700 E. Jefferson Street, Suite 100 Phoenix, AZ 85034 (602) 253-0090 www.aachc.org

Moving Towards Implementation of an Independent Practice Association (IPA)

Alliance for Community Health Centers - AACHC

AACHC Membership 2014AACHC Membership 2014

Full Members:– 19 Federally Qualified Health Centers (FQHCs)– 3 FQHC look-alikes – Total FQHC sites161

• Designations include:– 3 tribal grantees (638 & FQHC)– 2 behavioral health grantees– 2 homeless grantees– 3 migrant grantees– 1 public housing grantee– 2 county-based grantees

– 1 Rural Health Clinics

• Member sites are located in 14 of the 15 counties in Arizona. AACHC members serve patients in 213 statewide locations. Over 161 of those sites are FQHCs and FQHC look-alike.

• Community Health Centers served over 540,000 patients throughout Arizona with over 1.7 million patient visits in 2013.

• Each dot represents a city that has member services available to the public.

AACHC Network 2013AACHC Network 2013

AACHC Peer CommitteesAACHC Peer Committees

Community Health Centers’ Range of Coordinated Services-Medical HomeCommunity Health Centers’ Range of Coordinated Services-Medical Home

Clinical• Family Medicine• Pediatrics• OB/GYN• Prenatal• Pharmacy (340B drug formulary)• Dental• Dieticians• Behavioral Health• HIV/AIDS• Immunizations• Mobile programs• Referrals for Specialty Services

Ancillary• Counseling• Radiology• Laboratory• Physical Therapy

Enabling • Translation• Eligibility• Transportation• Outreach

Health Education Programs• Chronic Disease Management• Nutrition Counseling

Arizona Federally-Qualified Health Centers - 2013Payer Mix* (average)

Arizona Federally-Qualified Health Centers - 2013Payer Mix* (average)

*Excludes Neighborhood Outreach Access to Health

• Uniform Data Set - HRSA Reporting (Demographics, clinical/quality, financial) o % Hypertension patients with BP <140/90 AZ = 70.6 compare to national

rate 57.8%o % Adults assessed for tobacco is 68.6% or higher AZ =100% compared to

national 93.8

• Integration and automation of patient care datao 67% (soon to be 82%) of FQHCs have achieved level 3 PCMH accreditationo 100% of FQHCs have adopted EMR o 90% FQHCs are utilizing e- Prescribing (19 of 21 Health Centers)

• Center for Health information Research (CHiR)– independent research firm which includes AHCCCS claims data.o Project began February 2014o Overall Cost and HEDIS

• Heath Information Exchangeo FQHC participating with AZ Health-e Connection - IPA will be users of

databaseo Marriage EMR/Clinical information to Health Plan Claims Data

Value of Arizona FQHCs

CHiR Findings - Arizona State FQHCsCHiR Findings - Arizona State FQHCs

FQHC Patient Non-FQHC Patient

Note: • Data does not include prisons or HIV populations. MIHS included in non-FQHC data due to data clarification• An average PPS rate of $170.00 used per encounter based on 2012 and adjusted for 2013

$- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000

$4,505 $4,167

CHIR FINDINGS - ARIZONA STATE FQHCSCHIR FINDINGS - ARIZONA STATE FQHCS

2013 AHCCCS Patient Quality of Care ALL 128 HEDIS Measures

FQHC vs. Non-FQHC

FQHC Rates Bet-

ter 83 (65%)

All HEIDIS

Non- FQHC Rates Better

12 (9%)

No Statis-tical Dif-ference 33(26%)

FQHC Rates Better

59 (84%)Preventive

HEDIS

Non- FQHC Rates Better 7(10%)

No Statistical Difference 4(6%)

INDEPENDENT PRACTICE ASSOCIATION (IPA)

DEVELOPMENT

INDEPENDENT PRACTICE ASSOCIATION (IPA)

DEVELOPMENT

Alliance for Community Health Centers

Collaborative Ventures Network (CVN) IPACollaborative Ventures Network (CVN) IPA

Collaborative Ventures Network, an AACHC Affiliate

Organized in 1997 as a not-for-profit integrated services network consistent with BPHC policies

Mission: To foster collaborative business activities which enhance CHC’s individual abilities to serve their communities to meet the needs of Arizona’s uninsured, underinsured and underserved

Independent consultant engaged to assist with development of strategy, recommendations and “roadmap” for IPA development

Integrated Provider Association (IPA)

Messenger Model IPA: A model of contracting on behalf of multiple, independent practices that could be considered competitors. Messenger Model provides economies of scale in the time and effort necessary to prepare for negotiation of CHC contracts

Integrated IPA Model: A network of health care providers/organizations which provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and/or fiscally accountable for clinical outcomes and health status of the populations served. Creates more healthcare value by adopting evidenced-based guidelines, sharing “best practices”, and setting quality and performance expectations

Integrated Provider Association (IPA)

AACHC’s Goal in creating an integrated IPA model is to further promote Value Purchasing• Build upon Integration (aggregation) of services

• PCMH-Multiple services under one roof or campus• 100% FQHCs are on electronic medical/health record

• e-Prescribing -90%• Expand EMR use:

• Support integrated care model• Drive quality Improvement and utilization management

• Best practices, promoting clinical and utilization guidelines • Continue to build upon consumer engagement

• Access to care (O&E, Navigator program, expanded care/quick-care)• Care management• High-end (cost) users

IPA: Alliance for Healthy CommunitiesIPA: Alliance for Healthy Communities

Statewide community-based patient-centered primary care network to wrap around the patient to assure right care, right place, right time, and right cost.

Databased benchmarking & decision making (UDS, HEDIS, AzHIN, HP-claims, etc.)

Demonstrable continuous quality improvement, triple aim and overall improved health outcomes

Supports collaboration among FQHC/CHCs, Health Plans, Hospitals, Specialty care, etc. Able to better focus on quality and utilization for high risk pts., super users, care gaps, overall population management. Ultimately efforts will bend the cost curve.

Assist health plans with meeting Quality and Performance rating & Risk Adjustment Factor (STAR/RAF)

Financially sustainable program for payers that operates to meet continued health care needs of Arizonians while assuring high quality & appropriate cost

Integrated Health CarePatients, Services, Culture and CommunityIntegrated Health CarePatients, Services, Culture and Community