News from Community Clinic Voice

The Prevention and Public Health Fund (Fund), created in 2010, is the first federal funding source dedicated to public health and prevention and represents a unique opportunity to reduce long-term health costs. Seventy-five percent of all health care costs in our country are spent on the treatment of chronic diseases, many of which could be easily prevented.

In 2012, the Fund invested $1 billion in programs that will benefit every state and allow communities to move forward on proven, effective ways to keep Americans healthier and more productive. Over the next 10 years (FY2013-22) the Fund will invest a total of $12.5 billion in cross-cutting prevention programs that have the potential to transform our public health system.

Since 2010, California has received over $150 million dollars through the Prevention Fund...

In many regions across the country, "super-utilizer" programs providing intensive outpatient care management to high-need, high-cost patients whose complex physical, behavioral, and social needs are not met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to inpatient admission to readmission or institutionalization, in costly, chaotic, and ineffective ways

Super-utilizer programs strive to improve care coordination and overall quality, and help control spending through reductions in avoidable utilization, such as repeat emergency department visits and inpatient readmissions. Since low-income individuals overwhelmingly comprise this high-need population, Medicaid programs are well-positioned to partner with community-based programs to design strategies to more effectively reach super utilizers.

To discuss how Medicaid can advance models for this high-need group of patients, Center for Health Care Strategies (CHCS), in partnership with the National Governors Association, hosted the Super-Utilizer Summit earlier this year in Alexandra, Virginia. The summit brought together leaders from more than 10 states, super-utilizer programs across the country, the Centers for Medicare & Medicaid Services, several Robert Wood Johnson Foundation (RWJF) Aligning Forces for Quality alliances, health plans, and other key stakeholders to share strategies for changing how our health care system interacts with these individuals...

HRSA has proposed changes to the calendar year (CY) 2014 Uniform Data System (UDS) to be reported by Health Center Program grantees and look-alikes in early 2015. These changes also will be announced soon in the Federal Register. You are invited to submit your comments on the proposed changes directly to HRSA in order that they may be considered during the public comment review process.

The proposed changes involve Patient Characteristics and Counts, Reportable Services, Quality of Care Measures, Health Outcomes and Disparities Measures, Electronic Health Records Capabilities and Quality Recognition.

Read more.

If you have any questions or comments regarding the proposed changes to the CY 2014 UDS, please contact the Office of Quality and Data at OQDComments@hrsa.gov or 301-594-0818.

If you want to taking advantage of The Joint Commission’s new Behavioral Health Home certification, now is the perfect time to start working to get state recognition of this new option – before January 1, 2014 when the option becomes available.

The Joint Commission is working to see that state authorities recognize the new option for purposes of licensure or certification. They wrote to all state Medicaid agencies earlier this year, alerting them that The Joint Commission is developing a new certification option for behavioral health homes, and asking them to consider the Certification as a means of demonstrating compliance with any regulations they develop.

The Joint Commission is happy to partner with behavioral health care providers by offering support and technical information on this topic.

For more information, email BHC@jointcommission.org or call 630-792-5411...

Somewhere between 13 and 20 percent of kids in the United States experience some sort of mental disorder, according to a new report from the Centers for Disease Control and Prevention. That adds up to millions of children suffering from disorders like ADHD, depression, autism and illicit drug use.

The prevalence of mental disorders in kids seems to have increased over the past 15 years (though the growth could reflect better monitoring and awareness). Inpatient hospital admissions for mental health and substance abuse issues increased by nearly a quarter from 2007-2010. Suicide was the second leading cause of death for kids aged 12-17...

Since January, Medicaid agencies and health plans have been required to reimburse primary care providers at Medicare's generally higher rates. The increase, which is in effect only for two years, is expected to improve access to primary care services for this low-income population and potentially improve health outcomes.

These ACA dollars represent an $11.4 billion boost for Medicaid primary care. However, it isn't clear whether the gains will extend beyond that timeframe.

In a new blog post for the Commonwealth Fund, David Bricklin-Small and Tricia McGinnis of the Center for Health Care Strategies say that to ensure continued access to primary care, as well as opportunities to improve quality and lower costs, the payment rate increase should be made permanent...

"Fixing" health care by location doesn't automatically benefit resident

The Annie E. Casey Foundation has just released a thoughtful summary of lessons learned from its Making Connections Initiative, which focused funding and technical assistance on poor neighborhoods in 10 cities with the goal of improving outcomes for both people and places.

Margery Turner, VP for Research at the Urban Institute, appreciates that the assessment doesn't sugarcoat the difficulties the initiative encountered or hide the more disappointing results. It acknowledges that Making Connections failed to achieve population-level improvements in family and child well-being, even though sites did succeed in implementing important new programs that improved the lives of individual families and kids.

