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Q&A: Mich. primary-care leader on healthcare reform


By Ryan Kelly, Crain's Detroit Business
Posted: December 28, 2012 - 10:45 am ET
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Crain's Detroit Business talked to Kim Sibilsky, executive director of the Michigan Primary Care Association, about the ramifications of healthcare reform and top healthcare issues for 2013.

What's changed in the health care industry since this time last year?

The fact that more people are uninsured today than they were a year ago. … We've been deeply involved in attempting to get health centers expanded … (with) six new health centers at this point funded this year. (But) I'm seeing a much closer camaraderie and partnership between different sectors of the health care world: hospitals working with health centers, (and) community health organizations working really closely with our folks as well.

What are federally qualified health centers doing to prepare for health reform?

Part of the (Patient Protection and) Affordable Care Act (calls for) increasing the number of health centers and the number of people served, so that takes real business development. Also, the partnership with mental health organizations is consistent with what's happening with the Affordable Care Act in terms of creating continuous care for people. So that is comprehensive primary care, including mental health, substance abuse service, physical health, oral health — they're really working on increasing their services.

Another way is exemplified by the Detroit Wayne County Health Authority's recent grant that they received to establish residency training programs at the health centers.

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How do you prepare for the hundreds of thousands of newly insured people under health care reform?

In Michigan, they are projecting about 450,000 new insured under Medicaid expansion. Health centers in Michigan serve over 600,000 people. Over 36 percent of the people we serve are uninsured. If you attempt to estimate what portion of those that could get Medicaid expansion, it looks to be around 110,000. We've already done financial analysis. … It's not like we don't know who they are or what's going on with them. We should be able to, in the first 12 months, get about a quarter of those 450,000 people into coverage.

So then … we should be able to serve another 100,000 people within a year and a half or so, and that's just through health centers. The Affordable Care Act has money to help health centers expand through new access grants, a new round that is coming out very shortly, and another round coming out within a year.

What does it look like on the ground, setting up new medical centers?

Part of the thing with the health centers: They are to go into designated underserved communities. So if you look at primary care and the data and a map, you would be able to find the shortage areas, the areas designated as underserved — 73 of 89 counties in Michigan have an official shortage designation, so there is still a lot of room to put health centers and health clinics up.

We would really love to see the private sector rise to the challenge. The difficulty is that there is currently a shortage of primary care physicians. … Nurse practitioners and physicians aren't allowed to practice at the top of their education level. We really need to do work with PAs and nurse practitioners to expand their practice, as well as create new access points..

What are you working on personally on a day-to-day basis?

As CEO of the association, it's my responsibility to staff, to have highly competent and capable people to do things like community development. We have people working with academic training programs, with the administration, with legislators — to improve the practice environment for primary care practitioners. We are working a lot on improving our quality and getting our health centers certified. We have also been extremely focused on getting our health centers electronic. We are one of the lead states in the nation for converting to electronic; 85 percent are fully converted. It is really important for quality, for continuity.

What will you be working on in the new year?

(The governor) put forth what we consider to be a challenge. He had stated that he needed to be shown there is capacity to serve that many new people, and he really put that challenge to folks like us, the hospital association, the health clinics, that there would be capacity to take care of these folks. I just signed a letter to him today that will basically tell him much of the stuff that I just told you.

If that grant round (for access grants) comes up soon, which we expect that it will, we would love to see in the new year another six new access points at least. … We keep doing the same types of things we've been doing, but doing them better.


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