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Peter J. Cunningham, Gloria J. Bazzoli, and Aaron Katz Caught In The Competitive Crossfire: Safety-Net Providers Balance Margin And Mission In A Profit-Driven Health Care Market Health Affairs, September/October 2008; 27(5): w374-w382. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Community Health Centers in the Competitive Crossfire: Still Living Up to Mission

Daniel Hawkins   ( 14 August 2008 )

Community Health Centers in the Competitive Crossfire: Still Living Up to Mission 14 August 2008
Daniel Hawkins, Senior Vice President for Policy and Programs National Association of Community Health Centers Send comment to journal: Re: Community Health Centers in the Competitive Crossfire: Still Living Up to Mission dhawkins{at}nachc.com Daniel Hawkins	This article documents a perilous trend in health care, in which safety-net providers continue to struggle with worsening financial pressures and rising demand for services, especially in the face of rising numbers of uninsured and a shrinking pool of non-safety net providers willing to serve them. The authors conclude that safety-net providers are under pressure to maintain their mission-driven purpose while also maintaining financial viability. America's community health centers know all too well the pressures documented in this article; we are also aware that, as the article alleges, some safety-net providers have responded to those pressures by adopting strategies to limit their exposure to uninsured patients and to attract a more lucrative payer mix at the expense of their mission to deliver uncompensated care. However, we reject the implication that community health centers are engaging in such strategies, and we fundamentally disagree with the notion that efforts such as coordinating with other providers to expand obstetrical services, to ensure coordinated care for people with chronic illnesses, or to reduce the inappropriate use of hospital emergency rooms constitute evasive or "mission-shifting" strategies. On the contrary, these efforts are intended to improve care for the underserved and vulnerable patients that health centers serve -- and they are succeeding, even as they help to lower overall costs and save money for taxpayers. In fact, the article focuses mostly on hospital experience and generalizes those findings across all safety-net providers. In fact, the authors find no evidence that health centers specifically are withdrawing from their mission or reducing indigent/uncompensated care. Health centers are not immune to the financial pressures experienced by all safety-net providers. Yet health centers remain true to their mission to serve those who do not and cannot access care elsewhere. They currently care for 18 million low income and medically vulnerable people -- a majority of whom are uninsured or publicly insured and are members of racial and ethnic minority groups. Health centers do not choose their patients -- their patients choose them. A separate report released this week by researchers at the George Washington University documents that health center patients are poorer and sicker than those served by other providers, and yet health centers achieve significantly higher levels of preventive health care in key areas, including preventive screening for diabetes, hypertension, and breast and cervical cancer, which can significantly lower health care costs for the higher-risk populations they serve. Health centers are chosen because they do an excellent job of providing health care in areas with limited or no primary care resources. Yet federal data from the Health Centers Program show that health centers’ federal grants are not keeping up with the costs of serving uninsured patients, and that payments from private insurers, and even Medicare, are much lower than the cost of serving individuals who have such coverage. Despite this, the nationwide network of community health centers continues to provide high-quality, affordable primary care and preventive services to medically underserved communities, and even outperforms other types of providers whose patients tend not to be as sick or even at risk. They continue to find ways to expand their services into areas with high unmet needs, and to maintain the highest levels of quality in the care they furnish to their patients.