2020 LEGISLATIVE TOOLKIT Oklahoma Primary Care Association OKLAHOMA COMMUNITY HEALTH CENTERS STATEWIDE OVERVIEW 21 health centers in Oklahoma operate 110+ locations across the state WHAT ARE COMMUNITY HEALTH CENTERS? Community health centers (CHCs), also known as Federally Qualified Health Centers (FQHCs) or health centers, are non-profit health care providers that deliver comprehensive primary health care services to medically underserved communities. To best serve their patients, many health centers offer a one-stop-shop of integrated services under one roof like medical, dental, behavioral, vision, transportation, case management, and more. The health center program provides health care to over 28 million individuals in the United States. Health centers have long been a bipartisan solution to concerns about health care access, quality, and cost. Health centers treat all patients regardless of ability to pay. In Oklahoma, where many families and individuals lack access to primary care, health centers provide much-needed cost-effective and preventive services and save the health care system money by preventing expensive, avoidable emergency department visits and chronic illnesses. Health centers use sliding fee scales based on patients’ income, have after-hours coverage, meet extensive performance and accountability requirements, and are governed by patient-majority boards that reflect the communities they serve. From Afton to Guymon and Hollis to Idabel, community health centers create jobs and save lives in every corner of our state. OKLAHOMA COMMUNITY HEALTH CENTERS STATEWIDE OVERVIEW PATIENTS SERVED 2018 HEALTH CENTER PATIENT VISITS total patient visits 817,936 626,665 medical visits 78,639 behavioral health visits 69,797 dental visits 4,321 15,075 substance use disorder visits veterans served in 2018 11,772 vision visits 1,778 FTEs employed in 2018 8,475 enabling services visits 5,974 7,513 other professional visits homeless served in 2018 $32,256,830 $19,992,107 sliding fee discounts in 2018 collected in self-pay in 2018 from provided to patients with incomes patients with incomes below 200% below 200% of the Federal of the Federal Poverty Level Poverty Level Uninsured Medicaid Medicare Private Less than 100% of Federal Poverty Level 100-200% >200% <18 18-64 >64 Community health centers (CHCs) know good health care starts when individuals and communities take responsibility of their health! CHCs are private non-profits with patient-majority governing boards that know the issues specific to their communities. Across Oklahoma, from Tishomingo to Tulsa, CHCs provide much needed integrated primary care services in areas where demand for health care is greater than supply. CHCs are efficient! Studies show Medicaid patients treated in CHCs are 25 percent less likely to seek expensive, avoidable emergency room care than non-CHC Medicaid patients and have lower utilization of other services resulting in 24% less health care spending overall. CHCs are effective! Although their patients are predominantly low income and often have complex chronic conditions, CHCs consistently deliver top notch results! CHC patients are more likely to receive primary services like screenings for cancer and depression. CHC patients have lower rates of low birth weight than non CHC patients. CHCs are trailblazers! CHCs have been doing patient-centered primary care for decades! CHCs are private-public partnerships that provide integrated primary, dental, vision, substance abuse, and behavioral health care services alongside interconnected enabling services like transportation, education, and case management. CHCs are a part of the health care solution! The CDC reports that chronic diseases account for 7 in 10 deaths in America. By encouraging physical activity, nutrition, and substance abuse cessation, CHCs help patients avoid costly, preventable chronic illnesses that drive up health care spending. An Answer to Oklahoma’s Primary Care Shortage Community Health Centers target underserved areas and populations and are located in Health Professional Shortage Areas (HPSAs). Seventy-five of Oklahoma’s seventy-seven counties have or contain HPSAs. According to the Association of American Medical Colleges, Oklahoma ranks 45th in the nation in its ratio of physicians per 100,000 people and 44th in its ratio of active primary care physicians per 100,000 people. Three in five rural Oklahoman doctors are over age 50. The average age of physicians in Oklahoma is 52; the average age of rural physicians in the state is 56. As our physician workforce continues to age, community health centers are situated to address our workforce shortage by recruiting talented professionals to medically underserved parts of Oklahoma. Health centers use patient-centered health care provider teams to provide comprehensive, integrated care. From receptionists and medical assistants to nurses and doctors, all members of the medical team work together to provide seamless, quality care to their patients. Why Advocate? To make