Tag Archives: FQHC

Coverage expansion and primary care access

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

Coverage expansion and primary care access

Image result for primary care access

When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

“Given the duration of medical education, it’s not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand,” said the Penn health economist Daniel Polsky, the lead author on the study. There are other ways doctor’s offices can accommodate more patients, he added.

One way is by booking appointment requests further out, extending waiting times. The study findings bear this out. Waiting times increased for both Medicaid and privately insured patients. For example, the proportion of privately insured patients having to wait at least 30 days for an appointment grew to 10.5 percent from 7.1 percent.

The study assessed appointment availability and wait times, both before the 2014 coverage expansion and in 2016, using so-called secret shoppers. In this approach, people pretending to be patients with different characteristics — in this case with either Medicaid or private coverage — call doctor’s offices seeking appointments.

Improvement in Medicaid enrollees’ ability to obtain appointments may come as a surprise. Of all insurance types, Medicaid is the least likely to be accepted by physicians because it tends to pay the lowest rates. But some provisions of the Affordable Care Act may have enhanced Medicaid enrollees’ ability to obtain primary care.

The law increased Medicaid payments to primary care providers to Medicare levels in 2013 and 2014 with federal funding. Some states extended that enhanced payment level with state funding for subsequent years, but the study found higher rates of doctors’ acceptance of Medicaid even in states that didn’t do so.

The Affordable Care Act also included funding that fueled expansion of federally qualified health centers, which provide health care to patients regardless of ability to pay. Because these centers operate in low-income areas that are more likely to have greater concentrations of Medicaid enrollees, this expansion may have improved their access to care.

Other trends in medical practice might have aided in meeting growing appointment demand. “The practice and organization of medical care has been dynamic in recent years, and that could partly explain our results,” Mr. Polsky said. “For example, if patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand.”

Although the exact explanation is uncertain, what is clear is that the primary care system has not been overwhelmed by coverage expansion. Waiting times have gone up, but the ability of Medicaid patients to get appointments has improved, with no degradation in that aspect for privately insured patients.

Sutter will shift 10,000 Anthem Medi-Cal enrollees to community health centers

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.sacbee.com/news/local/health-and-medicine/article167900272.html

Image result for FQHC

 

In Sacramento and Placer counties, roughly 10,000 adult Medi-Cal enrollees with Anthem Blue Cross are learning this summer that Sutter’s primary-care doctors will no longer see them.

Instead, those patients are being shifted to primary-care doctors at community health centers such as Sacramento’s WellSpace Health or Auburn’s Chapa-De Indian Health, said Dr. Ken Ashley, the medical director for primary care at Sutter Medical Group. He said the change in providers will allow the patients to access more services.

“Some of the things that the (community health centers) can provide with the funding that they are receiving are things that sometimes we struggle to find for our Medi-Cal patients, things like optometry and dental, behavioral medicine,” Ashley said. “I feel like these patients are finally going to receive things I could not provide as their primary-care doctor. I’m OK with our partners helping to take care of these patients.”

Sutter, Dignity Health, UC Davis and other providers have all contributed funding and expertise to expand the network of community health centers, more formally known as federally qualified health centers.

The so-called FQHC’s have long been the primary-care delivery network for uninsured, low-income people across the country, but Sacramento did not have a strong network of the centers until the Affordable Care Act set aside funding to help them grow to meet the needs of an expanding Medicaid population.

That flood of new patients has swamped many primary-care providers and has made it harder for all patients to get appointments through commercial providers, Ashley said. Meanwhile, in meetings with the leaders of local FQHC’s, he and other leaders were hearing how those organizations had expanded services, lengthened hours and had capacity for more patients.

About a year ago at one of the meetings, Ashley said, all the attendees began to feel that, if they could shift Anthem’s adult Medi-Cal enrollees, they would improve the health of the primary-care delivery system for a broad set of customers.

“We’ve been having a difficult time getting all our patients in at the time they would like, where they would like,” Ashley said. “This is one more step to try to help allow the rest of the community to help us take care of all these patients.”

Jonathan Porteus, the CEO of Wellspace Health, also leads the Central Valley Health Network, a group of health centers up and down the Central Valley that manage almost 3 million visits a year. He said that Anthem began earlier this year investigating whether the FQHC’s truly had the capacity to absorb the adult Medi-Cal patients served through Sutter.

