Community Health Centers Celebrate Decades of Service

The lessons learned about population health management and the value of medical homes and coordinated care come straight from the nation's community health centers, which celebrate nearly 50 years of providing healthcare access.

If imitation is the sincerest form of flattery, then next week we should forgive the healthcare professionals serving the working poor and vulnerable populations at the 1,128 or so community health centers across the nation who might suffer a well-deserved swell of pride for the job they do.

August 11 marks the start of National Health Center Week 2013. After nearly 50 years of providing access to care for a generally sicker demographic of lower-income people in often medically underserved areas, the lessons learned at community health centers about population health management, and the value of medical homes and their coordinated and follow-up care are being replicated across the nation as other provider venues serving more-affluent patients cope with the move towards value-based reimbursements and a post-fee-for-service world.

"I have to say that we really have some capabilities that the marketplace really needs now and will need into the future. We were doing population health 10 years ago," says Lindsay C. Farrell, president/CEO of Open Door Family Medical Center. The nonprofit center has a $34 million annual budget and operates five clinics and five school-based programs that serve about 40,000 people in the Ossining, NY area.

"Population health is a relatively new term out there and it's been a term of art as a result of Accountable Care Organizations. But the feds were making us do it a long time ago because they wanted to make sure we were delivering value for the dollars they were investing. Those skills are important in our entire approach to patients and that is what the marketplace wants today so I have to believe that is going to serve us well in the future."

Farrell says community health centers are key institutions in the communities they serve because they not only provide proactive and preventative care, they teach wellness. "We are focused on prevention," she says. "We realize that a prescription might not necessarily be the be all and end all, that very often it is lifestyles and behaviors that have the most significant impact on health."

"That is not to say we don't write a lot of prescriptions over the course of the day, but we try to do more than that. We realize that life isn't about quick fixes. Rather, being healthy takes effort over time, and so we like to partner with our staff and our patients and their families that rely on us so that we can all be a little healthier.

The National Association of Community Health Centers estimates that the nation's health centers serve about 22 million people each year, and save about $24 billion by providing proactive and preventative primary care for low-income and uninsured people that keeps them out of the emergency room. In addition to primary care, community health centers often provide behavioral health services, dental health services, pharmacy, wellness and nutrition programs, and health counselors for their patients.

"We are cost effective because we are primary care providers and our job is to keep people healthy and out of the hospital. That is our primary focus," Farrell says.

"Also, our patients don't have a lot of money and we have a lot of uninsured patients, so that impacts the way we practice. If you have a patient who doesn't have insurance coverage, you are not going to be ordering a gazillion lab tests or diagnostic studies because the patients just can't afford it. You are going to be a bit more cautious because our patients can't have it all when they want it. That is actually not such a bad thing because there is a lot of literature that suggests that an overuse of the healthcare system doesn't necessarily make you healthier or happier."

Follow-up care coordinated by health counselors plays a big part in the success at Open Door. "There are lots of follow-up calls or face-to-face meetings to make sure that they got their medication and that they're taking the medication and that they can afford their medication. Do they know how to test their blood sugar? Can they afford the types of foods that they should be eating?" Farrell says. "We have classes and facilities outside of the exam room so that is how we are a little different than more traditional physician practices."

Unlike community health centers in rural areas, which serve a wider socio-economic demographic because they're often the only care provider in town, Farrell says Open Door's patients are largely working poor people, mostly Latinos, who have no other affordable venues in a part of the nation that is otherwise teeming with providers.

"We are in suburban New York and if anything, we are over-doctored and over-hospital bedded here," she says. "Isn't it fascinating that despite that federally qualified health centers still need to exist because our patients couldn't get served in the traditional setting? You wish that physician practices and hospitals could be accommodating, but the fact is that they aren't and that is why we needed to be here."

NACHC's Amy Simmons Farber says more than 1,000 events are planned next week under the theme of Transforming Health Care in Our Local CommunitiesCommunity health centers across the nation will host dignitaries and the public and members of Congress enjoying their well-earned five-week recess will be invited to learn about the unique services the centers provide and the impressive track record compiled while delivering nearly 50 years of value-based and coordinated care.

"Health centers go beyond the reach of traditional primary care and offer a number of other services that don't just focus on preventing illness but also looking at the factors that cause illness, such as nutrition, housing and unemployment," Simmons Farber says.

Community health centers are actually one of the few venues that command bipartisan support in the otherwise dysfunctional Congress. With about 39% of the programs funded through Medicaid and federal grants, community health centers avoided the impact of the 2% Medicare cuts mandated by sequestration.

"In fact we got more money," Farrell says. "That shows you how great our folks are and it also shows you how much Congress likes the work we are doing. We get results. We are very judicious about our resources. We are lucky that the feds have been as generous as they have been of late but that hasn't been the way it's always been over the last 30 years. We operate on the premise that dollars are scarce and precious and we have to utilize them for the greatest impact."