Fostering Rapid Advances in Health Care Learning from System Demonstrations (2003) / Chapter Skim
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3. Primary Care: 40 Stellar Community Health Centers
3. Primary Care: 40 Stellar Community Health Centers
Pages 41-56
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From page 41... ...
In 1992, an alternative term, federallyqualified health centers (FQHCs) was established and refers to CHCs eligible to receive Medicare payment for services provided (these same CHCs may or may not receive section 330 grants)
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From page 42... ...
In addition, primary care settings are where the large majority of patients enter the health system and receive the bulk of their care, making such settings critical for achieving key preventive, health promotion, and chronic care goals (Bureau of Primary Health Care, 20026; Institute of Medicine, 1996~. All CHCs those that do and do not receive Section 330 grants would be eligible to apply for a demonstration grant, with up to 40 CHCs being selected as demonstration sites.
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From page 43... ...
CHCs are highly variable in terms of geographic location; funding mix; and involvement in chronic care collaboratives, which relates to their ICT capacity. They also vary in particular populations served (e.g., poor families.
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From page 44... ...
Department of Health and Human Services, 2002~. In implementing proven models to redesign care delivery, demonstrations in this category would build upon and significantly expand the efforts of leading CHCs that are actively and successfully managing a select number of chronic conditions so that their care management approaches can be applied to all conditions and all health center patients.3 The demonstrations would help extend existing innovations, detailed below, to the next level so that all CHC patients wall have ready access to highquality,' science-based, state-of-the art care that is patient-centered and safe and allows for patient decision making and self-management.
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From page 45... ...
. Box 3-2 CHCs Demonstrate Success in Managing Chronic Illnesses: A Case Example The Hill Health Center in New Haven, Connecticut, began an asthma improvement program in 2000 with one clinician and 30 patients (National Coalition on Health Care and Institute for Healthcare Improvement, 2002b)
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From page 46... ...
This cost reduction has enabled the center to negotiate with managed care organizations to cover key medications and medical equipment and to make the reimbursement process smoother, although the center itself has not benefited financially from the improvements achieved. Given the growing experience of CHCs with redesigning care delivery and measuring the results 500 CHCs have participated in a learning collaborative, with many being able to point to impressive results (National Coalition on Health Care and Institute for Healthcare Improvement, 2002b)
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From page 47... ...
Equitable care Targeting of populations to meet diverse patient needs and reduce disparities A community orientation that gets diverse stakeholders involved in creative solutions for reducing ethic and racial disparities DEMONSTRATION ATTRIBUTES Patients' confidence that they will not be subjected to invasive, harmful care that will not help them 5. Shared best practices Sharing of best practices related to care delivery redesign and other learning across CHCs Patients' confidence that the best known approaches to care will be used to help prevent, address, and manage their illnesses, particularly in the case of chronic conditions The goal is for CHC demonstrations to become models for exemplary primary care practices over the next 3 years.
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From page 48... ...
Patient-Centered Focus As noted, demonstration CHCs would redesign and transform the way care is delivered for all patients so that eventually care for all conditions as well as routine preventive care is transformed. By adding collaboratives, the demonstrations may extend existing models they have been using the Chronic Care Model and the WI models for health care organizations and clinical office practices (see Box 3-4)
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From page 49... ...
In addition to integrating administrative and financial injunctions, the ISDI projects have also focused on clinical integration, such as creation of specialty referral networks and standardized disease management protocols and integration of management information systems (Health Resources and Services Administration, 2002~. Another BPHC-initiated Box 3-4 Care Delivery Models Adapted by CHCs CHCs have adapted and integrated leading models for the redesign of care delivery, including the Chronic Care Mode!
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From page 50... ...
As noted, few CHCs currently have computer-based patient records, although existing electronic patient registries and the Patient Electronic Care System provide an important building block by capturing care plans, protocols, and patient information and allowing for ongoing monitoring. A computer-based patient record is the next step, enabling integration of all of a patient's clinical information and the exchange of such information with patients and, when warranted, with outside organizations.
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From page 51... ...
. A number of California-based health centers that received funding from the Tides Foundation for ICT investments, including those designed to advance the use of computer-based patient records,.
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CHC staff, the health centers themselves, and other institutions that serve CHC patients should also share in the rewards when they demonstrably enhance the quality of and reduce costs of patient care. At present this is generally not the case.
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California Community Health Centers Project. Personal communication to S
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(National Association of Community Health Centers)
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From page 55... ...
2002b. Rivaling Private Care: Community Health Centers Meet the Needs of the Urban Poor.
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