Twenty-seven consolidated health centers currently operate within the State of Virginia and three more will go live in the coming months. The majority of these centers are in rural locations scattered throughout Virginia, with heavier concentrations in the southeast and southwest areas of the state. Four health centers, including two CHCs, support the Richmond population, 21 percent of which is below 100 percent FPL. Statewide, more than one million people — 14.9 percent of the population — are uninsured; the most current estimates for Richmond indicate that 8,265 of the city’s children were uninsured as of February 2003 (there are no estimates for number of uninsured adults).8 As of 1998, 689,571 Virginians were enrolled in the state Medicaid program, 61.7 percent of which were covered through a managed care plan.9
In addition to receiving core funding through the federal BPHC, consolidated health centers in Virginia interact with and are supported by a number of Government and association entities. In particular, the Virginia Primary Care Association (VPCA) has provided technical assistance and advocacy support for ambulatory care safety net providers in Virginia for several decades. In addition to the VPCA, health centers are supported by the State’s primary care office (PCO) housed in the Virginia Department of Health Office of State Health Planning and Policy. Consolidated health centers in Virginia also interact with various Medicaid payers. Distinct from many States, Virginia’s Medicaid office sits in a separate Department of Medical Assistance, not within the Department of Health with the State’s PCO.
Consolidated health centers also work with each other through various State and community-level consortia. Two of these consortia, REACH and the CCNV, are featured in this report. Our discussions with stakeholders suggest that government and association support for health centers is largely distributed among distinct organizations and that coordination between offices is sporadic, though there is some evidence of increased communication and coordination over the past year.
Methods. The site visit to Virginia involved initial telephone and email contacts followed with in-person interviews with 22 respondents representing 10 institutions involved in the primary health care safety net in the State of Virginia. Because of the concentration of both community health centers and BPHC-funded consortia in Richmond, we focused our site visit around health centers and stakeholders located in this area. To assure that we received a variety of perspectives capturing health center systems resources and experience, we conducted telephone interviews with a number of non-Richmond area health centers following the main site visit. Table 1 below lists all health centers and other stakeholders interviewed as part of the site visit and follow-up telephone calls.
Telephone discussions and in-person interviews with respondents were conducted using open-ended discussion guides that provided some structure to each exchange while allowing sufficient flexibility to capture all relevant information from each respondent. In addition, a table shell was emailed to information systems staff at respondent health centers prior to the site visit to facilitate collection of standard information relating to infrastructure and technical capacity. For each scheduled site visit interview, the NORC team prepared materials that outlined our preliminary knowledge of the respondent and highlighted outstanding questions to address during the interview. Examples of discussion guides, other data gathering tools and preparation materials used in the site visit are included as Appendices A and B.
Consolidated HealthCenter Respondents
|Daily Planet Homeless Health Center||Daily Planet is a HCH located in Richmond. In 2002 they served 2300 patients over 3900 encounters. They are not a CCNV shareholder but are a participating provider.|
|Vernon J. Harris East End Community Health Center||Vernon J. Harris is a CCNV shareholder and a CHC. It is located in Richmond and served 3300 patients in 2002, with 7000 encounters.|
|Kuumba Community Health & Wellness Center||Kuumba Health Center is a CCNV shareholder CHC located in Roanoke, VA.|
|Peninsula Institute for Community Health||PICH is a CHC and CCNV shareholder located in Newport News, VA. In 2003 they had 20,473 users over 77,600 encounters.|
|Eastern Shore Rural Health System||ESRHS is a CHC and CCNV shareholder. They operate several sites in Nassawadox, VA. In 2001 they had 61,229 patient encounters.|
|Irvin Gammon Craig Health Center||Craig Health Center is a CCNV shareholder, and is in the process of applying for CHC status. It is located in Richmond and served around 1849 patients in 2001, with 3075 total encounters.|
|Hayes E. Willis Health Center of South Richmond||Hayes E. Willis is a Richmond clinic affiliated with Virginia Commonwealth University Health System. They do not participate in CCNV and are applying for CHC status.|
|Richmond Enhancing Access to Community Healthcare||The REACH consortium provides its health stakeholder members with technological (through the MORE Access system) and non-technological services related to data storage, report generation, eligibility tracking, needs assessment, and general support.|
|Community Care Network of Virginia||CCNV is a for-profit, CHC-owned health management services company. Based in Richmond, VA, CCNV provides practice management software, billing, reporting, credentialing, training, and other services to all consolidated health centers in the state.|
|Virginia Primary Care Association||The VPCA is the statewide CHC association. Based in Richmond, it provides its 27 members with services related to provider recruitment, cooperative purchasing, consulting, information, and training.|
|Virginia DOH Office of Health Policy and Planning||The Office of Health Policy and Planning oversees Virginia’s Health Workforce Advisory Committee, the Board of Health, the Primary Care Office (PCO), rural and minority health, and the designation of medically underserved areas.|