Achieving Health Equity via the Affordable Care Act Promises, Provisions, and Making Reform a Reality for Diverse Patients: Workshop Summary (2015) / Chapter Skim
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5 The Safety Net and Beyond
5 The Safety Net and Beyond
Pages 45-56
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From page 45... ...
(Fiscella) • T he community health needs assessments required of tax exempt hospitals can be an important lever for health equity.
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The National Quality Forum has defined health care disparities as "differences in health care quality, access, and outcomes adversely affecting members of racial and ethnic minority groups and other socially disadvantaged populations" (NQF, 2012)
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Payment to FQHCs through the prospective payment system, which provides an enhanced Medicaid rate for each visit but not for other aspects of care, has kept these centers afloat over time but the prospective payment system has not given most FQHCs sufficient capital to implement changes or to move ahead. Fiscella advocated a global payment system that would provide FQHCs with the resources to support essential features for patientcentered medical homes while enhancing access to specialty care through ACOs.
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Most inmates lack any health insurance, and most health care providers in these institutions lack electronic health records (EHRs) and to date have not been eligible for meaningful use incentives.
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The Community Health Applied Research Network, supported by the Health Resources and Services Administration, and the partnership between Connecticut's Department of Corrections and the University of Connecticut represent notable, worthy exceptions. Dedicated funding is needed from both federal and non-federal funders to establish and maintain the research infrastructure necessary to inform best practices within the safety net, Fiscella said.
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Both the ACA and the HHS Action Plan to Reduce Racial and Ethnic Health Disparities (HHS, 2011) promote workforce diversity but successful strategies are in short supply.
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The ACA requires that hospitals conduct a community health needs assessment at least every 3 years to identify needs and priorities and develop a strategic plan to address those needs. It also requires that hospitals adopt written financial assistance policies that clearly state the hospital's eligibility criteria for financial assistance and requires that these policies be clearly communicated to patients and the community.
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For community needs assessments, community benefit planning, and the implementation of health improvement initiatives, hospitals may engage in multisector collaborations with community health centers, public health agencies, businesses and employers, community-based organizations, schools, and public safety organizations. Such a collaborative approach captures diverse perspectives and expertise and facilitates leveraging of the community's public and private resources for the common purpose of community health improvement.
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In addition, the activity or program must seek to achieve a community benefit objective, such as eliminating disparities in access to health care services or improving disparities in health status among different populations. Health professions Community health Cash or in-kind Research education contributions to 1.3% 5.3% improvement and community groups contributions to 2.7% community groups 8% Community health improvement 5.3% Charity care 25.3% Subsidized Subsidized care health services Free care 14.7% Under-reimbursed Unreimbursed costs for means- care tested government programs 45.3% FIGURE 5-1 Community health improvement and contributions to community groups.
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"To the extent that we're talking about bending the cost curve of health care and reducing health care costs, we have to look beyond the walls of the hospital," she said. Although the IRS has not recognized all community-building initiatives to be reportable as community benefits, if an initiative is undertaken for the express purpose of improving community health, responds to an identified need, and is based on evidence, said Somerville, it may be reported as community health improvement services, that is, as a community benefit.
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THE SAFETY NET AND BEYOND 55 A participant from the Partnership for Strong Communities, a statewide housing policy and advocacy organization, asked if there are examples of communities that have used community benefit funds for targeted initiatives around factors such as food insecurity and housing instability. Somerville responded that there are examples of this occurring.
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