Medicaid's high-cost clients grow in importance: Community health centers expected to double
Increased funding for Community Health Centers included in the health care reform legislation is expected to nearly double the number of patients seen by the centers over the next five years to nearly 40 million.
Daniel R. Hawkins, senior vice president for public policy and research at the National Association of Community Health Centers in Washington, DC, notes that the legislation also will result in some 35 million people gaining either Medicaid or private insurance coverage.
"That could result in incredible health care delays, unless there is adequate health care availability," says Mr. Hawkins. "We think Congress realized this. That is why is they included money to expand health centers now, in advance of the coverage expansion."
Mr. Hawkins says that ultimately, this is a positive development. "I know that states don't necessarily see the Medicaid expansion as good news, but I think that they actually should," he says. "Having a much lower uninsured population means they are going to be in a much better position [to] respond more effectively to people. You won't have a whole bunch of folks left out, who go through back doors to get the care they need because they don't have coverage."
Currently, there are 8,000 health center sites in the United States, which Mr. Hawkins says is "well short of the number needed. We have thousands upon thousands of medically underserved communities. These are typically low-income communities, often inner-city, but also rural, with too few providers."
More primary care
Mr. Hawkins notes that there are some 60 million people across the country today who do not have a family doctor or regular source of primary and preventive health care.
"We all know that this is important as a foundation for health care," says Mr. Hawkins. "That is where health centers are most needed, where communities don't have enough of the right kind of care. Primary care is on the downswing and needs to be revitalized."
The health reform bill also gave a significant increase in funding to the National Service Corp Bill. This provides scholarships or loan repayment to medical and dental and nursing students, in return for practicing in underserved communities. "The beauty of the Service Corp is that it focuses on the two most important aspects of workforce reform," says Mr. Hawkins.
First is the need to revitalize primary care. "Every single assignee provides primary health care. This, we hope and trust, will be a great incentive to pursue a primary care career path," says Mr. Hawkins.
The second issue is the distribution of primary care practitioners. "They come out of school and don't go where we're over-doctored. They go to places where they are really needed," says Mr. Hawkins. "So, it addresses the maldistribution issue, both by discipline and by location."
Mr. Hawkins says that he is already seeing positive changes, such as the fact that more primary care residency slots were filled in 2010 than in the past 10 years.
"Things are starting to turn around already," says Mr. Hawkins. "The [Service] Corp and some other programs in the health reform bill are going to accelerate that positive shift."
Low rates for primary care, which discourage some medical students from choosing a primary care career path, will be addressed. "In the reform bill, you have two things. Medicare is going to give a 10% bonus to those who work in underserved communities. Medicaid payment rates are going to be raised to the Medicare levels for primary care," says Mr. Hawkins. "That is going to be fully federally funded. With each of these changes, we are stepping on the accelerator a little bit more."
Medicaid will benefit
Mr. Hawkins says that Medicaid programs should see significant savings as a result of the expansion of community health centers, because underserved clients will have a place to go for appropriate care.
"Medicaid will benefit because of the incredible savings that health centers deliver by reducing inappropriate specialty care, diagnostic referrals, hospital admissions, and emergency room use," he says.
A June 2010 report from The George Washington University's School of Public Health and Health Services, Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform, suggests that the expansion of health centers over the next 10 years could result in as much as a $300 billion savings. Of this amount, $90 billion will be federal Medicaid savings and $60 billion in state savings for Medicaid.
"The federal government will invest about $430 billion in the Medicaid part of reform, and state share will be about $25 billion," says Hawkins. "But they will get $60 billion back in the way of lowered costs, for both their currently enrolled and newly enrolled beneficiaries, just because of the work that health centers do."
Mr. Hawkins says, "The data shows pretty clearly that when people go to health centers, the total cost of their overall care is 23% lower than if they get their care elsewhere." Community health centers have strongly supported an expansion of Medicaid.
"With all of its difficulties and shortcomings, Medicaid is still the very best health coverage for low-income Americans," Mr. Hawkins says. "The biggest problem it faces is getting enough providers to serve that population."
Community health centers are the providers today to one out of every eight Medicaid beneficiaries in America. "And they would strongly desire to do more, working in collaboration with the Medicaid agencies," says Mr. Hawkins.
For this reason, Mr. Hawkins says that it is in the best interest of Medicaid directors to reach out to health centers through state primary care associations.
"They know where the care delivery points are most desperately needed in the state," he says. "States, health centers, and the state primary care associations that represent them can and should work together to find and enroll these newly eligible people, and get them into a system of care that will provide the greatest value possible."
Contact Mr. Hawkins at (202) 296-0131 or [email protected].
Increased funding for Community Health Centers included in the health care reform legislation is expected to nearly double the number of patients seen by the centers over the next five years to nearly 40 million.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content