Health

HEALTH • Summer 2018 15 Noreen Johnson Smith, the vice president of development and advancement at Family Health Center, where the number of patients served last year was up 29 percent over 2009. have become a greater presence in the region. Saint Vincent Hospital and its associated physi- cian practices, originally organized as a Catholic non-profit, has been part of for-profit organiza- tions for more than a decade, and is currently owned by Tenet Healthcare Corp. Reliant Medical Group, which has primary care and specialist offices around the region, went from nonprofit to for-profit status last year when it was acquired by for-profit OptumHealth. The Central Massachusetts Independent Physician Association became part of private equity-owned Steward Healthcare last year. To Dickson, given that MassHealth reimburses providers at a lower rate than commercial insurers do, it appears that for-profit players will make fewer investments in areas where many people rely on the public insurer. "It's not bad people doing bad things, but the math doesn't lie," Dickson said. "If you're trying to enhance shareholder equity, you're not doing everything you can to grab market share in the Medicaid space." Challenges from reimbursement rates Dickson argues that UMass is taking on more than its fair share of publicly insured patients. When it comes to hospital visits, he said, UMass and its affiliates have 57 percent of the market share in its service area, but they have a 65-percent share of Medicaid services and only a 49-percent share of commercial ones. Some of the region's for-profit health care pro- viders push back against Dickson's arguments. Tarek Elsawy, president and CEO of Reliant, said Reliant provides care to 29,000 Medicare patients. "Reliant's commitment to caring for low-income and underserved populations is as strong as it has ever been," he said in a statement. Elsawy said his organization is expanding to accommodate more pri- mary care patients from all payer cat- egories. He noted that the group is also participating in the MassHealth Accountable Care Organization, an initiative designed to improve the coordination of care for MassHealth patients. UMass participated in a pilot of the ACO program but decided last August not to continue in it. After UMass announced the Plumley clinic closing, Family Health Center, located on Queen Street in Worcester, hired one of the clinic's two doctors and agreed to accommo- date any of the Plumley patients who want to get care there. "We are working very hard to make sure that's a smooth transition for any patient who wants to come," said Noreen Johnson Smith, vice president of development and advancement at Family Health. Family Health, which has locations serving much of Worcester County, is one of three federally qualified health centers in Central Massachusetts. The others are Worcester-based Edward M. Kennedy Community Health Center and Community Health Connections, which covers the Fitchburg-Gardner-Leominster area. These community health centers are the product of the 1960s War on Poverty. They provide a range of medical services, from primary care to behav- ioral health and dental care. Because health is closely tied to other basic needs like housing and jobs, they coordinate their work closely with other local service providers. By federal statute, the majority of their board members must be patients who get care at the clinic. "That remains a really important mes- sage in today's world, that we need to hear the voices of consumers of pro- grams," Johnson Smith said. "They play a very important role on the board." Busier community heatlh centers The community health centers are open to everyone, including commer- cially insured people and people without insurance. But in 2017, by far the most common form of insurance for Family Health Center's patients was Medicaid, at 71 percent, followed by Medicare at 12 percent. Johnson Smith said one in six Worcester residents receive care at either Family Health or Edward M. Kennedy, and the number of primary care patients served by Family Health Center alone has grown from 16,822 in 2009 to 21,723 last year, a jump of 29 percent. Community health centers may be becoming increasingly popular as some other health care providers choose not to accept MassHealth. Karen Culkeen, program director for the Gardner Visiting Nurses Association's Healthy Families program, said it can be hard to help the parents and children the pro- gram serves find primary care doctors. "Our greatest challenge is with physicians not accepting new patients and/or not accepting insur- ances, particularly MassHealth," Culkeen said in an email. Johnson Smith said the community health cen- ters face some of the same pressures as any other doctor's office, including an aging population with more complex needs and difficulty recruiting pri- mary care physicians in a system where specialists often get higher pay and greater prestige. But she said the centers can at least partially offset the inad- equacy of Medicaid reimbursement rates with pub- lic and private grants and donations, which are more crtical amid shaky federal funding. Community Health Connections, which serves 28 communities in North Central Massachusetts, has been growing by 4 to 7 percent a year. Jackie Buckley, the center's chief operating officer, said one area of growth has been retirees who find their pre- vious doctor's offices won't take Medicare. The cen- ter also opened a site on Water Street in Fitchburg early this year, offering specialized service for homeless city residents and other care. "We have to keep looking for additional providers and expanding our services," Buckley said. As for Dickson, he said UMass is increasingly focused on supporting the community health cen- ters—providing funding and space for their work, and placing medical residents from UMass Medical School at the centers—rather than trying to dupli- cate their services at UMass-run doctors' offices. "We've tried to partner more with the federally qualified health centers," he said. "They have a lower cost base, they have a higher reimbursement rate, and they have more comprehensive services." Community health center growth Source: Massachusetts League of Community Health Centers; (Edward M. Kennedy Health Center, Family Health Center of Worcester, Community Health Connections, and UMass's Community Healthlink) Patients seen at community health centers in Worcester County 65,883 79,600 2007 2017 H P H O T O / E D D C O T E

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