Flexible Funding Allows Innovations to Thrive in the Safety Net System

The passage of the Affordable Care Act (ACA) has the potential to relieve some of the infrastructure challenges facing the health care delivery system. The law includes funding to support and extend the health care workforce, and to promote efficient, high quality care. Some of the ACA’s provisions are targeted specifically toward meeting the extensive needs of the health care safety net. States and safety net systems are already hard at work developing a sustainable safety net infrastructure to continue serving vulnerable populations, as focused on in a recent NASHP webinar.
One safety net system, Hidalgo Medical Services (HMS) in rural New Mexico, participated in ademonstration program that mobilized Community Health Workers (CHWs) to address some of these infrastructure challenges. The CHWs interact most intensively with high-needs patients, but also engage the community at large in prevention activities. Hidalgo’s CHWs play several roles, including as:

• outreach workers, promoting community health and prevention campaigns including health fairs and cooking classes;
• patient communication specialists, helping with scheduling and reminders for clinical preventive services;
• navigators, providing patient support and education relative to clinical services and help with eligibility determinations for health and social services;
• care coordinators, monitoring and assisting patients with chronic disease management.

The funding streams HMS uses to support CHWs continue to evolve. As the model was being developed, the majority of funds came from federal grants. HMS now funds the CHWs throughcapitated Medicaid managed care payments to provide care coordination services. In the near future, HMS expects that most CHW expenses will be absorbed by the health center’s operating budget through savings achieved through service delivery efficiencies. Ultimately, HMS hopes for a more comprehensive primary care system with global primary care payments. The demonstration project invested approximately $500,000 in CHWs at three sites, which has paid off in cost savings of over $2 million due to reduced ER visits, fewer inpatient hospitalizations, and lower prescription drug costs.
In addition, HMS is taking advantage of ACA funding for community health centers to redesign its facilities to enable continued integration and expansion of care teams to include CHWs. CHW offices will be located throughout the clinic complex. Exam rooms will be large enough to accommodate expanded health care teams, and teaching kitchens are part of the clinic design.
States can do much to support such community innovations within the safety net. In North Carolina, the Office of Rural Health and Community Care supports the safety net infrastructureby providing the following services:

• Market, financial, and organizational analysis, including teaching safety net providers how to work with the state Medicaid billing system;
• Recruitment of and loan repayment for primary care, dental, and psychiatric providers;
• Assistance with electronic health record implementation;
• Distribution and support of prescription assistance software;
• Equipment and connections to allow data sharing with the North Carolina Health Information Exchange.

North Carolina’s Office of Rural Health provides flexible funding that allows community health centers, rural health clinics, school-based health clinics, free clinics, and local health departments to work together to advance community-wide objectives. The state has documented a positive return on investment for many of its safety net-supporting services.
As the health care delivery system continues to evolve to meet the needs of those newly insured and those who remain uninsured, flexible funding streams can help maximize the creativity of state and local service providers who know their communities’ needs. What is your state doing to support the safety net as health care reform implementation unfolds? Tell us in the comments below or on the discussion page about safety net providers.
 
The information presented here comes from a webinar hosted by NASHP and supported by a grant from The Commonwealth Fund.