Health Reform Implications for Wayne County

by Chris Allen, Executive Director and CEO, Detroit Wayne County Health Authority (as published in the Michigan Primary Care Association’s newsletter, News & Notes, Spring 2010 issue)

National health reform is the most significant health legislation since the implementation of Medicare and Medicaid in the 1960s.  For the safety net in Detroit and Wayne County, it offers a fiscal and emotional boost in our efforts to extend access to quality health care for everyone.  

Unfortunately, increased eligibility for Medicaid and MIChild, support for acquiring health insurance, and improving capacity for the community health system does not necessary equate to increased access, elimination of health disparities, or true health reform in a comprehensive sense.  It is a foundation from which we can build a new way of caring for the medically underserved.  It is a foundation based on values and sensitive to the unique nature of our communities.  

In our recent safety net stakeholder summit, we achieved a new level of consensus regarding the direction we need to take health reform at the local level, with specific emphasis on acting aggressively, in a collaborative manner, to maximize the benefits of health reform investment in our local community health centers.  

Enrollment:  Our first challenge is to reinforce our efforts to enroll everyone who qualifies for Medicaid and MIChild, as well as get health insurance coverage for as many people as possible.  While many of the features of national health reform legislation won’t take effect until 2014, we still have many people who qualify under the existing program but aren’t covered.  In addition, with the passage of health care reform, using web-based technology and community outreach, we can expedite enrollment with health systems and community organizations to reach people in creative and efficient ways.  

Capacity:  We need to anticipate demand on the community health system that will come with the newly enrolled Medicaid and MIChild beneficiaries, and continue our efforts to reach and meet the needs of the truly uninsured.  Our existing community health facilities need to maximize their capacity and plan for growth.  We also need to continue working with the Wayne County Medical Society and health plans to retain physician practices in underserved areas.  

Workforce Development:  Incentives need to be established to encourage physicians to pursue primary care, and they need training opportunities to realize the potential of working in community health centers.  Physician assistants and nurse clinicians also need to be developed and trained for primary care work.  And to assist them, we will need a host of technical and administrative staff.  Beginning this summer, the Health Authority will begin the two-year Richard Bohrer Safety Net Administrative Fellowship Program.  The Health Authority will train in partnership with the CEOs of Community Health Centers, two graduate prepared administrative fellows in community health center management.  Their administrative experience will include 80% of their time in a health center, 10% of their time at the Health Authority, and 10% of their time at the Bureau of Primary Care in Washington, DC.  

Reduce Disparities:  We need the right health programs in the right place caring for people in the right way.  Health equity is a value that the Health Authority espouses as we work with our community partners to ensure we get the maximum benefit from health care reform.  As our faith-based stakeholders assert, health reform, as it stands, is a legislative solution, not a moral commitment to guaranteeing health care for all.  

We need to reform health care, in our communities, with the tools available to us through this legislation.

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