Safety Net Providers and Underserved Populations
The Center conducts extensive research and program evaluation of laws, policies, and services affecting low-income medically underserved, and vulnerable populations and the health care providers and institutions that serve them. Strong emphasis is placed on projects that assess the structure and process of care within publicly supported health care delivery systems and the role that these systems play in addressing the basic and specialized health needs of vulnerable populations. Initiatives include:
- Urgent Matters, a national program of the Robert Wood Johnson Foundation that conducts local safety-net assessments and provides technical assistance to help hospitals relieve emergency department crowding. Urgent Matters has produced a series of safety net assessments in 10 communities and a cross-cutting national report, all examining issues impacting safety nets in our country.
- Expecting Success is an initiative of the Robert Wood Johnson Foundation aimed at improving cardiac care for racial and ethnic minority populations in the United States. Using a collaborative Learning Network of 10 hospitals around the country, the initiative will develop and disseminate quality improvement strategies, models and resources to improve cardiac care for underserved minority populations in a variety of clinical settings.
- Speaking Together: National Language Services Network is a national program funded by the Robert Wood Johnson Foundation aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). Speaking Together integrates quality improvement with language services, and brings together hospitals to pilot new performance measures and test valuable techniques for reducing health care disparities associated with language barriers.
- Monitoring federal health policy developments that impact safety-net providers.
- Analyzing federally funded health centers and their patients and services.
- Research on the education, training and supply of health professionals in the private sector and public health arena, with a focus on the needs of the underserved.
Related Publications
Publications Available Online
Shin, P., Ku, L., Jones, E., and Rosenbaum, S. Grantee-Level Estimates Show that 31 Percent of All Health Centers would Fail to Meet Tier Two Status under HRSA’s Proposed MUA/MUP/HPSA Designation Regulations. Geiger Gibson/RCHN Community Health Foundation Research Brief #3. May 2008.
Shin, P., Ku, L., Jones, E., and Rosenbaum, S. Revised to address April 21 clarification. Analysis of the Proposed Rule on Designation of Medically Underserved Populations and Health Professional Shortage Areas. Geiger Gibson/RCHN Community Health Foundation Research Collaborative. Research Brief #2. April 2008, revised May 2008.
Shin, P., Ku, L., Jones, E., and Rosenbaum, S. Revised to address April 21 clarification. Highlights: Analysis of the Proposed Rule on Designation of Medically Underserved Populations and Health Professional Shortage Areas. Geiger Gibson/RCHN Community Health Foundation Research Collaborative., April 2008, revised May 2008.
Rosenbaum, S. The CMS Medicaid Targeted Case Management Rule: Implications for Special Needs Service Providers and Programs. Center for Health Care Strategies, Inc. April 2008
Shin, P. Finnegan, B., Rosenbaum, S. How Does Investment in Community Health Centers Affect the Economy? Geiger Gibson/RCHN Community Health Foundation Research Collaborative. Research Brief #1. February 2008.
Shin, P., Finnegan, B., Sharac, J., and Rosenbaum, S. Health Centers: An Overview and Analysis of Their Experience with Private Health Insurance. Kaiser Family Foundation. February 2008.
Mead, H., Regenstein, M., and Lara, A. "The Heart of the Matter: the Relationship Between Communities, Cardiovascular Services, and Racial and Ethnic Gaps in Care." Managed Care Interface, August 2007. Also available from Expecting Success: http://www.expectingsuccess.org/uploads/ManagedCareInterfaceArticleMeadetal.pdf
Siegel, B., Bretsch, J., Sears, V., Regenstein, M., & Wilson, M. Assumed Equity: Early Observations from the First Hospital Disparities Collaborative. Journal for Healthcare Quality, Vol. 29 No. 5, pgs. 11-15. September/October 2007.
Shin, P. Finnegan, B., Hughes, L., and Rosenbaum, S. The Medicaid Documentation Requirements: An Initial Assessment of Medicaid Documentation Requirements on Health Centers and Their Patients. With Support from the RCHN Community Health Foundation. May 2007.
Shin, Reilly, and Schwartz. Update on the Status of the Medicaid Prospective Payment System in the States. National Association of Community Health Centers, September 2006
Rosenbaum, S., Shin, P., and Whittington, R.P.T. Laying the Foundation: Health System Reform in New York State and the Primary Care Imperative. June 2006.
