Community Health Centers Get Millions to Coordinate, Improve Care

Hundreds of community health centers in several states across the country will receive approximately $42 million over three years to as they seek to improve the coordination and quality of care delivered to people with Medicare as well as other patients, the U.S. Department of Health and Human Services announced. 500 community health centers in 44 states were just chosen to be part of the Federally Qualified Health Center (FQHC) Advanced Primary Care Demonstration project managing this feat with money made available by the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) in 2009.

“Health centers are integral parts of our communities,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald M. Berwick, M.D.  “This initiative will give participating health centers the help they need to improve care for many people with Medicare who rely on them as their main source of care.”

The demonstration project will be conducted from November 1, 2011 through October 31, 2014, and is set to show how the patient-centered medical home model can improve quality of care, promote better health, and lower costs. CMS will be operating the demonstration program in partnership with the Health Resources Services Administration (HRSA). Under the demonstration plan,  Medicare will pay community health centers based on the quality of care they deliver.  This improved payment system will reward clinics for such things as helping patients manage chronic conditions like diabetes or high blood pressure. 

“The goal of this demonstration is to help patients get the care they need in a primary care setting rather than in an emergency department,” said Dr. Berwick.  “When patients are able to use a health center as their primary source of care, it helps primary care doctors, nurses and specialists coordinate their care.  Health centers will also use health care dollars more wisely as patients receive the right tests, right medications and right treatments in the right setting.” 

The Advanced Primary Care Practice (APCP) is a physician or nurse practitioner-led medical practice that provides continuous, comprehensive, coordinated, and patient-centered medical care. It uses a team approach, and is designed to encourage all areas of care to work together with the patient to coordinate the patient’s care.

Under the demonstration project, FQHCs will be paid a monthly care management fee for each Medicare beneficiary receiving primary care services. FQHCs then in return, agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA), in addition to the established “all inclusive per visit payment amount,” for the FQHC to provide care coordination and management services as would typically be provided in an advanced primary care practice. The care management fee would apply to all Medicare beneficiaries who receive medical care from participating FQHCs as long as the beneficiaries remain eligible to participate. 

 To become an effective APCP, a medical practice must rethink the way it delivers medical care to its patients. The hope is that practices will shift from an acute care complaint-driven primary care paradigm that fragments health care delivery to one that is geared to maintain the patient’s overall health and anticipates when additional services or coordination needs to occur.

 CMS will monitor practice changes over time to determine how well participating FQHCs are progressing in providing and expanding the delivery of continuous, comprehensive, and coordinated primary health care.

 “The lessons learned from this demonstration project will help all community health centers improve on their long–standing commitment to providing high quality, patient-centered primary care,” said Health Resources and Services Administration (HRSA) Administrator Mary K. Wakefield, PhD., R.N. “This program will help strengthen the relationship between the more than 8,100 health center sites HRSA helps fund and the communities they serve.”