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Informing Policy. Advancing Health.

Safety Net Success Pre- and Post-Reform

June 23, 2011

I recently attended the National Academy for State Health Policy’s (NASHP) conference on implications of health reform implementation for federally qualified health centers (FQHCs). The promise is a whole new era of health delivery for our underserved and other vulnerable populations. The challenge is, as always, in the details.

FQHCs are, in some ways, the darlings of health reform. While the dollars dwindle with every budget negotiation, the Patient Protection and Affordable Care Act (ACA) originally designated $11 billion for FQHC expansions and improvements to take care of the country’s about-to-be-newly-insured populations – particularly those who will qualify for Medicaid, as well as those who will remain uninsured.

But reform is a game changer. Here’s the “short list” of what safety net clinics will need to do to survive in the post-reform era:

  1.  Manage the churn. Transient and vulnerable populations will not go away. But they will be harder to categorize for the sake of insurance and reimbursement. Successful safety net clinics will manage the churn, that is, patients with unstable health coverage, by mastering new eligibility systems and transparently caring for patients who swing back and forth between Medicaid and subsidized insurance.
  2. Redefine the workforce. Emerging players, called “navigators” and “community health workers,” will be essential to reform’s success. They will help our most vulnerable populations get access to care. Safety net clinics will need to capitalize on these workers through training, education and recruitment.
  3. Mind the governing board. As accountable care organizations (ACOs) take shape, incentive payments to providers will be based on the decisions of locally governed ACO boards. Safety net clinics will need to ensure adequate representation and recruit board members who understand and champion their mission.
  4. Adapt the business model. CHI estimates that more than 200,000 Colorado adults and children will become eligible for Medicaid after implementation of state and national health reform. This will change the reimbursement/payer mix of most safety net clinics. Managing costs and operating efficiently under the new, enhanced Medicaid rates will affect overall financial performance and sustainability.
  5. Partner effectively. Safety net clinics, now more than ever, will need to partner for a vast array of services across the continuum of care. These partners will include mental health centers, hospitals and specialist practices, and likely community-funded and free clinics. Well over 250,000 Coloradans will still be without health insurance, however. Partnering formally or informally with other community providers may be part of the answer to cost savings, effective operations and overall solvency.

Safety net clinics will remain an essential part of our total delivery system. Adapting to the new world order is paramount. A special shout out to NASHP for shedding light and furthering the conversation on this aspect of reform.