NACHC Gives Back

Employees at the National Association of Community Health Centers (NACHC) have been busy giving back to the local community through the Community Service Committee (CSC). In August we blogged about CSC’s back to school supplies donation to Building Hope Inc. and the CSC has since organized other service activities.

Walk to end HIVEarlier in the fall NACHC hit the ground walking (literally) for the Walk to End HIV  and raised over $2,000 to support Whitman-Walker Health, a Federally Qualified Health Center (FQHC) that provides dependable, high-quality, comprehensive and accessible healthcare to those infected with or affected by HIV/AIDS.

This month, the Community Service Committee ramped up efforts with two service activities.  The first was a Saturday trip to the Capitol Area Food Bank to sort and pack food for needy families in the DC Metro Area. The food bank serves over 500,000 people and distributes 42 million pounds of food annually, including17 million pounds of fresh produce.

CFAB3

photo 2Second, the CSC has collected warm winter clothes—for children and adults—to donate to DC’s Homeless Children’s Playtime Project.  The Homeless Children’s Playtime Project seeks to nurture health child development and reduce the effects of trauma of children living in temporary housing programs in DC. According to the National Center on Family Homelessness, one in 45 children experience homeless in the US each year and by age twelve, 83% of homeless children have been exposed to at least one serious violent event. The Playtime Project hopes to mitigate the effects of trauma by providing weekly activities, healthy snacks, and opportunities for children to play and learn.

The CSC has many projects lined up for the coming months. Stay tuned for more updates.

Going Without Care

The Commonwealth Fund

The Commonwealth Fund

Lately, we’ve been reading a lot about people who put off seeking care because they can’t afford it, even with insurance.  A case in point is an article that features 60-year old Jay Korobow in New Jersey.  Korobow suffers from high blood pressure and checks his blood pressure at a local drug store.  And what if the blood pressure reading is too high?  “I self-treat myself,” he tells the reporter with NJ.com.

Earlier this fall The Commonwealth Fund found that about 40 percent of adults with high-deductible private insurance plans were putting off care because they could not afford it.  The study (“Too High A Price: Out-of-Pocket Health Care Costs in the United States“) also found:

  • More than one of five 19-to-64-year-old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, 13 percent spent 10 percent or more.
  • Adults with low incomes had the highest rates of steep out-of-pocket costs.
  • About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford.

We also reported on this trend in Community Health Forum magazine, just out this week. Of the more than 7 million people who bought coverage on the federal and state exchanges, about 20 percent chose the bronze plans that include deductibles as high as $5,000 per person, according to Modern Healthcare.

That is where Community Health Centers come in — and why ensuring continued funding to meet the demand for care is critical.  Health centers are essentially “subsidizing” the bronze plans because these underinsured are counting on them for discounted care and the plans won’t reimburse health centers until the patients have met their deductibles—which may well be out of reach for many health center patients.  Compounding financial strain for health centers is the fact that private insurance only reimburses them on average of about 56 cents on the dollar (compared to 81 cents on the dollar for Medicaid patients).

“Health centers have a long history of supporting a coverage expansions of all types–but yet again, as the provider on the front lines, health centers are seeing that coverage does not necessarily equate to access to needed care,” said Dan Hawkins, NACHC’s Senior Vice President for Public Policy and Research.  “While health centers stand ready to meet the growing demand for care, unless the health center primary care funding cliff is fixed and new Qualified Health Plans pay health centers adequately, there will be a grievous strain on health centers already-limited resources.”

A Snapshot of O & E Progress from Health Centers

OE2 Poll ResultsThe second open enrollment period (also known as “OE2″) for health insurance coverage under the Affordable Care Act kicked off last month and early reports from health centers paint a much more positive picture compared to this time last year.

Nearly 65 percent of health center staff nationwide (who include Navigators, certified application counselors, in-person assisters, and enrollment coordinators) report that the open enrollment period is going better than expected, according to a recent NACHC poll. Sixteen percent of respondents reported that the current open enrollment period is going about the same as this time last year while only six percent said that it was going either worse or much worse than last year.

Over half (54 percent) of respondents say they are meeting their enrollment targets, and just under 30 percent of respondents reported assist numbers that were below expectations.

The biggest challenge for enrollment was the affordability of some of the plans (50 percent of respondents). Other issues cited included problems accessing the Health Insurance Exchanges because of incorrect login information (49 percent) and problems with the federal and state exchanges being offline or not working (36 percent). These responses track with early media reports during the first week of enrollment about technical problems with some state exchanges. There were also reports of people unable to access their accounts with user names and passwords.