Rosenbaum, S. and Shin, P. Health Centers Reauthorization: An Overview of Achievements and Challenges. Kaiser Commission on Medicaid and the Uninsured. March 2006.
Shin, P., Rosenbaum, S., and Mauery, D.R. Medicaid's Role in Treating Children in Military Families. The Robert Wood Johnson Foundation. October 2005.
Rosenbaum, S., Wilensky, S., and Shin, P. Achieving "Readiness" in Medi-Cal's Managed Care Expansion for Persons with Disabilities: Issues and Process. The California Endowment. August 2005.
Nolan, L., Regenstein, M., and Cox, M. An Assessment of Hospital-Sponsored Health Care for the Uninsured in Polk County/Des Moines, Iowa. June 2005. Executive Summary.
Rosenbaum, S., Shin, P. Migrant and Seasonal Farmworkers: Health Insurance Coverage and Access to Care. GW Department of Health Policy, Center for Health Services Research and Policy, Kaiser Commission on Medicaid and the Uninsured. May 2005.
Proser, M., Shin, P., and Hawkins, D. A Nation's Health at Risk III: Growing Uninsured, Budget Cutbacks Challenge President's Initiative to Put a Health Center in Every Poor County. GW Department of Health Policy; National Association of Community Health Centers. March 2005.
Kenney, K., Blake, Sarah C., Maloy, K., Ranji, Usha R., Salganicoff, A. Hearing Their Voices: Lessons from the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA). Kaiser Family Foundation. November 2004.
Urgent Matters. Bursting at the Seams: Improving Patient Flow to Help America's Hospitals. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. Walking a Tightrope: The State of the Safety Net in Ten U.S. Communities. (22 MB .zip file) Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Atlanta, Georgia. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Boston, Massachusetts. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Detroit, Michigan. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Fairfax County, Virginia. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Lincoln, Nebraska. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Memphis, Tennessee. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Queens New York. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in Phoenix, Arizona. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in San Antonio, Texas. Robert Wood Johnson Foundation. August 2004.
Urgent Matters. An Assessment of the Safety Net in San Diego, California. Robert Wood Johnson Foundation. August 2004.
Rosenbaum, S., Shin, P., and Darnell, J. Economic Stress and the Safety Net: A Health Center Update. Kaiser Commission on Medicaid and the Uninsured, June 2004.
Weinick, R.M., Shin, P. Monitoring the Health Care Safety Net: Developing Data-Driven Capabilities to Support Policymaking. U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, April 2004.
Kamoie, Brian. EMTALA: Dedicating an Emergency Department Near You. Journal of Health Law, Winter 2004.
Rosenbaum, S., Kamoie, B., Collins, C., Zuvekas, A., Feder, J., and Claxton, G. Analysis of CareFirst's Performance as a Charitable Not-for-Profit Health Insurance Company in the National Capital Area. Report to the DC Appleseed Center for Law and Justice. October 2003.
Shin, P., Jones, K., and Rosenbaum, S. Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities. Prepared under a grant from the National Association of Community Health Centers. September 2003.
Rosenbaum, S., and Shin, P. Health Centers as Safety Net Providers: An Overview and Assessment of Medicaid's Role. Kaiser Family Foundation. May 2003.
Health Foundation of Greater Cincinnati, Access to Care for the Uninsured and Underserved, March 2003
Wilensky, S. and Schipani, B. State of the State Addresses: Governors’ Discussions of Budget and Health Care Issues, March 13, 2003
Nolan, L., Kamoie, B., Harvey, J., Vaquerano, L., Blake, S., Chawla, S., Levi, J., and Rosenbaum, S. The Effects of State Dental Practice Laws Allowing Alternative Models of Preventive Oral Health Care Delivery to Low-Income Children. Download the Executive Summary. January 2003.
Rosenbaum, S, and Sonosky, C. Prepaid Ambulatory Health Plans (PAHPs): Implications for Safety Net Providers. December 2002.
Rosenbaum, S., Lambrew, J., Shin, P., Regenstein, M., Ehermann, T., and Roby, D. Health Coverage in Massachusetts: Far to Go, Farther to Fall. Report for the Blue Cross Blue Shield of Massachusetts Foundation. September 2002.
