Priority Area 4: Expand Provider and Health System Capacity
On average, people without health insurance use about 60 percent of the health care services as people with coverage. Expanding coverage will increase demand for services, which will strain the capacity of those parts of the health care system that are already under pressure. Particular challenges will arise in the areas of primary care, culturally competent and linguistically accessible care, and highly specialized care. Coverage expansions will occur at the same time as some institutions—community clinics, health centers and public and other safety net hospitals—are experiencing significant changes in their financing.
Expanding capacity is a long-term endeavor, so states must start now. The federal law provides some important opportunities. There are grant funds to support community health workers. There are opportunities for innovative payment and delivery models associated with telehealth in the areas of behavioral health and treatment of people with chronic illnesses, in particular by non-medical providers. There are significant changes in the allocation of graduate medical education training slots to emphasize primary care and outpatient settings and increased requirements on nonprofit hospitals to identify and meet community needs.
There are a number of new funding streams designed to expand provider supply in underserved areas, promote a more diverse workforce, expand the number of oral health professionals and expand nursing capacity in federally qualified health centers. Federal grants to states to support alternatives to the current medical liability system may affect supply. And, while the new federal law does not make any changes in this area, now would be an excellent time to revisit state scope of practice laws and the state’s approach to training and credentialing medical professionals.
Health coverage expansions will not create a provider supply problem, but they will highlight the problems states already have. The goals of health reform will not be met if the newly insured find that their coverage is a hollow promise.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