significant strides in policy priorities, community members – YOU – must be directly involved just as overall health does not improve if individuals do not strive to improve their own health. Further, while obvious, having representation only works if those elected know how to represent you. Health centers have moved beyond being the “best kept secret in the health care industry.” However, health centers must be much more proactive, innovative, efficient, vocal, and prominent to become the “health care home” for 30 million individuals in the next few years. Legislators, agency heads, the media and all of the community must be educated about the importance of sustaining these providers such that all people may have access to care. Consider what is at stake. Everyone wants part of the pie. Moving priority away from your issues when others are pushing theirs is relatively easy when officials do not know much about what you do; decision makers would not necessarily sense a constituent consequence. Policies change based on philosophies, evidence, value, popularity, and perceptions. If only one person calls and makes a reasonable case, that information can become the perceived reality. Further, changing perceptions is difficult. Would you like to be the one to make that call? Do a great job, and then tell everyone about what we collectively accomplish. As health care safety net providers, telling the story is a large part of what ensures that patients get what they need. Examples of policies that can affect primary care safety net providers: • Operational authority and appropriations • Treatment of FQHCs in Medicaid waivers • Health insurance reform • State agency / program regulations • Medicaid eligibility levels and benefits • Infrastructure support mechanisms We have designed this guidebook as a resource that can be updated as necessary to aid you, as a health care advocate, to spread the news about the Oklahoma’s health care needs and make recommendations to improve Oklahoma’s health care system. Not only do we want better health outcomes for patients, but we also realize the economic importance of having adequate health care for Oklahomans. Legislators, agency heads, the media, and communities must be educated about the importance of safety net providers so that all people can have access to high quality health care. In the coming months, we plan to call on you to use your advocacy power – together, we can make a difference! Keys to Health Center Advocacy Know your facts Know your facts and be able to express both your view and that of your opposition accurately. You want others to view you as a reliable source of information. It helps build your credibility and increases your ability to make your voice heard. Have a plan Effective advocacy can take time and planning is important. Having an advocacy plan in place can help you and your advocates respond quickly to important issues and be able to covey a single, cohesive message. Be sure your plan includes ongoing advocacy as well as how to mobilize advocates on short notice. Build relationships with elected officials AND their staff Get to know who represents your health center at the local, state, and federal levels. Invite them to take a tour of your health center. Learn who works in your U.S. Senators’ and Representative’s district offices as well as in D.C. and know what issues they work on. Remember that legislative staffs often act as gatekeepers and key resources for information - help them get to know your program and the benefit your health center brings to the community. Keep the relationships going Take every opportunity to involve your elected officials in your health center. Keep them informed of changes at the health center: the addition of new services or new facilities, new board members, or special events. Always remember to recognize publicly and thank your elected officials for their support of your health center. Learn to tell your story Personal stories are often the most compelling. Learn to tell yours and tell it often. Be able to tell how your health center has benefited you and those you know, share patient stories – or better yet - have them tell their own story. Remember: advocacy is education Advocacy is more than votes and legislation. Advocacy is educating elected officials, the public and your opponents about the work you do and why they should support your health center. Take every opportunity to educate others on the importance of access to high-quality health care and how health centers help provide that access. Keys to Communicating Effectively Basic Tips for Effective Communication 1. Know Your Message. Be sure you are clear about what you want to communicate to your audience. It is impossible to clearly articulate your message to others if you don’t understand it yourself. Have a few key points in mind that you want to make sure your audience understands. Know your facts and be prepared for how you will address any questions or provide information you don’t know or have. 2. Know Your Audience.