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Chapter 5 108 A lengthy debate over how to build a more effective and affordable health care system culminated in the enactment of the Patient Protection and Affordable Care Act of 2010 (ACA). The legislation is neither the beginning nor the end of efforts to improve health care and health outcomes in the United States. Many more steps, both large and small, will be needed to establish a stable, highperforming health care system. Among its many provisions, the ACA sets in motion an unprecedented expansion of health insurance coverage, projected to reach more than thirty million previously uninsured Americans. Over the next few years, a crucial test of health care reform will be whether the expansion of coverage is converted into a guarantee of cost-effective access to needed services. At the same time, expectations for better care will be raised for close to twenty million people who remain uninsured. Both the short-term and long-term success of health care reform will depend on the availability of high-quality primary care. It seems clear that the capacity and cost-effectiveness of the nation’s health care safety net, especially its community health centers (CHC), will be important determinants of how well the primary care needs of newly insured individuals and still-uninsured individuals are met as national health care reform proceeds (Adashi, Geiger, and Fine 2010). As chapter 3 of this volume explains, the ACA and the American Recovery and Reinvestment Act of 2009 (ARRA) include a number of incremental steps to strengthen CHCs, including funds to acquire new health information technology, support construction and expansion of centers, and support new clinical positions through the National Health Service Corps (NHSC). Community Health Center and Academic Medical Partnerships to Expand and Improve Primary Care Thomas R. Oliver, Richard E. Rieselbach, Byron J. Crouse, and John G. Frohna Health Center Academic Partnerships 109 While these are all necessary steps, an additional innovation could produce a catalytic effect and yield broad, lasting health system improvement. We propose an expansion of partnerships between the nation’s CHCs and the nation’s academic medical centers. The innovation we propose—the Community Health Center and Academic Medical Partnership (CHAMP)— would build upon current collaboration in the areas of patient care, health professions education, and community health services research (Morris et al. 2008; Brutger 2010). This chapter explains how CHAMP would expand graduate medical education and ambulatory-training opportunities for primary care residents in CHCs designated as “teaching health centers.” Such a partnership would improve the quality of primary care training and at the same time help CHCs meet the increasing demand for their services (Rieselbach, Crouse, and Frohna 2010). This initiative would help provide more affordable care and better outcomes for many of the people who will acquire health insurance as of 2014 and who are likely to be cared for by CHCs. A major expansion of these collaborative relationships is now possible. Enactment of the ACA, with its support for primary care and teaching health centers, provides the initial basis for CHAMP to further establish CHCs as a key component of a reformed, cost-effective health care system. Primary care residents would receive their final year of training in these centers, followed by the incentive of NHSC debt repayment for subsequent practice in an underserved area. Residents trained in this setting would immediately increase the clinical capacity of CHCs and ultimately expand the primary care physician workforce. We believe that this new visible commitment of our academic institutions to community health improvement may well inspire a new generation of medical students to consider primary care as a career choice. This partnership should be an integral part of a strategy to provide the number of well-trained and highly motivated clinicians needed to ensure a strong future for primary care across the US health care system. It would also respond to the recent call by a consortium of academic medical centers for leadership and cooperation with other sectors to address the social determinants of health and reduce disparities across population groups (Blue Ridge Academic Health Group 2010). This chapter develops the case for CHAMP first by outlining the problems in health care delivery this proposal would address and then by describing a variety of past and present initiatives intended to strengthen the link between primary care training and safety net providers. After specifying the key features of CHAMP, we discuss how this proposal meshes with various provisions in the ACA that encourage such initiatives and...


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