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Informing Policy. Advancing Health.

Health Reform: A Big Question

What can we expect as health reform moves people from the rolls of the uninsured to the insured? In Colorado, for example, CHI estimates that state and federal reforms will result in 159,000 adults newly enrolled in Medicaid—an insurance program in which enrollees have historically faced difficulty getting health care.

Fortunately, a number of experts are working on this issue. In fact, the July issue of Health Affairs features an article by staff members from Colorado’s own Department of Health Care Policy and Financing.  Jennifer Rothkopf, Katie Brookler, Sandeep Wadhwa and Michael Sajovetz compared the use of services by Medicaid enrollees whose usual source of care was a federally qualified health center (FQHC) with those enrollees whose usual source of care was a private, fee-for-service provider.  Why is this analysis so timely?  Because FQHCs will most likely play an increasingly important role in providing care to the growing number of Medicaid enrollees. The Affordable Care Act includes funding to help FQHCs meet this anticipated increase in demand.

The researchers found Medicaid enrollees whose usual source of care was a FQHC were around one-third less likely to have emergency department visits, inpatient hospital admissions or preventable hospital admissions compared to enrollees whose usual source of care was a private fee-for-service provider.  The findings suggest that the routine and comprehensive care provided by FQHCs lowers the use of expensive hospital services by FQHC users compared to their fee-for-services counterparts, according to the researchers.

While lower utilization is welcome news, the authors acknowledge that the analysis did not measure differences in expenditures between the two groups.  Due to their federal designation, FQHCs provide services to a large proportion of individuals who are uninsured or enrolled in public programs. And because of this designation, FQHCs generally receive higher payments than fee-for-service providers.  With the General Assembly anticipated to make more budget reductions in FY 2012-13, we hope that there will be a phase 2 analysis that includes cost savings in hospital services associated with this promising model of care.