The Future of Health Centers
Friday, August 15, 2014
Posted by: Joy Ingram
The party’s over. Well, that is, National Health Center Week (NHCW) has, once again, come and gone, marked by successful health fairs, barbecues, service projects and visits from dedicated legislators to local community health centers. We observe NHCW every year, but the 2014 story is a little different. This is the year of “fulfillment” of much of the promise of the Affordable Care Act, including the expansion of Medicaid in some states and the full launch of the health insurance marketplace. 2014 is also the final year for some of the key incentives that spurred the movement toward the Patient Centered Medical Home. In the next two years some of those incentives transform into disincentives. Despite of the great progress we’ve made, the road ahead is not necessarily free and clear.
This could be a good time to count our blessings, take stock, and adjust our rearview mirror. The National Association of Community Health Centers (NACHC), along with RCHN Foundation, have done that beautifully for us in the form of readable, convincing infographics in a report released during National Health Center Week called National Economic and Community Impact of Federal Health Center Funding. As a member association of 81 federally funded health centers, NWRPCA supports that message – in fact, we live it. We join NACHC and RCHN in celebrating past victories and attending to the challenges ahead. You’ll want to read the report yourself, so we’ll provide a link directly to those great infographics: NACHC reports, RCHN report. For the moment, though, here’s our take on the community health center story, positive and negative, with our thanks to NACHC and RCHN.
A system that works
In 2001, ten million Americans sought primary care at community health centers. Eleven years later, that number had doubled. With the generous funding increase of the ACA, the patient population of the nation’s community health centers is expected to soar to 25.6 million by the end of this year.
Why is it that one in fifteen Americans uses the community health center (CHC) as a medical home? Probably because CHCs are accessible and responsive in general, with more night and weekend hours than private practices and greater willingness to accept new patients. CHCs offer more preventive services than your typical “doctor’s office,” and they have, over the past few decades, added comprehensive services including behavioral health, oral/dental care, vision care and more. And only in the community health center are you likely to hear the term “enabling services.” That’s because, in exchange for the federal funds they accept, CHCs commit to ensuring their patients have ready access to primary care services through transportation, language interpretation, childcare, coordination with social services, and more. “Patient Centered Medical Home” has become a reality in our local community health centers.
So who goes to the local CHC to seek primary care? A cross-section of the community: people who are fully insured, underinsured, uninsured, newly-insured, self-paying, homeless, broke, fully employed, unemployed, professionals, migrant and seasonal farmworkers… everybody. It’s part of the community. And the patient population that benefits the most tends to include traditionally underserved and at-risk patients! Community health centers have proven their ability to reduce health disparities, including a lower rate of low-birth-weight babies than the national average. In fact, 94% of the time, when you measure a CHC’s quality outcomes against those of private practice physicians, the health center does as well as or better than the other practice.
Health center patients are satisfied with their overall quality of care, surveys show. They have 18% fewer emergency room visits than the general population and 64% fewer multi-day hospital admissions, and they spend 75% less time in the hospital over all. That really is higher quality for lower costs.
But quality care and good medical outcomes form only part of this 50-year success story. Consider the economic impact on a community that joins together to support a primary care medical home open and responsive to all in the community. Jobs are created within the community’s health center and in corollary industries. NACHC refers to the “economic ripple effect” of the CHC, citing 16,268 direct full time jobs in community health centers made possible through federal funding, and 15,592 jobs in other industries as a result of federal funding to health centers. These consumer-directed, locally focused sites purchase goods and services well beyond their service areas, fueling robust economic activity. Nationally the economic impact of federally funded community health centers is $4.3 billion! According to NACHC, the total overall economic impact of federal funding to CHCs has seen a 33% increase just since 2009, generating critical resources for poor and rural communities.
Because community health centers are located in areas suffering the greatest shortage of healthcare providers and the greatest number of medically underserved patients (often because they are in such economically depressed areas), such an economic impact to the community cannot be ignored. Since 2009, health centers have generated a 22% increase in jobs in the very communities that most need such an infusion of economic health. In 2012, community health centers fueled more than $26 billion in economic activity for their communities around the nation.
Now for the bad news
But it could all fall off the cliff in 2015! How did all those people suddenly find access to primary care in their local community health centers in recent years? It wasn’t actually “sudden,” although the Patient Protection and Affordable Care Act, which we’ve all come to call simply the ACA, provided a big push. That Act established an $11 billion trust fund to CHCs, acknowledging the high-quality/low-cost value proposition they offer in every state. This new infusion of federal funding followed a recent trend in increased health center funding, dating back to the Bush era. But the latest funding effort, that trust fund, which has opened new access points and extended service hours to medical homes across the nation, is set to expire September 30, 2015. NACHC calls it the “primary care funding cliff,” and it really could mean lights out, doors closed at many sites, and about seven million new patients right back out in the cold with no primary care.
If Congress fails to renew this funding to health centers, the 25.6 million patients served by CHCs in 2014 will fall dramatically to fewer than 19 million. A 25% drop in patients served would be a huge reversal of forward progress in community health. Loss of patient care aside, a catastrophic reverse economic ripple effect would also ensue, including the loss of 22,300 jobs due to facility closures, and an indirect negative impact of $1.4 billion. NACHC and RCHN estimate the economic impact of the primary care funding cliff disaster, should Congress fail to renew funding, in excess of $3 billion.
The better option is, of course, action by Congress, renewing the ACA funding to community health centers. And here is the really good news: not falling off the cliff will be much more than just a stop-gap measure. That funding and that continued Medicaid expansion are on track to increase again the number of patients served in CHCs – a 40% increase, as opposed to a 25%decrease, should Congress fail to act, according to NACHC projections. By 2020, if full ACA funding and Medicaid expansion are maintained, community health centers could well be serving 36.5 million patients!
So, why does it matter? Who cares? If you don’t seek care at your local community health center, what does it matter to you? Ah, a question close to our hearts at NWRPCA! Because we believe with all our hearts and minds that basic primary care for all, with intelligent consideration also of the socially determined influencers of health and wellbeing, lead to healthy communities. As the CHC provider secures the health of the individual patient, the community-owned and operated CHC develops the health of the community. Greater numbers of healthy individuals put less stress on social services and create a more equitable and healthier community. Replicate that effort over and over in CHCs across the country (and there are about 9000 CHC sites nationally), and “healthy communities” begin to foster general wellness and wellbeing in addition to the absence of illness and disease. Imagine the positive shift in focus that could engender across the country!
We are a four-state primary care association, working toward a healthy Northwest. We strengthen our community and migrant health centers as they treat one patient – without regard to financial or insurance status - at a time, creating health and well-being in their large and small communities, moving purposefully toward health equity and sustainable wellness. One week out of the year we observe National Health Center Week, but every week of the year we take immense pride in the CHCs of Alaska, Idaho, Oregon and Washington as they contribute measurably toward a badly needed, seminal shift in healthcare thinking to the promise of community health, wellness and wellbeing. It’s worth the funding; it’s worth the fight.