Health Care ReformOur State: Problems and Perceptions

State Medicaid: Issues and Direction

A Case for Federal Reform

Community Health Centers

WOOD-

FORD

WEBSTER

ADAIR

ALLENBALLARD

BARREN

BATH

BELL

BOONE

BOURBON

BOYLE

BRACKEN

BREATHITT

BULLITT

BUTLER

CALLOWAY

CAMPBELL

CARLISLE

CARROL

CARTER

CASEY

CHRISTIAN

CLARK

CLAY

CLINTON

CRITTENDEN

DAVIESS

ELLIOT

ESTILL

FAYETTE

FLEMING

FLOYD

FULTON

GALLATIN

GRANT

GRAVES

GRAYSON

GREEN

GREENUP

HANCOCK HARDIN

HARLAN

HARRISON

HART

HENDERSON

HENRY

HICKMAN

HOPKINS

JACKSON

JEFFERSON

JOHNSON

KENTON

KNOTT

KNOX

LARUE

LAUREL

LAWRENCE

LEE

Leslie

LETCHER

LEWIS

LINCOLN

LIVINGSTON

LOGAN

LYONMCCREARY

MCLEAN

MADISON

MARION

MARSHALL

MARTIN

MASON

MEADE

MENIFEE

MERCER

MONROE

MORGAN

NELSON

OHIO

OLDHAM

OWEN

OWSLEY

PERRY

PIKE

POWELL

PULASKI

ROWAN

RUSSELL

SCOTT

SHELBY

SIMPSON

SPENCER

TAYLOR

TODD

TRIGG

TRIMBLE

UNION

WARRENWAYNE WHITLEY

WOLFE

CRACKEN

MC- CUMBER-LAND1

NICHOLAS

CUMBER-LAND

MUA/P and HPSA Designations

Boyd

LYON

Designations as of March 2009

CALDWELL

BRECKINRIDGE

EDMONSON

METCALFE

WASHINGTON

ANDERSON

FRANKLIN

GARRARD

JESSAMINE

MONTGOMER

PENDLETON

MAGOFFIN

ROCKCASTLE

MUHLENBERG

Shortage Designation Legend

Medically Underserved Area or Population (MUA/P)

Health Professional Shortage Area (HPSA)

Both MUA/P and HPSA

FORD

ROBERTSON

Health Care Access: Lack of Primary Health Care Provider Kentucky BRFSS 2003 - 2004 Report

Lack of Primary Health Care Provider 2004 BRFSS Data by Area Development District

Lack of Primary Health Care Provider by Nation, Kentucky, and ADD

BRFSS 2003 and 2004

2003

%

National Median*

Total Kentucky

ADDs

Barren River

Big Sandy

Bluegrass

Buffalo Trace

Cumberland Valley

FIVCO

Gateway

Green River

Kentucky River

KIPDA

Lake Cumberland

Lincoln Trail

Northern Kentucky

Pennyrile

Purchase

*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. Hawaii was not included in the national median.

49

19.1

17.8

14.7

18.3

18.1

13.2

21.9

18.0

15.5

21.3

17.3

17.9

15.7

18.4

15.6

22.7

14.7

95% (CI)

(16.4 - 19.3)

(10.6-20.1)

(13.6-24.1)

(14.3-22.6)

(9.3-18.4)

(16.9-27.8)

(13.4-23.8)

(12.0-19.8)

(16.7-26.9)

(12.9-22.7)

(13.9-22.7)

(12.3-19.8)

(14.0-23.6)

(12.0-20.0)

(17.9-28.2)

(11.2-19.0)

%

19.3

17.1

19.3

24.1

9.9

12.9

17.1

23.3

21.6

19.2

22.2

17.2

16.3

18.1

13.2

24.3

22.2

2004

95% (CI)

(15.6-18.6)

(14.8-24.7)

(18.7-30.5)

(7.0-13.8)

(9.2-17.7)

(12.7-22.7)

(18.6-28.8)

(17.0-27.2)

(14.2-25.4)

(17.4-27.7)

(12.9-22.7)

(11.5-22.6)

(13.7-23.5)

(9.7-17.7)

(19.1-30.4)

(17.1-28.1)

National Median*

Total Kentucky

ADDs

Barren River

Big Sandy

Bluegrass

Buffalo Trace

Cumberland Valley

FIVCO

Gateway

Green River

Kentucky River

KIPDA

Lake Cumberland

Lincoln Trail

Northern Kentucky

Pennyrile

Purchase

%

14.5

17.1

18.6

27.6

15.7

21.4

23.9

20.2

19.7

16.8

25.4

12.7

22.5

14.0

14.1

18.7

15.7

2003

95% (CI)

