Online Program

Post ACA: The evolving business models of free clinics

Tuesday, November 3, 2015

Amy Brock Martin, DrPH, Division of Population Health, Department of Stomatology, Medical University of South Carolina, Charleston, SC
Grishma Bhavsar, PhD, MPH, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
Lauren Workman, PhD, MPH, Center for Health Services and Policy Research, Arnold School of Public Health, University of South Carolina, Columbia, SC
Janice C. Probst, PhD, University of South Carolina, South Carolina Rural Health Research Center, Columbia, SC
Purpose: The Affordable Care Act (ACA) aims to reduce the uninsured population through Medicaid expansion and health insurance exchanges.  Changes in the demography of the uninsured bring into the question the current business models and need for free clinics in the healthcare safety net.

Methods: Key informant telephone interviews were conducted with executives from 15 state/regional free clinic associations, of the 25 such associations nationally. Topics addressed included the impact of state policies on free clinic operations and business strategies or model adaptations used to meet the changing needs of the uninsured due to the ACA. We specifically explored the adoption of hybrid models, whereby clinics provide care to Medicaid beneficiaries as well as the uninsured, and charitable or reduced cost care, whereby patients pay a fee based on what they can afford.

Results: Overall, free clinic executives reported minimal changes in the demand for free clinic services in their states/regions. Large numbers of uninsured persons remain and locating new sources of care for newly Medicaid-eligible persons is challenging. A large majority of free clinics are waiting for more components of the ACA to be implemented prior to adopting alternate business models. Very few executives identified free clinic closures; only 2 were attributed to a reduction in need associated with the ACA.

Conclusion: As additional components of the ACA are implemented, changes in business models for safety net providers may be required. Monitoring these changes to determine their impact on vulnerable patient populations is essential.

Learning Areas:

Administration, management, leadership
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Discuss national changes in free clinic business models due to the ACA. Describe traditional, hybrid, and charitable care business models for free clinics.

Keyword(s): Accessibility, Affordable Care Act

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently the Director of the Division of Population Health at the Medical University of South Carolina. I was previously Deputy Director of the SC Rural Health Research Center and faculty in the Department of Health Services Policy and Management, Arnold School of Public Health at the University of South Carolina. I am a previous recipient of the Delta Omega Innovative Public Health Curriculum Award and NIH Loan Repayment Grant for Health Disparities Research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.