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A New Community Health Center/Academic Medicine Partnership for Medicaid Cost Control, Powered by the Mega Teaching
Richard E Rieselbach1, Ted Epperly, Aaron Friedman
1R.E. Rieselbach is professor emeritus of medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and past president, Association of Program Directors in Internal Medicine. T. Epperly is president and chief executive officer, Family Medicine Residency of Idaho, clinical professor of family medicine, University of Washington School of Medicine, Seattle, Washington, and past president and board chair, American Academy of Family Physicians. A. Friedman is professor emeritus of pediatrics, past vice president, Health Sciences, and former dean, University of Minnesota Medical School, Minneapolis, Minnesota, and former board chair, American Board of Pediatrics. D. Keahey is chief advocacy and research officer, Physician Assistant Education Association, and adjunct associate professor, University of Utah School of Medicine, Utah Physician Assistant Program, Salt Lake City, Utah; ORCID: http://orcid.org/0000-0003-3107-3678. E. McConnell is associate professor, Duke University School of Nursing, clinical nurse specialist and nurse scientist, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Durham, North Carolina, director, Center of Excellence in Geriatric Nursing Education, and codirector, Health Resources and Services Administration-funded Duke Geriatric Workforce Enhancement Program; ORCID: http://orcid.org/0000-0002-2896-8596. K. Nichols is professor of internal medicine and dean, Chicago College of Medicine, Downers Grove, Illinois, past president, American Osteopathic Association, and president, Institute of Medicine of Chicago; ORCID: http://orcid.org/0000-0002-4960-4118. G. Nycz is executive director, Family Health Center of Marshfield, Inc., Marshfield, Wisconsin; ORCID: http://orcid.org/0000-0001-6151-0336. J. Roberts is professor and former dean, School of Pharmacy, and director, Center for Interprofessional Practice and Education, University of Wisconsin-Madison, Madison, Wisconsin; ORCID: http://orcid.org/0000-0002-2309-7621. K. Schmader is professor of medicine and chief, Division of Geriatrics, Department of Medicine, Duke University Medical Center, director, Geriatric Research, Education and Clinical Center, and associate chief of staff, Geriatrics and Extended Care, Department of Veterans Affairs Medical Center, Durham, North Carolina. P. Shin is associate professor, Health Policy and Management, George Washington University, Washington, DC, and director, Geiger Gibson Program in Community Health, RCHN Community Health Foundation. D. Shtasel is founding director, Kraft Family National Center for Leadership and Training in Community Health, Massachusetts General Hospital Michele and Howard J. Kessler Chair in Public and Community Psychiatry, and associate professor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-8932-8066.
Abstract:
Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care. The authors propose that this CHC expansion could be instrumental in limiting the added cost of Medicaid expansion via the Affordable Care Act (ACA) or subsequent legislation. Nevertheless, expansion cannot succeed without developing this CHC-AMC partnership both (1) to fuel the currently deficient primary care provider workforce pipeline, which now greatly limits expansion of CHCs; and (2) to provide more CHC-affiliated community outreach sites to enhance access to care. The authors describe the current status of Medicaid and CHCs, plus the evolution and vulnerability of current THCs. They also explain multiple features of a mega THC demonstration project designed to test this new paradigm for Medicaid cost control. The authors contend that the demonstration's potential for success in controlling costs could provide help to preserve the viability of current and future expanded state Medicaid programs, despite a potential ultimate decrease in federal funding over time. Thus, the authors believe that the new AMC-CHC partnership paradigm they propose could potentially facilitate bipartisan support for repairing the ACA.
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