Challenges, opportunities for safety-net health centers: 4 thoughts from Health Center Partners of Southern California CEO Henry Tuttle

Safety-net providers are crucial to the communities they serve, often providing uncompensated care to the most vulnerable, including the uninsured and underinsured, as well as a large population of Medicaid patients.

Nationally, 1,400 community health centers care for 24 million patients in underserved areas regardless of insurance status — a figure that has doubled since 2000, according to a recent report from the National Association of Community Health Centers.

However, these centers face a number of challenges, such as declining reimbursement, recruitment and retention and scalability.

Henry Tuttle, CEO of Health Center Partners of Southern California, recently spoke with Becker's Hospital Review about the challenges safety-net providers face and how they can overcome them.

HCP is a consortium of 17 primary care organizations serving nearly 800,000 low income and uninsured patients in Southern California with 2.3 million visits annually.

HCP members deliver primary care to the safety-net population in Southern California in more than 120 clinical sites. HCP then supports members' efforts through managed care contracting, quality and performance improvement, data informatics and analysis, program development and implementation, research and development, group purchasing, technical assistance, clinical and financial resources, and advocacy work focusing on healthcare policy.

Here are four trends Mr. Tuttle has observed among safety-net providers in California and nationwide.

1. Workforce shortages. While health centers continue to expand to meet the access demand of the Medicaid population and the newly insured, a growth rate of 30 percent year-over-year in Southern California, safety-net providers nationwide have clinical vacancies, which create a significant challenge, according to Mr. Tuttle. There is a national shortage of primary care physicians affecting both private practices and health centers serving the safety-net population. Ninety-five percent of the 1,300 health centers across the country are experiencing at least one clinical vacancy today, most commonly family medicine physicians, a recent report from the National Association of Community Health Centers revealed. On average, health centers have 13 percent of their clinical workforce staff positions vacant. Health centers could serve two million more patients today if all of their clinical vacancies were filled. HCP members, for instance, employ about 650 primary care providers. Given their recent growth rate, HCP members could immediately hire 50 more primary care providers, which does not account for the national average turn-over rate of 8.6 percent, for another 56 providers, per year. These workforce challenges are one of the primary barriers to safety-net health center patient growth.

Another challenge is the limited number residency slots available across the country for primary care physicians. "We don't have enough people going into primary care because we don't have enough residency slots, and we don't have enough people staying in it because it's tempting to pick a higher-paying specialty," says Mr. Tuttle. "When residents complete their training, often saddled with hundreds of thousands of dollars in education loans, they are faced with the choice of entering primary care with low reimbursement rates or choosing a specialty with higher rates. This creates access problems for both the safety-net and the general population."

2. Loan repayment programs, flexible scheduling can incentivize physicians. Creating physician education loan repayment programs becomes helpful when recruiting for — and retaining — safety-net providers, according to Mr. Tuttle. California has adopted various strategies to recruit and retain primary care providers. That includes being flexible in terms of the number of required clinical contact hours, per week. "Most young providers coming out of residency are also looking to start families, and have other professional partners with their own workplace requirements, so flexibility in scheduling, which safety-net health centers can provide, often rises to the top in recruitment discussions," Mr. Tuttle says. Safety-net health centers "strive for a mutually agreeable balance between provider productivity and work/life."

3. Safety-net providers are moving toward integration, both clinically and financially. HCP members have more than 120 clinical practice sites in the four southern-most counties in California — Orange, Imperial, Riverside and San Diego. Ultimately, their members' patient volumes represent 21 percent of the overall care provided by health centers across California. Unlike other counties in California, in San Diego there is no public county hospital or primary care delivery system. Therefore, HCP members shoulder the provision of care for the safety-net population. With this increased responsibility, health centers continue to grow and improve. According to Mr. Tuttle, HCP members have become more financially and clinically integrated through the creation of Integrated Health Partners of Southern California. "Our members know their ability to grow will come from working more closely together through global contracting for managed care," he says. "Our members understand that they must work together and focus on population health and producing healthy outcomes to remain effective, particularly in this ongoing transition from volume to value-based care."

4. It pays to be part of a networked health center organization. Members of networked organizations — called Health Center Controlled Networks — perform better, according to Mr. Tuttle. Based on data provided by the Health Resources Services Administration, networked health centers have adopted meaningful use and achieved Level 3 Patient Center Medical Home status, at higher rates. Based on research by Capital Link, scale does make a difference. The ability to spread costs across a larger system is beneficial. Regional variations do occur — particularly in larger, urban settings where workforce labor is more expensive.


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