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Insurance enrollment at community health centers


From the National Association of Community Health Centers (NACHC):

“The Impact of Insurance Enrollment on Community Health Centers,” NACHC’s second case study in a series of two, illustrates the impact of federal funding used for outreach and enrollment activities at a federally qualified health center (FQHC) in a state that did not choose to expand Medicaid and did not establish a State-based Marketplace. It follows the first study, which examines a FQHC that conversely chose to expand Medicaid and establish a State-based Marketplace.’

(Cambridge Management Group has done intense work in the Federally Qualified Health Center sector.)

To read the case studies, please hit this link.

A Chicago-area clinics chief is upbeat



Health centers struggle to treat many new patients

By SARAH VARNEY, for Kaiser Health News

See this link for the accompanying PBS video.


The Affordable Care Act unleashed a building boom of community health centers across the country. At a cost of $11 billion, more than 950 health centers have opened and thousands have expanded or modernized.

In San Diego, new clinics have popped up on school campuses and busy street corners. Cramped storefront clinics have been replaced with gleaming, three-story medical centers with family medicine, radiology and physical therapy on site. They are outfitted to care for new immigrants in dozens of languages from Spanish to Somali.

The community health centers are the country’s largest primary-care system for low-income patients, now working to absorb a tsunami of new Medicaid enrollees.

At age 58, after several worrisome decades without health insurance, Lori Simpson is finally getting treatment for her dangerously high blood pressure, a serious thyroid disorder and, after years of double vision that had made it difficult for her to work and care for her grandchildren, surgery for her eyes.
“I have nine medications that I get every month, and mine comes to a little over two hundred dollars,” Simpson said. Prescription medications for her husband, a diabetic, cost $400 a month. “We don’t pay anything, it’s all covered. It’s just amazing.”

Simpson goes to the Family Health Centers of San Diego, which saw an increase of 24,000 patients, almost overnight, after the Medicaid expansion began in January 2014. Dr. Chris Gordon, the center’s assistant medical director, said it was a rush that primary-care clinics have been waiting for ever since President  Obama signed the health law in 2010.

“We’ve anticipated this for years and have been planning for it,” Gordon said. “We have capacity to take on patients. These are patients that haven’t had access before because they just didn’t have the financial means to get in. And now all of a sudden, they actually get to come in, get to spend time with somebody and get to feel like they’re heard.”

Still, problems have plagued the roll out. Three million more people than expected have signed up for Medicaid in California. Other states have also witnessed surges far beyond initial projections, including Kentucky, Michigan, Oregon and Washington State.

As successful as California has been at enrolling millions in Medicaid and in building new primary-care clinics, patient advocates said the Medicaid expansion has exacerbated long-standing shortages in specialty care. Community clinic directors say that it’s often difficult to find cardiologists, orthopedists and other specialists to see their patients and that low-income Californians still face formidable hurdles when they need medical treatment.

For Alessandro Gonzales Gomez, the search for specialty care has been burdensome. Gomez spent years working as a car salesman and auto-parts delivery driver. But now, at age 60 and living alone, he shuffles around his home in an Escondido trailer park, hampered by spells of dizziness that disrupt his daily prayers and curtail his driving.

Gomez is insured under Medicaid, but most of the specialists he needs to see are an hour away. During the drive to a recent doctor’s visit, Gomez said he became dizzy and turned his car around. He went back to the primary-care clinic that had referred him and told them, “’I can’t do this, it’s too far,’” Gomez said. He asked the clinic director about doctors who might be closer, “And she told me that that’s the way it worked out, that there were only certain doctors that would contract with them.”

One of the doctors Gomez has managed to reach is Dr. Ted Mazer, one of the few ear, nose and throat surgeons in San Diego County who accepts Medicaid patients. Mazer said the state does not pay specialists enough to cover their costs.

“If we’re doing some certain surgeries, I can be out of the office for two hours, and we might get $300. My overhead is more than that, so that’s a loss,” Mazer said.

Mazer sees only a limited number of Medicaid patients, but he often agrees to treat those like Qadir Khoshnaw, a 19-year-old in need of a complicated nose surgery. But Mazer said the state is failing to provide this level of care for all Medicaid patients.

“If it was working, I would not have patients coming here from Oceanside and Fall Brook and from the Mexican border and the Imperial County area and the Riverside border,” Mazer said. “I’m one office. Why am I seeing all of those people? Because nobody else is available in their communities to see them. Why not? Because the rates are unacceptable, the hassles from the managed-care plans, as well as the state are unacceptable to most offices to deal with.”

The complaints extend beyond San Diego.

A withering audit by the state of California released this summer found that regulators could not verify if health plans had enough doctors in their Medicaid networks or if the distances patients had to drive were unreasonable. The audit also found that the state’s call centers were overwhelmed, with phone representatives answering just half of incoming calls.

