By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), an important source of care in low-income communities. A Commonwealth Fund survey asked health center leaders in 2013 about current and anticipated workforce challenges, as well as efforts under way to prepare for the increase in patients. The majority of FQHCs reported shortages of primary care doctors (56%), especially bilingual physicians (60%). Health centers are engaged in activities to meet the needs of new patients, with 53 percent pursuing integration of behavioral health and 31 percent hiring additional clinical staff. To help them provide quality care to more patients, FQHCs will require assistance to recruit additional personnel, particularly bilingual staff and mental health professionals, and to expand access to care through telehealth and other strategies.

What is already known on this topic? Community health centers (CHCs) provide primary care to disadvantaged populations and have lower-than-average cancer screening rates. Stronger integration of CHCs and specialists is recommended to increase cancer screening, but the impact of integration efforts in the real world is unknown. What is added by this report? CHCs that are more strongly integrated with specialists have higher rates of cervical and colorectal cancer screening and better communication with specialists compared with the least integrated CHCs. What are the implications for public health practice? Integration between CHCs and specialists may enhance communication across health care providers and improve cancer screening rates. Efforts are needed to promote integration and identify the mechanisms that lead to long-term, effective partnerships.

This brief analyzes experts' reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. It finds that successful models have several common attributes: targeting patients likely to benefit from the intervention; comprehensively assessing patients' risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care; coordinating care and communication among patients and providers; facilitating transitions from the hospital and referrals to community resources; and providing appropriate care in accordance with patients' preferences. Overall, the evidence of impact is modest and few of these models have been widely adopted in practice because of barriers, such as a lack of supportive financial incentives under fee-for-service reimbursement arrangements. Overcoming these challenges will be essential to achieving a higher-performing health care system for this patient population. To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations. OVERVIEWFederally qualified health centers (FQHCs), also known as community health centers, provide comprehensive primary care, behavioral health services, and dental care to all patients regardless of their ability to pay or health insurance status. Located primarily in medically underserved areas, these centers are a core component of the health care delivery system for low-income and minority populations. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation's nearly 1,200 FQHCs operating in 8,500 sites. 1 In addition to health services, FQHC staff provide patients with insurance eligibility and enrollment assistance, case management, language interpretation, and transportation services. It is clear that these safety-net providers are a critical source of care for low-income and minority populations. 2 After Massachusetts implemented its health reform program in 2006, there was an increased demand for services at community health centers among newly insured low-and middle-income residents. 3 The Affordable Care Act (ACA) has the potential to do the same at FQHCs nationwide, raising questions about the ability of these centers to continue providing high-quality, cost-effective care.To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.