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FQHC’s: More funds but big challenges


The Affordable Care Act has provided Federally Qualified Health Centers  with new financial resources. However, a new study from the UCLA Center for Health Policy Research  cites continuing  challenges at these centers, including the need for more stable revenue streams, sufficient staffing support, including training, and help in dealing with new reimbursement systems.

Researchers found  that most FQHC’s now see more patients than they did before the health law went into effect, contradicting  some earlier projections that newly insured people would leave the centers for private providers.

The number of insured patients using FQHC’s surged 35 percent, from 12 million in 2010 to 16.5 million in 2014, says the study.

“Most … saw an increase in the number of insured patients, both because they retained previous patients who became insured and because they attracted new insured patients,” researchers wrote.

The study also found that the number of immigrants seeking care at the centers grew 12 percent between 2010 and 2014, to 5.3 million. The 31  FQHC’s  studied also reported that a common reason that patients were ineligible for insurance was that they were in the U.S. illegally.

The researchers found  that federal grants  awarded to FQHC’s as a result of the ACA provided needed funding to help serve the growing numbers of people using CHCs, particularly in states that didn’t expand Medicaid.

But the researchers added that much of the new funding is temporary, presenting possible long-term problems. Particularly problematic may me the predictability of Medicaid funding.

To read the report, please hit this link.

Smooth care transitions a point of pride for this small R.I. hospital


South County Health, a small nonprofit system in bucolic southern Rhode Island, owes a large part of its success to its ability to manage transitions of care – an increasingly urgent imperative as healthcare moves from fee-for-service to value-based reimbursement.
The system’s flagship is South County Hospital, a 100-bed community hospital. The system also includes South County Home Health Services (a home health agency); South County Surgical Supply (home medical supplies); South County Medical Group, with 65 physicians and advanced-practice providers, and two Medical and Wellness Centers, one in Westerly and the other in East Greenwich, with urgent-care facilities and an array of primary-care and specialist physicians.

South County Hospital has long had very high marks for quality and patient satisfaction. Indeed, surveys have often called it the best hospital in its state and one of the best in New England. It was recently awarded a five-star rating by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), putting it in the top 2 percent of those surveyed nationwide.

Louis R. Giancola, the system’s president and chief executive, attributes much of the hospital’s success in patient satisfaction — and fiscal stability — to the strong engagement of its staff, which “we keep in the know’’; a “supportive board’’; the long-term loyalty of people in the service area, and the “nimbleness of a community hospital’’. Having a relatively affluent market with many well-insured people hasn’t hurt either, he acknowledged.


Mr. Giancola.

A particular point of pride is: “We’re good at transitions of care. Maybe that’s a result of our being small.’’

South County Hospital, like virtually all health systems these days, faces many challenges in dealing with the rewards and penalties involved in the forced-march transition to value-based reimbursement. Mr. Giancola notes:

“Medicare incents us to improve patient satisfaction, reduce hospital infections and avoid various patient injuries.  Most commercial payers (insurers) have followed suit. I believe the threat of reduced payments has focused our attention on these measures even though we sometimes complain that the measures are not always fair.’’ (See below.)’’
“It’s all about blocking and tackling. The biggest issue is readmissions within 30 days. {South County has long had lower readmission rates than most hospitals.} We’ve really focused on managing the transition from the hospital to another level of care. The important element is good communication between the hospital providers and the skilled-nursing facility, home health and the doctors caring for the patients in the community.’’

Part of South County’s recognized success in overseeing clinically successful and financially efficient transitions – and, in so doing, reducing costly readmissions — has been its emphasis on using, when possible, home health care instead of nursing centers to save money and improve care, Mr. Giancola said.

The Centers for Medicare & Medicaid Services and other regulators and payers have been pushing hard for better patient-care management, especially since the Affordable Care Act took full effect. Much of South County Health’s work in this area involves helping primary-care physicians to be better traffic managers of their patients’ care.