Harvey, J., Vaquerano, L., Nolan, L., and Sonosky, C. School-Based
Health Centers and Managed Care Arrangements: A Review of State Models
and Implementation Issues. July 2002.
Nolan, L., Harvey, J., Jones, K., Vaquerano, L., and Zuvekas, A. The Impact of the State Children's Health Insurance Program (SCHIP) on Community Health Centers. June, 2002.
Markus, A.R., Roby, D., and Rosenbaum, S. A Profile of Federally Funded Health Centers Serving a Higher Proportion of Uninsured Patients. Kaiser Commission on Medicaid and the Uninsured. June 2002
Rosenbaum, S.and Shin, P. Trends in Health Care Organizations. Prepared for the Indian Health Service. April 17, 2002.
Maloy, K.A., Kenney, K.A., Darnell, J., and Cyprien, S. Can
Medicaid
Work for Low-Income Families? Kaiser Commission on Medicaid and the
Uninsured. April 2002.
Rosenbaum, S., Proser, M., Schneider, A., and Sonosky, C. Using Title V Maternal and Child Health Services Block Grant to Support Child Development Services. The Commonwealth Fund. January 2002. (Download PDF file now)
Rosenbaum, S., Proser, M., Shin P., Wilensky, S., and Sonosky, C. Child Development Programs in Community Health Centers The Commonwealth Fund. January 2002. (Download PDF file now)
Shaw, K. and Rosenbaum, S. Access to Pediatric Services under Medicaid Managed Care in the District of Columbia. December 2001. (Download PDF file now)
Zuvekas, A., and Nolan, L. Strategies for Early Network Development , Issue Brief 1. National Association of Community Health Centers, Inc. November 2001 (Download PDF now)
Zuvekas, A., and Nolan L. Building Trust Among Network Partners Through Communication and Leadership , Issue Brief 2. National Association of Community Health Centers, Inc. November 2001 (Download PDF now)
Zuvekas, A., and Nolan, L. Strategies for Maintaining Network Development, Issue Brief 3. National Association of Community Health Centers, Inc. November 2001 (Download PDF now)
Zuvekas, A. Community Health Center Affiliated Health Plans: A Viable Alternative for Medicaid Managed Care?. Association for Health Center Affiliated Health Plans. November 2001.
Rosenbaum, S. Health Status and Needs of the Poor: Policy Update. Ascension Health Advocacy Environmental Assessment. September 2001. (Download PDF now) (PowerPoint presentation PDF)
Rosenbaum, S., Shin, P., Roby, D., and Park, R. Health Centers: A National Profile. Prepared for the Bureau of Primary Health Care, HRSA. 2001. (Download PDF now) (Download PowerPoint presentation PDF now)
Chovan, T., and Shin, P. NACHC REACH 2000 Survey of Community Health Centers. Funded by the National Association of Community Health Centers. 2001.
Nolan, L., Harvey, J., and Zuvekas, A. Primary Care Development Corporation (PCDC) Training Module Evaluation: Marketing, Accelerated Learning Module (ALM) - Ramping-Up Patient Volume, and Reengineering. May 2001. (Download PDF now)
Shin, P., Roby, D., and Park,R. State by State Data on Community Health Centers, part of National Association of Community Health Center's A Legacy of Caring — A Commitment to the Future.
Maloy, K.A., Darnell, J., Nolan, L., Kenney, K.A., and Cyprien, S. Effects of the 1996 Welfare and Immigration Reform Laws on the Ability and Willingness of Immigrants to Access Medicaid and Health Care Services. May 2000.
Zuvekas, A., Nolan, L., Galaor, T., Dryer, M., Tumaylle, C., Harvey,
J., and Baysac, M.A. Mini-Environmental Assessment of the Health Status
and Needs of the Poor. July 1999.(Download
PDF now)
Mauery, D.R., Rosenbaum, S., Woolley, Wehr, E., and Sofaer. An Evaluation of Emerging Relationships Through Memoranda of Understanding Between Managed Care Organizations and Public Health Agencies: Implications for Population-Based Communicable Disease Prevention and Control Programs and Public Health Policy. 1998.(Download PDF now)
Rosenbaum, S., Shin, P., Markus, A., and Darnell, J. Health Centers' Role as Safety Net Providers for Medicaid Patients and the Uninsured. Kaiser Commission on Medicaid and the Uninsured. 2000.
