PCBH Practice Development in Safety Net Settings
Author: S Gedeon
What is a “safety net setting?”
“The Institute of Medicine defines the health care safety net as: ‘Those providers that organize and deliver a significant level of health care and other related services to uninsured, Medicaid, and other vulnerable populations’ (IOM, America’s Health Care Safety Net: Intact but Endangered, 2000).”
Click here for Definition of Health Care's Safety Net prepared by the Commission on the Public's Health System for Medicaid Matters NY and the Save our Safety Net Campaign 2012.
“The National Association of Public Hospitals and Health Systems (NAPH) adds that “they are distinguished by their commitment to provide access to care for people with limited or no access to health care due to their financial circumstances, insurance status, or health condition” (NAPH, What is a Safety Net Hospital?).”
They can be located in rural and urban settings and consist of Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes, and Rural Health Clinics (RHCs).
What are some important considerations when working within Safety Net Practices?
Some challenges in these settings include large patient populations with fewer providers, financial considerations, difficulty accessing specialty care. Benefits include access to resources from governmental agencies such as HRSA and CMS, access to social services on site, and a commitment to quality improvement.
Read more on working with safety net practices from the Agency on Healthcare Research and Quality (ARHQ).
What are FQHCs?
“Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors composed of 51% users “of”1 the primary care service. Certain tribal organizations and FQHC Look-Alikes (an organization that meets PHS Section 330 eligibility requirements, but does not receive grant funding) also may receive special Medicare and Medicaid reimbursement.”
Click here for link to the US Department of Health and Human Services (HRSA) definition of FQHCs.
What are FQHC Look-Alikes?
“Federally Qualified Health Center (FQHC) Look-Alikes are Health Centers that have been certified by the Centers for Medicare and Medicaid Services (CMS), based on recommendations provided by the Health Resources and Services Administration (HRSA)/Bureau of Primary Health Care (BPHC), as meeting all Health Center Program requirements. FQHC Look-Alikes do not receive funding under the Health Center Program. This certification makes them, like Health Center Program grantees, eligible for fair reimbursement through Medicaid and Medicare, participation in the 340B federal drug pricing program, and assists in recruiting and retaining providers through the National Health Service Corps and the State Loan Repayment Program.”
Click here for the MIchigan Primary Care Association definition of FQHC Look-Alikes
What is a Rural Health Clinic (RHC)?
A Rural Health Clinic (RHC) is a federally qualified health clinic certified to receive special Medicare and Medicaid reimbursement from CMS. RHCs must be located within non-urban rural areas that have health care shortage designations. They are required to provide outpatient primary care and basic laboratory services, but may also offer additional programs for mental health and substance use problems.
Click here for a link to the US Department of Health and Human Services (HRSA) definition of Rural Health Clinics.
How do you develop a PCBH program in these settings?
The PCBH model has been adopted in many safety net settings. The use of a behavioral health consultant (BHC) as a generalist provider allows for a wide scope of behavioral health concerns to be addressed in a manner that is consistent with the delivery of population-based primary medical care. Same day access and the brief, targeted functional approach used by the BHC increases access to mental health services that might otherwise be inaccessible due to cost, transportation barriers, lack of community providers.
In developing a PCBH program in a safety net setting, it is critical that the culture of the community being served and their needs be fully understood. A first step in program development should be a needs assessment in which the perspective of senior management, board members, medical providers, and patients is elicited. This is an opportunity to compare their needs to the benefits of what a PCBH program can offer. It is also the time for the organization that is considering integrating care using the PCBH model to review their strategic plan and vision. Is the provision of integrated care in the organization’s written vision? If not, this is critical to long-term success and should be taken seriously before starting a new initiative. If the vision is changed to include PCBH, a plan to communicate about this with staff and patients should be developed.
The next step is to determine how the program will be funded (link to FAQ on billing). Finally, hire the right BHC and start to build a care team. It is of critical importance that the BHC be a good fit for the culture of the center and the population being served. Appropriate training, experience, and proficiency in health psychology are essential. In addition, competence in working within primary care settings and program development are critical skills. This can be accomplished through formal educational programs (i.e., post-baccalaureate) and/or additional training and supervision.
Successful PCBH programs do not just locate a BHC among the PCPs; the care delivery process is transformed to include collaborative and proactive care planning. Traditionally, primary care medicine has not been delivered as a team. This is changing and challenging as people take on new roles that they may not yet feel confident in, but the rewards of shared care are great for the providers and the patients, thus it is worth the effort. For more information on team building go to:
How do you fund a PCBH program in a safety net setting?
Please see Billing FAQ
Click here for a PDF copy of this FAQ.
Click here to return to PCBH FAQs.