Addressing health disparities: 3 lessons from community health centers

As hospitals work to transition from the traditional model of service provision to meeting the requirements initiated by the Affordable Care Act (ACA), an examination of community health centers (CHCs) can point hospital executives to promising practices that can save them time and many sleepless nights.

The monumental shift in the landscape resulting from the ACA includes a shift in basic purpose, from "sick" care to "health" care, with performance standards and reimbursement slowly moving to value-based rather than volume-based. Individual and community wellness are the new metrics by which organizations are measured, and addressing social determinants of health that impact them is key.

The primary goal of CHCs during their more than 50-year history has always been to provide high-quality primary and preventive health services to people in medically underserved areas. The Public Health Services Act requires that they provide "all required primary, preventive, and enabling health services."

In order to do so effectively, CHCs have developed a range of services not traditionally found in private medical care practices, such as family and community outreach, transportation, health and nutrition education, parenting classes and referrals to social and behavioral health services.

Since CHCs tailor their services to the diverse populations they serve, they have become proficient as safety net providers in their communities, and are leading the effort to improve population health by strengthening the social environment.

Meeting the Triple Aim
In this new era of healthcare, hospitals are held accountable for adopting the strategies of the Institute for Healthcare Improvement Triple Aim Initiative as many shift from a focus on acute and specialized care for individuals to meeting the needs of population health. And the expectation is that they will do so with a systematic approach and collaboration with community partners.

CHCs are at the forefront of achieving the Triple Aim objectives. As indicated in a previous Becker's Hospital Review article, CHCs have lowered the rate of utilization of emergency rooms and specialty care, and patients who have used CHCs as their primary medical home have reduced hospital admission rates and lengths of stay.

In addition, it has been reported that patients who receive most of their medical care at a health center have significantly lower medical expenses: 41% below others facilities. The National Association of Community Health Centers (NACHC) has documented that, "If every American made use of primary care, the healthcare system would see $67 billion in savings annually..."

Hospital systems can accelerate their efforts to achieve the Triple Aim and address disparities by taking lessons from CHCs. Here are three areas of focus:

1. Create linkages to non-health community providers that address social determinants and support prevention and wellness. It has become common knowledge among healthcare professionals that acute medical care, which comprises the majority of services provided in hospital settings, is only 10% of what determines an individual's health status. The remaining 90% is determined by social, economic and environmental factors.

If hospitals are to maintain their role as anchor institutions and healthcare leaders in their catchment areas, they will need to follow the lead of CHCs. Hospitals must address social determinants by working with other providers to create a continuum of care that begins with prevention and moves from inpatient to outpatient care.

Hospitals can begin with those community-based organizations with direct interest in wellness (e.g., behavioral health providers, YMCAs, legal aid, CHCs) and expand from there to those working for improved access to healthy foods, affordable housing, legal advocacy and violence prevention, for example.

In addition to providing services along that continuum of care, these partners are closer to the patients, have community residents' trust and can help build portals of entry into the system, define effective engagement strategies and can share culturally competent practices.

The medical/legal partnership at St. John's Well Child and Family Center in Los Angeles provides us with one such example. St. John's has established a medical legal partnership with Neighborhood Legal Services. The collaboration enhances the hospital's continuum of care by connecting patients to free legal services for issues that affect their health. The medical legal partnership makes it possible for St. John's' patients to receive legal advocacy and assistance, when necessary, regarding tenant and/or immigration rights, discrimination and access to public benefits.

Jim Mangia, president and CEO, says, "I believe that health equals freedom for our patients to live the best lives possible — and that's how we approach care at St. John's. Our mission requires that we go beyond our exam rooms and into the community to support our patient's right to health."

2. Make the services family centered, as well as patient centered and culturally competent. This means offering services that are respectful of and responsive to individual and family preferences, needs and values, and includes integration of health literacy and language access services. Doing so encourages and enables patients to participate more fully in treatment planning, decision making and to succeed at self-management.

The most recent report by the Health and Medicine Division (HMD) focused on the importance of integrating health literacy, cultural competence and language access services. Speakers at the HDM workshop "Integrating Health Literacy, Cultural Competence, and Language Access Services" who discussed the topic noted the continuously changing demographics in our country require attention to these three factors in order to achieve healthy outcomes.

Venice Family Clinic in Los Angeles is a prime example of a CHC incorporating these effective strategies. The organization offers services in English and Spanish, health education through multiple media, programs that address all members of the family and all aspects of the individual's life, and easy access to satellite clinics, including locating them at a Head Start center and two area high schools.

3. Engage community members as leaders. It may require provision of leadership training and issues education, but engaging community residents in leadership positions is vital to increasing access by addressing barriers to care and using hospital resources wisely in ways that will truly improve community wellness.

CHCs have experience and success in this area. The Health Resources and Services Administration requires CHCs to have 51% of their boards consist of community consumers. This requirement ensures CHCs are community based and responsive to the needs of the people they serve.

The board of Community Health Service Agency (CHSA) in Greenville, Texas, is comprised of community members who live in, work in and serve CHSA's communities in some capacity, according to Michelle Carter, MPA-HCA, CEO of CHSA. The majority of the board members are also consumers of CHSA's services.

"The very quality that makes CHCs so special is that we strive to meet our communities' needs by being community driven and patient directed," Carter told the authors of this column. "These community leaders [on our board] advocate for our patients and the unique needs of their communities at the federal, state and local level."

She notes that CHSA also actively engages community leaders in a needs assessment process. "[This] identifies not only the strengths and resources in their community, but also disparities and needs that need addressing. This input provides direction for the health center's strategic goals and objectives."

Carter continues, "At CHSA, our community leaders are instrumental in advocating for access to healthcare services and generating community awareness of our health center, its mission and the services we provide to our communities."

Stronger communities, stronger partnerships
In addition to overall community health, CHCs have reduced and eliminated disparities in healthcare outcomes. A growing number of healthcare systems and organizations agree on the idea that there are important opportunities for them to increase the impact on health and wellbeing by addressing social, behavioral and environmental determinants of health.

Healthcare systems will meet Triple Aim by redesigning their organizations, focusing on population health initiatives and collaborating with community partners. The success stories of CHCs provide valuable learning opportunities for hospitals looking to maintain their status as true leaders in and of their community.

Ellen Sanchez, MEd, is a community collaboration consultant and Maria Serafine, MHA, is a consultant for community health centers for Avanza Healthcare Strategies, which provides hospitals, community health centers and federally qualified health centers with strategic guidance, with a focus on population health management and outpatient services.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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