Health Center Library

What does this study add? The study highlights differences in health care utilization among high-cost, high-need Medicaid beneficiaries who receive primary health care at health centers versus other primary care settings. Patients of HRSA-funded health centers received equal or more primary care compared to their non-health center counterparts while also having fewer specialty care, emergency room, and hospital visits.

What are the implications for the Health Center Program? The Health Center Program has the potential to reduce costly healthcare burden among high-cost, high need Medicaid beneficiaries through high quality care.

What does this study add? The researchers found health centers that provided the most enabling services performed better on nine of ten clinical quality process measures. However, these health centers had more patients with uncontrolled high blood pressure and diabetes.

What are the implications for the Health Center Program? These findings suggest enabling services may have a stronger positive correlation with clinical quality process measures than outcome measures. However, it is unlikely that enabling services have a detrimental effect on outcome measures, and it is more plausible that enabling services are unable to independently address certain poor health outcomes. Enabling services are intended to increase access to care, which is an example of a process measure, while other factors contribute to final health outcomes throughout the continuum of care. Even so, better clinical process performance shows that these services might mitigate some effects of social risk factors.

What does this study add? The study examined whether Patient-Centered Medical Home (PCMH) recognition promoted health center staffing structures that were more team-based and integrated by assessing growth of multidisciplinary medical or non-medical providers per primary care physicians (team-based ratio) and per 2,000 patients (colocation ratio). Researchers found that among three cohorts of health centers that received PCMH recognition in 2013, 2014, and 2015, all three had significantly larger colocation ratios after PCMH adoption. Additionally, 2013 and 2014 adopters of PCMH had significant increases in team-based ratios.  
 
What are the implications for the Health Center Program? These research findings indicate progress by HRSA-funded health centers to provide team-based care and integrated care delivery and the potential role of PCMH recognition in promoting transformational change. 

What does this study add? The study examined associations between weight management practices at HRSA-funded health centers and selected health outcomes. The researchers determined a greater proportion of patients who are obese reported receiving provider interventions compared to overweight patients, and patients who received a provider diagnosis of weight as a problem and/or recommendations to change their diet had better odds of improved health status.
 
What are the implications for public health practice? These findings demonstrate the importance of provider weight management interventions in improving patient health outcomes and the need for more consistent interventions across patients who are obese and overweight. Providers should continue to engage motivational interviewing techniques, initiate culturally appropriate discussions about weight, and work to address social determinants of health like lack of safe spaces for exercise and availability of healthy nutrition. 

What does this study add? Patients who used health centers as their usual source of care for three or more years visited the emergency department less often than patients who used health centers for less than three years. Overall, the study explored how patient experiences and care management approaches at health centers might affect how often patients visit the emergency department by analyzing 2014 Health Center Patient Survey (HCPS) data and 2014 Uniform Data System (UDS) data.

What are the implications for the Health Center Program? The findings suggest that patients who regularly access primary care at health centers make fewer visits to the emergency department in the long term. This means upfront costs for primary care may help avoid larger downstream costs. Other HRSA-funded research, such as this article on care for patients with Medicaid coverage and opioid use disorder, also finds that health centers may reduce overall spending on health care.

What does this study add? HRSA-funded researchers analyzed associations between health center characteristics and receipt of Quality Improvement Awards (QIA) from 2014-2018. Researchers found that almost all participating health centers (99.7%) received at least one QIA during the study period, and health centers with Electronic Health Record (EHR) reporting and Patient-Centered Medical Home (PCMH) recognition earned higher award funding even after excluding bonus payments for these two capacities.

What are the implications for the Health Center Program? Although the QIA program has since evolved into other value-based funding mechanisms, the findings suggest that investments in EHR and PCMH accreditation may have supported broader clinical quality improvement and that health centers are able to implement value-based payment initiatives to improve patient experiences and health outcomes. The findings also suggest that HRSA award programs should set clinical quality benchmarks ahead of time.

What does this study add? To estimate the impact of changes in revenue, HRSA-funded researchers simulated funding changes using statistical models that estimated the number of full-time equivalent staff (FTEs), number of patients served, and number of visits as outcomes of Medicaid revenue, Section 330 grant funding, other revenue, patient characteristics, and county-level characteristics.

What are the implications for the Health Center Program? HRSA-funded health centers could support care to over 2,000 additional patients with an increase of $1 million dollars in grants provided under Section 330 of the Public Health Service Act.

What does this study add? HRSA-funded researchers examined the relationship between smoking, mental health conditions and substance use disorders among adult patients served by HRSA-funded health centers. Using data from HRSA’s 2014 Health Center Patient Survey (HCPS), researchers found that smoking prevalence among adult health center patients is twice as high as the general U.S. population and is associated with mental health conditions and substance use disorders. 

What are the implications for the Health Center Program? Study results suggest that health center patients most benefit from smoking cessation interventions that are integrated into routine primary care and delivered in a patient-centered care environment that promotes open communication and shared decision making.  Results highlight the important role health centers play in providing tobacco cessation interventions tailored to the needs of underserved communities.

What does this study add? HRSA-funded researchers found that, among five social determinant of health (SDOH) indicator categories, health care access and utilization had the largest relative contribution to self-reported fair or poor health and diagnoses of diabetes, hypertension, cardiovascular disease, and depression or anxiety. The relative contributions of the other SDOH indicator categories (i.e., health behaviors, social factors, economic factors, quality of care, and physical environment) varied by each health status measure.

