Health centers have been lauded for providing to a large portion of the nation’s underserved population. In a community based primary care setting, health center patients receive culturally aware and focused care that is specifically directed by the patients themselves. Therefore it is not a surprise a recent analysis found lower utilization and spending for all services by Medicaid patients treated at health centers as compared to matched Medicaid patients overall across all comparison settings. Outpatient utilization and spending were decreased by 22% and 33%, respectively; inpatient utilization and spending were decreased by 25% and 27%, respectively; ED utilization and spending were decreased by 13% and 11%, respectively.
These findings are consistent with the concept of the medical home that bodes well for these community based centers. More than just a business, these health centers offer full spectrum services including social services, education, and case management. The clinicians are often mission-focused with an awareness of the many limitations of their practice. The primary care teams coordinate care regularly in order to address the institutional barriers and social determinants of health that their patients face. When services are not available within the community health centers, the teams continue to seek out cost efficient and patient centered options with their referrals to hospitals and specialty services. The formal partnerships between health centers and these other institutions allow for coordinated charity care that benefits all parties.
While we continue to debate the outcomes and future of the Affordable Care Act (ACA), the patients that are now afforded care under the ACA’s Medicaid expansion are able to access the health center network while also utilizing a more economical option of care. As other studies have shown, taking cost into account does not jeopardize the provided but instead assures that resources are sustained across a community of patients.
commentary by Kameron Matthews
OBJECTIVES: To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth.
METHODS: Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score-matched comparison groups receiving primary care in other settings.
RESULTS: We found that health center patients had lower use and spending than did non-health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients.
CONCLUSIONS: Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees.