Focus on: Access Community Health Network

A nationally recognized care model continues to grow By Cheryl England

As one of the largest Federally Qualified Health Centers (FQHCs) in the United States, Access Community Health Network (ACCESS) boasts several number one claims in Illinois: the largest provider of Medicaid- and Medicaid-managed primary care, and the largest primary care provider for minority patients, including African Americans and Latinos, in Illinois. The network includes more than 35 locations across two Chicago area counties, spanning diverse communities, suburbs and townships. The group treats predominately low-income patients and provides community outreach, resident training and clinical research in many locations throughout its network. “We treat about 40,000 uninsured patients every year in our health centers,” says Tariq Butt, MD, vice president of health affairs at ACCESS and one of the key drivers behind the group’s FQHC status. “That’s almost 10% of all patients in the Chicago area. And sometimes the number can grow even higher when the economy is weak.”

FQHCs are community-based organizations that provide comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. An FQHC is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services (CMS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid. They must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program and have a consumer-driven governing board of directors.

ACCESS is all of this and more, although it didn’t start out that way. When Dr. Butt joined ACCESS in 1989, it was not a FQHC. “But even before we were a FQHC,” he notes, “we never refused Medicaid and uninsured patients. We have always had a sliding scale of payment for the uninsured.”

In October of 1991, ACCESS first qualified as a FQHC “look-alike,” meaning the group provided services consistent with all statutory, regulatory, and policy requirements that apply to Health Center Program grantees, but did not receive funding under section 330 of the Public Health Service Act. In 1995, ACCESS became fully FQHC-accredited. At first, says Dr. Butt, the group was very small. “But then we hired physicians and executives; we partnered with local community hospitals and large academic centers, as well as developed regional health care delivery models so patients could receive quality health care within their own communities,” he says. “Many organizations partnered with ACCESS to run health centers more efficiently.”

ACCESS also unearthed some surprises along the way. “At first, we concentrated on low-income areas in the South and West suburbs, as well as in Chicago’s inner city,” says Dr. Butt. “But then we discovered that there was also a need in wealthier suburbs such as those situated in DuPage County and other affluent Cook County suburbs.”

In another learning experience, ACCESS discovered through its partnership with the University of Chicago Medical Center that some patients who showed up in emergency rooms were simply going because they needed specialty care. “We are a unique FQHC,” says Dr. Butt. “Most FQHCs are confined to primary care, but we have many specialties within our group.”

Today, ACCESS has more than 900 employees. There are physicians, midwives, nurse practitioners and physician assistants, as well as behavioral health consultants and subspecialists, including psychiatrists, in key hub sites. Not only is the workforce diverse in terms of professional specialization but also in terms of matching to the patient population—a total of 26 languages are spoken by team members in the delivery of care.

The group also offers a diverse range of programs from community outreach to research to resident training. Community-based programs range from smoking cessation and infectious disease consultation to its Healthy Start program, which aims to reduce infant and maternal fatalities. Other premier programs include prevention and early detection of diseases, youth services, HIV care, chronic disease management, and a patient-centered medical home.

A comprehensive research arm focuses on reducing racial and ethnic health disparities. And, the group partners with hospitals and other academic centers to offer family medicine and internal medicine residency training programs. “We were the first FQHC to house primary care residents,” says Dr. Butt. “We now offer residency training opportunities in pediatrics, internal medicine and obstetrics/gynecology to residents and students from Presence Health, Saint Francis Hospital and the University of Illinois at Chicago, Rush University and Southern California.”

With the advent of the Patient Protection and Affordable Care Act (ACA), ACCESS is expanding its reach. CountyCare, a new Medicaid program for uninsured adults that is supported by the State of Illinois and the Cook County Health and Hospitals System, and the Marketplace will give a medical home to 120,000 Medicaid-eligible, formerly uninsured Illinois residents.

When it comes to finances, ACCESS spends $20+ million in programs and uninsured care every year. “We have a very committed group,” says Dr. Butt. “We have great staff retention. We also have a financially sustainable model and a solid business strategy for how to deliver care to our patients and how to get funding streams.”

For example, ACCESS’ diverse branches—such as research and academia—in addition to its health centers, offer a variety of options for funding. “Plus,” continues Dr. Butt, “we are always reviewing our financial models and adding services. We need to always be able to adapt and provide high quality services for our growing patient base in Chicago and the surrounding areas.”