Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

Reviews 2008 legislation reauthorizing community health centers and the factors affecting their role as providers for the uninsured, publicly insured, and underinsured. Outlines health centers' patient mix, quality of care, revenues, and challenges

Assessing the Need for On-Site Eye Care Professionals in Community Health Centers

Poor vision health severely impacts school and work performance, quality of life, and life expectancy, and results in billions of dollars in medical expenditures each year. While eye and vision problems are often associated with age, low income and racial and ethnic minorities also have elevated risk of eye problems. Federally-funded community health centers, which are mandated to provide comprehensive primary care in underserved communities, are often the only option to improve vision health for low-income residents. With respect to certain chronic conditions, health centers are able to provide high quality care that meets or exceeds national benchmarks despite limited financial resources, a shortage of primary care providers, and greater health care demands. What is not well known, is the extent to which health centers are able to provide on-site professional vision care. Our analysis found that seven out of 10 health centers do not staff on-site eye care professionals to provide comprehensive eye exams. Rather, many health centers rely on referral arrangements with local optometrists and ophthalmologists for such services. Major barriers to providing on-site comprehensive eye care services include the inability to afford necessary space/equipment and the perceived lack of reimbursement or inadequate reimbursement from Medicaid, Medicare and private insurers. Health centers indicated also that they also need assistance in developing a business plan, designing space, and developing an inventory of eye care equipment. While the lack of health insurance coverage, differences in Medicaid coverage and benefits across states, and inadequate reimbursements are likely to limit capacity and access to vision care professionals, another challenge may be patient’s general lack of understanding about the need for routine eye exams. Therefore, strategies to improve access to vision care must go beyond developing financial incentives and restoring eye care professionals for eligible placements in underserved communities, to include education about the importance of routine eye care exams

Vision Exams for Children Prior to Entering School

Children\u27s vision problems are very common, affecting nearly 15 million children. Early screening and detection are essential in treating eye disorders in children. This fact sheet discusses statistical data associated with Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of vision/eye conditions, and provides recommendations from the National Commission on Vision and Health

How Does Investment in Community Health Centers Affect the Economy?

The economic slowdown that began in 2007 has prompted policymakers to focus on investments that can produce rapid economic gains in communities. Building on a previous analysis, this Research Brief estimates that a $250 million appropriations increase in the community health centers program would yield health care for an additional 1.8 million patients and a nationwide four-to-one return on investment: nearly$1 billion in direct community economic benefits, and over $1.1 billion in indirect benefits in jobs and other community investments. On a state-by-state basis, each$1 million in federal appropriations would assure care for an additional 8,400 patients and a six-to-one rate of return with more than $6 million in direct and indirect economic benefits

Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

This Policy Brief examines the role of health centers in the U.S. health care system, assessing their current and future roles in an era of both great promise and challenge. On one hand, government is poised perhaps more sharply than any time in nearly a generation to undertake a comprehensive effort at national health reform, addressing not only coverage but also access, quality, prevention, and the reinvigoration of primary health care, particularly for populations who face the highest health risks. On the other hand, the nation is facing the most severe economic recession in years, with lower income families and medically underserved communities particularly vulnerable to further loss of economic security including jobs and health care. Because of their special attributes, health centers represent a key component of the health care puzzle, not only for the patients and communities they serve, but also for the large number of people and communities who remain without a regular source of primary health care because of financial, social, cultural, and geographic barriers. Following a background and overview of health centers, this policy brief reviews 2008 legislation reauthorizing the health centers program and examines the factors that will determine the extent to which this resilient and respected program is able to achieve its promise. This analysis uses data derived from the Uniform Data System (UDS),1 as well as other data and research on health centers

Health Centers: An Overview and Analysis of Their Experiences with Private Health Insurance

Steady growth in the number of uninsured and under-insured has sparked health reform proposals at the national and state levels. With many proposals emphasizing expanded access to private health insurance among the low-income population through the use of tax credits and an emphasis on stable and continuous primary care as a key to improving health care access, the interaction between health centers and private health insurance becomes an important aspect of national health policy. This policy brief provides an overview of health centers, with a special focus on the relationship between health centers and private health insurance