Articles Published in Professional Literature
Siegel, B., Bretsch, J., Sears, V., Regenstein, M., & Wilson, M. Assumed Equity: Early Observations from the First Hospital Disparities Collaborative. Journal for Healthcare Quality, Vol. 29 No. 5, pgs. 11-15. September/October 2007.
Teitelbaum, J., and Rosenbaum, S. "Medical Care as a Public Accommodation: Moving the Discussion to Race," American Journal of Law and Medicine (American Society of Law, Medicine & Ethics and the Boston University School of Law (2003)), Volume 29: 381-394.
Nolan, L., Zuvekas, A., Harvey, J., Jones, K., Vaquerano, L., and Regan, J. "Enrolling Uninsured Children in SCHIP: Lessons Learned from Community Health Centers". The Journal of Ambulatory Care Management, Vol. 26, No. 1, January-March 2003, pgs. 51-61.
Hawkins, D., and Rosenbaum, S. "The Challenges Facing Health Centers in a Changing Healthcare System," The Future of the US Healthcare System: Who Will Care for the Poor and Uninsured? Edited by Altman, S, Reinhardt, and Sheilds, A. Health Administration Press (1998).
Henderson, T., Markus, A.R. "Medicaid Managed Care: How Do Community Health Centers Fit?" 17 Health Care Financing Review 4:135-142, Summer 1996.
Rosenbaum, S., Hawkins, D., Rosenbaum, E., and Blake, S., "State Funding of Comprehensive Primary Medical Care Service Programs for Medically Underserved Populations," American Journal of Public Health 88: 3 (March 1998).
Zuvekas, A., Nolan, L., Tumaylle, C., and Griffin, L. "Impact of Community Health Workers on Access, Use of Services, and Patient Knowledge and Behavior," JACM 22:4, October 1999.
Other Publications
Zuvekas, A., Nolan, L., Galaor, T., Dryer, M., Tumaylle, C., Harvey, J., and Baysac, M.A. Advocacy Environmental Assessment of the Health Status and Needs of the Poor. Prepared for Ascension Health. July 21, 1999.
Nolan, L. How's WRACC doing: Findings from an Ongoing Evaluation. Training Health Professionals in the Community Newsletter. Washington Regional Academic and Community Consortium: vol. 3, issue 1. Spring 1999.
Zuvekas, A., Darnell, J., Nolan, L., and Tumaylle, C. Inner City Safety Net Providers in an Era of Managed Care. Prepared for The Commonwealth Fund. 1999.
Stuber, J., Maloy, K.A., and Rosenbaum, S. Understanding the Insurance Status of Patients in Nine New Hampshire Community Health Centers: A Pilot Study. Final Report to the Robert Wood Johnson Foundation. 1998.
Zuvekas, A., Nolan, L., and Tumaylle, C. Impact of Community Health Workers On Access, Use of Services and Patient Knowledge and Behavior. Prepared for Bureau of Primary Health Care, U.S. Public Health Service, Health Resources and Services Administration. January 1998.
Shaw, K., Paulson, J., and DeGraw, C. Consortium Development for Health Professions Training in Community-Based Settings. September 1998.
Rosenbaum, S., and Shin, P. Medicaid Managed Care: Opportunities and Challenges for Minority Americans. Center for Political and Economic Studies under a grant from the Henry J. Kaiser Family Foundation. October 1997.
Zuvekas, A., and Nolan, L. Consensus Conference of Health Status Gaps of Low Income and Minority Populations: A Synopsis, December 7-8, 1995. June 1996.
Zuvekas, A., Nolan, .L.S., Azzouzi, A., Tumaylle, C., and Ellis. An Analysis of Potential Economies of Scale in Poison Control Centers: Final Report. Prepared for The Robert Wood Johnson Foundation. November 1997.
DeGraw, C., Fagan, M., Parrott, M., and Miller, S. Interdisciplinary Education and Training of Professionals Caring for Persons with Disabilities: Current Approaches and Implications for a Changing Health Care System. December 1996.
Solloway, S., Evans, L., and Haack, M. Assessing the Training and Education Needs of the Public Health Workforce. 1996.