One of the important insights generated by the Making Connections survey is the critical importance of family mobility...

Senators John Thune (R-S.D.) and Bob Casey (D-Pa.) on 5/15/13 re-introduced bipartisan legislation to remove barriers currently preventing health care professionals from volunteering their services at Community Health Centers (CHCs). The Family Health Care Accessibility Act (S. 955) would amend the Public Health Service Act to provide Federal Tort Claims Act (FTCA) medical malpractice coverage to all qualified health care professionals who volunteer at CHCs.

Health center employees, contractors, and board members receive medical malpractice coverage through the FTCA, but doctors, dentists, and other health care professionals who wish to volunteer their services at health centers are required to provide their own medical malpractice coverage, which is extremely costly. The Family Health Care Accessibility Act (S...

As the House votes, for the 37th time, to repeal part or all of health reform, an article from Center on Budget and Policy Priorities reviewed some of the ACA's accomplishments to date. In the nearly two and a half years since the first such vote, health reform has made significant progress in achieving its basic goals, writes Shannon Spillane: helping more Americans get affordable coverage, protecting consumers, and slowing cost growth across the health care system, both public and private, specifically:

• Health insurance for millions of young adults
• Free preventive care for tens of millions of Americans
• Protections for children and adults with serious illnesses
• More affordable prescriptions for more than 6 million seniors
• Initial steps to help slow health care costs.


Read more.

AND SEE: Tracking The ACA's Implementation- A series from Health Affairs.

We are interested in how you prefer to connect to each other and manage information about the health care safety net, particularly how you may or may not use the CCI Voice online community and other Voice resources.

Please take 5-10 minutes to complete a short survey: http://tinyurl.com/co8x4n8

Everyone who completes thesurvey by the end of today, May 17, will be entered into a raffle for a $50 Amazon.com e-gift card. Four winners will be selected when the survey closes.

Your individual responses will remain anonymous to CCI staff and others. We are working with BTW, an independent consulting group, to conduct the survey...

On May 8, 2013, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. The previous Bulletin was issued in 1999.

Potential penalties and scope of payment prohibition
Health care providers (including health centers) that contract with or employ an individual or entity that the provider knows or should know is excluded may be subject to civil monetary penalties (CMPs) of up to $10,000 for each claimed item or service furnished by the excluded individual or entity as well as treble damages and program exclusion. CMPs apply if an excluded individual or entity participates in any way in the furnishing of items or services that are payable by a Federal health care program. This includes providing direct services, indirect services, administrative services or management services paid directly or indirectly with federal health care program funds...

The latest CPCA Weekly Update of 5/16/13 reports on:

• CPCA's Quick Budget Analysis of The Governor's May Revise - The Governor does not seem to have any appetite to restore funds necessary to fully provide for the health and well-being of the people and communities we serve.

• Immigration Reform and Health Care Coverage Update - Immigration Reform Bill S.744 is in Senate Judiciary mark-up this week; most of the health-related amendments will be taken up next week. Many of the proposed amendments would have a detrimental impact on low-income immigrants in many immigration categories, but a few positive amendments have also been proposed.

• Advocacy Update Call Wednesday, May 22 & every Weds at 11:00 am Call-in Number: 1-866-469-3239 / Participant Code: 56814021

• Covered California Board Meeting May 23 in Sacramento - The announcement of which qualified health plans (QHP's) will participate in the California Health Benefit Exchange is expected to take place at this meeting.

• Register for the June Lunch & Learn on NCQA Standard 2: Identify & Manage Patient Populations

Patient-Centered Health Home Lunch & Learn Sessions now available on-demand!

(And see the Voice Discussion Patient-Centered Health Home in California – Strategies and Resources for Achieving Recognition and Beyond, for resources from Samantha Jones of CPCA.)

Plus other news, trainings, funding notices and much more.

Find the CPCA Update and several topic-specific Newsletters at: http://www.cpca.org/index.cfm/newsletters/

Many experts see a primary care physician shortage looming, particularly as millions gain insurance coverage under the health reform law. Currently, the U.S. has far fewer such physicians per capita than other wealthy countries have.

In an editorial in this week痴 New England Journal of Medicine, The Commonwealth Fund痴 David Blumenthal and Melinda Abrams explore one approach to addressing the primary care workforce shortage: using nurse practitioners, also known as advanced practice nurses, to provide a wide range of primary care services. Blumenthal and Abrams call for a flexible approach to crafting primary care workforce policy, one that痴 responsive to the changing roles of health care professionals and to changes in the organization and financing of health care...

