Payers Fund Community Health Centers to Aid Population Health

By directing funds towards health centers that serve vulnerable communities, payers can reinforce population health management strategies in those areas, as exemplified in CareSource’s recent investment.

CareSource has announced plans to invest $1.2 million in the Ohio Association of Community Health Centers (OACHC).

“It’s important to CareSource to support the Federally Qualified Health Centers across the state who serve our members,” said Steve Ringel, CareSource Ohio market president. “We’re proud to support OACHC who play such a critical role and to improve best practice quality, practice prevention and chronic care management.”

The funds will go towards a Practice Transformation Incentive to advance population health management goals. The goal of the population health program will be to improve quality of care and patient outcomes.

The community heath centers will also use the CareSource funding to adopt the Ohio Data Integration Platform (ODIP) through a data analytics vendor.

In addition to these changes, the community health centers will build on their value-based reimbursement contract.

“We are grateful for this generous investment from CareSource,” said Randy Runyon, president and chief executive officer of OACHC. “This will allow more health centers to adopt a population health tool that will drive, evaluate, and improve measures and interventions to transform the quality and delivery of health care through Ohio’s Community Health Centers.”

Investments in community health centers and collaboration with healthcare workers in such spaces have been critical to solving some payers’ population health management challenges during the coronavirus pandemic.

For example, in Massachusetts, some low-income and middle-income residents had trouble accessing the vaccination sites.

To remedy this issue, Blue Cross Blue Shield of Massachusetts (Blue Cross) invested $1 million in presenting a rideshare option through Lyft. The payer collaborated with community health centers through the Massachusetts League of Community Health Centers (the League).

Blue Cross also offered $2,500 grants to 46 community health centers for their own transportation programs.

Similarly, Anthem Blue Cross donated over $2 million to federally qualified health centers—which are a type of community health center that comply with the Public Health Service Act.

This funding enabled a program for the unhoused community, digital kiosks for telehealth services, telehealth kits for patients, and updating exam rooms and electronic systems. The investment also supported public outreach programs. These improvements aimed to meet population health management needs during the coronavirus pandemic.

Community Health Plan of Washington worked with community health centers to create a coding system fo social determinants of health barriers. Until a coding system existed that gathered data on social needs, the payer could not properly assess population health status in the area.

Using a population health management tool, Community Health Plan of Washington was able to pull data from electronic health records and clinical sources in the community health centers and stratify the patient population based on social needs.

“We’re able to have a lot of visibility about our patient population across the network,” Jennifer Polello, MHPA, PCMH-CCE, director of clinical data integration and social determinants of health at Community Health Plan of Washington, said at the time.

“This is the foundation that’s allowed us to expand our vision and our functionality in terms of how we’re able to pivot for different social needs based on this population health platform.”

With that data in hand, the health plan could then distribute resources to community health centers in order to address patients’ needs.

By channeling funds towards these centers, health plans can make a significant impact on population health among the most vulnerable populations.

In 2019, nearly half of all patients who were treated at community health centers were insured by Medicaid (49 percent), according to Kaiser Family Foundation data. Almost a quarter of the patients were uninsured (23 percent).

Nearly one in five of the patients (19 percent) had a private payer health plan either through their employer or on the individual health insurance marketplace and ten percent were on Medicare.

Although almost 20 percent of patients at community health centers in 2019 were insured by a private payer, these insurers only accounted for 12 percent of community health centers’ funding, Kaiser Family Foundation discovered.

About 45 percent of the centers’ funding came from Medicaid, 27 percent came from the federal section 330 grants and other grants and contracts, and the remaining 16 percent was split between Medicare, self-pay, and other funding streams.

“Health centers may be a valuable partner in containing costs and, at the same time, expanding high-quality medical services to underserved patients,” stated the National Conference of State Legislatures’ primer on community health centers.

“Health centers can help address barriers to care for the nation’s uninsured and underserved people. They can also address the shortage of primary care providers and disparities in services for people living in rural communities and for racial and ethnic minorities.