Healthcare Reform / Affordable Care Act (ACA)

1. I thought Healthcare Reform solved this problem?

The passage of the Affordable Care Act (ACA) in March 2010 created a perception in the minds of many Americans that this legislative action solved our nation’s healthcare problems.  As the subsequent history and current circumstances demonstrate, the reality is that coverage is not synonymous with access, and large gaps in available, affordable coverage and services continue to be a major issue for millions of people. In fact, the Congressional Budget Office (CBO) projects that if the ACA is fully implemented nationally, nearly 30 million Americans would remain without access to affordable healthcare.[1] The cost-sharing provisions of the new health exchange plans are already creating challenges for low-income people who choose to purchase health insurance coverage.[2]  In these first years of full implementation there is a growing population of newly insured people who are unable to afford their deductibles and co-pays, resulting in a larger underinsured population[3] and an equally substantial number of individuals who are electing to remain uninsured and accept the financial penalty, aware that the affordable coverage available to them remains beyond their means.  Large gaps in coverage and services will continue to be a major issue that will require safety net providers of free and charitable clinics.

For clinics already in operation, the ACA has brought about the need to determine how to respond to this shift in the health care landscape. Will your clinic change its service delivery model?  Will your clinic change its eligibility requirement for the patients it treats?  Will it continue providing the services it has historically offered?  ECHO has many services available to help you during this time of change.  Through our Support Services, our consultants can walk your clinic through the process of determining how it would like to respond to the ACA.  For those clinics that see the need to increase capacity to serve, our Expansion program can assist you in laying the foundation to build a strong and more robust clinic.  For members of the ECHO Network, we work hard to provide timely information on the impact of ACA and provide tools to assist you in moving forward.

2. The Affordable Care Act is undercutting our traditional patient population. Are safety net clinics still needed?

Without question, the ACA has provided affordable insurance options for millions of previously uninsured Americans. Nevertheless, the ACA was never intended to meet the needs of all the uninsured, not to speak of those who are under-insured (may have co-pays or deductibles that are so high that it is beyond their financial means to use the insurance). Reduced patient populations in your clinic may require a community assessment to determine the newly defined gaps in your safety net.  ECHO can assist with this process and aid a clinic in adopting a service delivery model to meet these needs.

Starting A New Clinic

3. What is a Clinic Sponsor? Why is it needed?

Starting a clinic is no small undertaking.  It takes a Visionary Leader along with a team of other motivated and skilled individuals to get the job done and the doors open.  ECHO has found that it is best to begin with a sponsor for this needed manpower and energy.  It may be a congregation, it may be a community service organization, it may be a hospital or a collection of hospitals, etc.  Once identified, this sponsor can serve to coalesce community interest and expanded manpower to develop a project that reflects community need and interest.

4. How long does it take to start an ECHO supported clinic?

There are many variables that determine how long it takes to launch a new clinic, but the process usually takes between 12 to 18 months.  Our consultants help to balance the need to capture the momentum and energy of a new and excited group with the thoughtful and deliberate process that will help to build a sustainable clinic of influence in the community.

5. What services and resources does ECHO provide to help me start a clinic?

ECHO will assign an experienced consultant to work with your project. You will have access to our planning guide, benchmarking tools, start-up files as well as other tools and processes only available to those clinics that have partnered with ECHO.  ECHO also offers periodic conference calls for training and networking with operational clinics and projects under development.  The ECHO team provides a wide range of expertise for issues unique to your project or community.

6. Does ECHO tell us what services we can or cannot offer in our clinic?

No. Your ECHO consultant will help your team determine the needs in your community and the resources available to address those needs and identify where gaps exist. It is then up to your team to determine how your clinic will address these gaps.  ECHO services are a best match for those groups who desire to make a significant impact in their communities and who seek to provide a wide range of services for their patients.  An initial phone call with ECHO staff will help to clarify your vision, community need and how ECHO’s mission can be of service to you and your community.

7. What ongoing help does ECHO provide once our clinic is operational?

ECHO offers an opportunity for networking with other similar clinics through our ECHO Network.  The ECHO Network is a subscription service providing access to one-on-one consulting time with one our ECHO Senior Clinic Consultants, webinars and other continuing education, and chances to network with other clinics.  Visit the ECHO Network page for more information.

In addition, ECHO is pleased to maintain a team of Consultants with over 100 years of experience in safety net clinic issues.  These Consultants are able to assist you with any needs of newly formed or long-running clinics.  Services include, strategic planning, executive coaching, program development, board training, and facilitation of community discussions to determine need, environmental scans, and more.  Contact us so we can better understand your needs in developing a proposal that will serve your interests.

8. How much money does it take to start a clinic?

Many variables contribute to the development of a start-up budget. Your ECHO consultant will help your team determine what is realistic for your situation.

