Developing Agendae for Training of CHCs

Mauda Monger, MPHDelta Region AIDS Education Training Center

2012 Faculty Development Conference LPS Coordinator- Mississippi

History of CHCs in the United States

Community Health Center defined and types of CHCS

Building collaborations and trainings with Community Health Centers

Points of Discussion

First clinics opened in 1965, Boston and 1967 in Mount Bayou, MS (neighborhood clinics)

Were developed to provide health and social services access points in poor and medically underserved communities and to promote community empowerment

Health Centers Consolidation Act of 1996 – Public Service Act (330 funds)

History of Community Health Centers

Health centers are community-based and patient-directed organizations that serve populations with limited access to health care.

What is a community health center?

Located in or serve a high need community (designated Medically Underserved Area or Population).

Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served.

Provide comprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care.

Provide services available to all with fees adjusted based on ability to pay.

Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.

Health Center Program Fundamentals

Community Health Center or Health Center:◦ An outpatient clinic that receives grant fundsfrom the federal government through §330 ofthe Public Health Service Act (PHSA).

Look-alike: ◦ An outpatient clinic that meets all requirements to

receive §330 grant funds but does not actually receive a grant.

Types of Health Centers

Rural Health Clinic: ◦ An outpatient clinic that may be for profit, is

located in a rural HPSA or MUA, and uses nurse practitioners and physician assistants to provide the majority of care.

Tribal or Urban Indian FQHC: ◦ An outpatient clinic or program operated by a tribe

or tribal organization or by an urban Indian organization.

Types of Health Centers

Low income

Minorities

Elderly

Young people (16-25)

Children

Who does the community health center serve?

Growth in Uninsured: Continue to be Largest Group of Health Center Patients

Decline in Charity Care: Cutbacks by Private Providers Squeezed by Managed Care

Loss of Medicaid and Other Public Funding: Severe “Deficit Reduction” Cuts by States & now Congress

Changing Nature of Insurance Coverage: Growing Shift to Catastrophic/High-Deductible Plans that Cover Little or no Preventive/Primary Care

Shortage of Primary Care Physicians:Growing Demand and Lack of Appeal to U.S. Medical Students is Already Causing Physician Vacancy Rates in Health Centers

Challenges of Health Centers

Need 1,843 primary care providers, inclusive of physicians, nurse practitioners, physician assistants, and certified nurse midwives.

1,384 nurses short.

To reach 30 million patients by 2015, health centers need at least an additional 15,585 primary care providers

Health centers also will need another 11,553 to 14,397 nurses.

Health Center Workforce Shortages

Health Center Workforce ShortagesSource: NACHC, Robert Graham Center, and The George Washington University School of Public Health and Health Services, Access Transformed: Building A Primary Care Workforce For The 21stCentury, August 2008, www.nachc.com/research.

Starting Points◦ Develop a plan

What is it we want from the CHCs? How are we willing to support them in their efforts?

◦ Learn the role and history of CHCs in your state

◦ Make a connections within the health care organizations that support and or govern the community health centers in your state

Building Collaborations

Establishing relationship with governing bodies (MPHCA)◦ May take a long period of time◦ Attend all functions( meetings, trainings, &

conferences)◦ Understand the dynamics◦ Connect with the board, medical directors and

lead persons of clinics

Developing your plan

Get educated about HIV/AIDS epi in the state

Provide a safe environment for their community to get information on HIV/AIDS

Offer HIV screening as a part of routine care

Provide information on HIV/AIDS prevention and modes of transmission

ULTIMATELY..provide primary HIV care

What do I want from these sites?

Provide training (onsite and offsite)

Provide resources and links to resources

Provide effective and efficient consultation options

Be a source of technical assistance

What are we willing to do to aid them?

Number of Organizations 21 Number of Delivery Sites 188 Total Patients 314,612 Number Seasonal Farmworker Patients 999 Number Homeless Patients 7,455

Mississippi Federally-Supported Health Centers, 2010

Health Center Population At or Below 100% of Poverty 72% Under 200% of Poverty 94% Uninsured 43% Medicaid 30% Medicare 9% Hispanic/Latino 3% African American 65% Asian/Pacific Islander 1% White 34% Rural 71%

Mississippi Federally-Supported Health Centers, 2010

Should be done in person

Should be direct and concise

Use the background data to have a realistic conversation

Demonstrate the true capability of your AETC, don’t oversale what you are able to do

Needs Assessment

Specialized for community health centers◦ Timing◦ Information

Culturally competent◦ Patients◦ Providers

Informative, but not overwhelming

Should be flexible◦ May be after your normal hrs

Development of trainings

Make them a priority◦ Assign someone to be their liaison

Continued offering of new trainings and information for all levels of staff

Annual needs assessments

Maintaining the Bridge

Finding connections

Answering the push-back

Ensuring that we have the resources they will need once we get them onboard◦ Specialized attention

Challenges for AETC

Long process

Requires a plan before the first meeting

Expect difficulty in getting changes/updates in place

They will have a major role in the Affordable Care Act,

Take away points

Questions…Questions