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The Effects of Expanding Primary Care Access for the Uninsured: Implications for the Health Care Workforce Under Health Reform

Dow, Alan W. MD, MSHA; Bohannon, Arline MD; Garland, Sheryl MHA; Mazmanian, Paul E. PhD; Retchin, Sheldon M. MD, MSPH

doi: 10.1097/ACM.0000000000000032
Articles

The Patient Protection and Affordable Care Act seeks to improve health equity in the United States by expanding Medicaid coverage for adults who are uninsured and/or socioeconomically disadvantaged; however, when millions more become eligible for Medicaid in 2014, the health care workforce and care delivery systems will be inadequate to meet the care needs of the U.S. population. To provide high-quality care efficiently to the expanded population of insured individuals, the health care workforce and care delivery structures will need to be tailored to meet the needs of specific groups within the population.

To help create a foundation for understanding the use patterns of the newly insured and to recommend possible approaches to care delivery and workforce development, the authors describe the 13-year-old experience of the Virginia Coordinated Care program (VCC). The VCC, developed by Virginia Commonwealth University Health System in Richmond, Virginia, is a health-system-sponsored care coordination program that provides primary and specialty care services to patients who are indigent. The authors have categorized VCC patients from fiscal year 2011 by medical complexity. Then, on the basis of the resulting utilization data for each category over the next fiscal year, the authors describe the medical needs and health behaviors of the four different patient groups. Finally, the authors discuss possible approaches for providing primary, preventive, and specialty care to improve the health of the population while controlling costs and how adoption of the approaches might be shaped by care delivery systems and educational institutions.

Dr. Dow is assistant vice president of health sciences for interprofessional education and collaborative care, assistant dean of medical education, and associate professor of medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.

Dr. Bohannon is associate professor of medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.

Ms. Garland is vice president of health policy and community relations, Virginia Commonwealth University Health System, Richmond, Virginia.

Dr. Mazmanian is associate dean for assessment and evaluation studies, School of Medicine, and director of evaluation, Virginia Commonwealth University Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.

Dr. Retchin is senior vice president of health sciences, Virginia Commonwealth University, and chief executive officer, Virginia Commonwealth University Health System, Richmond, Virginia.

Funding/Support: Dr. Dow is supported by a faculty fellowship grant from the Josiah H. Macy Jr. Foundation. Dr. Mazmanian is funded by a grant award (UL1TR000058) from the National Institutes of Health (NIH). The contents of this article are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences, the Josiah H. Macy Jr. Foundation, or the NIH.

Other disclosures: None.

Ethical approval: This study was approved by the Virginia Commonwealth University institutional review board.

Correspondence should be addressed to Dr. Dow, Virginia Commonwealth University, School of Medicine, Box 980565, Richmond, VA 23298-0565; telephone: (804) 828–9790; e-mail: adow@mcvh-vcu.edu.

© 2013 by the Association of American Medical Colleges