Democratic legislators and patient advocates said they will push to restore funding for California's health care and safety-net programs, despite Governor Brown's (D) revised fiscal year 2013-2014 budget proposal that does not reverse cuts to such programs, California Healthline reports.

In recent state budgets, officials have made several changes to Medi-Cal, including cutting reimbursement rates for physicians; eliminating services not required by the federal government; and imposing copayments on beneficiaries. In addition, California has eliminated adult dental services for an estimated three million low-income Denti-Cal beneficiaries to help reduce the budget deficit.

In March, California Controller John Chiang (D) said that state tax revenue for the first eight months of the fiscal year outpaced preliminary estimates by $4.5 billion, in part because of higher-than-expected personal income taxes. Democratic lawmakers have said they want to use the higher-than-expected revenue to restore cuts to certain health care and safety-net programs...

The Senate yesterday confirmed Marilyn Tavenner. CMS' acting administrator. as permanent head of the Centers for Medicare & Medicaid Services. She becomes the first confirmed leader of the agency in more than nine years, Reuters reports. In a rare show of bipartisanship, her nomination was confirmed in a 91-7 vote,; seven Republican senators, including Minority Leader Mitch McConnell, voted against her...

The May 15 issue of "What's New on CCI Voice" includes updates on the CA State Budget May Revision, Funding & Current Grants, Health IT, Health Reform, Innovation, Jobs, QI and more!

Four new analyses on health care costs, supported by Robert Wood Johnson Foundation, outline strategies for achieving a sustainable rate of spending, at the same time bolstering the quality of care:

Bending the Curve, a report from the Engleberg Center for Health Care Reform at the Brookings Institution, suggests systemwide reforms to Medicare, Medicaid, and private insurance markets and exchanges could save the U.S. $300 billion in the next 10 years, and $1 trillion in the next 20 years.

The Partnership for Sustainable Health Care presents five consensus recommendations, ranging from shedding the fee-for-service payment system to rewarding states that slow the growth in spending with some of the savings. The National Commission on Physician Payment Reform takes a close look at how physicians are paid.

A report by the Bipartisan Policy Center recommends ways to move America's health care system from a system driven by volume of care to one that places a premium on quality and value...

Gov. Brown has released his revised fiscal year 2013-2014 spending plan for California, which is a $1.3 billion reduction from his initial proposal. The new plan anticipates $1.2 billion more in Medi-Cal spending to implement health reform provisions, California Healthline reports.

The Governor’s May Revision showed an additional $4.5 billion in tax revenue, a $1.1 billion reserve, and proposed “an affordable and sustainable path for a state-based expansion” of the Medi-Cal program with a “commensurate shift in some responsibilities to counties,” reports ITUP. Read more from ITUP on how will this affect county funding and responsibilities to care for uninsured adults.

The revised plan also would permanently impose a tax on Medi-Cal managed care plans equivalent to the state sales tax rate, which would save the state about $343 million. In addition, Brown's revised plan includes a 10% cut to Medi-Cal provider reimbursements that currently is stalled in litigation, and does not restore Denti-Cal benefits for adults, as some lawmakers had hoped...

5/15/13 Update - Covered California, the state's health insurance exchange, announced the 48 recipients of $37 million in federal funding to help promote the exchange to uninsured residents. Recipients of the grants -- which range from $250,000 to $1.25 million -- include health foundations, nonprofit organizations, unions and universities.

According to Covered California officials, about $34 million of the grant funding will go toward outreach initiatives aimed at individuals and $3 million will go toward outreach initiatives aimed at small businesses.

The goal of the grant program is to increase awareness about the new benefits, to educate targeted audiences about the subsidy programs available to them and to motivate consumers and small businesses to be part of obtaining health insurance.

A list of grantees, grant amounts, and information on planned grantee activities is available at http://www.healthexchange.ca.gov/Pages/OutrchandEdProg.aspx

Hear more from grantees on Twitter: #coveredCa



Covered California on Tuesday, May 14, at 11 a.m...

New York Digital Health Accelerator (NYDHA) is bringing top providers, developers, and investors together to investigate how provider-developer collaboration can improve health IT, particularly the adoption and integration of new technologies into a healthcare organization’s or provider’s EHR system, reports EHR Intelligence.

Last week, the inaugural class of the NYDHA was announced jointly by the New York eHealth Collaborative (NYeC) and the Partnership Fund for New York City, The nation’s largest-funded healthcare IT accelerator program with $4.2 million in investments provides a unique opportunity to improve the design and implementation of health IT by bringing new perspectives into the healthcare industry. Read more.