Keeping it in the Community

Colorado has 140 community health centers (CHCs) that provide care for 9 percent of the state’s population and 36 percent of Colorado’s Medicaid and Child Health Plan Plus clients.  Community health centers are a potential solution to health care costs targeted by the Affordable Care Act of 2010. The authors of this study sought to assess the ability of Colorado’s CHCs to prevent several expensive and sometimes unnecessary events: emergency department visits, inpatient hospitalizations, preventable hospital admissions, and ninety-day hospital readmissions.

Of the almost 180,000 Colorado Medicaid clients, only 21 percent used the state’s community health centers while 79 percent used a private fee-for-service provider in fiscal year 2008.  The likelihood of the above outcomes for these two groups were compared.  Researchers controlled for sex, age, rural or urban residence, and disability when comparing patients who visited private fee-for-service providers and Medicaid clients  whose usual source of a care was a CHC. “Usual source of care” was defined as two or more office or clinic visits during the single fiscal year.  Acute conditions included dehydration, bacterial pneumonia, and urinary tract infections.  Chronic conditions included conditions related to diabetes, COPD, hypertension, CHF, angina and asthma.

CHC users were less likely to visit an emergency department (OR 0.65, p<0.01), have an inpatient hospitalization (OR 0.68, p<0.01), be readmitted to the hospital within ninety days (OR 0.65, p<0.01), be admitted for a preventable acute condition (OR 0.66, p<0.01), or be admitted for a preventable chronic condition (OR 0.62, p<0.01).

Commentary

While the Affordable Care Act of 2010 was mainly focused on the ability of stakeholders to fund health care services and the different mechanisms upon which those stakeholders rely, the legislation wisely provided new funding for community health centers. Thus, the Affordable Care Act ought to expand actual access to care and potentially will cut costs.  Though the authors were unable to assess actual costs saved, the decreased likelihood of using traditionally more expensive health care services among patients receiving care at CHCs is worth acknowledgment and promotion.

Health care financing through health insurance exchanges and private entities will become topics for discussion over the next few years; however, attention must not be diverted from the actual delivery of care in the short term.  Programs such as that have been shown to improve primary care and preventive health outcomes.  Why continue to devise complex funding strategies for expensive and sometimes inefficient services, when instead we might take advantage of known opportunities that save costs and provide more comprehensive care?

Rothkopf J, et al.  “Medicaid Patients Seen at Federally Qualified Health Centers Use Hospital Services Less than Those Seen By Private Providers.”  Health Affairs. 2011; 30 (7 ):1335-1342. 

by Kameron L. Matthews, MD, Esq.

Information below courtesy the National Association of Community Health Centers

• National Health Center Week is the 2nd week of August each year
• CHCs have been around for over 45 years
• They serve 20% of low-income, uninsured people
• 70% of their patients live in poverty
• They provide comprehensive care, including physical, mental and dental care
• They save the national health care system $24 billion a year by helping patients avoid emergency rooms and making better use of preventive services