Performance Improvement 2000. Community Health Centers


Development and Testing of Emergency Department Utilization as a Measure of Effectiveness for the Health Care for the Homeless Program

The purpose of this study was to test the hypothesis that the presence of a Health Care for the Homeless (HCH) program in a community, by providing homeless clients with a medical home, reduces their use of emergency departments (EDs) for non- emergency use. The HCH program provides primary care and substance abuse services for over 450,000 homeless annually. Through outreach, case management, and linkages with social services, the program has provided homeless clients with a comprehensive medical home. This study took a sample of homeless people in six communities with HCH projects. The study assisted in developing performance measures for the HCH program, and provided a foundation for future evaluation studies. For the six study sites, the project provided information on the ability of the HCH program to divert inappropriate use of EDs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Wells, Barbara, Ph.D.

PIC ID: 7415

PERFORMER: Lewin Group
San Francisco, CA

Primary Care of Patients with Hypertension By Community Health Centers

Community health centers (CHCs) are private, not-for-profit or publicly supported organizations that provide primary health care in medically-underserved areas throughout the U.S. and its territories. These health centers play an integral role in the Nation's safety net for people who lack health insurance or face other barriers to health care. As such, they receive substantial Federal support through grant funds and the Medicaid and Medicare programs. In 1994, the Bureau of Primary Health Care funded an in-person survey of CHC users modeled on the National Health Interview Survey (NHIS). The survey found that CHC users are disproportionately at risk for hypertension, and therefore at serious risk for coronary heart disease, stroke and premature death. The purpose of this project is twofold: (1) to compare the prevalence of hypertension among adult CHC users with other low-income, vulnerable U.S. adults who may similarly face barriers to health care; and (2) to assess whether CHC care of hypertensive patients meets nationally accepted standards.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Regan, Jerrilynn

PIC ID: 6805

PERFORMER: Mathematica Policy Research, Inc.
Princeton, NJ

Results of a Multisite Study of Mandatory Medicaid Managed Care Enrollment Systems: Implications for Policy and Practice

Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study describes the effects of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. The research indicated that while states had similar enrollment practices, their approach to outreach and education regarding enrolling in managed care differed; the lack of information available to beneficiaries on providers and plan networks was seriously compromising or foreclosing their choices; the rate of autoenrollment was not necessarily a useful means of assessing the effects of Medicaid policies; managed care plans were more concerned about the overall decline in Medicaid cases and financial losses due to the instability of the pool of eligible beneficiaries than in autoenrollment policies; while enrollment was important to FQHCs, they were more concerned about financing and reimbursement; beneficiaries felt the ability to choose and stay with a particular provider was their most important concern, despite the emphasis on choosing a plan during enrollment; and although information provided to beneficiaries was limited, they valued material from such familiar sources as their regular provider. Most important of all, the research revealed that pressure from the rapid implementation of enrollment and autoenrollment policies was creating a lack of accurate information on provider networks both before and during enrollment. The report recommends States make advance preparations for mandatory enrollment periods to ensure that more comprehensive information is available to beneficiaries.

AGENCY SPONSOR: Bureau of Primary Health Care


PIC ID: 6803

PERFORMER: George Washington University, Center for Health Policy Research
Washington, DC