It has been a year of trials and tribulations for Community Health Centers but our theme for the year is “Resilience.” Health centers have more than five decades of experience confronting setbacks and threats and emerging stronger than ever. The pattern remains unbroken in 2018. A brief funding cliff ushered in the New Year before Congress finally acted and boosted health center funding to the highest level ever. Health centers also managed to expand their reach to over 28 million people, or 1 in 12 Americans. Mother Nature also produced some challenges of her own, unleashing multiple hurricanes, wildfires and flooding — disasters that affected health centers on both sides of the U.S. Throughout it all, health centers remained strong, responsive to the needs of the community and focused on the future.
Here’s a look back at some highlights:
On Capitol Hill and in the States
In February, shortly after health center advocates stormed the halls of Congress to fight for their patients’ access to high-quality, affordable care, leaders in Washington voted to reauthorize funding for two years. By the end of March, with the funding cliff expiration in the rearview mirror, Congress provided health centers with an additional economic boost in their FY18 appropriations bill. Grassroots advocates, who now number over 190,000, also stepped up and let their voices be heard. They sent more than 340,000 emails to Congress, flooded social media with tens of thousands of posts and made an equal amount of phone calls to congressional offices.
The Community Health Center program is a worthwhile federal investment we can all be proud of.
— Letter to House Speaker Paul Ryan signed by 105 Republican House Members, led by U.S. Rep. Elise Stefanik, urging for a funding cliff fix.
Lawmakers also recognized the important role health centers play in caring for veterans and passed the VA Mission Act — a law that strengthens the role of health centers as care providers to veterans through the new Community Care program [see previous blog post].
Beyond the Capitol dome there was plenty of activity in the states, where many enacted policies that affected health centers in one way or another. Changes to Medicaid programs, which cover nearly half of all health center patients, were widespread. Several states made strides in expanding coverage and enhancing the delivery system. Highlights included the signing of Medicaid expansion legislation by Governor Ralph Northam in Virginia; the passage of Medicaid expansion ballot initiatives by voters in Idaho, Nebraska and Utah; and the approval of several innovations to enhance and sustain patient-centered care, particularly in the areas of behavioral health and substance use disorder. Recognizing this vital relationship, NACHC and the National Association of Medicaid Directors (NAMD) launched a formal workgroup focused on fostering strong partnerships between health centers and Medicaid programs, and identifying and advancing opportunities to collaborate around shared priorities.
Fighting the Opioid Use Epidemic
Health centers remain on the front lines of the opioid use epidemic. One in seven health centers (73%) reported increases in the number of patients with opioid use disorder in the past three years, according to an issue brief by the Kaiser Family Foundation. Lawmakers, in a nod to the important role of health centers, passed the SUPPORT for Patients and Communities Act [see previous blog post], which among many other critical provisions, provided $8 million to expand access to medication assisted treatment (MAT) at health centers (NACHC press release on opioid funding). But beyond legislation, the battle to fight addiction in communities will also require systemic change in the coming years.
Treating addiction requires systemic change in healthcare delivery. We need a new framework. From a patient’s perspective, it means being able to move seamlessly across a continuum of care from prevention, to management, to maintaining sobriety.
Health centers also continued to drive innovation when it comes to treating substance use disorders (SUD). Some of their work was featured in the 2018 P&I Brief, “Rising to the Challenge: Community Health Centers are Making Substance Use Disorder Treatment More Accessible than Ever.” NACHC also continues to work with CVS Health on a project to integrate addiction medicine into primary care. Health center projects this year include: increasing Screening, Brief Intervention, and Referral to Treatment rates; training all clinical staff in motivational interviewing; increasing the number of MAT providers; integrating pain management teams in primary care; keeping patients engaged in MAT through to recovery; convening grief groups for children impacted by SUD; conducting prevention presentations in local schools; offering telemedicine; offering complementary treatments like acupuncture; and bringing peer support specialists onto the team. Health centers continued to show their value — bringing forth innovative solutions, improving patient health at low cost and addressing social determinant of health needs.
