Community health centers: Transforming healthcare for the next 50 years

Maria Serafine, Consultant, and Joan Dentler, President and CEO, Avanza Healthcare Strategies - Print  | 

Community health centers (CHCs) have made a tremendous impact on U.S. healthcare over the past 50 years since the first CHC opened its doors in 1965.

As safety net providers, CHCs have assumed a prominent role in the delivery of healthcare and filled a huge void. In the emerging landscape of accountable care, with its emphasis on population health and preventive care, healthcare services will be delivered not only through private physicians and hospitals, but also in collaboration with community providers like CHCs.

As demonstrated by this infographic on the "50 years of Community Health Centers," by 1975, CHCs had served one million patients. By 2000, following the expansion of Medicaid to include children and pregnant women, creation of Children's Health Insurance Program and the addition of services provided by federally qualified health centers as a benefit under Medicare, 9.6 million patients were served. As of 2014, over 1,300 health centers operated 9,000 service delivery sites in every U.S. state, D.C., Puerto Rico, the Virgin Islands and the Pacific Basin provide care for nearly 23 million patients.1

CHCs are uniquely positioned to continue to be an important partner for hospital systems as healthcare delivery systems seek out new methods to improve health outcomes. The U.S. healthcare system can greatly benefit from increased utilization of CHCs. As the system undergoes significant changes in the coming years in an effort to improve outcomes while lowering costs, hospital communities will increasingly rely on CHCs.

Here are four main reasons why.

1. Cost reduction. The Office of Management and Budget has ranked CHCs as one of the 10 most effective federal programs.2 By focusing on prevention, CHCs can save substantial dollars in avoided emergency room visits, medical treatment and hospitalization. Patients who receive most of their medical care at a health center have significantly lower total medical expenses, with annual medical expenses 41% lower for health center patients.3 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..."4

NACHC estimates that CHCs generate $24 billion a year in savings to the healthcare system through efficient patient management.5 They also create jobs and generate an estimated $26.5 billion in needed economic activity to financially distressed communities.6

CHCs have proven to deliver a significant return on investment for the communities they serve.

2. Increased access. When patients have a usual source of care, or "medical home," they have demonstrated improved health status and outcomes.7 CHCs provide a medical home for the hardest to reach patients by addressing the obstacles that prevent them from accessing care. CHCs offer a comprehensive, coordinated system of care that includes access to essential services on site or by referral, including oral health, behavioral health, substance abuse and specialty care. These services are sometimes supplemented by a broad range of enhanced services that together assure access to care, including outreach, patient education, translation and interpretation, labor coaching, childbirth education classes, child care, transportation vouchers and assistance applying for health insurance coverage. Case management ties these together, assuring that patients receive the full range of services they need.

CHC collaborative partnerships with hospital systems deliver a seamless referral and coordination of services for patients, such as laboratory, radiology, specialty care and telemedicine. This improves access and, in turn, increases patient satisfaction.

3. Reduced health disparities. Effective management of chronic disease at CHCs has improved outcomes and lowered the cost of treating patients with chronic illness. A 2002 Institute of Medicine report describes the important role of health centers in increasing access to care and improving health outcomes for all patients.8

Medical homes have been shown to benefit patients by preventing sickness, managing chronic illness, mitigating disparities and reducing the need for avoidable, costlier care such as emergency department visits and hospitalizations.9,10

According to NACHC, CHCs' patient outcomes meet or exceed those of other primary care providers. Health centers' high quality and accessible care delivers results for their high-risk patients and improves health while narrowing disparities. CHCs are performing 22% more screenings for diabetes, hypertension, breast and cervical cancer than other primary care providers. Plus, rates of low birth weight are lower among health center patients: 7.5% versus 8.2% among all U.S. low income patients.11

4. Education and preventative care. Healthcare reimbursement structures have historically been volume driven, based on how many procedures a provider performed. We are beginning to see a shift toward outcome-based rewards that emphasize quality and value over quantity. This requires a rethinking and retooling of how care is delivered. A positive effect of the shift toward outcome-based evaluation is the focus on health education and preventative care.

CHCs' success are tied to their model of care of improving health and offering preventive healthcare services. They integrate medical, dental, behavioral, pharmacy, vision, OB/GYN and other services to improve and facilitate access to care.

CHCs: Pillars of the community
Since their inception, CHCs have provided a wide variety of primary care and preventive services, and have proven to play a vital role as safety net provider. Health centers have delivered comprehensive, patient-centered, community-based care and demonstrated their ability to reduce costs, improve access and quality, and reduce disparities across communities. The changing healthcare environment has allowed CHCs across the country to collaborate and create models of care that are transforming how healthcare will be delivered for the next 50 years.

Maria Serafine is a consultant with and Joan Dentler is president and CEO of Avanza Healthcare Strategies, which provides hospitals and federally qualified health centers with strategic guidance, with a focus on outpatient services and population health management.

References
1. http://bphc.hrsa.gov/about/what-is-a-health-center/index.html
2. www.communityhealthcenters.org/support-chc/109-communityhealthcenterfacts.html
3. National Association of Community Health Centers, The Robert Graham Center, and Capital Link. "Access Granted: The Primary Care Payoff," 2007, available at www.cq.com/flatfiles/ editorialFiles/healthBeat/reference/NACHCReport.pdf [accessed August 9, 2007].
4. NACHC, "Access Granted." Op Cit. www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdf
5. Ku L, et al. Using primary care to bend the cost curve: Estimating the impact of a health center expansion of health care costs. Policy Research Brief No. 14. September 2009. Geiger Gibson/RCHN Community Health Foundation Collaborative at the George Washington University.
6. NACHC, Capital Link. National economic and community impact of the health center program. Infographic #0814. August 2014. Available at www.nachc.com/research.
7. www.ncqa.org/Portals/0/Public%20Policy/Berenson_achieving_better_quality_care_low_income_8.30.12.pdf
8. http://iom.nationalacademies.org/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx
9. Rosenthal, T. C. (2008). The medical home: Growing evidence to support a new approach to primary care. Journal of the American Board of Family Medicine, 21(5), 427-440.
10. Shi, L., & Stevens, G. D. (2007). The role of community health centers in delivering primary care to the underserved. Journal of Ambulatory Care Management, 30(2), 159-170.
11. Community Health Centers Past, Present, and Future: Building on 50 Years of Success. National Association of Community Health Centers. March 2015. www.nachc.com/client//PI_50th.pdf

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