9. What are the expectations and obligations of the clinic to ECHO once we open?

In order for ECHO to evaluate the quality of our services, as well as to develop ways to help our clinics improve their operations and increase their impact, we require ongoing information and dialogue about your clinic operation and services.  In turn, we will offer an opportunity for interaction with other ECHO supported clinics nationwide and services to help you continuously improve.

ECHO’s mission and services are enhanced greatly by the experiences of the clinics we have helped to develop and strengthen. As with any nonprofit, we are accountable to our founders, funders and supporters, and we are earnest about collecting data and stories that support the accomplishment of our goals.  To this end, ECHO will request, on an annual basis, some fundamental data that clinics typically collect for their own program development, program evaluation and for funders. In addition, we are grateful to learn of clinic experiences and other indicators of your growth and development that can help us tell the story of the importance of free and charitable clinics across the country.

For Clinics Already In Operation

10. I’m a clinic already in operation. How can ECHO help me?

ECHO is able to assist clinics in operation in a number of ways.

First, the ECHO Network is an opportunity for safety net clinics to gather together to network, grow, and learn from each other.  Visit our ECHO Network page for more information.

Secondly, the Expansion Program is available to existing clinics that are interested in expanding their capacity to serve more patients and to assume a more integral part of their community healthcare safety net.  For a small fee, an ECHO Consultant will walk you through the process of exploring whether or not expanding capacity is right for your clinic and community.  Then they will develop the necessary plans with your staff and Board of Directors to extend your reach.  For more information visit our Expand A Clinic page.

Lastly, ECHO is proud of its team of Senior Clinic Consultants.  Their combined 100 year experience with the safety net makes them an excellent resource to help you with any needs you might have such as strategic planning, fund development, Board development, executive coaching, program development and more.  If you are interested in strengthening your clinic offerings or broadening your community impact, please visit Support Services to learn more about our service offerings and contact us so we can develop a plan to best fit your needs.

11. How do we stay relevant in our community given the changes in health care and the perception that clinics are no longer needed due to the ACA?

ECHO has developed approaches and tools that will benefit a clinic on the cusp of change.  Most revolve around a strategic planning process.  If you anticipate change in your future, contact ECHO to help assure that it’s a productive, pro-active process.

12. Can ECHO help us strengthen our clinic to better serve our patients?

Yes. The ECHO Consulting services are all designed to strengthen safety net clinics in a variety of ways.  From building your board resources to improving your service delivery to attaining recognition as a Patient Centered Medical Home, the ECHO staff will work with you to improve and expand service to your clients.


13. How can ECHO provide these services at low cost or no cost?

ECHO is a private nonprofit organization that was founded by the Nancy and John Snyder Foundation.  This foundation generouslyprovided the seed money to start ECHO and continues to support our work.  Outside of the Nancy and John Snyder Foundation, ECHO also seeks private support from other foundations and private donors, which allows the organization to subsidize our work with engaged clinics and startup initiatives.

15. I am not affiliated with a community of faith or an existing organization but I want to start a clinic. Can ECHO help me?

Yes. ECHO works with both faith-based and community organizations.  If you are not connected to a larger group that has a desire to open a clinic, the initial phone call with ECHO staff will help clarify what we are looking for in a clinic “sponsor.”  Please fill out the Initial Interest Questionnaire and one of our consultants will contact you.

16. Will ECHO consultants keep religion out of the conversation if we are not a faith-based group?

Yes. Your ECHO consultant will honor your group’s cultural and organziational identity and practices.

17. Will ECHO allow for our practice of faith in the operation of our clinic?

Yes. ECHO does not prescribe how or if your clinic incorporates a spiritual component to its operation.  If intended eligibility requirements include that patients profess a particular spiritual belief or must attend a religious service or participate in prayer as a condition of their medical care, please discuss this in your first phone call with an ECHO consultant.  ECHO ascribes to the practice that acceptance of a particular set of beliefs should not be a condition for service.

18. I am a doctor interested in volunteering, but I am concerned about my malpractice liability.

The number of lawsuits against volunteers offering care at free and charitable clinics is incredibly small, but ECHO recommends that each clinic provide protection for their board, staff, and volunteers. Clinics can provide professional liability protection for their volunteer and staff providers by purchasing an insurance policy or by accessing the no-cost federal immunity provided by the Federal Tort Claims Act.  Some states also offer very comprehensive liability protection for volunteers at free and charitable clinics. An ECHO consultant will guide the team through the decision process as well as assist a clinic in the submission of a successful initial application.



[1]Congressional Budget Office. (2012, July). Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision. pg 20
[2] McGuire, Leslie, Meehan, Kate. (2014, March). The Role of Free Clinics in the Era of Health Reform.  pg 3

[3] Ibid., pg 3