Look Who’s 50!

M50Community Health Centers are not alone in marking their 50th year. Medicaid is also turning 50! And it was fifty years ago today that President Lyndon B. Johnson signed Medicaid into law. In 1965, as today, Medicaid was designed to provide a healthcare lifeline for people when they need it. Over the past half century, Medicaid has had a positive and lasting impact on the many families it serves, providing healthcare to one in every five Americans from all walks of life. Nearly two-thirds of people in this country have received care covered by Medicaid or have family members or friends who have.

Despite its solid, half century-long track record of making sure everyone receives needed care, Medicaid still has its critics, who call it a gateway to lifelong dependence on the government and a source of subpar care. But the reality is just the opposite. The fact is, Medicaid is not what many people think it is. Here’s why:

The average adult with Medicaid spends only a portion of any given year enrolled in the program–less than ten months of the year, on average.

  • The majority of adults with Medicaid are employed and pay taxes, but work in low-wage jobs for small firms or service industries that typically don’t offer health insurance.
  • Two-thirds of Medicaid’s budget goes toward care for people with disabilities and low-income seniors.
  • One in five people with Medicare rely on Medicaid to cover the things Medicare doesn’t: nursing home care, and dental and vision care, for example.

Medicaid and health centers have a longstanding partnership. “Community Health Centers were early adopters of Medicaid and welcomed Medicaid patients when other sectors did not,” recall Kevin Mattson, president and CEO of San Ysidro Health Center, and Gary Rotto, Director of health policy of the Council of Community Clinics in this San Diego Tribune op-ed.  While Medicaid patients account for 16 percent of the general population, they comprise 40 percent of health center patients. Research shows that health centers produce Medicaid savings by reducing unnecessary, avoidable, and wasteful use of health resources. As a result, health centers save the federal-state Medicaid program $6 billion annually. Health centers are also significantly more likely than other providers to accept new Medicaid patients.

Like health centers, Medicaid is also smart with taxpayer dollars. The program has been a model of efficiency. Coverage for an adult costs an average of $5,671 a year, 20 percent less than the cost of private coverage. Medicaid also leverages the efficiencies of managed care, with more than half its beneficiaries enrolled in managed care plans.  Debates about healthcare will never end. But in the past half century, Medicaid has proved its worth to the people it serves – and to taxpayers. Over the next 50 years, Medicaid will continue to evolve to remain that lifeline that, one day, you might need.

For more information on the 50th anniversary of Medicaid, visit www.medicaidat50.org. For more information on The Partnership for Medicaid, please visit us at www.thepartnershipformedicaid.org, or follow on Twitter @P4Medicaid.

Addressing the Social Determinants of Health

As we continue to celebrate the 50th Anniversary of the Community Health Center Movement it’s important to highlight what has led to the success of movement. This month we’ve been focusing on the health center workforce through blog posts on individuals and groups that contribute to this success. There is something very unique about the health center workforce that has been cultivated over the last five decades from working in underserved communities—a consideration of how barriers to care impact the health of their patients.

“You know better than anybody that health is much more than an interaction in a provider’s office. Health starts where people live, labor, learn, play and pray. That’s what the social determinants of health is all about. And [health centers] got that right from the beginning,” once noted Howard K. Koh, MD, MPH, Former HHS Assistant Secretary for Health at a NACHC conference.

From the very beginning health centers have sought to provide comprehensive and culturally competent healthcare, not only by working to address language barriers but also providing services like transportation, nutrition education, fitness classes, and even job training. Health center clinicians regularly reach beyond the walls of an exam room to understand what keeps their patients from leading healthier lives– whether it is lack of nutrition, stress, homelessness or other environmental factors.  Recently, for example, a health center in Massachusetts teamed up with a grocery store to bring healthy food to a community that is a designated a food desert—an urban area lacking access to healthy food—so their patients, especially those with chronic diseases like diabetes, could eat healthier.

Barriers to care are only now beginning to be understood more broadly. In fact, according to a recent NPR article, the Medical College Admissions Test just this year began including a section on psychology and sociology to “make sure the doctors of tomorrow are better prepared to care for an increasingly diverse patient population in a rapidly changing health care system.”

But this is not a new idea for people who work at health centers. The clinicians, nurses, pharmacists and CEOs at health centers know that providing quality care isn’t just about writing prescriptions or handing out medicines, it’s about building trust and relationships with patients. It’s about providing them with a medical home where they can get the care they need and be treated like individuals, with dignity and respect. Health centers are what healthcare should be. Perhaps that’s why nearly 100% of health center patients report being satisfied with the healthcare they receive.

Do you work at a health center that is doing innovative work addressing the social determinants of health? Let us know and we’ll write about it on this blog.