What are the implications for the Health Center Program? The study highlights how health centers can prioritize which SDOH to target for interventions based on patients’ specific health conditions. An improved understanding of which SDOH most strongly influence their patients’ health outcomes can help health centers develop proactive and appropriate interventions. 

What does this study add? HRSA-funded researchers found that primary care utilization and spending were higher for health center patients with Medicaid insurance who have been diagnosed with opioid use disorder compared to similar patients in other settings, but total healthcare costs were lower. The researchers determined that health center patients were more likely to receive timely behavioral health therapy and less likely to fill inappropriate co-prescriptions, demonstrating the strength of holistic and coordinated care in the Health Center Program. However, health center patients were less likely to receive timely Medication-Assisted Treatment (MAT), which may be partly attributed to the availability of providers with MAT waivers at the time of this study.

What are the implications for the Health Center Program? Health centers are uniquely positioned to provide integrated primary and behavioral health care to medically underserved populations. 

What does this study add? HRSA-funded researchers identified innovative and effective approaches to improve diabetes care for Medicaid enrollees in health center primary care settings. 

What are the implications for the Health Center Program? The key takeaway from this research is that a higher proportion of patients receive diabetes care at HRSA-funded health centers and that health centers are an important primary care practice setting for diabetes care. Additionally, compared to diabetes care in other primary care settings, diabetes patients at health centers received diabetes education more regularly, have a lower rate of hospitalizations, a higher rate of emergency department visits, and lower rates of laboratory-based tests for diabetes. 

What does this study add? To better understand drivers of financial stability, HRSA researchers collaborated with the University of Chicago to review six measures of health center financial performance that provide insight into health centers’ long-term financial health. The researchers found that higher proportions of Medicaid patients and non-physician healthcare providers (e.g., nurse practitioners, physician assistants, etc.) have positive associations with a health center’s financial sustainability. Patient-Centered Medical Home (PCMH) recognition was also associated with better financial health.

What are the implications for the Health Center Program? Ensuring that health centers remain in good financial health is essential to avoid the risk that these organizations close their doors or reduce vital scope of services. 

What does this study add? This study assessed health center value-based payment (VBP) participation in seven states and found increased participation over time as well as associations with improved health center financial outcomes. Researchers found that in these seven states VBP participation grew from 35% to 58% from 2013 to 2017. During the same time period, health centers increasingly participated in more advanced payment models, which allowed them to improve care coordination and quality and cost outcomes.

What are the implications for the Health Center Program? To increase health center patient participation in VBP, research findings highlight the importance of financial incentives from Medicaid agencies and Medicaid managed plans as well as health center-Medicaid collaboration under strong Primary Care Association (PCA) and health center leadership. 

What does this study add? HRSA-funded researchers found that health centers provide equitable diabetes care, including HbA1c testing and eye exams, and advance racial/ethnic parity in diabetes-specific outcomes. Researchers also identified opportunities to further advance health equity by improving foot exams, individual treatment plans, and cholesterol checks for racial and ethnic minority patients.

What are the implications for the Health Center Program? Findings suggest that health centers are uniquely positioned to advance equity in access and quality in care. This study highlights opportunities for health centers to scale more tailored diabetes care management approaches that are culturally competent and facilitate equitable access to diabetes management services such as individual treatment plans and cholesterol checks. 

What does this study add? Health centers play an integral role in addressing social determinants of health (SDOH) among medically underserved populations, yet information on how health centers utilize SDOH data to inform care is limited. HRSA-funded researchers conducted a systematic review to understand how health centers integrate SDOH into primary care practices. Researchers found that many health centers are making progress on collecting SDOH data using standardized reporting tools and other initiatives, but they may require more support to use the data in primary care practices and program evaluation efforts.

What are the implications for the Health Center Program? Health care delivery models that emphasize accountability for patient outcomes should support initiatives for primary care providers to integrate SDOH data in efforts to improve care quality and outcomes.

What does this study add? Rural health center patients reported lower unmet and delayed medical care according to an analysis comparing Health Center Patient Survey (HCPS) data from 2009 and 2014. The study also showed that patients reported steady access to mental health care but a decrease in Pap tests and mammogram screenings during the same period.  

What are the implications for the Health Center Program? Although other HRSA-funded research suggests that performance is on par between urban and rural health centers, understanding barriers to providing timely and accessible preventive services to rural health center patients remains critical. Key areas for future policy and practice include improving multi-disciplinary management of patient care, supporting additional research about the barriers to access of preventive and primary care services, and investing in infrastructure improvements in rural areas to promote connectivity.  

What does this study add? The study identified health center patients with complex health conditions who are high health care utilizers. The researchers categorized patients as those with mental health conditions (32%), multiple chronic conditions (27%), or low risk (41%). The researchers also categorized patients as low utilizers (73%), high utilizers (24%), and super high utilizers (3%). The findings determined high and super high utilizers with mental health conditions often had comorbid conditions of obesity, smoking, hypertension and cardiovascular disease.

What are the implications for the Health Center Program? These results indicate that concurrent mental health and physical chronic conditions are major drivers of high health care system utilization. The findings highlight the importance of primary and mental health care coordination and the Patient-Centered Medical Home (PCMH) model to meet the needs of health center patients with complex conditions.