(15.8-18.5)

(13.8-24.6)

(22.3-33.5)

(12.1-20.2)

(16.8-26.8)

(18.6-30.1)

(16.0-25.2)

(15.9-24.2)

(12.5-22.1)

(19.9-31.8)

(9.2-17.1)

(18.3-27.4)

(10.5-18.6)

(10.7-18.3)

(14.5-23.9)

(12.1-20.1)

47

%

14.9

14.9

15.3

20.5

8.7

20.0

19.6

20.9

24.7

15.5

26.9

14.0

24.5

12.2

10.9

15.7

16.4

2004

95% (CI)

(13.6-16.4)

(11.0-20.9)

(15.5-26.6)

(5.8-12.8)

(15.5-25.3)

(15.0-25.2)

(16.7-25.7)

(19.6-30.6)

(11.6-20.4)

(21.5-33.0)

(10.2-18.9)

(19.1-30.8)

(9.0-16.4)

(7.9-14.7)

(11.7-20.7)

(12.3-21.4)

Health Care Access: Lack of Health Care Coverage Kentucky BRFSS 2003 - 2004 Report

*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. In 2004, Hawaii was not included in the national median.

Lack of Health Care Coverage 2004 BRFSS Data by Area Development District

Lack of Health Care Coverage by Nation, Kentucky, and ADD

BRFSS 2003 and 2004

National Median*

Total Kentucky

ADDs

Barren River

Big Sandy

Bluegrass

Buffalo Trace

Cumberland Valley

FIVCO

Gateway

Green River

Kentucky River

KIPDA

Lake Cumberland

Lincoln Trail

Northern Kentucky

Pennyrile

Purchase

%

12.0

17.9

21.6

24.8

16.7

21.6

25.9

21.5

19.0

19.9

22.4

13.0

24.4

13.9

15.5

20.1

16.1

2003

95% (CI)

(16.6-19.3)

(16.9-27.2)

(20.3-29.8)

(13.1-21.0)

(17.2-26.8)

(20.5-32.2)

(17.2-26.6)

(15.1-23.6)

(15.6-25.1)

(17.7-28.0)

(9.6-17.4)

(20.2-29.1)

(10.5-18.3)

(11.8-20.0)

(16.1-24.8)

(12.5-20.4)

51

%

12.8

17.8

14.4

32.3

16.1

14.7

24.4

19.3

18.3

15.1

27.5

14.7

23.1

15.6

14.6

17.8

22.4

2004

95% (CI)

(16.4-19.3)

(10.8-18.9)

(26.4-38.7)

(12.1-21.0)

(11.3-18.9)

(19.6-30.0)

(15.3-23.9)

(14.5-22.8)

(11.6-19.6)

(22.5-33.3)

(11.1-19.1)

(18.0-29.1)

(12.1-20.0)

(11.3-18.8)

(13.7-22.9)

(17.4-28.3)

Health Care Access: Cost as a Barrier to Health Care Kentucky BRFSS 2003 - 2004 Report

*National Median is the middle value of the prevalence estimates from all 50 states, Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. The confidence interval is not available. In 2004, Hawaii was not included in the national median.

Cost as a Barrier to Health Care 2004 BRFSS Data by Area Development District

Cost as a Barrier to Health Care by Nation, Kentucky, and ADD

BRFSS 2003 and 2004

Cunningham, Peter J., and Laurie E. Felland, Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007, Tracking Report No. 19, Center for Studying Health System Change, Washington, D.C. (June 2008).

