Americares Survey: Free and Charitable Clinics Adapt Models in Affordable Care Act Era

Facing declining resources under the Affordable Care Act, a critical sector of health care providers that collectively serve 2 million low-income patients annually are varying their operational models—with those in Medicaid expansion states making more changes than those in non-expansion states, according to an AmeriCares survey presented at the American Public Health Association annual meeting.

Specifically, the survey found that free and charitable clinics—nonprofit organizations that provide health care to uninsured and underinsured patients either for free or a reduced fee—in Medicaid expansion states are receiving less volunteer support and finding fundraising more challenging.

The web-based survey, conducted by researchers at AmeriCares and the University of Illinois at Chicago, indicates clinics are responding innovatively to the changing environment. “Free and charitable clinics in Medicaid expansion states are making major changes to their operations in response to the Affordable Care Act,” said Julie Darnell, Ph.D., associate professor in the School of Public Health at the University of Illinois at Chicago, who analyzed the survey data.

The researchers asked clinics in AmeriCares U.S. Programs’ vast partner network about their resources and operations under the Affordable Care Act. Many of those in expansion states said that they were making changes to their organizational delivery model, billing model, day-to-day operations, technology integration and data collection. For example, some clinics are transitioning to a hybrid clinic model, enabling them to bill third-party payers such as Medicaid for services.

“Clinics in expansion states have been forced to look at their model and adapt or consider changing,” said Lindsay O’Brien, director of U.S. Programs at AmeriCares. “Our survey shows how dynamic these organizations are in meeting the critical health care needs of uninsured and underinsured patients in the communities they serve.”

Further analysis of the survey results will help to inform AmeriCares capacity-building initiatives and programs, which include the operation of four free clinics in Connecticut.

AmeriCares U.S. Programs develop resources for the free and charitable clinic sector, including free webinars, online toolkits and information sharing resources, available atSafetyNetCenter.org. Further, the organization is implementing chronic disease and operations-focused initiatives that provide technical assistance to help clinics improve their quality of care and clinic efficiency.

In fiscal year 2015, AmeriCares U.S. Programs delivered $117 million in medicines, vaccines and supplies to its network of more 800 clinic and health center partners that together serve nearly 6 million patients annually. AmeriCares partners receive free medical products, enabling them to deliver additional health care services by providing critical budget relief, reducing patients’ out-of-pocket expenses and expanding their treatment options.

The American Public Health Association’s 2015 annual meeting (Oct. 31 to Nov. 4) brings together nearly 13,000 public health experts in Chicago to present the latest research and share best practices. For more information on AmeriCares survey, the abstract is available on the APHA website.