The NACHC 2017 P & I is Here!

From left to right: Julie Wood, MD, AAFP; Kemi Alli, MD, Henry J Austin; Brenda Johnson, La Clinica

The NACHC 2017 Policy and Issues Forum is about to start and we could not be more excited.  More than 2,500 Community Health Center leaders from around the country have signed up to attend this national gathering, including a record number of consumers [see media advisory]. The policy conference began today with a panel discussion on Capitol Hill on the topic “Primary Care: High-Value Care for Underserved Communities.” The discussion is part of a series hosted by NACHC, the National Coalition on Health Care, AAFP, the American College of Physicians, and the American Osteopathic Association, groups that are part of the larger National Coalition on Health Care. In their remarks the panel of experts made the case that primary care must become a national health policy priority, underscoring that the U.S. spends only 4 to 8 percent on primary care, compared to an average of 12 percent among other industrialized countries, each of which spends substantially less on health care overall than the U.S.

Two Community Health Center leaders presented on the panel, Kemi Alli, MD, a pediatrician with Henry J. Austin Community Health Center in Trenton, NJ. Also, Brenda Johnson, with La Clinica, in Medford, OR.

Dr. Alli described the range of comprehensive primary care services that her health center provides for patients (adult medicine, pediatrics, gynecology, dental, nutrition, social services and heatlth education) explaining, “A whole healthy human being is a happy human being. We try to provide as many services as we possibly can because our patients are vulnerable and disenfranchised.”

She also described the value of integrating primary care and behavioral health care “at the same point of touch in a trauma informed system.”

Brenda Johnson of La Clinica shared how the state’s efforts to expand Medicaid and coordinate care has saved the federal and state government $1.4 billion in Medicaid costs since 2012.  But even more compelling was her description to a captive audience about how her health center “knits together” a host of service providers that connect patients not just to good care, but better housing, a living wage employment and higher education, as well as coordinated care to address behavioral health and substance abuse.

“We are all really lucky we can save peoples’ lives,” she said.  “We can talk about data, services but these are our neighbors.”

The services La Clinica offers such as nutrition/cooking classes, mindfulness classes, and personal development seminars, have changed the lives of the patients, and some of their success stories were featured in the discussion.

Lastly, we should also note that today’s panel discussion coincided with the release of a new NACHC report,“Strengthening the Safety Net: Community Health Centers on the Front Lines of American Health Care” makes the case that while the debate over insurance coverage is important, the question of ensuring access to high-quality, affordable care is equally important. Health centers have succeeded for decades in providing that care in some of America’s hardest to reach communities where there are few or no options for care.

A few of the report’s highlights:

  • Community Health Centers serve nearly 5 million more patients today than in 2010.
  • Behavioral health services have grown by 56 percent since 2010. Over 80 percent of health centers now offer behavioral services, such as mental health counseling and addiction-related services.
  • More than 76 percent of health centers offer oral health, and 40 percent offer pharmacy services.
  • More than half of health centers (55 percent) are located in rural areas, serving 13 million patients and in many cases are the only provider for hundreds of miles.
  • Health centers serve more than one in six Medicaid beneficiaries for less than two percent of the national Medicaid budget.
  • In terms of total costs of care, health centers save 24 percent per Medicaid patient and up to 30 percent per Medicare patient, when compared to patients cared for in other settings

You can read the press release by visiting this link.


The Challenges of Providing Equal Health Care Access to All

Today’s guest blog post is by Susan West Levine, CEO of Lowell Community Health Center in Massachusetts.  This article originally appeared in the March/April’17 issue of Merrimack Valley Magazine, Reprinted with permission from the publisher, 512 Media, Inc.

Photo Credit: Kevin Harkins

As CEO of Lowell Community Health Center (CHC), I am often asked just what a Community Health Center is. I tell people that a CHC is like any primary care provider, with one exception: We do not turn anyone away due to inability to pay.

Lowell CHC provides equal health care access to everyone in Greater Lowell. That means caring for patients who speak more than 40 languages, including some refugees who experienced torture and persecution. In nearby Lawrence, the Greater Lawrence Family Health Center focuses on the cultural needs and health concerns of a predominantly Latino population.

It is safe to say that no two CHCs look the same.

Lowell CHC accepts public and private insurance and earns 74 percent of our income from fees and services, raising the remaining 26 percent through contributions, grants and a small number of subcontracts. We also operate a pharmacy, which is open to patients and the general public, and partner with Circle Health/Lowell General Hospital to offer a full-service lab. These are amenities typically available in larger private practices. Both are on-site. Soon we will offer dental and vision services.

CHCs are not your typical health care providers. More than 88 percent of Lowell CHC patients earn less than 200 percent of the federal poverty level. Forty-six percent of our patients are best served in a language other than English, which is why we provide medical interpretation — a service not covered by insurance — in 28 languages. We also operate two full-service, school-based health centers, one at Lowell High School and another at Stoklosa Middle School, making it easier to assure that students have required vaccines and easy access to health care and behavioral health services.

