Community Health Centers Poised for Expansion

Gary M. Wiltz, MD, the newly elected chairman of the National Association of Community Health Centers, vows to expand the public profile of the organizations he calls "the base of primary preventive care."

Since the mid-1960s community health centers have done the heavy lifting and often thankless work of providing healthcare to poor and low-wage earners in underserved areas. In those decades they have proven their value and now serve about 22 million people who otherwise might go untreated. By some estimates community health centers will serve as many as 50 million people by 2019.

Gary M. Wiltz, MD, the newly elected chairman of the National Association of Community Health Centers, sees the role of community health centers growing dramatically over the next few years with the advent of the Affordable Care Act and its emphasis on population health and expanding Medicaid to improve access.

"We touch one in every 15 Americans right now, which is quite a statement about the expansion that we have enjoyed historically. We are projecting a lot of growth in the next five years, so there is a lot of work out there and a lot of people in need," says Wiltz, who also is the CEO at Teche Action Clinic in Franklin, LA.

"Quality is very important to us and we just want to make sure that we are making ourselves available and accessible. Our center here in Franklin is open six days a week, 12 hours a day, and a lot of our centers are trying to do extended hours to make sure we have the capacity to serve all of the newly insured that we hope when they come through our doors. It's the right thing to do for the country and the right thing to do by people."

Spend any time around these community health centers and the people who run them and it's hard not to be impressed, both with their dedication to their mission, and with the cost-effectiveness with which they deliver care.

Primary Care Starts Here
Community health centers have been around for close to a half-century because they deliver on both of those values. "If you look at healthcare as a triangle, we are the base of primary preventive care," Wiltz says.

"If we do our jobs correctly, if we bring people in and screen them for diseases and get those diseases under control and manage them and not always be reactionary, if we get people to quit smoking and lose weight, and exercise, do the cancer screenings and heart disease and do the things we do well then we can keep people from getting secondary and tertiary diseases, doing the prenatal care to protect against low birth weight bottles or preventing baby bottle tooth decay. That is our whole emphasis."

"I have been doing this for 30 years. I see patients now who I saw when they were 40 years old and got them to quit smoking and now they are 70 and they haven't had a heart attack or a stroke or developed cancer. That is the benefit of what we do."

Unfortunately for Wiltz and the people he serves his health center is in Louisiana, which is one of the 20 or so states that have opted out of the Medicaid expansion under the Affordable Care Act.

"In our state we estimate it will affect about 400,000 people who would be eligible for Medicaid expansion that are not going to get it," Wiltz says. We are going to try our best to get them into traditional Medicaid and the health insurance exchanges, but it really doesn't make any economic sense let alone moral sense. It is purely politics and philosophy that is operating and it's unfortunate for the people who are suffering and who could benefit."

Wiltz says expanding Medicaid would save money because treating people in community health centers costs a fraction of what it would cost in an emergency room. "On average, a Medicaid patient seen in a health center is $110. That same person in a hospital setting is almost $800. We have demonstrated tremendous savings."

Community health centers have also been caught in the budget battle between the Obama administration and Congress. The Obama administration included $11 billion in the ACA for capital improvements to the 1,128 federally funded community health centers across the nation.

Congress, however, cut funding for health centers by $600 million in 2011. Also, sequestration cuts are expected to cost community health centers about $120 million, which some studies estimate would translate into 900,000 fewer patients served. Community health centers are stutter stepping.

A Downward Slope
"Having prepared for a decade of strong growth, health centers now face significantly diminished funding and the prospect of a slower expansion of Medicaid, both of which exert downward pressure on health center expansion," the Kaiser Commission on Medicaid and the Uninsured stated in March.

"In light of health centers' role in our healthcare system and their unique potential to advance the goal of expanded access to care for the medically underserved, these shifts in the direction of retrenchment pose a challenge going forward." Wiltz says he is experiencing the effects of that retrenchment.

"We got money to do the capital development at almost all centers in the U.S. Before that we were in two double-wide trailers and an old house. A lot of centers were in churches and schools and had not gotten any money from capital development to even get out of those dilapidated buildings into more modern facilities," Wiltz says.

"We built these facilities with the thought that these uninsured would be covered through Medicaid expansion. That was the model that we have been operating on. I have two buildings that have been renovated and are ready to go but I can't open them because if I do and 80% who come to us are uninsured, I don't have operational dollars."

Wiltz concedes that community health centers have done an inadequate job of "tooting our own horns." He vows to expand their public profile during his two-year chairmanship.

"We represent 22 million people and I don't think all of our voices have been fully heard," he says. "I would like to see us get more media savvy and have people understand that when you touch one in every 15 Americans that says a lot."

Demonstrated Worth
He takes solace knowing that community health centers have endured for nearly a half-century because they've demonstrated their worth and no one else steps in to fill the need.

"When you look back on our beginnings in 1965, no one expected us to thrive and survive. We have a history of being creative and finding solutions. I don't have the exact road map, but I can tell you that we have enough talented and creative people and enough force and drive that we are going to make it happen one way or another."

"We are like that inscription below the Statue of Liberty: 'Send these, the homeless, tempest-tossed to me.' No one else wants to deal with them, but we have always provided a welcoming door. That is part of our DNA."