By Robert L. Murry, PHD, MD, FAAFP, Chief Medical Officer of NextGen Healthcare.
Community Health Centers—U.S. Health Care Done Right
With so much talk about how the U.S. health care system is spending more but achieving poorer outcomes, it’s good to know there are some bright spots. Near the top of the list of U.S. healthcare gems are Community Health Centers—otherwise known as Federally Qualified Health Centers (FQHCs). Despite the successes and care that health centers deliver, few people know anything about them. If health centers are a mystery, it’s time to de-mystify them.
Mission-Driven, but with Remarkable Outcomes
The first two health centers were founded in 1965 as “Neighborhood Health Centers.” Pioneers such as Dr. H. Jack Geiger ensured that the centers were open to everyone, regardless of ability to pay or insurance status. They also knew that local health care needs, and the challenges of being healthy in an inner city are different than in a rural community. For this reason, all health centers are governed by a board comprised of local community members—the majority of which must be patients. This ensures the needs of each local community are understood and met. However, they also knew that disadvantaged communities needed significant, long-term investment especially if coordinated and resourced at the federal level.
This concept of a community-centered, community-governed health center connected to federal resources and providing a wide variety of healthcare services to those in need evolved over the next half century to become wildly successful. There are now almost 1,400 health centers today, operating in 14,500 locations spread across the country in rural and urban areas—serving as the primary medical home for over 30 million people.
Although health centers were founded in efforts to combat poverty and deliver services to the underserved, they provide better medical care than many private entities while serving a population that experiences more health risks to begin with—and they do it at a lower cost. Here’s why almost everyone should know more about health centers:
- Health centers are open to all, regardless of insurance status or ability to pay. While about half of patients who visit health centers are on Medicaid, roughly 20% have private commercial insurance. In fact, the vast majority of health centers welcome patients with private insurance, since it reimburses them a little better than public payers.
- Health centers are your lowest cost option if you don’t have insurance. Another 20% of patients visiting health centers are uninsured or under-insured. A sliding fee scale helps ensure costs are far lower than paying out of pocket anywhere else. Furthermore, many health centers offer low-cost medications through an arrangement called 340B.
- Health centers are bright, clean, modern facilities. (Visit https://findahealthcenter.hrsa.gov/ to find a health center near you and check out their website)
- Health centers provide whole-person care, in a medical home model. Many provide dental care, behavioral health services, eye care, and other services in addition to primary care. All are staffed by board-certified physicians and advanced practitioners who are well-trained, mission-driven, approachable, and caring.
- Health centers frequently become experts in the specialized care of certain populations. They are sensitive to the cultural differences in healthcare for communities they serve—offering language and translation services, addiction treatment, HIV/AIDS treatment, care for homeless populations, the LGBTQ+ community, recent immigrants and more. They also connect patients with transportation, free or low-cost food or medications, case management, health education, housing information, or legal advice.
What’s the Downside?
With many clinics in urban or rural areas, people may not come across health centers in suburbs or medical office parks as often. They don’t pop up in many “Find a doctor” searches or on commercial insurance plan websites. However, patient satisfaction surveys show health center patients are highly satisfied with their providers and their care.
Getting Things Right
Health centers achieve better outcomes on many standard clinical quality metrics. For instance, rates of good control of high blood pressure and diabetes are better in health centers than the national average. They provide more preventive services than other primary care providers and have lower rates of low birth weight, and one study showed an overall lower mortality rate for patients over 65 years old in communities with a health center. Health centers also save the health care system billions of dollars annually, providing extensive access to primary care as an alternative to the (more expensive) Emergency Department. They have lower overall per-patient annual costs than the national average. In fact, they provide lower cost care for Medicaid patients, Medicare patients, children, and all patients when compared to other providers.
So how do health centers provide these services and still achieve better outcomes? It boils down to the mission-driven philosophy, the structure of health centers, and the dedication and excellence of their physicians, providers, and staff. These highly trained professionals come from the best schools and are working in health centers because they want to. Many clinicians and staff live in the neighborhoods serving the health center patients, so they are naturally invested in the health and well-being outcomes of their community. Together, they provide a comprehensive, primary care based medical home for everyone with a basket of services tailored to the health needs of the community. Furthermore, they directly tackle barriers to the access of care such as language, distance, and ability to pay.
This short overview may not have unveiled all the mysteries of health centers, but they are a part of the U.S. health care system that works. Health centers should be kept in mind when anyone is considering health care options now, or in the future.