Performance Improvement 1999. Health Resources and Services Administration

02/01/1999

COMMUNITY HEALTH CENTERS

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. 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 a primary provider 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. Results were: 1) the experience of FQHCs showed great variation in the amount of change in their Medicaid population, varying 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 expanding capacity in other centers increased access to services; 5) the financial impact is complex and 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) consumer were generally satisfied with FQHC services despite changes resulting from the implementation of managed care. Study results are being used as source for identifying factors that will affect health centers in future waiver programs, and to improve 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: This study looked at the impact on and responses to Medicaid managed care among federally qualified health centers (FQHCs) in eight U.S. markets. The study found that: 1) nearly all of the centers in the study 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 (e.g., adding services, expanding hours), 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, strengthened their ties with local hospital systems, and expanded their involvement in Medicare and managed care contracts.

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, DC
 

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. 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 used in discussions with managed care associations and networks concerning C/MHC experiences, 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
 

COMMUNITY HEALTH WORKERS

TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior

ABSTRACT: In recent years, HRSA's primary health care programs have increased their use of community health workers (CHWs) to augment and complement the care patients receive from medical and social service staff members. This study examined the impact of CHWs on access to and use of health services and on patient knowledge and behavior. The study found that CHWs were effective in helping clients find needed services and in providing services that were previously unavailable or limited; CHWs assisted patients with the proper use of services, such as immunizations and breast cancer screening; and CHWs provided education programs to increase patient knowledge about a variety of topics such as hygiene, substance abuse, nutrition, and domestic violence. CHWs were actively involved in case finding and case management in most programs. In some locations, CHWs provided services (e.g., adult day care) that had been unavailable in the community.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Remy Aronoff

PHONE NUMBER: 301-594-4461

PIC ID: 6355

PERFORMER ORGANIZATION: The George Washington University, Washington, DC
 

MATERNAL AND CHILD HEALTH

TITLE: The Implementation of Healthy Start: Lessons for the Future

ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates in the country. The National Evaluation of the program includes a cross-site process component and an outcome study of the original 15 demonstration sites. This report, the final product of the process component, features an analysis of the factors that facilitated or impeded implementation in 14 of the 15 original projects. (A separate report will be issued on the Northern Plains project). The study found that, with substantial federal funding, local communities can develop and implement innovative approaches to reducing infant mortality. Program components include community involvement, outreach and case management, enhanced clinical services, non-traditional support services, and community-wide public information campaigns. Ability to mange effectively-that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff), and monitor contractors-was found to be a critical factor in successful implementation.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Washington, DC