- Each year, HHS celebrates Community Health Centers week. It is a time where the agency recognizes the impact community health centers have on patient-centered care and how they promote access to care in vulnerable or medically underserved populations.
“House calls are less common these days, but community health centers can offer patients the same kind of relationship: a welcoming place where patients can receive care from physicians they know and trust,” HHS Secretary Tom Price, MD wrote in a blog post about the 2017 Community Health Centers week.
But aside from a place to receive healthcare, what are community health centers? What role do they play in the healthcare industry? And how do these facilities help patients achieve wellness?
PatientEngagement.com explains community health centers, and discusses how they work to drive patient access to care and patient engagement.
What is a community health center?
Community health centers are affordable safety net clinics and are the largest providers of primary care to the nation’s most vulnerable and medically underserved communities. Community health centers are prevalent in both urban and rural communities that have high poverty rates or low numbers of private or non-profit health systems and hospitals.
“Health centers also often integrate access to pharmacy, mental health, substance abuse, and oral health services in areas where economic, geographic, or cultural barriers limit access to affordable health care services,” the Health Resources & Services Administration (HRSA) explains on its website.
“Health centers deliver care to the Nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and the Nation’s veterans.”
Community health centers are also a part of the federally-qualified health center (FQHC) umbrella. FQHCs are government-funded networks of care providers that include community health centers, migrant health centers, health centers for the homeless, and public housing primary care providers.
A hallmark of community health centers and other FQHCs is strong care coordination to deliver high-quality healthcare at a lower cost.
Community health centers currently operate on funds allocated by the Affordable Care Act (ACA). These facilities were designed for patients with no other options for affordable care, such as patients who cannot afford private health insurance or who do not qualify for the Children’s Health Insurance Program (CHIP), according to HealthCare.gov.
However, it should be noted that many patients who visit community health centers also have another form of insurance. This insurance is usually inadequate, either with access restrictions or cost prohibitive deductibles, premiums, or copayments.
Data from the Kaiser Family Foundation (KFF) showed that community health centers serve 24.3 million individuals who were uninsured or underinsured at about 1,200 community health centers nationwide. About three-quarters of those patients are under the federal poverty level.
Most of those patients also have some form of health insurance, either private or via Medicaid expansion.
How do community health centers operate?
Community health centers operate on a fundamentally patient-centric model. Community health centers drive a high level of care coordination and focus on care transitions for the vulnerable communities they serve.
“Health centers overcome geographic, cultural, linguistic, and other barriers to care by delivering coordinated and comprehensive primary and preventive services,” HRSA says. “This care reduces health disparities by emphasizing care management of patients with multiple health care needs and the use of key quality improvement practices, including health information technology.”
Some community health centers use the principles of coordinated care to become distinguished patient-centered medical homes (PCMHs). In 2011, the government allocated funding for FQHCs and community health centers to become PCMHs. Seventy percent of the FQHCs receiving funds successfully achieved PCMH status, but it took them three years to do so.
The journey to becoming a PCMH is likely long because the care model requires the community health center to adopt a few more techniques, such as extended after-hours access. That was difficult because of financial restrictions.
Adopting patient-centered or value-based principles can have a positive effect on community health centers. Patients in the PCMH study reported more ample access to care. And as community health centers continue to care for the overall wellness of vulnerable individuals, they may become more cost effective.
Community health centers are paid on a prospective payment system, which means they receive payments based on the actual costs of care. For that reason, community health centers are incentivized to deliver high-quality and coordinated care to patients, which usually results in lower ambulatory and prescription drug costs.
Ultimately, community health centers can be a prototype for leveraging patient engagement and access strategies to drive patient wellness and success in value-based models.
What are the challenges associated with community health?
As with any healthcare organization, community health centers face their own set of challenges. In this specific case, challenges lay with limited funding and extremely complex and vulnerable patient populations.
HRSA noted that most patients in a community health center have multiple chronic conditions. Patients visiting these care sites are more at-risk for HIV/AIDS, viral hepatitis, STDs, and tuberculosis, according to the CDC.
Coordinating care and organizing transitions of care for these patients is thus extremely critical. But it is difficult to keep track of patients and ensure they receive the follow-up care they require because these patients are vulnerable and face high levels of poverty.
Funding can also complicate matters. Community health centers receive payments for the services rendered, as well as grant funding from the government to support operational costs of vulnerable patients. However, community health centers continue to struggle, potentially because those government payments are not enough.
Community health centers are hindered from achieving value-based care models because of financial restrictions, for example. The PCMH study indicated that limited funding kept more community health centers from becoming PCMHs and from achieving that distinction faster.
CMS paid the community health centers $6 per Medicaid enrollee per month, which the researchers said was not adequate. Future efforts should focus on what an appropriate government grant would be, said the study authors from RAND Corporation.
"Future tests of medical home interventions in federally qualified health centers should consider alternative approaches that consider the magnitude of financial assistance and the evaluation's duration to better understand how to help federally qualified health centers implement practice change and how these changes can lead to improvements in health outcomes for vulnerable Medicare beneficiaries," explained RAND researcher Katherine Kahn, who is also a professor at the David Geffen School of Medicine at UCLA.
Community health going forward
The fundamental value for community health centers is their ability to provide necessary health intervention to extremely vulnerable populations. Patients without health insurance, or without adequate health insurance, can receive primary care at these centers. This can drive overall wellness and prevent chronic conditions from worsening.
As the healthcare industry continues to emphasize value over volume, this will be integral. Vulnerable patients too often fall through the healthcare cracks, receiving little or no preventive primary care. However, these are the patients who need this care the most. Doing so will prevent more costly interventions down the road.
Community health centers will rise to prominence moving forward, especially as the industry begins to address the social determinants of health. These facilities serve patients in disparate geographic locations, or who suffer from social barriers such as poverty. The healthcare industry must continue celebrating the work community health centers do to keep addressing social needs.