Healthcare Centers Serving Minnesotans

Statewide Federally Qualified Health Centers in Minnesota provide comprehensive primary care, dental, and mental health services to over 180,000 individuals. These not-for-profit organizations operate under a patient-centric model, offering care to all, including the uninsured, with a sliding fee schedule. Patient demographics include varying insurance coverage, racial and ethnic backgrounds, and poverty levels, with a strong emphasis on quality indicators such as Patient Centered Medical Homes recognition.

• Healthcare
• Minnesota
• Federally Qualified Health Centers
• Primary Care
• Patient-Centered

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1. February 25, 2015 1

2. 17 organizations at 70+ service sites in state serving 180,000 Minnesotans. Also known as Federally Qualified Health Centers FQHCs Not-for profit corporations. 51% of Board are patients. Serve a Medically Underserved Area. Comprehensive primary care medical, dental and mental health. Enabling services key to model. Serve all regardless of ability to pay. Sliding fee schedule for the uninsured. ROI 9% of non-disabled MHCP with 1.2% of budget

3. TWIN CITIES GREATER MN Open Door Health Center Mankato Lake Superior Community Health Center Duluth Sawtooth Mountain Clinic Grand Marais, Grand Portage, Tofte Scenic Rivers Health Services Cook, Bigfork, Big Falls, Floodwood, Northome, Tower Community Health Service Moorhead, Rochester, Wilmar, Olivia (*Seasonal), Owatonna*, Breckenridge*, Northern Mobile Unit, Southern Mobile Unit Minneapolis Axis Medical Center Community-University Health Care Center Health Care for the Homeless Indian Health Board Native American Community Clinic Neighborhood HealthSource North Point Health & Wellness People s Center Southside Community Health Services St. Paul Open Cities Health Center United Family Medicine West Side Community Health Services

4. 2013 CHC Patient Insurance Status 2013 MN Patient Insurance Status Uninsured 7% Private 24,219 14% Medicare 13,851 8% Uninsured 66,084 37% MA/MNC are 13% Private 67% Medicare 13% MA/MNC are 73,564 41% Source: Kaiser State Health Facts, 2013 Source: HRSA Uniform Data System, 2013 4

5. 2013 CHC Patient Race/Ethnicity 2013 MN Race/Ethnicity White 81% Other/ >1 Race 2% Asian/PI 7% Black/Afr. Amer. 28% Latino 25% Latino 5% Amer. Ind. 5% Amer. Ind. 1% Other/ >1 Race 3% White 33% Black/Afr. Amer. 6% Asian/PI 4% Source: US Census Bureau, 2013 Source: HRSA Uniform Data System, 2013 5

6. CHC Patients by Poverty, 2013 MN Population by Poverty, 2013 <100% 12% 101- 200% 14% >200% 7% 101- 199% 14% <100% 79% > 200% 74% Source: Kaiser State Health Facts, 2013 Source: HRSA Uniform Data System, 2013 6

7. SELECTED QUALITY INDICATORS 88% of CHCs are recognized as federal Patient Centered Medical Homes (PCMH) 78% of pregnant women entered prenatal care during first trimester 90% of patients screened for tobacco-use 86% asthma patients age 5 through 40 have a treatment plan 71% of diabetic patients have A1c under control (<=9.0%) Lower LBW rates compared to state averages by every race/ethnicity 7

8. FFS TCOC Pay for SERVICES Pay for VALUE Participating in Health Care Reform Serving the Underserved MN DHS ACO Demonstrations Moving away from fee-for- service to Total Cost of Care (TCOC) arrangement while meeting Financial & Quality Benchmarks 8

9. Only FQHC led Medicaid focused Accountable Care Organization in the nation. 1st virtual ACO in MN non affiliated providers Attributed 25,000 patients Met all patient satisfaction goals and quality benchmarks 8.6% reduction in ED Visits in Year One, and currently at 16.2% in Year Two $2.6 million in savings Trending toward 20% reduction in ED Visits in Year Two Line of sight into clinical care picture. 9

10. FUHN ED Visits per 1,000 patients per year 1,086 End of Year 1: 8.6% Reduction in ED Visits 1,063 1,062 1,062 1,071 1,051 1,021 1,011 1,026 995 1,022 974 1,004 993 938 930 952 Baseline of 1,062 ED visits per 1,000 patients per Year 911 940 903 924 890 Most Recently: 16.2% Reduction in ED Visits Compared to Baseline 10

11. 9% reduction in ED Visits 3% reduction in Inpatient Admissions 2.5% increase in Primary Care Visits 10.8% increase in patients meeting Optimal Diabetes Care 23.5% increase in patients meeting Optimal Vascular Care 7.6% increase in patients meeting Optimal Asthma Care 11

12. Care coordination is at the core of the model. Ensuring patients with multiple chronic diseases are managed Data analytics for population health management is critical (and expensive). Patient Outreach and Education necessary to engage patients in their care. Value of connecting with social services our patients use/need to address the social determinants of health. 20% of outcomes influenced by services provided within the 4 walls of the clinic 12

13. Reduce health disparities Care Coordination Reduce avoidable ER & Hospitalizations Oral Healt h OUTCOMES Access Integrate Care Data Analytics Engage Consumers 13

14. $2 million increase to CHC appropriation operated under Minn. Stat. 145.9269 to continue, expand, and improve federally qualified health center services to low-income populations Currently at $2.5 million per year and scheduled to decrease by $125,000 in each year of FY16-17 biennium Minnesota Department of Health (MDH) Office of Rural Health and Primary Care (ORPHC) Established in 2007 14

15. Care 23,300 patients 40.00 FTE Coordination 44 Investments 25,100 patients 5.50 FTE Data Analytics Nearly 60.00 FTE Expanded Access 24,673 patients 6.50 FTE Impacting 85,000 FQHC Patients 12,577 patients 6.25 FTE Oral Health 15