In a recent passionate plea, Dr. Mark Smith with the California Healthcare Foundation, inquires, “can Medicaid still succeed in a post-ACA world after absorbing millions of new enrollees (and) rely on its existing networks of clinicians and institutions—despite evidence that many enrollees have more difficulty than other insured individuals in getting an appointment when they need one?” And with the proclamation of National Community Health Center Week, it seems only fitting to consider how these institutions will play an important role in the ensuing Medicaid debate.
With their community oriented team-centered approach, focusing on patient engagement and social determinants beyond traditional primary care concerns, many feel that community health centers present a viable solution for the onslaught of Medicaid enrollees that will exist in the near future. Operating in 8500 locations, these entities serve more than 20 million patients and provide a substantial share of the nation’s primary care infrastructure. And with the help of ACA funding, new health center service delivery sites will expand access to care to more than 1.25 million additional patients and create approximately 5,640 jobs in 2012.
As a strong advocate of the advance practice nurse led medical home, I do agree that the community health center model lends itself to a population centered health management approach. Providing access to much needed services in one succinct spot can be very appealing to those, not only with Medicaid, but private insurance as well. And for those organizations benefiting from the participation of Community Health Corps members, there is no doubt that the truest sense of ‘community’ permeates their mode of service delivery. But despite the additional funds and workforce assistance, I can’t help but wonder about Dr. Smith’s query, “will those who have historically served as the health care safety net have the capacity to care for an influx of some 12 million Medicaid patients, and, why are many so quick to excuse high-performing healthcare systems from the responsibility of providing care that low-income individuals can afford?
For the good news, there are a number of providers that envision a role in delivering care to those falling in the ‘safety net’. As noted in a recent Health Affairs article, hospitals and healthcare systems recognize the need for access to subspecialty care for this vulnerable population and are developing various relationships with their community health centers in order to close the loop. Noted for their ability to create healthier communities, reduce emergency room visits and further the local economy, will these enterprising minds couple patient-centered technology with community oriented healthcare to model healthcare delivery of the future?