From Research to Policy: Building the Evidence for Community Oriented Primary Health Care

1. From Research to Policy: Building the Evidence for Community Oriented Primary Health Care Vicki M. Young, Chief Operating Officer South Carolina Primary Health Care Association 3 Technology Circle, Columbia, SC 29203 (Phone) 803-788-2778 / (Fax) 803-788-8233 / www.scphca.org September 27, 2013 Access to Quality Health Care for All South Carolina

2. The US CHC Story • Background • Where we are, where we’re headed • Parallel Stories: Canadian CHCs and US CHCs Access to Quality Health Care for All South Carolina

3. “The Movement” The Beginning • The health center movement began in apartheid South Africa • In the 1950s, Dr. Sidney Kark created the first health center in South Africa Access to Quality Health Care for All South Carolina

4. “The Movement” The Beginning • In 1964, the American version was formed by Dr. Jack Geiger and Count Gibson • occurred when War on Poverty and Civil Rights Movement were major social issues • funded through the Office of Economic Opportunity • Included the social and environmental factors that affect health in communities and by communities Access to Quality Health Care for All South Carolina

5. “The Movement” The Beginning • First Two Community Health Centers in US • Columbia Point- Massachusetts • Mount Bayou- Mississippi • Focus was to Stimulate Change in Family and Community Knowledge and Behavior • prevention of disease • informed use of available health resources • improvement of environmental, economic and educational factors related to health Access to Quality Health Care for All South Carolina

6. “The Movement” The Beginning • Two-Fold Purpose • Agents of Care • Agents of Change • Three Elements of the Health Center Model • Community health services • Community economic development • Community participation Access to Quality Health Care for All South Carolina

7. “The test of our progress is not whether we add more to the abundance of those who have much; It is whether we provide enough for those who have too little. - Franklin Delano Roosevelt Access to Quality Health Care for All South Carolina

8. Federal Requirements • Must be a non-profit organization, accessible to all • Community Governance representative of health center patients • Comprehensive, patient- and community-centered across the life cycle • Broad definition of “health” • Located in federally-designated medically underserved areas or serving medically underserved populations • Ongoing needs assessment and quality improvement (QI) Access to Quality Health Care for All South Carolina

9. Federal Requirements • Bureau of Primary Health Care (BPHC) requires community health centers to meet 19 Key Health Center Program Requirements • Health Center Program Requirements are divided into four categories: • Need • Services • Management & Finance • Governance Access to Quality Health Care for All South Carolina

10. “Where We Are Today” Health Center Funding Sources • Medicaid • Medicare • Private Insurance • Federal Grants (DHHS, HRSA, BPHC) • Patient Fees • Other Access to Quality Health Care for All South Carolina

11. “Where We Are Today” 2012 Demographics- US Community Health Center • 1,198 Health Centers Grantees • 21,102,391 Medical Patients Served • 92.6% of Patients ≤ 200% of Poverty; 71.9% ≤100% of Poverty • 36% Uninsured; 40.8% Medicaid; 8% Medicare • 13.9% Special Populations Grantees • Homeless • Migrant/Seasonal Farm Workers • Public Housing • School- based • Veterans Access to Quality Health Care for All South Carolina

12. “We are only as strong as we are united as weak as we are divided” - J.K. Rowling Access to Quality Health Care for All South Carolina

13. How Did We Get Here? Advocacy Strategy and Quality Care • Qualitative Data/Evidence • Quantitative Data/Evidence • Cost effectiveness • Quality evidence-based health care • Access • Data Sources • UDS • Health Disparities Collaboratives data • Individual health center stories Access to Quality Health Care for All South Carolina

14. How Did We Get Here? • Commitment to working collaboratively at the national, regional/state, and local levels to make the case with available data • Commitment to “Tell Our Story” • Recognition of the importance of research and data in “Telling Our Story” • Recognition that the “right” partnerships with academia and other community partners is key to success Access to Quality Health Care for All South Carolina

15. How Did We Get Here? • Commitment by health centers with capacity and interest to engage in health services and outcomes research • Comparative Effectiveness • Translational/Dissemination • Clinical Outcomes • Commitment to explore building capacity for research in the community health center setting Access to Quality Health Care for All South Carolina

16. Where Are We Headed? • Assess Health Center Research Activities and Needs through National Survey • Diverse partnership- Clinical and Translational Science Institute-CN, National Association of Community Health Centers, George Washington University, SC Primary Health Care Association, University of SC • Results • 386 respondents (health centers); 35.3% response rate • 55% of respondents indicated that the health center conducted or participated in research • 54% of respondents indicated interest in participating in research activities Access to Quality Health Care for All South Carolina

17. Where Are We Headed? National Research Agenda (health center policy) • Patient Complexity and Risk Adjustment • Document Health Center Value • Model addresses access, quality, and cost • Comprehensiveness- enabling services • Inform Health Center Growth Strategy • Support Transformation and Health Reform Implementation Access to Quality Health Care for All South Carolina

18. Where Are We Headed? • Continue to Focus on and Expand Participation in Health Services and Outcomes Research • Comparative Effectiveness • Translational/Dissemination • Clinical Outcomes • Impact of Non-medical Services and Evidence-based Practices/Programs Access to Quality Health Care for All South Carolina

19. Parallel Stories – Canada and US • Services • Primary Care • Enabling • Health Care Service Delivery System • Comprehensive- Integrated Services • Patient-centered • Federal Government Involvement/Assistance • Populations Served • Data and Research agendas Access to Quality Health Care for All South Carolina

20. “I am a strong individualist by personal habit, inheritance and conviction; but it is a mere matter of common sense to recognize that the State, the community, the citizens acting together, can do a number of things better than if they were left to individual action” - Theodore Roosevelt Access to Quality Health Care for All South Carolina