In September 2022, a team from the Center of Chronic Disease Research and Policy completed a three-year federal contract with the Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care. Led by CDRP director Elbert Huang and CDRP faculty affiliate Marshall Chin, the Financial Analysis Research Agenda (FARA) project evaluated the performance of the national Health Center Program.

Health centers are community-based organizations funded by the Health Resources and Services Administration to deliver primary and preventive health care services to low-income patients in the United States and US territories. The Health Center Program serves over 30 million individuals, including people experiencing homelessness, agricultural workers, residents of public housing, and veterans.

Drs. Huang and Chin led a team of researchers from the University of Chicago, John Snow, Inc, and Kaiser Permanente Bernard J. Tyson School of Medicine to assess the current value, effectiveness, and financial viability of the Health Center Program, examine how the program is adapting to health care payment reforms, and offer recommendations for the future.

The FARA project found the Health Center Program generally successful in serving diverse, vulnerable populations by increasing access to primary care and lowering the need for tertiary care. The expansion of Medicaid through the Affordable Care Act was shown to improve the financial stability and clinical capacity of health centers. Patients enrolled in Medicaid who used health centers for their primary care tended to have lower total costs for their medical care compared to patients who sought primary care elsewhere. However, there remain opportunities for improvement in the prevention and management of chronic diseases and increasing the integration of care.

FARA KEY FINDINGS

At health centers compared to other primary care settings:

• Adult patients used primary care and the emergency department more often and had fewer preventable hospitalizations at a lower cost to the healthcare system.
• Children attended more primary care visits, attended fewer non-primary care visits, and received the same quality of care at a lower cost to the healthcare system.
• Diabetes patients were less likely to be hospitalized but visited the emergency department more often.
• Patients with substance use disorders were prescribed fewer medications for opioid use disorder but were more likely to receive behavioral health therapies; they also were less likely to be incorrectly prescribed benzodiazepines and opioids.
• For patients who were eligible for both Medicare and Medicaid, there were higher costs for primary care but lower costs to the healthcare system overall for their healthcare.

For health centers:

• Health centers with strong financial performance served more Medicaid patients, had a higher percentage of nurses and physician assistants to support patients, and were more likely to be designated Patient-Centered Medical Homes, centers that offer comprehensive, coordinated, accessible, quality care.
• Medicaid expansion would significantly increase revenue, staffing, and number of patients seen at health centers.
• Section 330 grant funding provides essential support for planning, staffing, and increasing capacity at health centers.
• Direct stimulus funding to health centers maintained healthcare and supported some job recovery in disadvantaged neighborhoods; however, this stimulus did not prevent decline in non-healthcare establishments, suggesting that other forms of stimulus funding may be needed to achieve overall economic recovery after recessions.
• Health center patients in socioeconomically disadvantaged areas have higher rates of preventable hospitalizations, suggesting that patients should receive more care before requiring hospitalization. Value-based payment, a method of payment that incentivizes efficient, high-value care rather than the volume of health services, is promising. The use of value-based payment is increasing modestly; however, state policy, financial incentives from Medicaid, and greater collaboration between health centers and Medicaid is needed to increase overall adoption.

Six of twelve peer-reviewed manuscripts detailing these findings, published or forthcoming in Health Services Research, Milbank Quarterly, PLoS One, and Medical Care, are currently available online:

• Factors associated with Federally Qualified Health Center Financial Performance 
• Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on Health Center Staffing and Patient Capacity 
• Early Experience of the quality improvement award program in federally funded health centers
• Health Centers and Value-Based Payment: A Framework for Health Center Payment Reform and Early Experiences in Medicaid Value-Based Payment in Seven States
• Quality of Care for US Adults with Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared with Other Primary Care Settings
• Health Care Use and Spending for Medicaid Patients Diagnosed with Opioid Use Disorder Receiving Primary Care in Federally Qualified Health Centers and other Primary Care Settings

The following are forthcoming, under review, or in progress:

• Quantifying the Impact of Health Center Expansion on Local Economies 
• Health Service Use, Cost, and Quality of Care for Adult Medicaid Enrollees Receiving Primary Care in Health Center Compared to non-Health Centers
• Health Service Use, Cost and Quality of Care for Pediatric Medicaid Enrollees Receiving Primary Care in Health Centers Compared to non-Health Centers 
• Cost of Care for Medicare Enrollees in Health Centers versus Other Settings
• Key Policy Issues in Maximizing Health Center Program Value (FARA Final Summary) 
• Association Between Primary Care Practice Characteristics & Cost and Quality 

The FARA Research Team at the University of Chicago
Elbert Huang, Director, CDRP (PI)*
Marshall Chin, (Co-PI)*
Nour Asfour
Rachel Jantke, CDRP Administrative Director*
Shiyin Jiao
Janel Jin
Daniel Jung
Alexandra Knitter
Tamara Konetzka, CDRP Associate Director*
Neda Laiteerapong, CDRP Associate Director *
Jeanne Marsh*
Manu Morgeson
Lauren Peterson
Harold Pollack*
Elizabeth Tung*
Anna Volerman *
Wen Wan*

Additional Members of the FARA Research Team
Rachel Tobey, John Snow, Inc.
Robert Nocon, Kaiser Permanente Bernard J. Tyson School of Medicine

FARA Technical Advisory Panel
Heidi Allen, Columbia University
Emily Jones, CMS Information Center
Allison Coleman, Capital Link
Brent Copen, Alluma
Dana Mukamel, University of California, Irvine
Todd Gilmer, University of California, San Diego
Rachel Gonzales-Hanson, National Association of Community Health Centers (NACHC)
Jason Greer, Colorado Community Managed Care Network (CCMCN)
Stephanie Harrison, Wisconsin Primary Health Care Association (WPHCA)
Katherine Kahn, UCLA / RAND
Michelle Mills, Colorado Rural Health Center (CRHC)
Ninez Ponce, University of California, Los Angeles
Sarah Brazier, National Association of Community Health Centers (NACHC)
Pamela Riley, District of Columbia Dept. of Health Care Finance (DC Medicaid)
Brad Wright, University of North Carolina-Chapel Hill

HRSA Bureau of Primary Health Care, Data and Evaluation Division (DED), Office of Quality Improvement Representatives
Alek Sripipatana, DED Director
Hank Hoang, DED Deputy Director
Ben Picillo, DED Health Statistician
Helen Yu-Lefler, DED Health Statistician
Minh Wendt, Public Health Advisor

* Indicates member of CDRP

 

Story by Irene Hsiao