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Commercial Insurers' Reimbursement Rate to New York's Community Health Centers Jeopardizes Care
Date:10/1/2007

New Study Calls for Measures to Recognize Value and Enhance Payments

NEW YORK, Oct. 1 /PRNewswire-USNewswire/ -- Inadequate reimbursement rates from private insurers threaten the future of many of New York State's community health centers (CHCs) and their ability to continue serving all patients, concludes a new study released by the Community Health Care Association of New York State (CHCANYS), and funded by CHCANYS and the RCHN Community Health Foundation. CHCs receive significantly lower reimbursement rates from private insurers compared with those from public payers including Medicaid and Medicare. Commercial reimbursement rates are far below the actual costs of care.

CHCs, which provide comprehensive primary care to over 1 million patients at more than 400 urban and rural CHC delivery sites throughout New York State, serve as "medical homes" for their patients. They are federally mandated to provide primary and preventive health services as well as a wide range of enabling services crucial to underserved populations. Numerous studies demonstrate that CHCs' comprehensive model provides high-quality care that meets or exceeds national benchmarks, while remaining cost-effective. While CHCs are driven by mission and legal mandate to provide care to the uninsured and underserved communities, they also serve large numbers of patients with private, commercial insurance.

The study, entitled Improving Commercial Reimbursement for Health Centers: Case Studies and Recommendations for New York, was conducted by Manatt Health Solutions, a policy and advisory division of one of the nation's premier law and consulting firms, and RSM McGladrey, the fifth-largest provider of accounting, consulting and business advisory services in the U.S.

After completing an in-depth analysis of six CHC networks across New York State, the study found that:

-- Commercial payment rates per visit were, on average, $38 less than

Medicaid fee-for-servi
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SOURCE CHCANYS; RCHN CHF
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