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Safety Net Providers and Safety Net Providers and Health Care Health Care
TransportationTransportation
Presented byPresented by
Oklahoma Primary Care AssociationOklahoma Primary Care AssociationHRSA/BPHC State LiaisonHRSA/BPHC State Liaison
Human Nature & Health Human Nature & Health CareCare
Health care is put on ‘back burner’ Health care is put on ‘back burner’ until neededuntil needed
Can’t schedule earaches, sore throats, Can’t schedule earaches, sore throats, etc.etc.
Risky behavior (e.g., smoking, Risky behavior (e.g., smoking, overeating) is hard to reverseovereating) is hard to reverse
Health care provision is one of first Health care provision is one of first items to get cut from personal budgetsitems to get cut from personal budgets
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Oklahoma Primary Care AssociationOklahoma Primary Care Association
America’s Health Structure America’s Health Structure 20082008
Tertiary Care
Secondary Care
Primary Care
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Where We Want to BeWhere We Want to Be
Tertiary Care
Secondary Care
Primary Care =PREVENTIVE
HEALTH!
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Who is OPCA?Who is OPCA? Funded by Health Resources and Services Funded by Health Resources and Services
Administration (HRSA)/Bureau of Primary Administration (HRSA)/Bureau of Primary Health Care (BPHC) to assist community Health Care (BPHC) to assist community health centers (CHCs) and create a health centers (CHCs) and create a regional and state presenceregional and state presence
OPCA has hybrid membership – OPCA has hybrid membership – community health centers (CHCs), other community health centers (CHCs), other safety net providers and health advocatessafety net providers and health advocates
Mission: Mission: Strengthening access for community-Strengthening access for community-based health care through advocacy, based health care through advocacy, education, and technical assistanceeducation, and technical assistance
Oklahoma Primary Care AssociationOklahoma Primary Care Association
What are CHCs/FQHCs?What are CHCs/FQHCs?
Community Health Centers (CHCs), initially Community Health Centers (CHCs), initially referred to as “Neighborhood Health Centers,” referred to as “Neighborhood Health Centers,”
are an outgrowth of President Lyndon B. Johnson’sare an outgrowth of President Lyndon B. Johnson’sGreat Society Program,Great Society Program, in 1966. in 1966.
CHCs, receiving grant funds under Section 330 of CHCs, receiving grant funds under Section 330 of thethe
Public Health Service Act are federally mandated to Public Health Service Act are federally mandated to provide access based on affordable sliding fees for provide access based on affordable sliding fees for
anyone seeking primary health care.anyone seeking primary health care.
Note: FQHC – a deemed reimbursement status for Note: FQHC – a deemed reimbursement status for 330-funded CHCs330-funded CHCs due to greater amount of due to greater amount of mandatory uninsured servicesmandatory uninsured services
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Oklahoma CHC Presence Oklahoma CHC Presence Prior to 2001Prior to 2001
Six CHC SitesSix CHC Sites
- 4 CHC grantees- 4 CHC grantees
- 2 Homeless - 2 Homeless SitesSites
CHC Grantee
Homeless Center
2008 Oklahoma CHC 2008 Oklahoma CHC PresencePresence
Over $9.5 million in CHC funds to OK since the inception of President Bush’s
Initiative!
CHC Grantee
Homeless Center
Expansion/Satellite
Oklahoma Primary Care Association
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Core Elements of CHCsCore Elements of CHCsOvercoming Health Care Access BarriersOvercoming Health Care Access Barriers
Federal Resources be targeted to communities Federal Resources be targeted to communities with highest need – must serve an MUAwith highest need – must serve an MUA
Health services are available to all people Health services are available to all people regardless of regardless of abilityability to pay (sliding fee scale) to pay (sliding fee scale)
Provide comprehensive primary care enabling Provide comprehensive primary care enabling services (transportation, translation) and services (transportation, translation) and health educationhealth education
Health centers must be directed by a Health centers must be directed by a governing board of which 51% are patients of governing board of which 51% are patients of the health centerthe health center
Must meet performance & accountability Must meet performance & accountability requirementsrequirements
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Who Do Oklahoma CHCs Who Do Oklahoma CHCs Serve?Serve?
By Income Level, 2006By Income Level, 2006
100% FPL and Below75.6%
101-150% 16.4%151-200%
4.0%
Over 200% 4.0%
Source: BPHC, HRSA, DHHS, 2006 Uniform Data System
Of Health Center Patients in America…
•Half reside in rural areas
•One in five low income children are served
•Over 70% have family incomes at or below poverty ($17,600 annual income for family of three – 2008 FPL)
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Who Do Oklahoma CHCs Who Do Oklahoma CHCs Serve?Serve?