Innovative Approaches in HealthcareInnovative Approaches in Healthcare

Technology

National Quality Initiative

WOOD-

FORD

WEBSTER

ADAIR

ALLENBALLARD

BARREN

BATH

BELL

BOONE

BOURBON

BOYLE

BRACKEN

BREATHITT

BULLITT

BUTLER

CALLOWAY

CAMPBELL

CARLISLE

CARROL

CARTER

CASEY

CHRISTIAN

CLARK

CLAY

CLINTON

CRITTENDEN

DAVIESS

ELLIOT

ESTILL

FAYETTE

FLEMING

FLOYD

FULTON

GALLATIN

GRANT

GRAVES

GRAYSON

GREEN

GREENUP

HANCOCK HARDIN

HARLAN

HARRISON

HART

HENDERSON

HENRY

HICKMAN

HOPKINS

JACKSON

JEFFERSON

JOHNSON

KENTON

KNOTT

KNOX

LARUE

LAUREL

LAWRENCE

LEE

Leslie

LETCHER

LEWIS

LINCOLN

LIVINGSTON

LOGAN

LYONMCCREARY

MCLEAN

MADISON

MARION

MARSHALL

MARTIN

MASON

MEADE

MENIFEE

MERCER

MONROE

MORGAN

NELSON

OHIO

OLDHAM

OWEN

OWSLEY

PERRY

PIKE

POWELL

PULASKI

ROWAN

RUSSELL

SCOTT

SHELBY

SIMPSON

SPENCER

TAYLOR

TODD

TRIGG

TRIMBLE

UNION

WARRENWAYNE WHITLEY

WOLFE

CRACKEN

MC- CUMBER-LAND1

NICHOLAS

CUMBER-LAND

Section 330 Health Center Sites by Countywith MUA/P and HPSA Designations

Boyd

LYON

Health Center Legend

New Section 330 Health Center sites funded by the ARRA Stimulus Package

Section 330 Health Center Sites by County (Number of sites in the County is indicated in circle)

Shortage Designation Legend

Medically Underserved Area or Population (MUA/P)

Health Professional Shortage Area (HPSA)

Both MUA/P and HPSA

2

10

6

12 1 1

6

21

1

1

3

8

122

2008: 19 grantees with 76 sites in 30 counties

As of March 2009: 20 grantees with 83 sites in 37 counties (The additional sites will be open by July 2009)

CALDWELL

BRECKINRIDGE

EDMONSON

METCALFE

WASHINGTON

ANDERSON

FRANKLIN

GARRARD

JESSAMINE

MONTGOMER

PENDLETON

MAGOFFIN

ROCKCASTLE

MUHLENBERG

3

1

1

1

2

1

1

1

1

1

1

1

1

1

1

What is a Health Center? For more than 40 years, HRSA-supported Health

Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations.

Health centers are community-based and patient-driven organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those living in public housing.

Health Center Program FundamentalsLocated 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.

1. Vanceburg

4.Tollesboro

5. Flemingsburg

2. Garrison

3. Laurel

Fleming

County

Lewis

County

Mason

County

6. Maysville

Bracken

County 7.

Robertson County

Augusta

Brooksville

8. Mt. Olivet

Service Sites:

1. Family Medicine Clinic, Pharmacy, Women’s Center, Dental Clinic, Fitness/Rehab

2. Garrison Elementary School Clinic 3. Laurel Elementary School Clinic 4. Tollesboro Clinic, Pharmacy and Tollesboro

Elementary School Clinic 5. Fleming County Family Medicine Clinic 6. Maysville OB/GYN, Family Medicine and Pharmacy 7. Bracken County Family Medicine Clinic 8. Robertson County Family Medicine Clinic (Planned)

Legend: MUA/MUP Counties: Bracken, Lewis, Mason and Robertson HPSA Designation: Bracken, Lewis and Robertson Other FQHCs, CHCs or Groups with Sliding Fee: 0

Internet

T-1

TeleradiologyHospital Portals

PrimaryPlus Vanceburg

T-1 Video Only

PrimaryPlus Robertson County

University of Louisville

PrimaryPlus Flemingsburg

PrimaryPlus Tollesboro

PrimaryPlus Maysville

PrimaryPlus Bracken

University of Kentucky

Insurance

Other Data Sources

Other

Comprehend

Family Med., Women’s Health, Dental, PT and Fitness Center and Pharmacy

T-1 Voice Data TeleHealth

T-1 Voice Data TeleHealth

T-1 Voice Data TeleHealth

T-1 Voice Data TeleHealth

T-1 Voice Data TeleHealth

Family Med., Pharmacy

Family Medicine

OB/GYN, Family Medicine, Pharmacy

Family Medicine

Community ProgramsCommunity Programs

National Quality InitiativeNational Quality Initiative

HOW IS DATA BEING USED TO IMPR0VE CARE IN CHCs

An example is provided by the analysis we performed in linking data on diabetics from Big Sandy’s information system with Medicaid claims data. We accomplished this with the assistance of Artemetrx. We had observed, as stated earlier, that Big Sandy clinicians prescribe 80% of their diabetic patients renal-protective agents. In looking at the Medicaid claims data, however, we find that a full 29% of those patients prescribed such medications never get them filled at a pharmacy. Further analysis of claims data reveals that only 39% of patients prescribed these medications are compliant with the medication at least 75% of the time. With access to this type of information, Big Sandy would be in a position to greatly enhance its already leading edge care management programs.