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Community Health Centers bring quality care to nation's underserved

By Dan Hawkins & Oliver Spurgeon III, National Association of Community Health Centers


NACHC Dan Hawkins and Oliver Spurgeon IIIWith origins in the civil rights movement and President Lyndon Johnson’s War on Poverty initiative, today’s health centers are one of the best examples of carefully targeting federal resources to deliver care to diverse and underserved communities.  The community health center movement began as an innovative social experiment during the mid-1960s, and has evolved into the largest primary care network in the country. This is largely due to years of longstanding bipartisan support from both Congress and the Executive Branch that now allows health centers to serve nearly 27 million Americans each year, in nearly 10,000 communities.

Two-thirds of health center patients are people of color, and the vast majority experience myriad social factors including poverty, social isolation, and housing instability that put them at higher risk for suffering costly and deadly chronic diseases. Despite these structural challenges, the nation’s health centers continue to improve the health and wellbeing of their patients and communities, while generating $24 billion a year in savings to the healthcare system.

Delivering top notch healthcare and improving health outcomes for health center patients, who are often minority or low-income, requires an “at-all-costs” attitude. For decades, health centers have been abiding by that maxim, and today’s community health centers are using team-based care to ensure that doctors, nurses, pharmacists, and other providers can treat patients with multiple costly chronic conditions all under one roof. Community health centers recognized long ago that good health doesn’t solely come from delivering primary care services such as child healthcare, family planning, and prenatal care. It also takes creative ideas, and lots of helping hands, to deliver care that is easy, accessible, affordable, and culturally relevant for health center patients.

At every health center, transportation services are available for patients without cars or access to public transportation; translators work with doctors to explain medical choices to non-English speakers; and caseworkers are often on hand to help patients navigate bureaucracy to secure housing or food assistance. These additional services are far outside traditional healthcare thinking, but each day they help millions of patients with little money or time to spare to access affordable care at health centers.

The ability of states to expand Medicaid eligibility requirements under the Affordable Care Act (ACA) has also been key to the recent success health centers have seen. This expanded eligibility has boosted local healthcare coverage rates in communities across the country, and also reduced the amount of uncompensated care at health centers. More importantly, with the latest enrollment period for qualified health plans in the ACA Marketplace now open until December 15, community health centers continue to perform community outreach to ensure as many people as possible are enrolled in health insurance plans. Expanded healthcare coverage has been especially crucial in health centers’ efforts to improve the health of racial and ethnic minorities ‒ especially those who reside in inner city and rural communities that other providers have largely avoided.

The secret of health centers’ success is rooted in three key features:

  • First, each health center is firmly grounded in its local community, and governed by a patient-majority board that ensures a focus on the community’s most pressing needs. These ‘patient democracies’ give patients a voice and a choice in how their healthcare is delivered – a feature unmatched anywhere else in our healthcare system.
  • Second, they make their care affordable to everyone, regardless of ability to pay, removing barriers that cause too many to delay necessary care or to use costly alternatives such as ERs.
  • And third, they are held to high standards for performance and accountability by the federal regulators, and by competition between health centers.

Decades after their creation in the 1960s, recent turmoil surrounding the gathering of white supremacists in Charlottesville, VA stands as a stark reminder that the nation, and health centers, have more work to do on issues of equity and inequality for racial and ethnic minorities. Community health centers continue to move with ever greater zeal and purpose to confront the racial and economic disparities in health and healthcare that seem only to have intensified in recent years, and the rest of the healthcare system appears to be slowly coming to the recognition that a broader focus on population health is vital to the wellbeing of marginalized communities. In 2016, the U.S. Department of Health and Human Services released its Healthy People 2020 report, which emphasizes the need to consider poverty, education, nutrition, employment, and numerous social factors that influence the health of low-income individuals and populations of color. Health centers are focused on addressing those challenges every day.

Health centers bring $26.5 billion in economic activity, along with much needed jobs, to the 10,000 inner-city and rural communities they serve. However, most importantly, health centers have succeeded for decades in building a powerful and effective network that stretches from coast to coast. Today’s health centers continue to hold fast to the dream that gave birth to the original community health centers in Mississippi and Massachusetts: the dream of good & affordable healthcare for everyone.

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