By Insurance Status, 2006By Insurance Status, 2006
Uninsured50.7%
Medicaid/SCHIP26.3%
Medicare11.8%
Private11.2%
Source: BPHC, HRSA, DHHS, 2006 Uniform Data System
2006 Oklahoma Health 2006 Oklahoma Health Center Population by AgeCenter Population by Age
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Examples of Health Center Examples of Health Center ServicesServices
Primary Care – All AgesPrimary Care – All Ages Well ChildWell Child Well BabyWell Baby Lab, X-RayLab, X-Ray Oral HealthOral Health Mental Health/Mental Health/
Substance AbuseSubstance Abuse Pre- and Postnatal Pre- and Postnatal
CareCare Family PlanningFamily Planning PharmacyPharmacy ImmunizationsImmunizations
TranslationTranslation PreventionPrevention OutreachOutreach Home HealthHome Health Child CareChild Care Social ServicesSocial Services ReferralReferral Patient EducationPatient Education School-Based School-Based
ServicesServices Homeless Health Homeless Health
CareCare TransportationTransportation
Transportation Barriers for Transportation Barriers for Low-Income & Elderly Low-Income & Elderly
PatientsPatients Inability to afford personal Inability to afford personal
transportationtransportation- initial cost of car- initial cost of car- fuel costs and maintenance- fuel costs and maintenance
Unable to drive due to…Unable to drive due to…- vision impairment and other health - vision impairment and other health conditionsconditions- medications that prohibit driving- medications that prohibit driving
Absence of an ‘on call’ driverAbsence of an ‘on call’ driverOklahoma Primary Care AssociationOklahoma Primary Care Association
Transportation Barriers Transportation Barriers Cause…Cause…
Delay in care Delay in care - more serious illness- more serious illness- reduced quality of life - reduced quality of life - increased cost of care- increased cost of care
Inability to secure medication, social Inability to secure medication, social services, etc.services, etc.
Use of ER for non-emergent problemsUse of ER for non-emergent problems Increased medical costs for everyoneIncreased medical costs for everyone
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Oklahoma Primary Care AssociationOklahoma Primary Care Association
The Driving Forces Behind The Driving Forces Behind Health Care PolicyHealth Care Policy
1.1. Cost, Cost, CostCost, Cost, Cost
2.2. Wide Variation in Health Wide Variation in Health Care DeliveryCare Delivery
3.3. Public OutcryPublic Outcry
Oklahoma Primary Care AssociationOklahoma Primary Care Association
1. 1. America’s Health Care America’s Health Care CostsCosts
Health care costs in America exceed $2 Health care costs in America exceed $2 trillion now expected to double within next trillion now expected to double within next decadedecade
The U.S. is the worldwide leader in costsThe U.S. is the worldwide leader in costs In FY2006, Medicaid and Medicare In FY2006, Medicaid and Medicare
expenditures totaled $600 billion expenditures totaled $600 billion By 2030, 50% of all federal dollars are By 2030, 50% of all federal dollars are
projected to be spent on Medicaid and projected to be spent on Medicaid and Medicare – given the current trendMedicare – given the current trend
Spending is unevenly distributed with a Spending is unevenly distributed with a reimbursement system that encourages reimbursement system that encourages ‘churning’ – 43% of ‘top 5% population in ‘churning’ – 43% of ‘top 5% population in expenditures’ is 65 years or olderexpenditures’ is 65 years or older
Oklahoma Primary Care AssociationOklahoma Primary Care Association
Health Care Costs &Health Care Costs &The Aging of AmericaThe Aging of America
Medicare populationMedicare population1960 – 16.6 million1960 – 16.6 million2050 – 78.9 million (projected)2050 – 78.9 million (projected)
While Medicare costs escalate, Social Security While Medicare costs escalate, Social Security funding mechanisms are beginning to flat linefunding mechanisms are beginning to flat line
The intersection where Medicare costs exceed The intersection where Medicare costs exceed the Social Security funding mechanism is the Social Security funding mechanism is expected just before the year 2025expected just before the year 2025
In SFY2006, 19.17% of Oklahoma Medicaid In SFY2006, 19.17% of Oklahoma Medicaid Enrollees were Aged, Blind & Disabled (ABD); Enrollees were Aged, Blind & Disabled (ABD); 59.30% of Total Expenditures were for ABD59.30% of Total Expenditures were for ABD
Transportation Issues Transportation Issues Facing Safety Net ProvidersFacing Safety Net Providers
Schedule difficulties result in ‘no shows’Schedule difficulties result in ‘no shows’ Lack of culturally-sensitive servicesLack of culturally-sensitive services Insurance rarely pays for transportationInsurance rarely pays for transportation Rural areas have no or limited public Rural areas have no or limited public
transportation options with many transportation options with many patients residing more than 30 miles patients residing more than 30 miles away from health centeraway from health center
Logistically difficult to schedule a ‘van Logistically difficult to schedule a ‘van load’ of patientsload’ of patients
Oklahoma Primary Care AssociationOklahoma Primary Care Association
What Safety Net Providers What Safety Net Providers Do to Enable Transportation Do to Enable Transportation
Offer transportation service – limited by Offer transportation service – limited by budget constraints, manpower, etc.budget constraints, manpower, etc.
Use SoonerRide when possible (3-day Use SoonerRide when possible (3-day process)process)
Connect with local community action Connect with local community action agencies for transportation solutionsagencies for transportation solutions
Offer vouchers and bus tokens to patients Offer vouchers and bus tokens to patients Develop health center sites near public Develop health center sites near public
transportation lines transportation lines Oklahoma Primary Care AssociationOklahoma Primary Care Association
What Safety Net Providers What Safety Net Providers Would Like to SeeWould Like to See
Statewide transit plan for OKStatewide transit plan for OK Dedicated funding for non-urgent Dedicated funding for non-urgent
health care transportationhealth care transportation Culturally sensitive services for all Culturally sensitive services for all
peoplepeople Increased dependability of SoonerRideIncreased dependability of SoonerRide
Oklahoma Primary Care AssociationOklahoma Primary Care Association