Safety Net Providers Innovate to Integrate

The Affordable Care Act (ACA) offers a number of ways to improve health care delivery, enabling states to create accountable care organizations (ACOs), health homes, health insurance exchanges, or basic health programs. The big question is: “Will the need for safety net providers remain if these provisions are implemented?”
The answer at a session at the NASHP annual state health policy conference was a resounding “yes.” Predating the ACA, a number of states have been actively exploring how to integrate safety net providers, such as Federally Qualified Health Centers (FQHCs), free clinics, rural health clinics, and public hospitals, into delivery systems reforms. Many safety net providers also have been working to provide coordinated and integrated care to the country’s most vulnerable populations in creative ways. The NASHP session showcased some of these innovative state and community efforts.
North Carolina’s Health Reform Safety Net Workgroup is looking at innovative ways to improve and integrate care in the safety net. The state projects that 536,000 uninsured, nonelderly adults could qualify for Medicaid under Medicaid expansion. Strategies the state is exploring to meet their needs include: securing funding for FQHCs and school based health centers, linking safety net providers to health information exchange, and expanding scopes of care in medical homes to enhance the role of midlevel providers in the healthcare workforce. As more people gain Medicaid coverage and state expenditures increase, the state could see reduced expenditures to safety net providers currently used to pay for services to the uninsured.
Colorado has had substantial Medicaid caseload growth in recent years and expects growth to continue with implementation of the ACA. Concerned about quality and cost as this expansion unfolds, the state is working to redesign the Medicaid health care delivery system by developingRegional Care Collaborative Organizations (RCCOs). Each of seven regional RCCOs connects Medicaid enrollees with health services in their communities. Providers in each RCCO are paid a per-member-per-month fee for each enrollee and receive additional incentive payments for reaching stated performance targets. (For more on Colorado’s RCCOs, tune into NASHP’s webinaron November 15.)
In Iowa, a grant from The Commonwealth Fund is helping assess the potential impact of the ACA on the state’s safety net. The Iowa Collaborative Safety Net Provider Network, created in 2005, provides a forum for collaboration on primary medical and preventive care, dental care, mental health, and pharmacy needs of vulnerable populations. Researchers at the University of Iowa are working with the network, holding stakeholder meetings, gathering background information on funding sources, and interviewing safety net providers. Some of the questions they are examining include: 1. How can the safety net integrate with ACOs or health benefit exchanges? 2. How will the ACA impact workforce shortages in primary care and behavioral health? 3. What are the opportunities for integration and coordination with the private sector?
The Commonwealth Fund is supporting a NASHP-led Workgroup that is discussing ways to integrate the safety net with health reform implementation. Are your state and its safety net providers working together on delivery reform? What will be the role of your state’s safety net providers in serving vulnerable populations in future? Share your successes and strategies atState Refor(u)m.