And too often, those obstacles have forced patients to seek help in expensive hospital emergency rooms. In a recent national survey, three out of four emergency room physicians said patient volume had increased, a pressing concern the Medicaid expansion was meant to address.

Emergency room visits at University of California at San Diego Health Systems have increased 11 percent since the Medicaid expansion, says Dr. Christian Tomaszewski, the hospital’s emergency room medical director. “A lot of these patients are coming here looking for sub-specialty care,” he said. “They need an orthopedist for a complicated fracture. They might need a head and neck doctor for some complicated throat problem. And they’re using the emergency department as a gateway to have access to that kind of care.”

At nearby Scripps Mercy Hospital, visits by new Medicaid patients are up 30 percent due to the health law. “It’s a great thing they have insurance,” said Dr. David Cracroft, the hospital’s medical director. “They come for care, but the overall goal was to get them into a primary-care doctor’s office or get them the specialty care that they need, and oftentimes that’s difficult for them to achieve.”

California’s Medicaid program is a budgetary behemoth that falls to Jennifer Kent to manage. As director of the Department of Health Care Services, Kent acknowledged the growing pains as the state stretches to provide health care for nearly one in three Californians.

“We are struggling just as every other state is in terms of how do we bring people into California, how do we grow primary care providers, and then more importantly, how do we provide specialists in areas where there may not be specialists today,” Kent said.

Still, her department is closely measuring complaints and unnecessary hospital stays. Further, undercover agents investigate provider networks and call out deficiencies in the private health plans the state pays to provide care. But Kent says problems with physician access are isolated and are being addressed.

Gov. Jerry Brown, a Democrat, has championed the Medicaid expansion, but like other governors, he has been leery of paying physicians more money just as the state confronts a drop in federal aid. The federal government covers the entire cost of the Medicaid expansion until 2017, but that support scales down gradually, reaching 90 percent in 2020.

Instead, Brown’s administration has pushed the state to spend its money revamping a medical delivery system accustomed to serving poor children, the elderly and disabled to better serve low-income working adults. Across the country, adults on Medicaid are sicker than those with private insurance, and poverty often upends their lives: they change addresses often and can be difficult to reach.

“We have a working population that really has challenges in terms of accessing care in a more traditional sense,” Kent said. “We’re having to work with the providers to say you’re going to have to stretch, in terms of the hours that you offer, using alternative locations and working with nurse practitioners and physician assistants.”
Despite the challenges, there is evidence progress is being made. A recent survey by the Commonwealth Fund found that in states that expanded Medicaid, 93 percent of those who signed up in the past two years are satisfied with their coverage.

For Alessandro Gonzales Gomez, he says he’ll continue to the long drives across the county to see the doctors he needs because his Medicaid card has opened up doors, even if those doors are often difficult to reach.

This story was created in collaboration with PBS Newshour. Jason Kane contributed to this report.

Details on $500 million to go to health centers


The U.S. Department of Health and Human Services  is distributing nearly $500 million in Affordable Care Act funding to support  community health centers nationwide in providing primary-care services to  low-income and other disadvantaged patients

The awards include about $350 million for 1,184 health centers to increase access to such services  as medical, oral, behavioral, pharmacy and vision care. Nearly $150 million will be awarded to 160 health centers for facility renovation, expansion, or construction to increase patient or service capacity.

More details, including a list of recipients, can be found at this link.

The tight bonds of Medicaid and health centers



As Medicaid marks its 50th anniversary, this HealthAffairs article looks at Medicaid’s symbiotic and enduring  relationship with community health centers — a relationship that the Affordable Care Act is making even stronger.

FQHC’s brace for Scotus ruling

America’s 1,200 Federally Qualified Health Centers would be hit hard by a possible U.S. Supreme Court ruling this month eliminating health-insurance premium subsidies for federal exchange-plan enrollees. Modern Healthcare reports that  leaders of  some of these clinics say they’d have to provide far more uncompensated care if the Supremes throw out subsidies.
“Given the shortage of primary-care physicians, community health centers have been key primary-care providers for Americans who have received expanded private and Medicaid coverage under the Affordable Care Act,” the publication noted.
With the subsidies gone,  the centers “could draw a line and say they simply don’t have the resources to serve any more people,” Dan Hawkins, policy director of the National Association of Community Health Centers, told the publication.
Many FQHC’s have already been hit by declines in state funding.
“More broadly, a ruling striking down the subsidies would set back many years of efforts by presidents and congressional leaders of both parties to expand healthcare access to low-income Americans through community health centers,” Modern Healthcare said.
But the direness of the  situation  and its political heat could ironically lead to the long-term effect of a single-payer system like Medicare being extended to everyone.