The NACHC poll underscored the problem of health insurance literacy. Many people are gaining access to health insurance, often for the first time in their lives. Sixty percent of respondents to the NACHC poll reported that their consumers have some, but limited, knowledge of insurance terms and how to use their insurance. Assisters reported having to spend time during the enrollment process explaining terms to consumers and how to access care as a result of this challenge. Nearly 17 percent of respondents said that consumers are very confused by terms and how to access their care.

The poll consisted of 277 responses from 44 states.

Focus on Hepatitis C: Health Centers Work to Address the Chronic Disease

This three-part blog series spotlights the great work of three Community Health Centers addressing Hepatitis C. Hepatitis C is a significant public health problem in the United States.  Of the approximately 3.2 million people in the US who have chronic hepatitis C (HCV), most do not know they are infected. HCV is more prevalent in patients who are seen in Community Health Centers than HIV.  According to the 2013 Uniform Data System (UDS) 145,309 patients had a primary diagnosis of HCV, up from 61,294 in the prior year. Left untreated, chronic HCV can cause significant liver complications, including cirrhosis, cancer and failure.  It is the leading reason for liver transplants in the United States. In this third and final post on HCV we highlight the role of telemedicine in helping provide holistic, coordinated care to HCV patients.

Community Health Center, Inc. (CHC) has 13 service delivery sites in Connecticut, but its single Hepatitis C treatment provider could at best see patients at two or three.  How could the organization extend holistic, coordinated HCV care and treatment to all of its patients within its primary care patient centered medical home?  In 2012, CHC became the first health center to replicate the Project ECHO™ (Extension for Community Healthcare Outcomes) model, which was pioneered by the University of New Mexico and has been traditionally implemented by academic institutions.

The CHC HCV ECHO™ program allows primary care providers and teams to gain skills and knowledge to diagnose and treat HCV within their own primary care settings. Using state of the art technology, a multidisciplinary panel of experts with front line clinical expertise hosts virtual sessions for primary care teams that want to incorporate HCV diagnosis and treatment into their daily practice. Regularly scheduled sessions are comprised of brief instruction on a relevant HCV related topic and discussions of actual patient cases. Initially established to prepare CHC’s own primary care providers and teams to manage HCV so that their patients could be cared for in a medical home familiar and comfortable to them, CHC’s HCV ECHO™ is now open to providers from health centers around the country.

Daren Anderson, MD, VP/Chief Quality Officer at CHC

Daren Anderson, MD, VP/Chief Quality Officer at CHC

An important feature of CHC’s HCV ECHO™ is its emphasis on team-based care. Daren Anderson, MD, VP/Chief Quality Officer at CHC points out that this is particularly important for managing patients with HCV, as many have co-morbid (co-occurring) health conditions, such as addiction and other behavioral health diagnoses that require a team approach.  In fact, says Dr. Anderson, it is the primary care provider and the behavioral health provider who share the responsibility of presenting patient cases during the ECHO™ sessions.  Recommendations from the panel of experts regarding specific patient cases involve various members of the primary care team and emphasize collaboration and integration across the organization.

As primary care providers and teams become skilled in caring for complex, co-morbid patients with HCV, Dr. Anderson stresses that it is critical that the delivery systems that surround them are supportive and not limiting. In tandem with its HCV ECHO™ program, CHC runs a Quality Improvement Coaching ECHO™, which teaches the science of quality improvement and how to engage with and redesign systems of care.  Clinical expertise and an efficient delivery system must go hand in hand.

In addition to HCV, CHC runs ECHO™ programs for Chronic Pain, HIV, and Buprenorphine Management Therapy.  To learn more about these programs, please visit http://quality.chc1.com/ECHO.

For more information and resources on HCV, visit http://www.nachc.com/hepatitisc.cfm.

A Legacy of Saving Lives Gains Notice

The study focused on health centers during their first 10 years of operation.

The study focused on health centers during their first 10 years of operation.

Just as Community Health Centers prepare to mark their 50th year of existence a new study emerges that shows how effective health centers were even in their earliest years. The new research has focused on when health centers were first funded from 1965 to 1974 and found that health centers sharply reduce mortality rates at a low cost.

“Mortality rates dropped 7-to-13 percent among individuals 50 and older after CHCs started operating,” said Martha Bailey, a research associate professor at the University of Michigan Institute for Social Research in an article published by the University of Michigan. “CHCs also cut the mortality gap between the poor and nonpoor in that age group by 20-to-40 percent.”

The article notes that the most significant reductions were to death linked to cardiovascular problems. Health centers saved the lives of 81,644 individuals 50 and older during their first ten years of operation. The University of Michigan study was the first to focus on the long-term affect health centers have on mortality rates and to examine effects by age group, race and population density.