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The New Health Dialogue

A Blog from New America's Health Policy Program

QUALITY: Improving Access To Care At Community Health Centers

Published:  June 1, 2010
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Community health centers play a vital role in our health care safety net, but they are often overlooked in our national conversation. Luckily they weren't overlooked in the health reform legislation -- community health centers get $11 billion. What do they need to overcome barriers to care, give vulnerable and underserved populations the care they need, and plug in some of the gaps in the primary care system? A new report from the Commonwealth Fund, Enhancing the Capacity of Community Health Centers to Achieve High Performance, has some answers.

The report found that many federally qualified community health centers (FQHCs -- but we'll just call them "health centers" here) can provide patients with timely access to on-site care, but face barriers when they try to refer to off-site specialists. Connecting uninsured patients with off-site specialty care was difficult for all health centers (91 percent called it somewhat or very difficult), but it was slightly easier for health centers that were formally affiliated with a hospital. And we mean slightly easier -- a whopping 80 percent of the centers affiliated with hospitals still reported difficulty getting specialist access for their uninsured patients. For unaffiliated centers, 60 percent reported difficulty obtaining specialist access for Medicare patients and 79 percent report difficulty for Medicaid patients. Again, affiliated ones did a little better, at 46 percent and 69 percent, respectively.

Other markers of a successful health center included the capacity to use health information technology and the ability to serve as a patient-centered medical home. More advanced use of health IT allows clinics to better coordinate care across various settings. For example, using HIT, health centers can track patient specialist referrals and receive notifications when test results are available. According to the report:

  • Twice as many health centers with advanced HIT use indicate their providers receive alerts to provide patients with test results than do centers with the lowest IT functional capacity (51 percent vs. 25 percent).
  • Forty-three percent of centers with advanced HIT use report that their providers will receive a prompt at point of care for appropriate services needed by patients; by comparison, just 10 percent of centers with low HIT use are able to do this.
  • Fifty-five percent of centers with advanced HIT use can track referrals until a specialist consultation report returns to the referring provider; only 42 percent of centers with low IT use have this capacity.

The Commonwealth Fund report also measured the health centers it surveyed against the National Committee for Quality Assurance's list of the qualities that describe a patient centered medical home. They include the ability to:

  1. “usually” provide patients with same-/next-day appointments or “usually” provide patients with telephone advice on clinical issues during office hours or on weekends or after-hours;
  2. easily generate a list of patients by diagnosis using the center’s medical records system;
  3. “usually” or “often” track referrals until the consultation report returns to the referring provider;
  4. “usually” track laboratory tests until the results reach clinicians or “usually” alert or prompt clinicians to provide patients with test results; and
  5. collect and report data on clinical outcomes or patient satisfaction surveys.

Most of the health centers had at least one dimension, but only 29 percent had capacity in all five. Medical home models are often linked to better coordinated care and lower costs. The report found that health centers possessing more medical home attributes were more likely to have better care coordination and fewer physician and nurse shortages.

The report concluded that successful community health centers need referral partnerships with hospitals, increased health IT capacity, and to adopt the qualities of patient centered homes. As we move forward in building and improving our community health center infrastructure, it’s important to keep these qualities in mind.

Hat tip to BNA. Read the full report here.

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