Performance Improvement 1999. Community Health Centers

02/01/1999

TITLE: ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers

ABSTRACT: The purpose of this study was to explore the extent to which Medicaid beneficiaries who rely on Community Health Centers (CHCs) as their main source of primary care are likely to experience hospitalization for ambulatory care sensitive conditions (ACSCs), as compared with beneficiaries who rely on other providers. Medicaid claims data for 1992 from five States were used to provide data on inpatient services, outpatient visits, clinical information and demographics. ACSCs were coded for hospitalization and a list of ICD-9 codes was developed for outpatient ACSC visits. The study sample comprised 16,145 CHC users and 32,594 other Medicaid beneficiaries from the same community as a comparison group. The study found that Medicaid CHC users experienced ACSC hospitalization rates 22 percent lower than those of the comparison group. Medicaid CHC users were 16 percent more likely to have outpatient visits for ACSCs and had lower emergency room use. Finally, outpatient visits were found to be reasonably good markers and performance measures for identifying populations potentially at risk for ACSCs. HRSA is using the study results as a source for a performance measure concerning hospitalization rates for ACSCs. The results have also served as the basis for a current study focused on episodes of care. (See PIC ID 7127)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6001

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
 

TITLE: Evaluation of the Impact of the Medicaid Waivers on Consumers and Services of Federally Qualified Health Centers

ABSTRACT: This study assessed the early impacts of Medicaid managed care waivers on federally qualified health centers (FQHCs) as Medicaid providers, and on their consumers. FQHCs have often been primary providers of services to Medicaid recipients in their community and have derived between 30 to 40 percent of their revenues from Medicaid. Therefore, the shift of States to managed care systems for Medicaid beneficiaries can have a significant impact on FQHCs. The study focused on the impact of the first year of Medicaid waiver program implementation on two FQHCs in five States. Site visits were conducted at 10 centers. In addition, data from health plans, primary care associations and State Medicaid programs contributed to the analysis. An exit interview was conducted at some centers, in order to gain consumer perspectives. The study showed that: (1) FQHCs experienced widely varying amounts of change in their population of Medicaid users, from a decrease of 22.7 percent to an increase of 58 percent; (2) managed care placed a new and increased emphasis on the importance of primary care and primary care providers; (3) access to care for FQHC patients, especially adults, improved in many cases; (4) demands on FQHCs by Medicaid enrollees strained the capacity of some FQHCs, resulting in fewer services available to uninsured patients while, in other centers, expanding capacity increased access to services; (5) the financial impact is complex, and is the result of a variety of interacting factors; (6) FQHCs experience a number of administrative and management challenges, such as increasing paperwork demands and complex billing procedures; and (7) consumers were generally satisfied with FQHC services despite changes resulting from managed care. Study results are being used as a source for identifying factors that will affect health centers in future waiver programs, and to inform HRSA program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 5738

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA
 

TITLE: Medicaid Managed Care and FQHCs: Experiences of Plans, Networks and Individual Health Centers

ABSTRACT: The purpose of this study was to examine and compare different managed care participation strategies among 36 federally qualified health centers (FQHCs) in eight markets, focusing on how FQHCs are responding to Medicaid managed care, their reasons for forming plans and/or networks, and factors contributing to their success in plans and networks and under different participation strategies. The study focused on three strategies: (1) being part of an FQHC-owned or sponsored health plan, (2) being a member of an FQHC network, and (3) being an individual contractor with non-FQHC plans. Findings are based mainly on site visits to four FQHC-sponsored plans, eight FQHC networks, and 24 individual health centers. Market-level information from secondary sources and program data were also used. The study found that: (1) nearly all of the centers in the study had experienced a decline in users, revenues, and/or net income under managed care since 1993, with more centers experiencing losses during 1996 than in the earlier time periods; (2) most centers reported having experienced an increase in the volume and proportion of uninsured users; (3) many centers (but less than half) have improved their facilities and operations, but several have had to make cuts in hours and services. In addition, FQHCs have responded to managed care by choosing to participate in FQHC plans and networks, strengthening their ties with local hospital systems, and expanding their involvement in Medicare and managed care contracts. The manner in which FQHCs chose to participate in managed care did not, in itself, appear to make a difference in effects on the center. During the study period, however, many FQHC plans and networks were just becoming operational. Study results are helping to shape policies for participation of centers in managed care, and for the Health Resources and Services Administration's (HRSA's) technical assistance strategies concerning managed care.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6353

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.
 

TITLE: The Performance of C/MHCs Under Managed Care: Case Studies of Seven C/MHCs and Their Lessons Learned

ABSTRACT: This study examined how Community and Migrant Health Centers (C/MHCs) have performed as managed care providers, how participation in managed care has affected C/MHC operations, and how C/MHCs could be assisted in improving their performance in a managed care environment. It is critical that C/MHCs be successful participants in the managed care market in order to be financially viable sources of care for the uninsured and other vulnerable populations. Visits were made to one site in each of seven States. On-site and telephone interviews with key personnel at managed care organizations (MCOs) that had contracted with the C/MHCs formed the basis of the performance assessment of these centers. On-site interviews with key C/MHC staff were used to develop an organizational assessment, which concerned the effect of managed care on C/MHC decision-making, strategic planning, administrative and financial management practices, demands for information and data collection systems, and clinical operations. Based on data provided by managed care organizations (MCOs) for each C/MHC and the regional network of providers, average C/MHC costs were consistently lower for referrals and pharmacy services, and C/MHCs experienced lower or comparable total hospital and non-maternity admissions. Centers reported higher maternity admissions and maternity days. MCO staff emphasized the centers' strategic importance in the network because of geographic location, reputation in the community, experience with Medicaid beneficiaries, and focus on primary care and prevention. Weaknesses cited for some centers included physician turnover, insufficient extended hours and inadequate 24-hour coverage. Findings are being used in discussions with managed care associations and networks, and to inform program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6354

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA