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Health Centers and the American Recovery and Reinvestment Act (ARRA):

Issues in Policy Research

Sara Rosenbaum

Hirsh Professor and Chair

February 23, 2009

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Major Investments in a Short Time-Frame

• Capital: $1.5 billion for investments in infrastructure, equipment, buildings and HIT adoption

• Ongoing patient care: $500 million for operational support and expansions

• Increased use of EHRs: Additional Medicaid payments and other grants to enhance adoption and “meaningful” use of EHRs

• Workforce: $500 million for primary care workforce (National Health Service Corps)

• Medicaid: Potential patient growth as a result of the economic crisis, enhanced federal payments and CHIP reauthorization

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The Enormous Reach of Health Centers Even Before the Stimulus

• In 2007:– 1,067 federally funded health centers operating

7,200 sites in all states and in territories. – 16 million patients – 1 in 7 of uninsured – 1 in 5 low income uninsured– 1 in 8 Medicaid beneficiaries– 1 in 5 low-income children– 1 in 4 low-income minority residents

Source: 2007 UDS data, HRSA; and CMS and Census data

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Expected Effects• Increase in infrastructure, operations & other

funding will lead to:– More sites, especially in underserved areas– More patients served: uninsured, underinsured, and

Medicaid/CHIP– Wider range of services available. More dental and

mental health services– An expanded workforce to staff and deliver care

• Increased HIT & capital investments leading to:– Improvements in clinical quality measures

(intermediate and outcome)• Rapid influx of funding should:

– Stimulate local economies in health & non-health sectors (e.g., construction and real property)

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Key Questions

• Speed: – Translation of health center direct investment legislation into

implementation policy and program spending by HRSA, CMS, and ONCHIT

– Translation of direct investment opportunities into actual investments in particular communities (operational funding, capital investment, workforce recruitment)

– Translation of federal Medicaid policy reforms into state policy change, given high impact of Medicaid eligibility, payment, and coverage policies on the success of health centers

– Translation of workforce reforms into actual recruitments

• Strategic investments: – How and where will the funds be used?– How is balance struck between new grantees, new access points,

investments in service upgrades, technology upgrades– The array of investments directly related to health care quality

improvement and anticipated outcomes

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Key Questions• Quality outcomes:

– How will these investments improve health access, health quality, and health status in underserved communities?

• Sustainability: – Will these changes be sustainable when the

stimulus funds expire?• Value:

– How should the value of the stimulus investments in community health centers measured and expressed? To patients? To communities? To the health care system? To society?