Health Center Trends: Recent Experience in Medicaid Expansion and Non-Expansion States.

In thousands of medically underserved communities across the U.S., community health centers enroll lowincome people in health coverage and provide care to millions of patients. Against the backdrop of significant health center expansion over several years and a full year of expanded health coverage under the Affordable Care Act (ACA), this brief examines change between 2013 and 2014 in the volume and health coverage profile of health center patients, and health center enrollment activities and service capacity, comparing states that implemented the ACA Medicaid expansion in 2014 and states that did not expand Medicaid in 2014. The study is based on 2014 data from the federal Uniform Data System and a 2014 national survey of health centers

Combining sanitation and hand washing promotion: an example from Amhara, Ethiopia

Given the importance of the MDGs, sanitation coverage is a focus of many programs. Hand washing is often not integrated into sanitation promotion even though hand washing with soap at certain junctures helps reduce morbidity and mortality associated with diarrheal disease and is easy to incorporate into sanitation programming. With support of the World Bank-AF’s Water and Sanitation Program and USAID’s Hygiene Improvement Project, the Amhara Regional Health and Education Bureaus in Ethiopia implemented a program promoting sanitation uptake together with the installation of a hand washing device at latrines, fully supplied with water and a cleansing agent, in accordance with the national hygiene and sanitation strategy. This document reviews the results. Although statistically significant drops in sanitation uptake were observed, hand washing device installation kept pace with existing (substandard) trends but did not surpass them. Hand washing promotion may need to rely on social mobilization approaches as much as sanitation does

Quality of Care in Community Health Centers and Factors Associated With Performance

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for assessing the quality of care provided by health centers, which serve a uniquely disadvantaged population, have been lacking. Recently, the Kaiser Commission on Medicaid and the Uninsured (KCMU) partnered with the George Washington University to analyze health center performance relative to Medicaid managed care organizations (MCO), which also serve a low-income population, on important measures of quality of care – diabetes control, blood pressure control, and receipt of a Pap test in the past three years. The study also aimed to identify factors that differ significantly between high-performing and lower-performing health centers. Using data reported in the federal 2010 Uniform Data System (UDS) by health centers and the 2008 Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid MCOs, we defined health centers as “high-performing” if their rates exceeded the 75th percentile of Medicaid MCO HEDIS scores on all three of our quality measures. We defined health centers as “lower-performing” if their rates were below the mean Medicaid MCO HEDIS score on all three measures

Integrating hygiene improvement into HIV/AIDS programming to reduce diarrhea morbidity

This paper highlights discrete hygiene activities that organizations working in HIV/AIDS prevention and care can integrate into HIV/AIDS programs to help achieve the hygiene objectives outlined in the Preventive Care Package Guidance issued by the President’s Emergency Plan. These discrete hygiene activities can help mitigate the impact of diarrhea on people living with HIV and AIDS (PLWHA) and their families thereby prolonging and improving their quality of and protecting family members and caregivers from contracting diarrhea

Horizontal challenges: WASH and nutrition integration

Vertical development programming is not delivering the results or progress that countries need to develop and thrive. At the household level, undernutrition in all its forms is estimated to contribute to 3.1 million child deaths each year. Collaboration among sectors such as WASH, nutrition, and health is necessary and recognised but is only beginning and as in all integration efforts, presents challenges. Recent emphasis on integrative and comprehensive approaches has the implicit hypothesis that by integrating we can make headway and perhaps achieve cost efficiencies as well. Yet evidence is still scant, this paper begins to document several modalities for integrated WASH programming, using experiences in two countries, Mali and Uganda to highlight the challenges we have encountered to integration while trying to make programming more horizontal and true to life

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and small businesses. In addition, the law established a Health Safety Net (HSN) Fund that finances health care for residents who remain uninsured permanently or on an intermittent basis. Understanding that outreach and enrollment assistance would be essential to the health reform law’s success, Massachusetts policymakers launched high-profile public education campaigns, but they also provided for person-to-person, hands-on assistance, especially in low-income communities with large numbers of uninsured residents, many of whom have no previous experience signing up for insurance subsidies or selecting and enrolling in a health plan. Community health centers – a critical source of comprehensive primary health care and many other services for medically underserved populations and communities in Massachusetts – have played a central role in this outreach and enrollment effort. To help inform current outreach and enrollment efforts associated with the ACA’s coverage expansion, the Kaiser Commission on Medicaid and the Uninsured asked researchers at The George Washington University to examine the enrollment assistance experience of Massachusetts health centers six years into that state’s health reform program. Because of their safety-net role, health centers are uniquely aware of and knowledgeable about the challenges and requirements of assisting uninsured individuals and communities disadvantaged by poverty, minority race/ethnicity, poor health status, language barriers, homelessness, and other factors. As states and communities nationwide gear up to provide outreach and enrollment assistance for the first time under the ACA, the experience of Massachusetts health centers offers valuable lessons to health centers nationally, and to other community-based efforts to reach and enroll millions of low-income uninsured Americans in health coverage