Stories from the Field: One Doctor’s Reflections on 30 Years at Community Health Centers

As we celebrate the 50th anniversary of Community Health Centers, we continue to shine a spotlight on those who have helped the movement.  Our focus this week is Peter Simon, MD,  or “Dr. Martes” (which is Spanish for “Dr. Tuesday) as his patients familiarly called him because of his once-a-week sessions at Providence Community Health Centers, in Providence, RI.

Dr. Simon, a now-retired pediatrician, spent 30 years acting as the back up to other physicians during the 4 to 8 pm shift on Tuesdays.  He took on the job after serving as Medical Director of the Division of Community, Family Health and Equity at the Rhode Island Department of Health.

“When a dad or a mom called, usually after work, and their child had a problem that needed attention the same day, I was offered as an option if their primary provider was either fully booked or absent,” Simon said.  He preferred prescribing chicken soup and rest over antibiotics, when possible, and resisted pressures to change care for reasons other than the patient’s medical condition. This stance also earned him the nickname “Dr. Chicken Soup.”

Dr. Simon reveled in “the rewards and challenges of practicing medicine cross-culturally,” learning patients’ stories, building trusting relationships, as well as the challenges of caring for children in families whose economic realities made it difficult for parents to take time off to care for a sick child.

“I guess that this complex relationship with the staff and families is what I will miss the most,” he said. “I will miss hearing the stories about where they came from, what was it was like for them to be in Providence now, what the kids liked and disliked about being here, rather than in the Dominican Republic, Guatemala, Haiti, Nigeria, Russia, etc.”

Though he didn’t practice in a health center full time, the experience marked him for life, both personally and professionally.  “These families helped keep me grounded in the work I was doing during the regular working hours at the Department of Health.  I think it contributed to the design of our prevention programs for children, which have been recognized [mostly by knowledgeable folks outside of Rhode Island] as the highest-performing in the U.S.”

Read more of Dr. Simon’s reflections on 30 years working at health centers in his self-penned piece in Convergence RI.

Training the Leaders of Tomorrow’s Community Health Centers

One of the great challenges for Community Health Centers is meeting the increasing demands of a growing healthcare system while facing a shortage of primary care physicians. Fortunately, some programs have made it their mission to encourage students to train to return to work at health centers  — programs like A.T. Still University’s, which we profiled in a blog post earlier this week, and the GE-NMF Primary Care Leadership Program.

The GE-NMF Primary Care Leadership Program is a service-based program backed by National Medical Fellowships and the GE Foundation. The program aims to give students the chance to examine the rewards (and challenges) of primary care practice at health centers by placing them at partner health centers across the country.

And then, hopefully, they’ll decide to stay.

This year, three scholars will train at International Community Health Services, a health center in Seattle. In personal essays these young scholars shared varying reasons about why they wanted to be a part of the program.  Katie Cho is among the three scholars, and writes in her personal essay that “growing up in less privileged communities with immigrant parents unable to afford health insurance, I have firsthand knowledge of how social status limits health resources and attention. Witnessing such disparities drive me to work towards a health care system that is unbiased and all encompassing.”

All three scholars expressed a common aim in their essays — that they wanted to give back to the community.  They should fit right in at ICHS.

To learn more about the three GE-NMF scholars working at International Community Health Services this summer, read more on ICHS’ website.

Is your health center training the doctors of the future? Let us know in the comments below and we could write about it in a future post.

Homegrown Recruitment Is the Wave of the Future for Health Center Workforce

11692492_10152889729036481_7876110168129291187_n[1]

Meet Bucky.  He is the mascot for A.T. Still University (ATSU ). But, more important, the medical students standing on either side of Bucky are the real story because they represent the future of health centers. ATSU has two campuses, one in Kirksville, MO, and the other in Mesa, AZ, but no matter the location the university is focused on one important issue: building the primary care workforce for the next generation.  As we’ve noted earlier, health centers have not just survived for the last 50 years, they have also expanded to become the largest, if not most successful, system of primary care.  But the success of the future expansion of health centers depends on a robust workforce to staff the health centers.  We need to train more providers to meet the demand for care that is expected to grow.

That is where ATSU comes in.  In Mesa, for instance, the university is home to the School of Osteopathic Medicine in Arizona (ATSU-SOMA), which operates a family residency program that will place 87 graduates over three years in health centers around the country.  This is part of a “homegrown” recruitment strategy that encourages local students to become primary care physicians in their own communities.   These students also learn firsthand at medical residencies operated by select Community Health Centers around the country.

To learn more about this innovative program and two future healers, who are on a path to primary care, read this blog post from ATSU-SOMA.