase (134,000) in patients between 2005 and 2009, even as growing numbers of residents obtained coverage under Chapter 58, our state’s health reform law. Reasons cited by patients: Convenience Affordability Non-medical services Multilingual providers Welcome all regardless of payment source

ALL

CENTERS

2006 2013Total

Increase

Total Percentag

e Increase

Patients 594,000

889,000 295,000

49.6%

Massachusetts Health Centers Growth in Patients, 2006 - 2013

Continued Growth Under State & Federal

Uninsured: As Percentage of Total Patients

MA Health Centers

2006 2012

UninsuredPatients

32.7% 18.7%

Caveat: Although the percentage of health center patients who are uninsured has declined, the total number of uninsured patients at health centers has increased. What’s more, the highest concentration of Massachusetts’ uninsured residents continue to receive care through the state’s community health centers.

Patients By Coverage*

Massachusetts Community Health Centers

Coverage Type Percentage of Total Patients

Medicaid 41.4% (40% pre-reform)

Subsidized 10.5% (new coverage)

Medicare 9.7%

Private 19.6%

Uninsured 18.7% (32.7% pre-reform)

90% of Massachusetts health center patients fall below 200% of the federal poverty guidelines, with 36.7% better served in another language*Based on 2013 UDS

Patients By Race, Ethnicity*

Massachusetts Community Health Centers

Patient Race, Ethnicity

Percentage of Total Patients

By Race

White 48.6%

Black, African-American

16.9%

Asian 9.4%

More than one 4.6%

By Ethnicity

Hispanic 32.1%

*Based on 2013 UDS

National Health Care Reform

“Health care must be a right for all rather than the privilege of a few.”

What Are the Issues?

• Fair payment

• Disruptive policy

• Workforce Public-private

partnerships

• Continuing uninsured

• Readiness…

Risk Readiness

Readiness • What is it?

• How is it measured?

• What is the “secret sauce” that gets you to the table?

Quality

• What about value-based incentives?

• Is the Primary Care Medical Home THE ANSWER?

• Retail health care anyone?

• How important is customer service?

Influencers of Payment Reform

What constituencies wield the most influence in California?• Providers?

• Insurers?

• Consumers?

• Employers?

• Labor?

• Government?

Reflections from Massachusetts

• Complexity of managing vulnerable patients

• Need for real-time medical expense & claims data

• MCO participation, Alternative Payment & PCPRI

• ACO & integrated system needs

• Fair Rates

• Promotion of PCMH

• Value over Volume