A Place for School-Based Health Centers within the New Era of Alternative Payment Models in Medicaid

Winston F. Wong, M.D., M.S., Ben L. Bynum, M.D., M.B.A., M.P.H.

Abstract


School-based health centers are a key part of the health care delivery system in many states, particularly in addressing the needs of low income and underserved communities.  As the momentum for adopting alternative payment models (APM) develops and influences the reimbursement of Medicaid services, school-based health centers (SBHC) should be included in APM models.  SBHCs serve as vital primary care sites for youth living in low income communities. Delivery systems undergoing alternative payment model reform will do well to leverage school-based health centers as a means to address health disparities experienced by low income, underserved youth.

There are a handful of states that have begun to strategically embed school-based health centers into alternative payment models.  New York State recently announced it will be moving SBHCs into the state’s Medicaid Managed Care program in July 2016, and transitioning reimbursement away from fee-for-service.  Per member per month (PMPM) payments linked to school enrollment data can offer better budget predictability for the provider groups that serve as operating sponsors of SBHCs.  In some cases, upfront, capitated payments can serve as the initial investment capital needed to build and operate new SBHC sites in order to capture the financial savings generated when managing patients in this lower cost setting.  Through Medicaid 1115 waivers, states are innovating and transforming the way care is delivered and paid for within their state.  Statewide lessons should be studied and shared nationally in hopes of creating policies that shape a comprehensive and standardized reimbursement environment which supports and expands the financial sustainability of school-based health centers.  


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References


JAMA. 2015 July;314(4):343-4. Medicaid’s New Role in the Health Care System. Mann JD, C., Oslus, MPA, E.

Health Soc Work. 2014 May;39(2):83-91. Understanding the relationship between school-based health center use, school connection, and academic performance. Strolin-Goltzman J, Sisselman A, Melekis K, Auerbach C.

Arch Pediatr Adolesc Med. 2012 Jul 1;166(7):675-7. doi: 10.1001/archpediatrics.2012.553. School-based health center use and high school dropout rates-reply. Kerns SE, Pullmann MD, Walker SC, Lyon AR, Cosgrove TJ, Bruns EJ.

J Adolesc Health. 2015 Jun;56(6):658-65. doi: 10.1016/j.jadohealth.2015.02.016. Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation. Gilmore K, Hoopes AJ, Cady J, Amies Oelschlager AM, Prager S, Vander Stoep A.

Arch Pediatr Adolesc Med. 1998 Jan;152(1):25-33. Managed care and school-based health centers. Use of health services. Kaplan DW, Calonge BN, Guernsey BP, Hanrahan MB.

Health Care Finance Rev. 1997 Spring;18(3):149-75. Managing access: extending Medicaid to children through school-based HMO coverage. Coulam RF1, Irvin CV, Calore KA, Kidder DE, Rosenbach ML.

J Adolesc Health. 2003 Jun;32(6 Suppl):98-107. School-based health centers: accessibility and accountability. Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ.

Am J Public Health. 2010 Sep;100(9):1617-23. doi: 10.2105/AJPH.2009.185181. Epub 2010 Jul 15. School-based health centers: cost-benefit analysis and impact on health care disparities. Guo JJ, Wade TJ, Pan W, Keller KN.

Pediatrics. 2013 Mar;131(3):e709-17. doi: 10.1542/peds.2012-1883. Epub 2013 Feb 11. Cost-effectiveness of the School-Based Asthma Therapy (SBAT) program. Noyes K, Bajorska A, Fisher S, Sauer J, Fagnano M, Halterman JS.


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