QUALITY: More Getting Primary Care From Community Health Centers

A growing number of Americans rely on federally qualified health centers for care, reports The Wall Street Journal. Last year, community health centers, as well as migrant and homeless health centers, served approximately 18 million people. That number is expected to hit 20 million this year, according to the WSJ and the National Association of Community Health Centers.

 
A disproportionate number of patients seen at the centers live in such low-income or underserved communities as inner cities and rural areas. According to the NACHC, 70 percent live at or below the poverty line. But with unemployment levels high, more middle class, college educated people are falling into the safety net of community heath centers, reports the WSJ. Loudoun County, VA Community Health Center operating chief Stephanie Kenyon told the WSJ the center's waiting list ballooned from 20 to 500 in just a few months.

Support for federally funded health centers (also known as Federally Qualified Health Centers or Community Health Centers) increased both during the Bush administration and more recently in the Obama administration through the American Recovery and Reinvestment Act (better known as the stimulus bill). By the end of the Bush administration, there were about 1,200 clinics nationwide, and this year's stimulus package provided $2 billion in funding to clinics. (That's $1.5 billion for infrastructure and another $500 million for operations -- and it represents a lot of money in the world of community health centers). Under the provisions in the pending House health reform bill, community heath centers could see an additional $38 billion over the next 10 years, although the specifics of the various congressional bills are still in flux.

Both Democrats and Republicans have seen the value of community health centers -- not just for the care they provide to millions who need it, but how they can help contain health costs by providing primary and preventive care in a community setting. According to the NACHC, the clinics save the U.S. health care system billions of dollars every year by providing preventative care that helps patients avoid costly trips to the emergency room. The centers are able to provide patients with comprehensive primary care services, including physical, dental and mental health. Patients pay for the visits based on a sliding scale, anywhere from $0 to $20 to $100 or more.  According to the WSJ, the average cost of a visit to the health center in Loudoun County is $145 -- that's a lot cheaper than the national average for trips to the ER, which tend to run about $1,000 for a single visit.

Community health centers can also become a vital component of care coordination and disease management. As we've written before, Denver Health in Colorado has been a model of bringing community health clinics into an integrated system. And they've been a pioneer in the use of health information technology. The network of community health clinics, a 911 ambulance and trauma system, school-based clinics, the local hospital, an HMO, and the county public health department all use health IT and electronic medical records so that doctors can communicate more easily -- with each other and with their patients. That helps them create efficient coordinated care plans, and help patients adhere to their treatments.

Colorado, where community health clinics have been ahead of much of the nation in adopting health IT, also has a program called Connected Care  to expand telehealth resources for patients in remote, underserved rural areas. The program, a partnership between the state of Colorado, UnitedHealthcare, Centura Health and the Colorado Rural Health Center, aims to allow health centers and other providers to use timely and efficient electronic information so that clinicians can coordinate care, improve quality, and lower cost.

Community health clinics don't get a lot of attention in our national health care conversation. But with their focus on affordable primary care and chronic disease management, many of these clinics are at the forefront of the move to lower costs while improviding the quality of health care.