Cooperating for better care.

James Maxwell

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Accountable-care strategies for health centers


James Maxwell, Rachel Tobey, and Christine Barron write in HealthAffairs that community health centers “are well suited to pursue accountable care strategies and serve as the integrators of care on a community basis for a variety of reasons. ….Unlike hospitals, health centers have a clear incentive to reduce inpatient use when medically appropriate. Finally, health centers have a history of addressing social determinants of health and behavioral health concerns, and a strong mission of improving the population health of the communities they serve.”

But many health centers have not participated in or led ACOs. In fact,  hospitals and health plans lead the majority of Medicaid ACOs, despite the fact that health centers’ clientele are mostly low-income people.

“Size is the paramount challenge to community health centers’ ability to participate in accountable care. Accountable care is characterized by providers accepting increased levels of financial risk in exchange for assuming responsibility for populations of patients and changing the delivery of care to improve cost and quality outcomes. To take on risk-bearing contracts, a provider must have a sufficient number of lives so that the cost impact of any individual can be spread across a large population. Large size can also be beneficial for the purposes of negotiating contracts, establishing partnerships, and affecting broader policy discussions. Finally, perhaps most importantly for improving community-level health, having a sizable revenue stream and number of covered lives provides the economies of scale to make large investments in delivery system transformation possible.”

“{One} strategy, applicable to smaller community health centers even if an intrinsic growth strategy is limited by infrastructure, is for a health center to become a dominant provider in a given geographic service area. In the words of one senior leader at a health center, ‘You don’t have to be big, but it helps to be big in your small pond.”’


“Another option is for community health centers to affiliate with a compatible hospital partner that would play the dominant role in leading accountable care efforts.”





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