Managed Healthcare Executive - March 2009 - (Page 26) { HOSPITALS AND PROVIDERS } is to improve access to care and the overall health of bene ciaries by providing care in the most e cient manner,” Kilstein says. “Community-a liated health plans have strong ties to their communities and typically reinvest their operating margins in programs that improve access to care at the local level, create e ciencies in the delivery of healthcare services, and increasingly seek to reduce unnecessary use of emergency rooms.” The April 2007 paper, “The Impact of Community Health Centers & Community-A liated Plans on Emergency Department Use,” notes the partners typically concentrate their e orts on providing patient education, care management and access to services in primary EXECUTIVE VIEW care settings, including FQHCs. In 2007, FQHCs provided “Recognition and replication of these care to more than 16 million successful models, coupled with funding people. for enhancements such as the expanded use of health IT, are critical . . . for adHealth centers serve one in dressing this issue,” Kilstein says. eight people with insurance. AN EMERGENCY, INDEED Partnerships between health centers FQHCs saved the system While overall health insurance numbers and local hospitals also o er signi cant $17.6 billion annually. took a positive turn in 2007, a closer look bene ts. Researchers at the Morehouse at the data underscores the continued School of Medicine published a study need for a strong network of FQHCs. Health centers currently serve one in the Journal of Rural Health in January, In 2007 (according to the U.S. in three people below the poverty lev- which examined emergency room visits Census health insurance update), the per- el, and one of every eight people with by uninsured people in rural Georgia. It centage of U.S. residents without health health insurance; found a 33% excess of uninsured emerinsurance was 15.3%, down from 15.8% Studies have shown that health cen- gency room visits in counties without in 2006, and the number of uninsured ters reduce ethnic and racial healthcare a health center. was 45.7 million in 2007, down from disparities; and About 40% of the patients seen at 47 million the previous year. Experts estimate that health centers ACHR are uninsured, Sniezek says, so The percentage of people covered by have saved the healthcare system $17.6 support from local companies allows the government health insurance programs billion annually by diverting patients clinic to stay a oat while providing so increased to 27.8% in 2007, up from 27% out of the hospitals, and could provide many unreimbursed services. in 2006. The percentage and number of a similar savings if avoidable emergency “It’s always a challenge to nd local people covered by Medicaid went from room visits were diverted to clinics. community partners, but many are will38.3 million (12.9% of the population) in ing to help—and they are the ones who 2006 to 39.6 million in 2007 (13.2%). LOCAL PLANS allow us to provide a level of care as Studies have shown that at least a Community-based health plans are in good as you would nd in any private third of all emergency room visits are an especially good position to make a setting,” he says. MHE “avoidable,” meaning that they were di erence. non-urgent and treatable in primary “Health centers and community-a liFOR MORE INSIGHT care settings. Overcrowding and in- ated health plans are ideal partners in this See more Hospitals and Providers creasing demand in emergency rooms initiative because their mission and focus managedhealthcareexecutive.com 26 MARCH 2009 he is concerned that “the demand for our services is rising faster than ever before, as even middle-class workers now nd themselves without healthcare coverage.” Amy Simmons, director of communications for the National Association of Community Health Centers (NACHC), concurs with Sniezek’s assessment. “The biggest challenges are a surge in new patients—especially uninsured—in almost every community, and a drop in support from state and local governments, and from philanthropic sources as well, all as a result of the recession,” she says. Meeting that challenge will require collaboration between health centers, health plans and hospitals to reduce inappropriate emergency room use, and experts agree that such partnerships are a critical step toward creating a more cost-e ective and higher-quality healthcare system. for primary care services not only drive higher healthcare expenditures, but also adversely a ect the quality of care, Kilstein says. But as critically important as their mission is, FQHCs don’t always receive as much recognition as they should in their communities. “By and large, community health centers devote most of their resources to providing care; few have full-time people who can help promote their work,” Simmons says. Fortunately, some national media outlets have helped the cause. A New York Times article in December highlighted some positives: http://www.managedhealthcareexecutive.com
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