“We were notified – we being the federally qualified health centers – that this change was coming and that there was a keen interest to make sure that it was smooth, that people would not be left without access,” Porteus said. “The wisdom of Sutter and others has been to help our region have a network of federally qualified health centers, a true blanket of care for the first time ever. This is one of the early tests.”

Porteus said he knows that people have questions about whether the quality of care at his centers is on par with what they would receive from primary-care doctors. He said he welcomes those questions because they give him an opportunity to tell the WellSpace story.

“The Joint Commission, which is the accrediting body that accredits hospitals and shuts them down if they don’t think they’re good enough, has accredited us to be a patient-centered medical home, has accredited all our behavioral health,” Porteus said. “This is a standard many of our commercial colleagues in this community don’t have. If you went into some of these primary-care practices and asked them if they had Joint Commission accreditation for ambulatory care, they will tell you ‘no.’”

There will unquestionably be upheaval in this process for both doctors and patients, Ashley said.

Sutter’s pediatricians will continue to provide primary-care to Medi-Cal-enrolled children covered by Anthem Blue , and the insurer’s Medi-Cal enrollees also still will be able to access Sutter specialists. Sutter primary-care doctors will continue to see anyone on Regular Medi-Cal recipients whose medical providers are paid directly by the government.

Doctor Shortage Under Obamacare? It Didn’t Happen

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

Image result for Doctor Shortage Under Obamacare? It Didn’t Happen

 

When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

“Given the duration of medical education, it’s not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand,” said the Penn health economist Daniel Polsky, the lead author on the study. There are other ways doctor’s offices can accommodate more patients, he added.

One way is by booking appointment requests further out, extending waiting times. The study findings bear this out. Waiting times increased for both Medicaid and privately insured patients. For example, the proportion of privately insured patients having to wait at least 30 days for an appointment grew to 10.5 percent from 7.1 percent.

The study assessed appointment availability and wait times, both before the 2014 coverage expansion and in 2016, using so-called secret shoppers. In this approach, people pretending to be patients with different characteristics — in this case with either Medicaid or private coverage — call doctor’s offices seeking appointments.

Improvement in Medicaid enrollees’ ability to obtain appointments may come as a surprise. Of all insurance types, Medicaid is the least likely to be accepted by physicians because it tends to pay the lowest rates. But some provisions of the Affordable Care Act may have enhanced Medicaid enrollees’ ability to obtain primary care.

The law increased Medicaid payments to primary care providers to Medicare levels in 2013 and 2014 with federal funding. Some states extended that enhanced payment level with state funding for subsequent years, but the study found higher rates of doctors’ acceptance of Medicaid even in states that didn’t do so.

The Affordable Care Act also included funding that fueled expansion of federally qualified health centers, which provide health care to patients regardless of ability to pay. Because these centers operate in low-income areas that are more likely to have greater concentrations of Medicaid enrollees, this expansion may have improved their access to care.

Other trends in medical practice might have aided in meeting growing appointment demand. “The practice and organization of medical care has been dynamic in recent years, and that could partly explain our results,” Mr. Polsky said. “For example, if patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand.”

Although the exact explanation is uncertain, what is clear is that the primary care system has not been overwhelmed by coverage expansion. Waiting times have gone up, but the ability of Medicaid patients to get appointments has improved, with no degradation in that aspect for privately insured patients.

In Nod to Sanders, Clinton Offers New Health Care Proposals

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.nytimes.com/aponline/2016/07/09/us/ap-us-dem-2016-clinton-health-care.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=31499894&_hsenc=p2ANqtz-_YVFuV6N-xd__Ij8NeuODTC1G45rv_nDpH-lD8mfWo9RVqCpIS4TlEHahl3hu9_slRYFpZJvUCv1oIF7xCOxVI5gIXnA&_hsmi=31499894&_r=0

Medicare3

Clinton’s campaign says the proposal is part of her plan to provide universal health care coverage in the United States. The presumptive Democratic presidential nominee also is reaffirming her support for a public-option insurance plan and for expanding Medicare by letting people age 55 year and older opt in.

Medicaid Expansion: Driving Innovation In Behavioral Health Integration

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://healthaffairs.org/blog/2016/07/05/medicaid-expansion-driving-innovation-in-behavioral-health-integration/

Blog_DoctorPatientConvo

Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care. We found that safety-net providers in states that expand Medicaid are delivering more services and better-coordinated care than what is available in states rejecting the expansion.

