Working Paper Examines Community Health Centers’ Role in Medicaid Managed Care

Health plans affiliated with community health centers are "growing rapidly; provide access and quality of care that exceeds those of other Medicaid health plans; and despite challenges, are likely to remain committed to providing care in their underserved communities, a reflection of their community health center ownership," a working paper from the Association for Health Center Affiliated Health Plans, an organization comprising 17 health plans owned by or affiliated with community health centers, says (Zuvekas, "Community Health Center Affiliated Health Plans: A Viable Alternative for Medicaid Managed Care?" January 2002). The paper, written by Ann Zuvekas of the George Washington University's Center for Health Services Research and Policy, was funded by the Health Resources and Services Administration's Center for Health Services Financing and Managed Care (AHCAHP release, 1/10). The working paper examines the history of community health centers, presents a survey on such centers and analyzes data comparing centers' health plans with commercial health plans. There are currently 700 community health centers (with more than 2,000 clinical sites) in the United States; most of their patients are poor and minorities and either have public health coverage or are uninsured. Over the last decade, these centers "have grown increasingly dependent on Medicaid as a funding source"; Medicaid in 1997 accounted for 34% of community health centers' revenues, compared with 15% in 1985. In addition, during the late 1990s, the number of community health centers participating in Medicaid managed care rose. Also in the last decade, more community health centers began to create managed care organizations of their own to bolster the safety net for Medicaid beneficiaries and the uninsured.

Numbers and Quality
To evaluate these safety-net plans, Zuvekas conducted a survey of 14 community health center-affiliated plans across the country. Plans gave two reasons for their formation: "to improve care of Medicaid patients" and to "maintain or increase their volumes of Medicaid patients, especially in the face of mandatory managed care." Of the 11 plans submitting multiyear data, all showed "explosive" membership gains from 1996 to 2000, with almost all of the increases linked to Medicaid and CHIP beneficiaries. One reason for this is that state officials have turned to community health center-affiliated plans as commercial health plans have exited Medicaid due to lower payments from states, the paper explains. The working paper also questions the "assumption" among some policymakers that "mainstream" plans and care providers offer better care than safety-net plans and providers. The working paper cites data from the American Public Human Services Association's study of health plans' performance on the 1999 Health Plan Employer Data and Information Set from the National Committee for Quality Assurance, finding that community health center plans "outperformed the pool of Medicaid health plans." The working paper concludes, "States are leaning ever more heavily on these safety-net plans to purchase health services for their most vulnerable populations. As a group, these plans have shown themselves to be able to meet the challenges. They require only reasonable accommodation to their unique characteristics" (Zuvekas, "Community Health Center Affiliated Health Plans: A Viable Alternative for Medicaid Managed Care?" January 2002). The working paper is available online.