FQHC Experiences with ACA

FQHC Experiences with ACA

Peoples Community Health Clinic, Inc.

Peoples Community Health Clinic, Inc.

PPACA impact to safety net providers

Concerns:

Patient - Pent-up demand, complexity of multiple chronic illnesses due to delayed care and poor health habits, low health literacy, unfamiliarity in navigating the health system, substance abuse and mental illness, large segments of the population entering the system at the same time

Provider – Lack of primary care provider workforce, high number of new, complex patients entering the system at the same time, fear that the provider will “miss” something, time required to address each problem, crowd-out of established patients

Primary Care organization – Lack of human resources, systems and finances to manage competing priorities associated with EMR adoption and meaningful use expectations, service expansion, corporate compliance, HIPAA and other regulatory expectations. High degree of uncertainty in funding streams designed to support the safety net. Impact on all services – pharmacy, lab, radiology, referral and care coordination, social services, nutrition counseling, chronic illness management counseling, etc.

Care system – Disjointed funding streams for public, private for-profit and nonprofit providers (Federal, State, County, private insurance products and public insurers (Medicaid and Medicare); high degree of reliance on in-home and other outpatient services to support patient post discharge in rural areas where these services do not exist or are extremely limited; ill-defined responsibilities between primary care medical home, specialty care and hospital care that are exacerbated when costs can be shifted to another entity.

Benefits:

Iowa is slowing entering the universal insurance coverage world ahead of other states and should be better prepared by 2014.

Patients and providers can often see significant health improvements with basic primary care interventions.

Financial recognition of care coordination and achieving quality of care goals.

Reimbursement for a group that was previously not covered.

Opportunities:

FQHCs are developing PCMH capacity that could be valuable to solo private practices or RNCs that may want care coordination, tracking and referral services.

Improvements in managing chronic illness should save overall cost to the system.

Greater empowerment for patients to take responsibility for their health.