Another transition success story he cites is medication reconciliation. “Often patients are confused about their drugs and that can lead to readmission because they take drugs that are contra-indicated or they take two meds designed to address the same problem. We’ve hired pharmacists that review meds in the hospital to ensure they are reconciled and the patients get clear advice on discharge.’’

He notes as an example of what might sometimes be unfair pressure from the Feds: CMS’s making hospitals put many patients who have to stay in the hospital for a night or two into “observation’’ status instead of as inpatients, thus slashing potential hospital reimbursement.

Bundled payments, Medicaid and an ACO

An increasingly important strategy for controlling costs and improving care is bundled payments.

South County Health participates in a bundled-payment program for joint-replacement patients with Blue Cross for their Medicare Advantage and commercial-insurance members. (Cambridge Management Group has been doing a lot of work in bundled-payment programs and so this particularly caught our eyes.)

With older-than-average market demographics, the joint-replacement business is a major contributor to the system’s bottom line. (However, while the system is financially stable, its operating margin is only about 2 percent; the system is closely managed.)

Mr. Giancola said that, as with many things in the brave new world of value-based medicine, it’s unclear what sort of savings may come out of the move to bundled payments. However, he thinks that the clinical benefits are clear:

“The bundling process helps us to get a better handle on the clinical process. Having to report quality throughout the entire episode of care makes for better transitions and final outcomes.’’

South County Hospital’s leaders are happy that the Affordable Care Act has put so many uninsured people into Medicaid. While Medicaid reimbursements lag those of Medicare it’s a lot better than no insurance for low-income people. Many of those people, of course, have long used the emergency room as their major source of “free’’ (to them) medical care.

But, perhaps surprisingly, Mr. Giancola told us, Medicaid expansion has not yet cut the flow of people into South County Hospital’s ER, despite efforts encouraged by public and private insurers to promote more and better preventive care to keep people out of the ER. “ERs are too handy for lots of people,’’ he observed.

South County Hospital has had to deal with many other changes, whose long-term fiscal effects are difficult to predict. One is the rising number of employed physicians, hired, Mr. Giancola says, to ensure that the hospital can maintain the range of services that patients want and need in an acute-care facility, such as obstetrics.

Mr. Giancola notes that’s expensive. “Hiring doctors away from private practices to be based in the hospital puts them in more expensive places, with expensive support staffs, equipment and technology. The jury is out on whether the increase in hospital-employed physicians will save money in the long run.’’

Also unknowable at this point is whether South County’s participation in an Accountable Care Organization with Blue Cross & Blue Shield of Rhode Island (BCBSRI) and Integra Community Care Network will ultimately save money. Integra is a partnership of Care New England Health System and its network physicians, Rhode Island Primary Care Physicians Corporation and South County Health and its network physicians. Focused on population-health management, the ACO provides incentives for Integra’s providers to proactively manage patient health, with a heavy emphasis on prevention of illness, while trying to restrain costs.

South County Health, as befits a, well, beloved local institution is big on promoting community-wide collaboration of institutions that can help improve not just healthcare in a clinical sense, but population health.

Toward that end, it has brought together such diverse agencies as the YMCA, the five Federally Qualified Health Centers in its area, school systems, the local Community Action Program and community members to harness the resources of the community. Whatever happens to the ACA, the move toward community and population health will continue, and South County Health will help lead it in southern Rhode Island.

Mr. Giancola has written: “Our long-term goal is to inspire the broader community to see health as a community issue and to mobilize government, schools, businesses and citizens at large to rally around efforts to ensure a healthy community.’’

Feds giving health centers over $260 million for facilities improvements


Federally Qualified Health Centers, a sector in which  Cambridge Management Group has worked intensely, provide an essential service to millions of patients, especially to the still-uninsured.  The information below from HealthcareDIVE was good news for many of them.

