Healthcare policies at risk, and the implications for community health centers

Recent news has come to light about US policies like the 340B Drug Pricing Program and risk adjustment being taken advantage of or leveraged unethically.

These actions from a few parties put the policies at risk for all those who rely on them.

The community health centers serving disenfranchised communities are a primary reason the 340B program and risk adjustment policies were set up to begin with. These health centers rely on the policies’ benefits to help provide affordable, accessible, high-quality care for their patient population. We can’t let a few bad actors strip CHCs of these critical supports. ‍

The 340B Program: Crucial for patients and providers

The 340B Drug Pricing Program allows covered entities like community health centers to get outpatient drugs at reduced prices, lowering drug costs for vulnerable patient populations. Community health centers rely on 340B not just as a cost-saving measure, but as a necessary revenue stream.

Some organizations have been found to “leverage their arrangements within the 340B program to boost their own bottom lines,” including hospitals that were “using savings from the program for purposes ‘seemingly unrelated’ to patient care.”

When organizations exploit the program like this, we all lose: health centers lose the financial stability it helps provide and patients lose an affordable and accessible program they rely on.

Risk adjustment: An opportunity for fairness for all health centers

Risk adjustment is designed to accurately describe the conditions of a provider’s patient population—how sick or complex the patients are. Used correctly, risk adjustment allows us to compare apples to apples from a cost standpoint — not all patients cost the same amount to treat — and give providers credit for the riskiness of the population they’re serving.

Community health centers are the only provider group with payments that are not currently risk adjusted. They need this opportunity within the same guidelines as everyone else, otherwise, they’re not set up for success. But the missteps of others could deny them the opportunity to participate at all.

The few shouldn’t hold back the many

These policies may be at risk because of a few organizations who unethically game the system or tweak risk adjustment codes to earn more.

Putting these policies at risk puts health centers in a precarious position. They haven’t been handed the same rulebook as many other providers. They’re providing care without the same access, resources, and support systems that other providers have. The 340B Program and risk adjustment can help level the playing field.

Punishing all health centers for the actions of a few would perpetuate inequities that leave CHCs behind, stripping them of necessary revenue sources and jeopardizing their ability to treat our most vulnerable community members.

Conclusion

Gaming the system does a disservice to the health centers that need the system to work just as it should. It does an even bigger disservice to their patients — who are people in need of care, not a revenue source.