Citizen-centered health promotion: Building collaboration to facilitate healthy living

Unhealthy behaviors, notably tobacco use; unhealthy diets; and inadequate physical activity are major contributors to chronic disease in the U.S. and are more prevalent among socioeconomically disadvantaged groups. Differences in the prevalence of unhealthy behaviors among communities with different physical, social, and economic resources suggest that contextual environmental factors play an important causal role. Yet health promotion interventions often are undertaken in isolation and with inadequate attention to these holistic social and economic influences on lifestyle. For example, clinicians\u27 advice to patients to stop smoking or lose weight can help motivate people to change behaviors, but their ability to take subsequent action can benefit from coordination with community-based and public health programs that offer intensive counseling services, and from modified environmental conditions to facilitate behavior change where people live, work, learn, and play. Reshaping these environmental conditions to support healthier living is the subject of six recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier America. Changing the conditions of daily life to make them conducive to healthy behaviors--what is here called citizen-centered health promotion--requires a concerted effort by clinical, educational, business, civic and governmental partners within communities. Linkages among clinical practices and community-based programs have been demonstrated to be effective, but moving from demonstration projects to sustainable community collaborations nationwide will require a proactive effort to establish the necessary infrastructure and financing

Quality Incentives for Federally Qualified Health Centers, Rural Health Clinics and Free Clinics: A Report to Congress

This report to Congress is submitted pursuant to Section 13113(b) of the American Recovery and Reinvestment Act of 2009 (hereafter, the Recovery Act), under Title XIII, also known as the Health Information Technology for Economic and Clinical Health Act or the HITECH Act. The Section requires the Secretary of Health and Human Services to provide a study that examines methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics, and free clinics. The report discusses current initiatives and incentives that apply to these categories of primary care clinics and the current knowledge regarding quality of care and the use of health information technology in this sector. Insofar as the report was authorized under the HITECH Act, it particularly addresses issues related to the use of health information technology by these clinics

Safety-net providers after health care reform: Lessons from Massachusetts

Background National health reform is designed to reducethe number of uninsured adults. Currently, many uninsured individualsreceive care at safety-net health care providers such as communityhealth centers (CHCs) or safety-net hospitals. This projectexamined data from Massachusetts to assess how the demand forambulatory and inpatient care and use changed for safety-netproviders after the state\u27s health care reform law was enactedin 2006, which dramatically reduced the number of individualswithout health insurance coverage. Methods Multiple methods were used, including analysesof administrative data reported by CHCs and hospitals, casestudy interviews, and analyses of data from the 2009 MassachusettsHealth Reform Survey, a state-representative telephone surveyof adults. Results Between calendar years 2005 and 2009, the numberof patients receiving care at Massachusetts CHCs increased by31.0%, and the share of CHC patients who were uninsured fellfrom 35.5% to 19.9%. Nonemergency ambulatory care visits toclinics of safety-net hospitals grew twice as fast as visitsto non–safety-net hospitals from 2006 to 2009. The numberof inpatient admissions was comparable for safety-net and non–safety-nethospitals. Most safety-net patients reported that they usedthese facilities because they were convenient (79.3%) and affordable(73.8%); only 25.2% reported having had problems getting appointmentselsewhere. Conclusions Despite the significant reduction in uninsurancelevels in Massachusetts that occurred with health care reform,the demand for care at safety-net facilities continues to rise.Most safety-net patients do not view these facilities as providersof last resort; rather, they prefer the types of care that areoffered there. It will continue to be important to support safety-netproviders, even after health care reform programs are established

Medical-Legal Partnerships: Addressing the Unmet Legal Needs of Health Center Patients

Medical-legal partnerships (MLPs), now available at over 180 hospitals and health centers across 38 states, are an important option for addressing the legal needs affecting low-income and vulnerable patients, and thereby improving their overall health. We estimate that each year, anywhere between 50 and 85 percent of health centers users - or between ten and 17 million people - experience unmet legal needs, many of which negatively impact their health. In a medical-legal partnership, health care staff at hospitals, clinics, and other sites are trained to screen for health-related legal issues, refer the patient to an affiliated lawyer or legal services team as necessary, and work with the attorney to resolve problems that impact patient health. Medical-legal partnerships assist patients with securing health care and other public benefits, addressing housing issues and family problems, and other concerns that can affect one\u27s health and are often more successfully remedied through legal, rather than medical, channels. This brief examines the role medical-legal partnerships can play in addressing the unmet legal needs negatively affecting the health of health center patients

Coordinating and Integrating Care for Safety Net Patients: Lessons from Six Communities

This report examines efforts to improve the coordination of health care among safety net providers in six communities (Austin, TX; Brooklyn, NY; Indianapolis, IN; Marshfield, WI; San Francisco, CA; and St. Louis, MO), based on case study site visits and a roundtable discussion. Across the communities, we identified three approaches to improving coordination: (1) collaboration of providers using a coordinating organization, (2) coordination facilitated by Medicaid managed care plans, and (3) development of highly integrated care systems. These represent models that could be used by different communities, based on their local circumstances. Successful development of coordination approaches involved shared commitment to a coordinated system and financing arrangements to support coordination. A key challenge was how to provide and support care, especially specialty care, for uninsured patients. A common trend across all the communities was the development of health information technology systems and movement toward patient-centered medical homes. At the time of this study, it was unclear whether the safety net providers in these communities would form accountable care organizations (ACOs), except for one which had already participated in a precursor to the ACO model