Health centers’ bipartisan appeal


Community health centers  have developed a constituency that cuts across political divides. Since Cambridge Management Group works with health centers, that’s good news to us as well as  to their millions of patients. Even many conservative Republicans who strenuously oppose the Affordable Care Act laud the Obama administration to help build more of them, as can be seen by recent congressional votes.

And these centers are not just for the poor: Many middle-class people use them because of the range of their services and convenient hours and locations.

Just one example: Republican Sen. Roy Blunt of Missouri visited a St. Louis community health center late last week to indicate his support for such clinics despite his overall opposition to the Affordable Care Act.

He told St. Louis Public Radio:

“I think [health centers] are a great example of how you meet the needs of a community that otherwise would not have their needs met nearly as effectively,” said Senator Blunt, who chairs the Senate committee that  decides how to parcel out the two-year mandatory funding set aside by the Medicare Access and CHIP Reauthorization Act.

Ruth M. Kelley, FQHC expert, joins CMG

Ruth M. Kelley  is joining Cambridge Management Group as a senior adviser.

She has decades of leadership in behavioral health. Her management experience and clinical knowledge  from serving Federally Qualified Health Center  (FQHC) clients are of increasing value as the importance and number of FQHC’s swells and as the role of behavioral health becomes better understood by patients, clinicians, payers and policymakers.  She has extensive knowledge of community health centers’ role in integrating primary care and behavioral health.

Ms. Kelley, a seasoned executive  and a registered nurse, has wide experience with a panoply of behavioral-health issues, particularly in serving populations suffering from substance use  and  co-occurring disorders. Her work at The Dimock Center, which runs  a large FQHC in Boston, where she was chief of behavioral health, received national attention.

In 2014, she received The Lifetime Achievement Award from the Association of Behavioral Healthcare,  the largest Massachusetts advocacy organization for mental-health and substance-abuse issues.

She has worked in substance-abuse matters for more than 30 years, during which time she has gained extensive experience in general administration, contract negotiations, grant procurement, program and policy  development for women, men and their families.  She has sat on multiple  professional committees at the local, state and national level.

Before her career at Dimock, Ms. Kelley served as nurse, counselor and coordinator  for patients with substance-use disorders  at the Massachusetts Osteopathic Hospital  and at  New England Memorial Hospital. Before then, she worked at Sancta Maria Hospital, in Cambridge, Mass., where, among other achievements, she designed and implemented a substance-abuse awareness program .

Ruth Kelley has a master’s degree in management from The Heller School of Social Policy at Brandeis University and a bachelor of science degree in nursing from   Northeastern University.

Happy news for community health centers

The National Association of Community Health  Centers very happily reports:

“The Senate has passed H.R. 2, and the President has signed into law, the Medicare and CHIP Reauthorization Act of 2015. This follows House passage by a vote of 392-37 last month.  The law includes a 2 year extension of critical mandatory funding for Community Health Centers, as well as for the National Health Service Corps (NHSC) and the Teaching Health Centers Graduate Medical Education (THCGME) Program.

“’America’s Health Centers and the more than 23 million patients they serve are extremely grateful that this bipartisan legislation recognizes and invests in the health center system of care’ said Tom Van Coverden, President and CEO of the National Association of Community Health Centers (NACHC). ‘Health centers have been living under the uncertainty of the Primary Care Cliff, and, now that this legislation has passed,  our dedicated clinicians and staff can  get back to the daily work of providing high quality primary and preventive care to underserved patients and communities. In particular, health centers are grateful to the Congressional champions who led the fight to invest in the health center model and bring stability to federal funding.”’

Savings from community health centers are touted


Melanie Zanona,  of Roll Call reports: “Advocates for community health centers facing a drop-off in federal payments later this year are highlighting the estimated $24 billion in medical spending {they say} the centers save annually.”
“Mandatory funding authorized by the 2010 healthcare law—which makes up almost 70 percent of the centers’ overall funding—will run out on Sept. 30 unless Congress intervenes.”
“Supporters acknowledged that federal funding cuts could spell doom for the centers, which have existed since the 1960s and have long enjoyed bipartisan support.”
Miss Zanona reports that “Community health centers are projected to serve 28 million patients this year in areas that typically lack access to large hospitals or doctors’ offices.  The facilities are often credited with generating healthcare savings by improving patient outcomes and enhancing poor and uninsured individuals’ access to care.”

Many of these facilities are in low-income rural areas, such as Appalachia, that vote heavily Republican. That’s one reason why we at Cambridge Management Group, which has done extensive work  with Federally Qualified Health Centers, guess that a bipartisan deal will save federal funding for these community health centers, though maybe, as is often the case on Capitol Hill, at the last minute.


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