Medicaid Expansion: Swapping Health Clinics for PCMH

When Medicaid expansion came to Louisville, Ky., it created an opportunity for a population traditionally served by public health clinics to receive healthcare through a wholly different mechanism -- and so far that mechanism appears to be reaping benefits.

LaQuandra Nesbitt, MD, MPH, Director, Louisville Metro Department of Public Health and Wellness, made the executive decision to limit access to certain services in public health clinics in an effort to "steer" residents into local patient-centered medical homes (PCMH).

Kentucky has more insured residents since the expansion, and Nesbitt, a board-certified family physician, believed the care available in a public clinic was falling short of what residents really needed. "Those services were extremely fragmented, and not necessarily integrated with any of the comprehensive primary care systems," Nesbitt said. "And that's sort of antithetical to the concept of PCMHs."

That piecemeal care, Nesbitt said, appears to have contributed to the well-recognized poor health outcomes in Kentucky, a state that typically ranks among the bottom three states in the nation for several health categories, including smoking, cancer deaths, heart disease, and heart attacks.

"If we're really going to think that the PCMH is about improving health outcomes for our community, how could we in good faith and good conscience as a health department say we want to hold onto providing family planning services and immunization services?" Nesbitt told MedPage Today.

To facilitate enrollment, the state trained a group of application assisters, Kynectors, pronounced 'connectors,' to help residents. Kynectors and state-funded, in-person assisters have been all over the place, working everywhere from hospitals, clinics, federally qualified health centers (FQHCs), and PCMHs, to churches and community centers. Nesbitt said they've been working with social support services, special populations, corrections, and have even signed up refugees.