Of particular interest is the effect of Medicaid expansion on attempts to integrate behavioral health services with primary health care — long a thorny issue for safety-net providers. Research has shown that the Affordable Care Act (ACA) has increased access to behavioral health services. We present case studies from two provider systems that illustrate some of the innovative approaches that are improving the quality of behavioral health care at safety-net institutions.

Halting 340B funding would force 73% of hospitals to cut staff, study finds

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.beckershospitalreview.com/finance/halting-340b-funding-would-force-73-of-hospitals-to-cut-staff-study-finds.html

340B_prescription_bottle

Click to access may-2015-report-to-the-congress-overview-of-the-340b-drug-pricing-program.pdf

The 340B Drug Pricing Program allows certain hospitals and other health care providers (“covered entities”) to obtain discounted prices on “covered outpatient drugs” (prescription drugs and biologics other than vaccines) from drug manufacturers. Manufacturers must offer 340B discounts to covered entities to have their drugs covered under Medicaid. The discounts are substantial. The Health Resources and Services Administration (HRSA), which manages the program, estimates that covered entities saved $3.8 billion on outpatient drugs through the program in fiscal year 2013. The 340B program has grown substantially during the past decade. Covered entities and their affiliated sites spent over $7 billion to purchase 340B drugs in 2013, three times the amount spent in 2005. The number of hospital organizations (a single organization includes a hospital and all of its eligible affiliated sites) participating in 340B grew from 583 in 2005 to 1,365 in 2010 and to 2,140 in 2014. The increase from 2010 to 2014 was driven by growth in the number of CAHs and other types of hospitals that became eligible for 340B in 2010 through the Patient Protection and Affordable Care Act of 2010 (PPACA). In 2014, about 45 percent of all Medicare acute care hospitals—including CAHs—participated in the 340B program.

Celebrating National Health Center Week – FQHC Infographic

Posted on by • Posted in Uncategorized • Tagged , , • Leave a comment

This week — August 9-15 — we’re celebrating National Health Center Week. For the last 50 years, community health centers have delivered comprehensive, high-quality preventive and primary healthcare to patients regardless of their ability to pay. In 1965, the Health Center Program started with just two clinics. Today, there are over 1,300 health centers serving nearly 23 million medically underserved individuals. By overcoming geographic, linguistic, cultural and socioeconomic barriers to care, health centers provide a medical home to one in fourteen people living in the U.S.

More than ever before, hospitals, health systems and community health providers need to understand each other and work together.

Nearly 1,300 FQHCs are delivering care through more than 9,200 clinic locations across the U.S. As primary care providers (PCPs), they are well positioned to work with other local organizations, including hospitals, academic medical centers and public health departments, to identify, address and meet the overall healthcare needs of a community.
The number of patients treated at FQHCs is skyrocketing, providing further evidence of the rapidly increasing importance of community health centers. Watch this number continue to rise as more Americans become insured and hospitals and community health providers jointly establish patient-centered medical homes.
FQHCs provide comprehensive preventive and primary care to medically underserved populations. FQHC patients are typically low-income and are disproportionately members of ethnic and racial minority groups. They historically have been uninsured or underinsured, a trend that is changing in many states as a result of the Affordable Care Act. As a group, FQHC patients have a high rate of serious and chronic conditions that can be effectively treated through population health management strategies that include community health centers working in collaboration with hospitals and other providers.
Hospitals and payers would be wise to begin piloting population health strategies in partnership with community health centers, many of which are becoming accredited as primary care medical homes. FQHCs nationwide are leading the way in reducing costs, in part because as health center utilization increases, avoidable visits to emergency departments decrease.
More than ever before, FQHCs are looking to diversify revenue streams. In many cases, revenue is shifting toward less dependence on grant funding as some states expand Medicaid services and more patients assume responsibility for their healthcare purchases. FQHC leaders will face new challenges as they take on billing, collections and contract negotiations while continuing to advocate for their patients.
By providing primary and preventive care to high-risk populations, FQHCs are dramatically reducing the cost of care. Savings to the healthcare system is expected to reach 40 percent by 2019, with federal and state governments being the biggest beneficiaries.