Our patients often have complicated stories and involved medical needs. We might spend as much time making sure a patient has food and shelter as we do taking their vitals and gauging their physical health. And our community health workers are out in the community, visiting patients at home, screening people for diabetes or high blood pressure at health fairs, senior centers and during festivals and community events. Our behavioral health services provide prompt mental health care. By offering affordable health services to those who might otherwise visit hospital emergency rooms for routine care, CHCs reduce unnecessary and costly emergency room and hospital admissions.

Lowell CHC is a vital resource in our community, both as a health care provider serving 50,000 people annually and as an economic engine. The health center movement was launched 51 years ago, right here in Massachusetts, providing health care to all and creating jobs in communities where living-wage job opportunities were lacking. Lowell CHC is the 10th largest employer in the city of Lowell, providing jobs to nearly 400 people from throughout the Merrimack Valley.

So, what exactly is a Community Health Center? It’s a vital health care resource assuring that everyone — you, me, our neighbors and friends — has equal access to the kind of health care we all deserve.



Hot Off The Press from the Bipartisan Policy Center

There are a lot of good ideas floating around Washington, D.C., and one of the first places to look for them is the Bipartisan Policy Center (BPC), the only think tank in town that takes the best ideas from both political parties and uses them to promote health, security and opportunity for everyone.  That is why we should pay close attention to the report issued this month from BPC that underscores the important role Community Health Centers play in the safety net. The report, “Preserving the Children’s Health Insurance Program and Other Safety-Net Programs,” makes the case for continuing funding for programs designed to improve coverage and access to care for vulnerable populations.  Funding for these programs — the Children’s Health Insurance Program, mandatory funding for health centers, the National Health Service Corps, and the Maternal, Infant and Early-Childhood Home Visiting Program — are set to expire on September 30, 2017 unless congressional lawmakers take action.

The report devotes a section to health centers which describes the cost-savings health centers generate among Medicaid patients, noting, “health centers have 24 percent lower spending per Medicaid patient when compared to non-health center sites.”  The broad bipartisan support that health centers have received in recent decades is also underscored in detail, especially the recent letters issued by Republicans and Democrats in the House and Senate “requesting the continued recognition and support of health centers during the FY2017 Appropriations process.”

The BPC report recommends that Congress should “extend funding of health centers at the current total level of $5.1 billion annually (including both mandatory and appropriated funding) through FY2021” to maintain access to care for both insured and uninsured populations.


Kentucky Health Center Clinician Honored as “Country Doctor of the Year”

It’s not often that health center clinicians who toil away in medically underserved communities are singled out for the spotlight but that’s exactly what happened to Van Breeding, MD, the Director of Clinical Affairs at Mountain Comprehensive Health Corporation (MCHC). Dr. Breeding  could have gone anywhere after graduating and completing his residency at the University of Kentucky, but he chose to return to his hometown of Whitesburg, a pocket of eastern Kentucky with some of the highest rates of obesity, tobacco use, diabetes cancer, and most respiratory ailments associated with mining coal, such as “black lung.”

In a recent interview with Health Leaders Media, Breeding explained that going any place else was never a consideration.  “I grew up in this town. I went to high school in this town. All of my family is this town. My patients are either family or friends of mine.”

Breeding’s dedication to his job and patients (he typically works a 16-hour day) is why Breeding has been named Staff Care’s 2017 Country Doctor of the Year . The national award, established in 1992, was established as a way to recognize rural physicians.  “The selection committee was greatly impressed by the many years of commitment and devotion you have shown to the people of Whitesburg, Kentucky, and the surrounding areas in the face of extraordinary professional and personal challenges. As a mainstay of primary care in Whitesburg, you have provided an exemplary level of care and compassion to your patients.”

Breeding is passionate about his patients, and about access to care, and was recently interviewed on ABC News about the impact of the state’s Medicaid expansion on his patients.

Affordability and Access to Care Still a Struggle in the U.S.

This study missed our radar when it was published last fall, but now we’re paying attention.  According to the Commonwealth Fund, paying medical bills is still a challenge for more than one-third of Americans.  Adults in the U.S. are more likely than those in 10 other countries to go without needed health care because of costs. One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs.  Even though there has been a decrease since 2016,  the percentage is higher than in other countries, such as the United Kingdom and Germany.  Also, half of U.S. adults have struggled to get health care on weekends or evenings without going to the emergency room.

The researchers note, “Although the U.S. has made significant progress in expanding insurance coverage under the Affordable Care Act, it remains an outlier among high-income countries in ensuring access to health care.”  That is because, the authors note, all of the other countries surveyed provide universal insurance coverage, and many provide better cost protection and a more extensive safety net.

Speaking of safety net, the value of Community Health Centers is that they not only now reach 25 million people (or 1 in 13 Americans), they also make health care more affordable and effective. Services are offered on a sliding scale basis and the care is also cost-effective. For instance, a patient visit is a fraction of the cost of an emergency room visit, on average a dollar less per patient a day compared to all other physician settings, according to this NACHC fact sheet. The care is also accessible in medically underserved communities and that is an important consideration when factoring in the need to put more health centers in medically underserved communities.  And certainly the need is there, according to the Commonwealth Fund researchers.  The bottom line, they write, is that people in the United States “remain more likely to go without needed health care because of costs compared to adults in other high-income countries.”

The 2016 survey, published in Health Affairs,  covered adults in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.