Medicare Competitive Acquisition: Implications for Persons with Diabetes

Nearly one in five Medicare beneficiaries has diabetes and these patients face major challenges in managing their health. The high diabetes rate among beneficiaries also means that the Medicare program itself is highly vulnerable to the high costs of uncontrolled diabetes. As a result, great care must be taken when implementing any new cost containment strategy that has the potential to disrupt access to preventive health care. This is particularly in the case of the Medicare Competitive Acquisition Program for Durable Medical Equipment and Supplies (DMEPOS), because of its potential impact on access to products needed for a basic preventive service, diabetes testing supplies. Yet despite these concerns over both beneficiary health and program costs, the DMEPOS program, as it is now being implemented, lacks the types of basic patient safeguards considered standard in competitive bidding arrangements such as Medicare Advantage and Medicare Part D

Assessing the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients: Results of a Second Wave Survey

This report represents a second wave follow-up to a first wave study whose purpose was to measure the effects of the Deficit Reduction Act\u27s citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This second wave survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, the second wave survey finds that: Three-quarters of all health centers continue to experience significant problems with citizenship documentation barriers for one or more patient groups; among health centers experiencing problems, the situation appears to be worsening rather than lessening on key measures. Documentation requirements appear to have particularly affected several specific patient categories, including pregnant women, children, patients new to the service area, and newborns. About one-third of health centers report a longer and more difficult application and enrollment process. Nearly one-half of health centers continue to report that Medicaid application and enrollment disruptions and delays continue to affect their ability to arrange for specialty care and many affected centers report increased costs associated with helping patients with application and enrollment problems. Although regulatory changes issued in 2007 were intended to address the problem, a significant number of health centers continue to report enrollment delays affecting newborns. Despite the fact that the DRA did not modify the State Children’s Health Insurance Program (SCHIP) when administered as a separate program, fully one-third of health centers located in states with separate SCHIP programs, and 45 percent of respondents in states with combination programs (Medicaid expansions plus a separate SCHIP expansion), reported that citizenship documentation requirements are being applied to SCHIP applicants as well. These findings suggest that changes implemented in the final rules have done little to ease burdens associated with the DRA’s citizenship documentation requirements, and that the law\u27s greatest impact is falling on low income children and pregnant women and the health care providers that serve them

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment Act

The American Recovery and Reinvestment Act of 2009 (ARRA) will invest approximately $49 billion to expedite health information technology (HIT) adoption through Medicare and Medicaid. Our analysis of 2006 NAMCS data found that approximately 15 percent of the practicing office-based physicians in the country would qualify for up to$63,750 over six years in Medicaid financial incentives for HIT adoption. Included within the 45,000 eligible physicians are about 99 percent of all community health center physicians. If all qualifying physicians apply for the Medicaid incentives and receive the maximum level of payments, the federal government would invest more than $2.8 billion in HIT

Financing Community Health Centers as Patient- and Community-Centered Medical Homes: A Primer

This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status and access to care. Health centers are models for the organization and delivery of health care based on the principles of community-oriented primary care, which focuses on the health of both patients and communities. National discussions of health reform often consider the potential for the patient-centered medical home model to strengthen primary care, prevent or alleviate the long-term consequences of chronic health conditions and disease, and bring greater efficiency to the health care system. A 2008 report released by Senate Finance Committee Chairman Max Baucus describes an emphasis on primary care as a common element of high-performing health systems and recommends further testing and implementation of the PCMH model. The report notes that community health centers represent a critical component of the health care safety net, and have already implemented many elements of the PCMH model. An April 2009 bipartisan policy options report released by the Senate Finance Committee also cites patient-centered medical homes as a possible way to improve care for chronic health conditions. This brief provides a summary of the patient-centered medical home concept, followed by an overview of health centers and an in-depth look at health center financing. Because further evolution toward a PCMH model depends on the realignment of health center payment incentives, it is critical to understand how financing arrangements currently operate, what types of conduct and practices may be incentivized or deterred, and the types of challenges that lie ahead as health care payment policies are reformulated over time. Some of these challenges are faced by all providers as they attempt to reconcile multiple—and potentially competing or inconsistent—incentives created by insurers. Other challenges are associated with the unique mission of health centers and their ability to align quality improvement efforts with their fundamental duty to serve all community residents, regardless of their uninsured or underinsured status