Wednesday, February 25, 2009

Stimulus Role for CHCs

The presenters at the Alliance for Health Reform briefing held on February 23rd on Capitol Hill emphasized how Community Health Centers play a key role in the U.S. healthcare safety net. They provide primary health care and other health services for medically underserved populations including one in eight Medicaid beneficiaries, one in seven uninsured persons, one in three people in poverty, one in ten minorities, and one in nine rural Americans.

Ed Howard Executive Vice President of the Alliance pointed out that healthcare is a major part of the stimulus. The figures show that almost $90 billion to go to Medicaid and CHIP, $19 billion to go to health IT, NIH will receive 10 million, $1.1 billion will to go for comparative effectiveness research, $26 billion to go to COBRA subsidies, plus $2 billion to go to Community Health Centers.

Sara Rosenbaum, Founding Chair of the Department of Health Policy at George Washington University, outlined how the major investments of the American Recovery and Reinvestment Act (ARRA) will specifically be used to help health centers:

  • $1.5 billion will be invested in infrastructure, equipment, buildings and HIT adoption
  • $500 million will provide for ongoing patient care for operational support and expansions, and provide for additional Medicaid payments and grants to increase the adoption and use of EHRs
  • $500 million will go to help stabilize the primary care workforce
  • Funding will be used to deal with the potential Medicaid patient growth resulting from the economic crisis by providing for enhanced federal payments and CHIP reauthorization.

Dr. Rosenbaum reports that the increase in infrastructure, operations and other funding will lead to more available sites especially in underserved areas. As a result, more uninsured, underinsured, and Medicaid/CHIP patients will be served, along with an increase in mental health and dental services. Health IT and capital investments funding will lead to improvements in clinical quality measures. In general, the funding should also stimulate the local economies in both the health and non-health sectors.

To present the picture of a community health center in action, Paloma Hernandez, President and CEO of Urban Health Plan (UHP) located in South Bronx, discussed the impact and value that UHP provides to the community. UHP operates with four primary care traditional practices sites in South Bronx and Corona Queens.

UHPs main site is located in a community that lacks primary and preventive healthcare where over 70 percent of the patients are Latino and Spanish speaking. UHP offers a sliding fee scale based on family income and size where no one is denied services regardless of their ability to pay. In addition, the center provides care at schools, homeless shelters, adult day treatment programs, and boys and girls clubs.

UHP’s service area has one of the highest rates of asthma in New York City. UHP has been able to provide more effective care for asthmatic patients than other Affinity Network providers in 2006-2007. In terms of dollars, UHP cost Affinity 22% less for treating the adult asthmatic population and 39% less for treating the pediatric population when compared with the entire Affinity Network for the two years.

The impact of the stimulus package will enable UHP to expand their main site, take care of the growing uninsured population, and be able to recruit workers from a larger pool of candidates, The funding will help support the required ongoing IT infrastructure in place at UHP, but as Hernandez explained, funding is also needed to build a HIE among all community health centers on a national level to improve tracking performance, outcomes, and the collection of comparative data.

Allison Coleman, Founder and CEO of Capital Link, explained that as a nonprofit Capital Link provides health centers and primary care associations with capital-related technical assistance for building and equipment projects. She pointed out that the $1.5 billion to be available from the stimulus funding represents the largest investment in health center infrastructure in the history of the health center program.

Coleman reports that there are many “shovel-ready” projects that can move ahead as soon as HRSA can make the funds available. She continued to say that some of the projects will likely be 100% grant funded, while others will leverage the federal investment with other funds from a variety of sources including new market tax credits, and other state and foundation grants and loans.

The investment of $1.5 billion over 2 years should result in $3 billion in overall economic impact, including direct, indirect and induced stimulus effect, along with more than 20,000 construction-related jobs.

Also based on new capital projects coming on line and growth resulting from $500 million in new funding for health center operations, there will be 48,00 new permanent health center jobs plus 28,000 additional jobs in low income communities based on the health centers’ spending in the community.