Community health centers prepare for influx of new patients under Obamacare

One provider says clinics need to be “ready when the spout turns on.”

November 16, 2012

(Chicago Family Health Center/Lucy Ramirez)
Health educator Daisy Gallardo does an assessment at the Chicago Family Health Center

Medical providers are preparing for an avalanche of new patients as the federal health-care overhaul becomes a reality in Cook County.

One in five adults in Cook County is currently without health insurance, and the Affordable Care Act (ACA) mandates that all Americans access health insurance of some kind beginning in 2014.

“The population that’s coming into coverage hasn’t been consumers of the service,” said Warren Brodine, CEO of Chicago Family Health Centers (CFHC). “So I’d submit that none of us really knows how to care for that population completely. We don’t know what their preferences are. Are we gonna need to be providing primary care at 10 o’clock at night? That very well may be the case.”

Illinois has already turned in its blueprint for an exchange, a state-run marketplace for private insurance that will also help connect low-income people to federal aid. And Cook County is planning to expand Medicaid coverage to 115,000 new patients beginning in January 2013.

What remains unclear to many – including providers themselves – is just how many new patients will start flooding the health system as soon as six weeks from now, when Cook County begins its Medicaid expansion.

“Even without the Affordable Care Act people are really struggling to get appointments in a timely manner,” said Kimberley Tester Smathers of Heartland Health Centers. Medicaid patients are subject to long waits because their options are limited; Illinois’ Medicaid reimbursements are notoriously slow.

In Cook County alone, over 800,000 currently uninsured people will be required to get insurance or pay a fee in 2014; many will be eligible for subsidies. But whether it’s Medicaid or private insurance that covers their visits to the doctor, the newly insured will still need a place to get care.

Community health centers prepare to fill the gap

Hundreds of community health centers across the country have received ACA funding since 2010 to build new facilities and expand capacity. Two years after the ACA funds first started to flow, new health centers are popping up with regularity across the city and suburbs.

CFHC is currently building a new health center in Pullman funded by a $6.2 million grant under the ACA. It takes up an entire city block, and will replace an outdated facility nearby. The facility, expected to open in summer of 2013, will have the capacity to serve 10,000 new patients per year.

But Brodine has no idea just how many newly insured people will flock to his organization’s five South Side locations - or precisely what their needs will be.

“We’re pretty sure there’s quite a bit of pent-up demand in underserved communities, people who today drop in at an emergency department when they have some urgent need that really should have been taken care of in the context of a primary care relationship,” he said.

CFHC serves 28,000 low-income Chicagoans at five South Side locations; more than half of their patients are on Medicaid, and only 4 percent have private insurance.

The federal government's long-term goal is to help expand the capacity of community health centers by 20 million – double what they serve now. Nearly  $80 million in federal funds has already been doled out in Illinois, and in 2012 alone, the Department of Health and Human Services made grants for the creation of 219 new sites nationwide.

Community health centers, also known as Federally Qualified Health Centers (FQHCs), are non-profits tasked with providing primary care at sliding scale rates. These health centers were first created nationwide in 1965 and they are required to accept Medicaid and Medicare; most also receive federal grant funding. Many of Chicago’s FQHCs have been providing care for low-income people for thirty or forty years.

FQHCs are used to taking on the uninsured. But now, they also need to plan ahead to be able to help patients get on insurance under the ACA, even though it is not entirely clear yet how the insurance exchange will work.

“Some of those questions are just starting to be answered on the logistics level,” said Smathers. “But this is all really confusing. It’s confusing for me, and I can’t imagine how confusing the insurance options might be for our patients.”

A shift from response to prevention
 
Brodine said the state of Illinois has dragged its feet more than some states on setting up its insurance exchange and making it clear how healthcare providers will be involved in enrollment.

But to him, implementing Affordable Care is not just about increasing the number of health centers and doctors.

“An insurance card is not enough; it’s only half the equation.” The other half of the equation is a transition to a system in which nearly everyone has primary care – and knows how to use it. As Mitt Romney reminded us during the 2012 presidential campaign, the emergency room has long been the fall-back of the uninsured. Community health clinics will be tasked with convincing people to come to them for preventive care, rather than waiting until they already have severe health conditions.

CFHC has already brought in 1,500 new patients through a program focused on hypertension. Hypertension, or high blood pressure, has a disproportionate impact on youth of color, particularly young men. Hypertension can be easily treated if a doctor catches the signs early. And it affects a group that is unlikely to be going to the doctor preventively right now.

“We very purposefully targeted this program toward individuals who we know would be covered in 2014, so that when they have coverage...they already know us,” said Brodine. The project should help young people get used to preventive care and treatment, and in the process, help them get used to the idea of having a primary care physician before they become eligible for insurance.

Brodine also predicted the new healthcare model will lead to an increased focus on the quality and outcomes of preventive care.

"We need to flip it around to a preventive approach, where people are exercising, people are eating right, people can get fresh fruits and vegetables in their local communities,” he said. “And you can’t take away the issues of things like housing adequacy and violence as real contributors to health. Those things are going to have to be addressed in a coordinated way.”

All of which means it’s an exciting time to be in the business of running community health clinics, whose mandate since their creation has been to provide community-centered care in low-income areas. If Affordable Care works out the way he hopes, Brodine said he’ll finally see some of his own dreams for community healthcare realized.

“We want the ‘health center’ to take that name,” said Brodine, “and mean more than a beefed up doctor’s office, but your center of health in the community.”