Newswise — In the midst of the current health reform debate, policy makers increasingly have shown interest in spurring the establishment and growth of " patient-centered medical homes" to improve the quality of primary care, prevent or alleviate the long-term consequences of chronic health conditions and disease, and bring greater efficiency to the health care system. The nation's 1,067 federally funded community health centers, considered by many to be among the earliest adopters of many elements of the medical home, are uniquely positioned to serve as a model as the health care delivery system is redesigned to enhance quality and value. A major challenge, however, is assuring that payments to health centers align with the building blocks of medical homes.
When properly supported, health centers, both federally funded and an additional 100 "look-alike" health centers that meet all requirements for federal funding, have demonstrated their ability to serve as patient- and community-centered medical homes, furnishing high quality care that meets or exceeds the national average. However, the authors of a new report have found that further evolution by health centers toward a PCMH model depends on the realignment of health center payment incentives to ensure that health centers have the sustained resources necessary to become full medical homes. This includes resources to: adopt and maintain the clinical, administrative, and health information technology changes linked to quality improvement efforts; recruit and retain clinical, administration, and support staff; secure the financial capital needed to add additional operating hours and locations, and establish reliable referral arrangements for patients in need of specialty care.
All providers face myriad challenges as they attempt to reconcile multiple—and potentially competing or inconsistent—incentives created by public and private insurers. But health centers " whether federally funded or look-alike -- face additional challenges for the 18 million patients they serve. These challenges are associated with their unique mission and their obligation to serve all community residents, regardless of their uninsured or seriously underinsured status. Insurance mis-alignment problems include failure to target additional incentives to specific goals, as well as serious under-payment (in the case of private insurance), that in turn causes health centers to use grant funds intended for expanding services to provide primary care for insured patients. In the case of Medicare, a cap on cost-related payments imposed in 1991 means that payments lag well behind the growing proportion of Medicare beneficiaries using health centers. Between 1996 and 2007, the number of Medicare beneficiaries served by health centers increased by 89%, while the total U.S. elderly population grew by only 12%.
The report's authors found that key to sustaining the health centers mission are:"¢ Incremental changes to the current financing systems to better accommodate quality improvements under a PCMH model, or a community-centered medical home model, for the major public payers such as Medicaid, CHIP, Medicare, and the federal grants. "¢ Creating new types of insurance payment mechanisms that might evolve to serve many of those who are currently uninsured or privately insured.
"This report shows that although health centers play a critical role in providing preventive and primary care for many uninsured and insured Americans who cannot afford health care, they face numerous payment policy challenges which could undermine their mission." noted Peter Shin, Ph.D., lead author and the Geiger Gibson/RCHN Research Director in the Department of Health Policy at the School of Public Health and Health Services at The George Washington University Medical Center. Added Professor Sara Rosenbaum, Chair of the Department of Health Policy and study co-author, "Any effort to improve health care financing should not only incentivize high performance but also recognize and support fairly the higher burden of costs associated with medically vulnerable populations."
Financing Community Health Centers as Patient- and Community-Centered Medical Homes: A Primer" can be viewed online at: http://www.gwumc.edu/sphhs/departments/healthpolicy/CHPR/downloads/PCMH_CHC.pdf
The research was conducted by GW faculty with the Geiger Gibson Program in Community Health Policy, located in the Department of Health Policy at The George Washington University School of Public Health and Health Services, and funded by The Commonwealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.
About The George Washington University Medical CenterThe George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area, since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.
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