Community clinic readiness for health care reform

Background and Objectives. Community clinics are the cornerstone of the safety net. The Affordable Care Act (ACA) is anticipated to change their patient mix because the newly insured may leave community clinics for private providers. This study assesses the readiness of community clinics for health care reform in the early stages of ACA implementation.

Methods. We surveyed Los Angeles (LA) County community clinics (12/2013-2/2014) about National Committee for Quality Assurance (NCQA) patient-centered medical home (PCMH) recognition, meaningful use attestation, and participation in quality improvement collaboratives. We supplemented the survey results with publicly reported 2011 utilization data to identify clinics’ public managed care participation and size of the primary care workforce. We used these data to score clinics’ readiness for health care reform from one (low) to five (high).

Results. 49% of the 204 community clinics in LA County offering comprehensive primary care responded to the survey. Among these, 20% achieved an ACA readiness score of 4-5, 31% scored 3, and 45% scored 1-2. Among the score’s subcomponents, 21% had already been recognized as PCMH, 34% had applications pending, and the rest had no plans (21%) or planned to apply at a future date (24%). 29% had providers that had attested for meaningful use, 39% had electronic health records (EHR) but no providers who had attested, and the rest had some electronic data management systems but no EHR. 91% of clinics had participated in or conducted quality improvement initiatives, and 17% had participated in multiple overarching initiatives. 28% of clinics had 25-45% of patients with public managed care coverage, 58% had 1-25% of patients with public managed care coverage, and the rest did not have any managed care patients. About 56% of the clinics had patient-provider ratios below the median value of 1,373 patients per full time equivalent primary care provider.

Conclusions. LA County community clinics have made significant progress in improving care processes, delivery and infrastructure required to become providers of choice upon ACA implementation. This progress included gaining PCMH recognition from NCQA and providers with meaningful use attestation, participating in major quality improvement collaboratives, and retaining contracts with Medicaid managed care organizations. 

Readiness for the ACA requires significant effort by community clinics. LA County clinics leveraged federal and foundation grants that provided consulting and infrastructure support to prepare for the ACA. Community clinics elsewhere will benefit from such support to remain viable and survive in the ACA climate.