Transcript Strategic Planning: Vision for the Future

Safety Net Providers and
Health Care Transportation
Presented by
Oklahoma Primary Care Association
HRSA/BPHC State Liaison
Human Nature & Health Care
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Health care is put on ‘back burner’ until
needed
Can’t schedule earaches, sore throats, etc.
Risky behavior (e.g., smoking, overeating)
is hard to reverse
Health care provision is one of first items
to get cut from personal budgets
Oklahoma Primary Care Association
America’s Health Structure 2008
Tertiary Care
Secondary
Care
Primary
Care
Oklahoma Primary Care Association
Where We Want to Be
Tertiary
Care
Secondary
Care
Primary Care =
PREVENTIVE
HEALTH!
Oklahoma Primary Care Association
Who is OPCA?
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Funded by Health Resources and Services
Administration (HRSA)/Bureau of Primary
Health Care (BPHC) to assist community
health centers (CHCs) and create a regional
and state presence
OPCA has hybrid membership – community
health centers (CHCs), other safety net
providers and health advocates
Mission:
Strengthening access for community-based
health care through advocacy, education, and
technical assistance
Oklahoma Primary Care Association
What are CHCs/FQHCs?
Community Health Centers (CHCs), initially
referred to as “Neighborhood Health Centers,”
are an outgrowth of President Lyndon B. Johnson’s
Great Society Program, in 1966.
CHCs, receiving grant funds under Section 330 of the
Public Health Service Act are federally mandated to
provide access based on affordable sliding fees for
anyone seeking primary health care.
Note: FQHC – a deemed reimbursement status for
330-funded CHCs due to greater amount of
mandatory uninsured services
Oklahoma Primary Care Association
Oklahoma CHC Presence
Prior to 2001
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Six CHC Sites
- 4 CHC grantees
- 2 Homeless Sites
CHC Grantee
Homeless Center
Oklahoma Primary Care Association
2008 Oklahoma CHC Presence
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
Core Elements of CHCs
Overcoming Health Care Access Barriers
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Federal Resources be targeted to communities
with highest need – must serve an MUA
Health services are available to all people
regardless of ability to pay (sliding fee scale)
Provide comprehensive primary care enabling
services (transportation, translation) and health
education
Health centers must be directed by a governing
board of which 51% are patients of the health
center
Must meet performance & accountability
requirements Oklahoma Primary Care Association
Who Do Oklahoma CHCs Serve?
By Income Level, 2006
Over 200%
4.0%
Of Health Center Patients
in America…
•Half reside in rural areas
101-150%
16.4% 151-200%
4.0%
100% FPL
and Below
75.6%
•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)
Source: BPHC, HRSA, DHHS, 2006 Uniform Data System
Oklahoma Primary Care Association
Who Do Oklahoma CHCs Serve?
By Insurance Status, 2006
Private
11.2%
Medicare
11.8%
Uninsured
50.7%
Medicaid/SCHIP
26.3%
Source: BPHC, HRSA, DHHS, 2006 Uniform Data System
Oklahoma Primary Care Association
2006 Oklahoma Health Center
Population by Age
Oklahoma Primary Care Association
Examples of Health Center Services
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Primary Care – All Ages
Well Child
Well Baby
Lab, X-Ray
Oral Health
Mental Health/
Substance Abuse
Pre- and Postnatal Care
Family Planning
Pharmacy
Immunizations
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Translation
Prevention
Outreach
Home Health
Child Care
Social Services
Referral
Patient Education
School-Based Services
Homeless Health Care
Transportation
Oklahoma Primary Care Association
Transportation Barriers for
Low-Income & Elderly Patients
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Inability to afford personal transportation
- initial cost of car
- fuel costs and maintenance
Unable to drive due to…
- vision impairment and other health
conditions
- medications that prohibit driving
Absence of an ‘on call’ driver
Oklahoma Primary Care Association
Transportation Barriers
Cause…
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Delay in care
- more serious illness
- reduced quality of life
- increased cost of care
Inability to secure medication, social
services, etc.
Use of ER for non-emergent problems
Increased medical costs for everyone
Oklahoma Primary Care Association
The Driving Forces Behind
Health Care Policy
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Cost, Cost, Cost
Wide Variation in Health Care
Delivery
Public Outcry
Oklahoma Primary Care Association
1. America’s Health Care Costs
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Health care costs in America exceed $2 trillion
now expected to double within next decade
The U.S. is the worldwide leader in costs
In FY2006, Medicaid and Medicare expenditures
totaled $600 billion
By 2030, 50% of all federal dollars are projected
to be spent on Medicaid and Medicare – given the
current trend
Spending is unevenly distributed with a
reimbursement system that encourages ‘churning’
– 43% of ‘top 5% population in expenditures’ is
65 years or older
Oklahoma Primary Care Association
Health Care Costs &
The Aging of America
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Medicare population
1960 – 16.6 million
2050 – 78.9 million (projected)
While Medicare costs escalate, Social Security
funding mechanisms are beginning to flat line
The intersection where Medicare costs exceed the
Social Security funding mechanism is expected just
before the year 2025
In SFY2006, 19.17% of Oklahoma Medicaid
Enrollees were Aged, Blind & Disabled (ABD);
59.30% of Total Expenditures were for ABD
Oklahoma Primary Care Association
Transportation Issues Facing
Safety Net Providers
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Schedule difficulties result in ‘no shows’
Lack of culturally-sensitive services
Insurance rarely pays for transportation
Rural areas have no or limited public
transportation options with many patients
residing more than 30 miles away from
health center
Logistically difficult to schedule a ‘van load’
of patients
Oklahoma Primary Care Association
What Safety Net Providers Do to
Enable Transportation
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Offer transportation service – limited by
budget constraints, manpower, etc.
Use SoonerRide when possible (3-day
process)
Connect with local community action
agencies for transportation solutions
Offer vouchers and bus tokens to patients
Develop health center sites near public
transportation lines
Oklahoma Primary Care Association
What Safety Net Providers
Would Like to See
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Statewide transit plan for OK
Dedicated funding for non-urgent health
care transportation
Culturally sensitive services for all people
Increased dependability of SoonerRide
Oklahoma Primary Care Association
Questions?
For further information, contact
Judy Grant, Director of Community Development
Oklahoma Primary Care Association
4300 N. Lincoln Blvd., Ste. 203
Oklahoma City, OK 73105
(405) 424-2282Fax (405) 424-1111
Oklahoma Primary Care Association