  • “HHS announced Wednesday a total of more than $260 million in funding granted to 290 health centers across 45 states, the District of Columbia, and Puerto Rico for building construction, expansion or renovation.
  • “The funding is intended to help health centers increase their patient capacity and bolster their provision of comprehensive primary and preventive healthcare to medically underserved communities.
  • “HHS notes that since 2009, nearly 1,400 health centers operating 9,800 service delivery sites have absorbed an additional 6 million patients to serve almost 23 million every year.

“With some rural health centers closing and the uprise in the insured, some hospitals have noted that it may be hard to deal with an uptick in admissions and HHS is noting that physical space to handle the increase is important.

“Helping health centers improve and expand their clinical space will make it possible for them to serve more than 800,000 new patients nationwide, HHS says, noting the investment builds on a previous $150 million awarded to 160 health centers for building and renovation in September 2015. ”

CMG partner MediQuire gets more venture capital

MediQuire, a  New York City-based health IT company — and  a Cambridge Management Group (CMG) partner– that uses big-data analysis geared to treating low-income and high-risk patients, has closed a Series A round of investment led by FCA Venture Partners.

MediQuire’s data-analytics tools help reduce quality-of-care disparities and avoidable medical costs for the riskiest patient populations treated by a wide range of providers and health insurers, especially Medicaid. These providers include many Federal Qualified Health Centers, a sector in which CMG has done intensive work.

The company, like Cambridge Management, has been heavily involved in helping physicians and healthcare institutions  move from fee-for-service to outcomes/value-based care. MediQuire’s unique products let providers augment the limited reporting capacity of electronic health record systems, enabling providers to report true clinical performance on metrics linked to value-based payments. They also help prevent costly coding errors for both providers and insurers.

The company said  that the  FCA funding, whose amount was not  publicly disclosed, will support MediQuire’s technology development and  expansion of its customer base. 

Matt King, FCA’s managing partner, said: “MediQuire’s proprietary technology to analyze vast amounts of data to accurately calculate provider performance  really sets them apart in the marketplace. When talking to customers {we find that} the overwhelming response has been that their service levels, user-friendly technology and analytics know-how sets them miles apart from the speed and customization received from their electronic health record vendor.”

Meanwhile, Ray Welch Jr., former chairman of AmeriHealth Caritas and former chief executive of Mercy Health System Southeastern Pennsylvania, and  Cathrin Stickney, a former executive at Evolent Health, Cigna Healthcare and Kaiser Permanente, will join MedQuire’s board.

Mr. Welch observed: “MediQuire technology and tools create value for providers…by expanding access to data required for development of effective care plans that improve quality and reduce costs fir Medicaid patients. I look forward to working with the MediQuire team to achieve their vision of becoming a leader in providing Medicaid health technology solutions.”


Health centers get bipartisan praise


This  press release from the National Association of Community Health Centers caught the eyes of us at Cambridge Management Group because we have  worked at Federally Qualified Health Centers:

“An overwhelmingly bipartisan coalition of House and Senate lawmakers called on key subcommittee chairs  ‘to recognize health centers as providers of high quality, cost-effective primary care’ and to ensure continued funding for a model of care that offers a ‘bipartisan solution to the primary care access problems’ facing the U.S.

“The Senate letter, to U.S. Senators Roy Blunt (R-MO), Chairman of the Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, and U.S. Sen.  Patty Murray (D-WA), Ranking Member was signed by 62 Members of the Senate (39 Democrats, 22 Republicans and 2 Independents).  The House letter, to U.S. Rep. Tom Cole (R-OK), Chairman of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, and Ranking Member, U.S. Rep. Rosa DeLauro (D- CT), was signed by 307 Members of the House (178 Democrats, 129 Republicans).  The letters were circulated as the House and Senate prepare to work out FY 2017 funding bills, and on the heels of visits by thousands of health center advocates from across the country.

