Community health centers (CHCs) represent a key source of primary health care for medically underserved populations and communities. In 2011, over 1,100 federally funded health centers operating in more than 8,500 communities furnished comprehensive primary health care to more than 20 million patients. An additional 100 “look-alike” health centers that meet all federal health center requirements served an additional one million patients that year. Under the Affordable Care Act (ACA), both Medicaid and private coverage will expand to cover millions more Americans in 2014. To help meet the expected increased demand for care, the ACA provided a new $11 billion dedicated trust fund for expansion of the health centers program, and the law envisions that current health center capacity will increase to 40 million patients by 2019, roughly doubling.
This issue brief from the Kaiser Commission on Medicaid and the Uninsured analyzes the performance of federally-funded community health centers on three health care quality measures, using the performance of Medicaid managed care organizations (MCOs) as a comparison group. The three measures examined are: 1) diabetes control, defined as HbA1c levels at or below 9, for patients with diabetes; 2) blood pressure control (<140/90mm Hg) for patients with hypertension; and 3) the share of women ages 24 to 64 who received a Pap test within the past three years. Using data reported in the 2010 Uniform Data System (UDS) by all community health centers and the 2008 Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid MCOs, the analysis identified health centers as “high-performing” if their rates exceeded the 75th percentile of Medicaid MCO HEDIS scores on all three of our quality measures. The analysis identified health centers as “lower-performing” if their rates were below the mean Medicaid MCO HEDIS score on all three measures.
Among the findings in the analysis:
- More than 1 in every 10 health centers was high-performing; few were lower-performing. In all, 12% of health centers (130) met the definition of high performance, ranking above three-quarters of Medicaid MCOs on all three of the quality measures. Fewer than 4% of health centers (41) met the definition of lower performance, lagging behind the average Medicaid MCO on all three measures.
- Most health centers met or exceeded the Medicaid MCO high-performance benchmarks for the two chronic care measures, but lagged behind the average Medicaid MCO on the Pap test measure. When health center performance is analyzed measure by measure, rather than on the basis of all three measures together, the data show that 80% of health centers exceeded the Medicaid MCO high-performance benchmark on diabetes control, and over half exceeded that standard on blood pressure control. However, 70% of health centers had Pap test rates below the mean Medicaid MCO score on this measure.
- Lower-performing health centers had a significantly higher uninsured rate than high performers, and an extremely high homeless rate. While both health center groups had high rates of uninsured patients, the rate was significantly higher among the lower performers – 50% versus 36%. The share of patients with Medicaid was roughly one-third in both groups, but lower-performing health centers had significantly smaller shares of patients with Medicare and privately insured patients. The homeless rate was 40% in lower-performing health centers – ten times the average rate in the high performers.
The analysis concludes:
Medicaid MCO high performance is a demanding benchmark to use for health centers, considering that all MCO patients are insured, whereas a large share of health center patients are uninsured, making timely preventive care and successful management of their chronic conditions harder to achieve. In this light, the finding that more than 1 in 10 health centers were consistently high-performing, and that most performed well relative to Medicaid MCOs in managing diabetes and high blood pressure, is notable. Focused study of high-performing health centers may inform current efforts to understand the foundations of high-performing systems of care more generally.
Ignatius Bau 