As noted in the recent editorial by Ellen Andrews, discussions are taking place in Hartford about how people receive health care and how health care providers should be paid. Requiring people across the country to have health insurance was an important step in changing how Americans think about health care, but our country still falls behind others in life expectancy, incidence of chronic diseases, and overall quality of life.
We have the most expensive health care system in the world, but we are not getting what we pay for. So, there is little disagreement that a large-scale effort is needed to reform the system — to (1) control costs, while improving (2) the patient experience and (3) our “population health.” One of the ways Connecticut can meet this “Triple Aim” is by investing additional resources in federally-qualified health centers (“FQHCs,” also called “community health centers”).
A federal grant called the State Innovation Model (SIM) can provide funding for this investment as one of its many related initiatives all aimed at improving the health of Connecticut residents.
Ms. Andrews raised some points of disagreement with the current SIM proposal, one piece of which aims to transform health care for about 200,000 HUSKY patients (about a quarter of the total HUSKY population). It will also change how providers are paid, including the FQHCs, which care for 30 percent of all HUSKY enrollees.
Collectively, FQHCs serve almost 350,000 people in CT each year — about one out of every 11 people in our state. They have it in their mission to provide comprehensive, high-quality medical, behavioral health, and dental care to all people, regardless of their ability to pay. In addition to health care, they also provide social services, such as help with transportation, enrollment in SNAP (formerly food stamps), and translation.
They are governed by and employ neighborhood residents. Because they are rooted in their communities, people who work at FQHCs really know what it is like to be on HUSKY, and, more generally, to live as a low-income person in Connecticut. Nobody understands the needs of HUSKY patients better than those who treat them every single day.
The committee designing our SIM grant proposal is charged with transforming health care in Connecticut, and to do that, part of the focus must be on HUSKY, both because of its size (more than 20 percent of our state population) and its cost to state taxpayers (more than 20 percent of our state budget).
Unfortunately, despite its high cost to taxpayers, the current HUSKY payment system does not cover the costs for any health care providers. So, from both the provider and taxpayer perspectives, the HUSKY program is ripe for a careful transformation.
The SIM proposal seeks to provide more resources “up front” for prevention. Additional resources will allow health care providers to help their patients understand their medications, have coordinated care across providers, better manage their chronic diseases, and overall be more empowered to get and stay healthy. Keeping people out of emergency departments and better managing diabetes, asthma, and other diseases are the right things to do — and also can lead to savings in HUSKY.
A piece of the proposal involves “sharing” some of these savings with health care providers. This change in how providers get paid can guide providers’ movement from thinking about “volume” of health care services to “value.”
The FQHCs as a group have been examining alternative methods of reimbursement, which would enhance existing efforts at improving both quality and access. The SIM grant proposal aligns with and supports FQHCs’ ideas for better health care delivery.
Another component of the SIM proposal is for the expansion of Teaching Health Centers, which will train the next generation of primary care providers in FQHCs across the state. There, they will learn how to practice in the community, with diverse populations, and will hopefully stay in Connecticut to practice primary care medicine, an area which has a projected shortage.
The SIM proposal also contains references to an 1115 waiver, which could have dramatic impacts on the HUSKY program and would necessitate careful consideration by all stakeholders. This issue needs further analysis and discussion in order to protect HUSKY enrollees and all health care services.
All agree that, unless something changes, the current model of health care delivery is unsustainable. The SIM proposal may not fully solve the problem, but the status quo is not the answer.
Evelyn Barnum, is the chief executive officer of the Community Health Center Association of Connecticut, which represents 13 FQHCs.