What are the goals of the Primary Care Access and Stabilization Grant?

• Increase access to health care on a population basis
• Provide evidenced based, high quality health care
• Develop sustainable business entities
• Develop an organized system of care

Where can patients find affordable and quality health services?
Healthcare in Your Neighborhood

Which healthcare providers are participating in the grant program and to whom do they provide services?

Twenty-five public and private not-for-profit organizations that met federally determined eligibility criteria across the four-parish region were awarded funding through the grant for the duration of 3 years. These organizations operate 91 primary and behavioral health care sites across the region, including fixed and mobile facilities. Fifty-six percent are primary care centers, 30% are behavioral health only sites, and 14% provide a combination of services. Fourteen percent of these locations are mobile sites and 86% fixed. The network provided services to approximately 140,000 people between September 2007 and September 2008 (45% uninsured, 26% Medicaid and the balance split between Medicare and commercial coverage).
 

What has been accomplished thus far towards the PCASG goals? 

• As of June 22, 2009, over $80 million has been distributed to participating organizations to stabilize and increase primary and behavioral health care capacity in Orleans, Jefferson, Plaquemines and St. Bernard parishes
• A regional forum for healthcare capacity planning and technical assistance has been regularly convened 
• Data systems have been established to effectively monitor compliance, capacity and performance
• Grantees are actively reducing the number of people (with an emphasis on the low-income uninsured) in the region who do not have a regular source of primary and behavioral health care. There is strong evidence of progress towards bridging access gaps since the grant began in September of 2007, and continued outreach and capacity enhancement is ongoing
• For each six month period beginning in March of 2007, there has been an average increase of 15% in patients served per period 
• As of 12/20/08, compared with the period prior to the grants beginning, there are 36 percent more service locations (from 67 pre-grant to 91 today)

LPHI has partnered with the National Committee on Quality Assurance (NCQA) and has reserved a $3.8 million incentive pool for organizations that meet the NCQA requirements for being recognized as a Patient Centered Medical Home. Thirteen of the participating organizations (representing nearly 36 service locations) have achieved NCQA recognition as Patient Centered Medical Homes in the first of three opportunities to become recognized through the PCASG Quality Improvement Program.

What still has to be done? 

• Expand capacity to meet population needs 
• Create and maintain referral arrangements and information sharing networks among participating organizations to enable access to comprehensive and continuous services for patients 
• Continue to closely monitor grant expenditures to assure adherence to federal guidelines 
• Provide technical assistance and work with stakeholders at all levels to ensure that gains in capacity and quality can be sustained beyond grant funds

What challenges remain?

1. Financial. With the grant ending in September 2010, stakeholders are concerned about establishing funding sources to sustain the investment in primary / preventive care so the value in terms of cost and outcomes can continue to be realized. Important ingredients will likely include the following: 

• Medicaid eligibility expansion to increase the number of individuals with insurance coverage
• Flexibility in the use of Medicaid Disproportionate Share (DSH) dollars as outlined in LAs 1115 Medicaid waiver request so it can be used to support outpatient primary care
• Expansion of the Federally Qualified Health Center program in the New Orleans Region and the State to bring it in line with levels of funding received by states/ regions with similar needs

2. Investment in Health Information Technology (HIT) and its implementation. Additional funding/ investment is required immediately if we are to get the most from this federal investment in terms of sustainable efficiency and outcomes.

3. Capital investment to build more community health center sites in areas in need of facility upgrade/ expansion, and in areas currently without adequate geographic access.

Can my organization apply for funding through PCASG?

The Federal grant rules called for a one time request for applications in July 2007. New applications are not being accepted. However, individuals and organizations interested in supporting the grant goals are welcome to participate in regional planning efforts, and can contact us here for more information.

What are the expected accomplishments by the end of the 3-year grant? 

• Every citizen will know where to access a primary care provider they can trust to get the services they need
• Assurance that the services being provided meet a high level of quality based on nationally recognized standards 
• A sustainable network of high quality primary and behavioral healthcare services that meet the needs of the people of the region

PCASG Sustainability Strategy Guide 

How is the program being evaluated?

As the local partner of the State administering the grant program, the Louisiana Public Health Institute has collaborated with the Commonwealth Fund and researchers at the University of California at San Francisco to conduct an objective evaluation of the impact of the federal investment at the patient, clinic and system levels. This evaluation will help policy-makers and other stakeholders understand the return on the federal investment, inform future decisions about investing in primary care, and share lessons learned with other states and communities struggling with similar challenges. However, LPHI also maintains and analyzes program data as a part of its role as administrator.