State Health Reform; Primary Care; Quality Improvement; Health Homes
This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status and access to care. Health centers are models for the organization and delivery of health care based on the principles of community-oriented primary care, which focuses on the health of both patients and communities. National discussions of health reform often consider the potential for the patient-centered medical home model to strengthen primary care, prevent or alleviate the long-term consequences of chronic health conditions and disease, and bring greater efficiency to the health care system. A 2008 report released by Senate Finance Committee Chairman Max Baucus describes an emphasis on primary care as "a common element of high-performing health systems" and recommends further testing and implementation of the PCMH model. The report notes that community health centers represent a critical component of the health care safety net, and have already implemented many elements of the PCMH model. An April 2009 bipartisan policy options report released by the Senate Finance Committee also cites patient-centered medical homes as a possible way to improve care for chronic health conditions.
This brief provides a summary of the "patient-centered medical home" concept, followed by an overview of health centers and an in-depth look at health center financing. Because further evolution toward a PCMH model depends on the realignment of health center payment incentives, it is critical to understand how financing arrangements currently operate, what types of conduct and practices may be incentivized or deterred, and the types of challenges that lie ahead as health care payment policies are reformulated over time. Some of these challenges are faced by all providers as they attempt to reconcile multiple—and potentially competing or inconsistent—incentives created by insurers. Other challenges are associated with the unique mission of health centers and their ability to align quality improvement efforts with their fundamental duty to serve all community residents, regardless of their uninsured or underinsured status.
Shin, P., Ku, L., Jones, E., Finnegan, B., & Rosenbaum, S. (2009). Financing community health centers as patient- and community-centered medical homes: A primer. Washington, D.C.: Geiger Gibson Program in Community Health Policy, Department of Health Policy, School of Public Health and Health Services, The George Washington University.