Responding to Disasters
Storms, floods and fires ravaging communities forced health centers yet again into the dual role of victim and responder. The recent fires in California provide a heartbreaking example. Ampla Health in Yuba, CA, was in the path of the massive blaze, and still responded to residents’ needs, keeping their doors open at nearby sites and even volunteering to visit the shelters where families fled with their belongings, providing N95 masks, conducting outreach activities to inform the victims of the services and programs at the health center and donating personal care items to people in need. This, despite the fact that 13 staff members lost their homes [read previous post].
State planners should look to local health center employees as pre-positioned experts, prepared to mobilize on behalf of the most vulnerable community members after a disaster. Long after responders return home, those employees become the steady workforce of recovery, treating individuals as they navigate a disaster’s invisible aftershocks: homelessness, economic uncertainty, chronic stress, hypertension, and substance and domestic abuse.
Experts and national leaders are recognizing the important and unique role health centers play in responding to disasters and emerging public health threats. A report issued by a division of the Department of Health and Human Services, “Medical Surge and the Role of Health Clinics,” acknowledged health centers’ role in emergency preparedness and response and outlined opportunities to improve health center readiness [read previous blog post].
Research and Data
2018 was also the year of showing health center value through research and data. Access to care through telehealth was a hot topic — NACHC produced a short fact sheet, a policy paper, and a snapshot of health centers’ telehealth utilization and barriers. Health Affairs likewise published a special issue on telehealth in December 2018, with two articles focusing on the way health centers use telehealth. Finally, NACHC published its annual Chartbook for a comprehensive review of research and data that covers health center services, cost-effectiveness, quality of care, accessibility, patient demographics, and the challenges health centers face in meeting demand for care.
NACHC continued to work with the Association of Asian Pacific Community Health Organizations and the Oregon Primary Care Association to help health centers identify and respond to social determinant of health needs using the national standardized social determinants assessment known as PRAPARE. The assessment draws growing participation from dozens of PCAS and HCCNS. To date, more than 1,000 organizations in every state and even internationally have downloaded the free PRAPARE Electronic Health Record templates, with interest growing among hospitals, health systems, health plans, state Medicaid agencies, and others in addition to health centers.
And speaking of the social determinants of health, the Million Hearts project funded by the Centers for Disease Control and Prevention helped drive the implementation of self-measured blood pressure monitoring. The project aims to reduce the number of people in the United States who have high blood pressure and are both unaware of and untreated for it.
National Health Center Week
National Health Center Week 2018 (NHCW) was also a success, drawing upon the theme “Celebrating Health Centers: Home of America’s Health Care Heroes.” Seven hundred health centers in all 50 states, Washington, D.C., Puerto Rico, and the U.S. Virgin Islands held more than 1,600 events—everything from health screenings, to back-to-school fairs, to 5Ks, to employee barbecues, and more! National corporate sponsors supported more than 100 of those events, and partner organizations contributed to each of the week’s focus days. Countless state and local elected officials also threw in their support. More than 40 states, counties and localities issued resolutions and proclamations in recognition of this year’s celebration and numerous Members of Congress participated in NHCW events, joining the celebration in recognition of the critical role health centers play in their communities. NHCW garnered much media attention, with 3,000 traditional news media spots and more than 50 million impressions on social media. NHCW 2018 also focused on the “Health Care Heroes” who work at health centers making a difference and saving lives.
Lastly, we should note that 2018 ends with a bit of a cliffhanger. In a move that could potentially impact millions of health center patients, a Texas federal judge has ruled that the Affordable Care Act is unconstitutional. The decision has no immediate affect on health center patients and coverage for now, but it is causing confusion. Estimates are that roughly 12 million people could lose coverage gained through Medicaid expansion and 8 million people would lose access to subsidies that allow them to purchase insurance on the individual marketplaces (see NACHC Blog post). Going into 2019, it’s almost certain that health care access and insurance coverage will be a key focus for health centers. With the midterms behind us, and a host of new leaders ready to be sworn in, health centers must set a course to secure sustained funding and put the cliff behind us once and for all.