Report Identifies Ways that Medicaid Delivery and Payment Reform Can Impact Community Health Centers

An analysis released today highlights the role of community health centers in state health care delivery system transformation, through investigation of Medicaid delivery system and payment reform (DSRIP) demonstrations in the states of New York and Massachusetts. Other states, such as the other eight with current DSRIP projects, may benefit from developing a strong working partnership between Medicaid and community health centers, which the analysis suggests will facilitate successful delivery system reform.

Researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH) and Viaduct Consulting, LLC conducted the analysis of the contributions and experiences of health centers in these DSRIP projects. The authors say that their findings provide valuable insights for state and national policymakers involved in the effort to transform Medicaid health care delivery systems.

DSRIP programs are carried out under the demonstration authority of Section 1115 of the Social Security Act. They enable states to test new approaches to health care delivery and payment aimed at improving health care quality and cost effectiveness. Community health centers assume an important role in Medicaid agency delivery transformation because of where they are located, whom they serve, and what they do.

The researchers focused on Massachusetts and New York because of their leadership roles within Medicaid reform, their focus on primary care within their DSRIP programs, and their differing histories in health center collaboration with the state. The study, conducted over the spring and summer of 2018, looked at the roles and experiences of community health centers in the development and implementation of these DSRIP programs. In addition to background research, the study included interviews with state officials and in-person focused discussions with health centers and primary care association leaders.

“The relationship between Medicaid and community health centers is especially strong, and these centers have been extensively involved in payment and delivery reform efforts around the country,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the study’s authors. “Our analysis provides insight into both the local and state-level aspects of this involvement in helping states achieve lasting and deep health system change.”

The research team found several key lessons from the evaluation of the DSRIP projects in New York and Massachusetts:

  • The shared mission and mutually dependent relationship that exists between Medicaid and community health centers can help bring about substantial change.  Because delivery and payment reform turn on high-value primary care integrated with social services, health centers play a key role, since from the beginning, health centers were designed to provide exactly this type of bridge.
  • Health centers in both states have assumed leadership roles, although in distinctly different ways. For example, health centers in New York have played a central role, in partnership with other providers, in advancing the state’s goals of addressing population health and integration. In Massachusetts, health centers were extensively involved in early program design and also are piloting new, primary-care centered delivery system models.
  • A strong working partnership between Medicaid and community health centers can produce important benefits relevant to payment reform, since a carefully designed policy partnership creates an opportunity to strengthen health center performance while also testing alternative payment models to Medicaid’s traditional “federally qualified health center (FQHC)” encounter-based payment structure.

“While it is too early to assess how the models being used by either New York and Massachusetts will affect health centers specifically, the two states are national leaders in delivery and payment reform,” said Vikki Wachino, MPP, principal of Viaduct Consulting, former Director of the Center for Medicaid and CHIP Services, and one of the co-authors of the study. “Their commitment to collaborating with health centers will inform state and national efforts to strengthen systems of care for vulnerable populations.”

The New York and Massachusetts case studies in the report illustrate the importance of community health centers in distinct DSRIP approaches. The studies underscore the importance of comprehensive primary care and integrated service delivery in transformational payment and delivery reform models.

“Successful health care delivery transformation hinges on a strong base of comprehensive primary care. While New York and Massachusetts differ in approach, the DSRIP experience in each state illustrates the singular importance of health centers in advancing health care quality and improving population health,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, which supported the study.

In addition to Rosenbaum and Wachino, the authors of the analysis are Rebecca Morris, a doctoral research assistant at the Milken Institute SPH, and Rachel Gunsalus, MPH, Assistant Program Director of the Geiger Gibson Program in Community Health Policy.  “Community Health Centers and Medicaid Delivery and Payment Reform: A Closer Look at Massachusetts and New York,” can be accessed below.