“Combined with the investments made on a bipartisan basis through the Medicare Access and CHIP Reauthorization of 2015 (MACRA), the annual appropriation is critical to the operations of health centers nationwide as they meet that demand,” the lawmakers write.

“Without access to primary care, many people, including the chronically ill, delay seeking health care until they are seriously ill, leading to higher costs and worse health outcomes. The health center model is designed to address this and other health challenges by fostering innovation and high-value care at the community.

“The historic number of signatories on these letters underscores the strong bipartisan support for Community Health Centers and their mission among Members of Congress,” said Dan Hawkins, Senior Vice President for Policy and Research at NACHC.  “In an era when nearly every issue breaks down along party lines, it is clear that majorities in each party support smart investments in access to primary and preventive care. We hope and trust policymakers will take this into account as this year’s appropriations process moves forward.”

Medicaid to reimburse some Conn. FQHCs for telemedicine with specialists

The New Haven Register reports that Medicaid will reimburse some  Connecticut Federally Qualified Health Centers  for providing patients with access to specialists via electronic consultations. The idea is that this might widen some low-income patients’ access to care.

“The impact is potentially huge,” said Dr. Daren Anderson, director of the Weitzman Institute, the research and quality improvement arm of Community Health Center Inc., said.

CHC is a  network of 13 health centers with facilities in New Britain, Stamford, Norwalk, Clinton and Old Saybrook.

The newspaper said: “An e-consult enables a primary care doctor to contact a specialist — for a second look at patient’s echocardiogram, for instance — and securely send part or all of a patient’s medical records electronically. The specialist then replies to the primary care doctor within a few days (but more typically within just a few hours), reducing the need for a patient visit to the specialist.”

“Anderson, who studied e-consults for about a year, said he found the process increased access to specialty care for underserved populations, reduced the need for in-person care, streamlined specialty referrals and had the potential to reduce emergency department visits.”

The missing 6 million potential Medicaid clients


The Journal reported:

“The Obama administration was closing out the latest sign-up period for coverage under the health law on Sunday, already heralding a late rush of applicants for private coverage. They put the administration well on track to exceed targets of having 10 million people enrolled in plans bought through and state equivalents at year-end, up from nine million at the end of 2015.

“From here, making a bigger dent in the uninsured rate will likely hinge on Medicaid sign-ups, an area that has gotten little formal attention. Federal officials have focused on continuing to expand eligibility for Medicaid and will soon ask Congress for fresh financial incentives for the 20 states that hadn’t agreed to do so at the start of 2016.”

“There are about three million people who now can’t get government-funded insurance because their states haven’t extended Medicaid eligibility, and they don’t make enough money to qualify for private coverage. Still, they are significantly outnumbered by those… who have chosen not to enroll.”

Using community health workers


This Commonwealth Fund report on using community-health workers to help patients navigate the healthcare system by, in part, addressing their socio-economic needs reminded us at Cambridge Management Group of our work to improve community health in various places around America, most recently at Jackson Care Connect, in Oregon, and at Federally Qualified Health Centers.

It should be noted that community-health workers are common in most Developed Nations, but not in the U.S., with its very high healthcare prices and mediocre outcomes.

Post-Katrina primary-care revolution in the Big Easy




Bourbon Street.

Here’s a look at how post-Katrina New Orleans has transformed primary and behavioral health there as seen by Susan Todd, executive director of 504HealthNet, a nonprofit alliance of nearly two dozen healthcare organizations in the greater New Orleans area.

There are numerous lessons in New Orleans’s experience for other localities seeking to improve care of underserved populations, for example through Federally Qualified Health Centers, with which Cambridge Management Group has worked.

Before the storm, low-income and uninsured residents largely received care through the very troubled state-run public hospital system, particularly the flagship Charity Hospital, downtown. The system had overcrowded clinics, long wait times, frequent budget shortfalls, and a location inconvenient to many patients.

Calif. support rises for extending coverage to illegal aliens


The border between Tijuana, Mexico, and San Diego.


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