World AIDS Day and Beyond: How Health Centers Help

wad2016-instagram-square-1081x1081_cropToday is World AIDS Day and we are taking a moment to highlight the work Community Health Centers are doing to reduce the incidence of HIV and care for people living with HIV.

The National HIV/AIDS Strategy for the United States: Updated to 2020 calls for the integration of high-quality HIV services in health centers and implementation of sustainable HIV testing and care coordination programs. Health centers are essentially on the front lines of HIV treatment and prevention, and making a difference. The number of health center patients receiving HIV testing has increased by 66 percent during 2010 and 2015, according to federal data.

Because the HIV/AIDS epidemic has disproportionately affected the medically underserved, health centers are uniquely positioned to provide comprehensive HIV prevention and treatment and are developing ways to continually improve their services to patients. They are integrating care management and coordination services to boost health outcomes, and are poised to make HIV screening part of a routine exam any patient receives. They are also trying to increase prescriptions of pre- (PrEP) and post- (nPEP) exposure prophylaxis for HIV to keep persons at risk of HIV from becoming infected. Health centers have begun training their expanded care teams to engage patients in discussions about their sexual health, specifically asking all patients about their sexual orientation and gender identity, and asking questions to better understand patient risk for HIV infection.

There are also resources for training and technical assistance. A case in point is the Denver Prevention Training Center (Denver PTC). The Denver PTC works with health centers and Primary Care Associations to assess and improve current HIV prevention services. One way they can do this is by working on routine HIV screening workflows and providing free consultation to help support or enhance a health center’s current HIV care coordination efforts.

Metro Community Provider Network in Colorado is one group using Denver PTC’s free services. Realizing the need to limit their providers’ time away from serving patients, they worked with Denver PTC to have them conduct PrEP trainings for all of their providers at six different clinics in a lunch and learn style to prepare providers for PrEP provision. The Denver PTC offers resources in formats easily accessible to busy clinicians, such as recorded webinars and online tools and have even developed flexible trainings such as onsite mentoring on their website, www.denverptc.org.

NACHC is partnering with Denver PTC to provide free HIV prevention capacity building services to health centers and PCAs. For more information on this service, contact Ashley Barrington at abarrington@nachc.com.  

Related Resources:

AIDS Education and Training Center

Taking Routine Histories of Sexual Health:  A System-Wide Approach for Health Centers

Upcoming Webinar:

Discover HIV Navigation Services: A New Model for Patient Navigation
December 15, 2016: 12:00pm – 1:30pm Eastern. Register.

Facing Addiction in America

sgr-reportU.S. Surgeon General Vivek Murthy, MD, has issued a groundbreaking report on America’s addiction crisis. The report concludes that millions of Americans suffer from alcoholism or addiction to legal and illegal drugs, but only a fraction are being treated. One in seven people in the United States is expected to develop a substance use disorder at some point, but only 1 in 10 will receive treatment, the report said. This is the first report of its kind from a surgeon general that addresses substance use disorders and the wider range of health problems associated with them. It could not come at a more critical time. More people died of drug overdoses in 2014 than any year on record. It is estimated that 79 Americans die every day from an opioid overdose. The report also underscores what many in the health center community are already saying: that addiction is a chronic brain disease, not a character flaw, and addressing the problem will require a cultural change in understanding.

The report also contains some startling numbers:  More people use prescription opioids than use tobacco. There are more people with substance use disorders than people with cancer. And substance use disorders are expensive, costing the U.S. more than $420 billion a year. Among the Surgeon General’s recommendations are that highly effective community-based prevention programs “should be widely implemented,” and that “full integration of the continuum of services for substance use disorders with the rest of health care could significantly improve the quality, effectiveness, and safety of all health care.”

As we’ve noted before in this blog, Community Health Centers have been fighting addiction in their communities for some time with a variety of approaches. Of late, opioid addiction has been a focus as health centers have seen their communities decimated by addiction to the drug.  Over 270 health centers also received $94 in federal funding to improve and expand the ways to treat opioid addiction in underserved populations. Many health centers are using these funds to innovate and expand services beyond medication assisted treatments to include pain management, counseling, group therapy, acupuncture, and holistic medicine.

Stay tuned for our next NACHC podcast, which will feature an interview with Louise Reese, CEO of the West Virginia Primary Care Association, a state which is at the epicenter of the nationwide opioid addiction epidemic.

Related posts:

A Health Center Writes a Book to Help Kids Understand Addiction

The New York Times Looks at Treating Opioid Addiction and Pain in West Virginia

A Note About Bipartisanship on Election Day

maureenWith Election Day finally upon us, we’re reflecting on the strides Community Health Centers have made in their journey for over half a century. Regardless of the election’s outcome, health centers and the people who are proud to work in them are committed to the idea of empowering communities, whether it’s through voting, fighting for affordable access to care, or improving health outcomes for at-risk populations. We’re also proud that expanding health centers remains an issue on which both Republicans and Democrats can and do agree. There are more health centers located in medically underserved communities because elected leaders on Capitol Hill and in the White House decided they are a solution to saving lives and keeping down health care costs.

As NACHC Board Chair Ricardo Guzman explained in this op-ed recently published in The Hill:

“The success of the Health Center Program has helped drive its growth to nearly 25 million people or one in 13 Americans. The surge is extraordinary in part because it could not have happened without the agreement among Republicans and Democrats to put more health centers in communities. Both Presidents George W. Bush and President Barack Obama were key architects of the program’s expansion over the course of their administrations. They understood that expanding affordable care is a moral imperative but, more to the point, it’s also a good investment in the public’s health.” 

Outreach and Enrollment Kicks Off Today

Apply now to get health insurance that works for you and your employeesNovember 1 can only mean two things: mounds of leftover Halloween candy to eat and the first day of Outreach and Enrollment (or, as we like to say, O & E). What that means is consumers have the next three months to find an insurance coverage option that works for them.  It also means that Community Health Centers are working hard on the ground with enrollment assistance and education activities (check out NACHC’s podcast on the topic). They are donning their “ASK ME ABOUT INSURANCE” buttons, setting up staffing tables at the entrance of their waiting rooms, or at the local shopping mall, community festivals or state fairs. Health centers are also partnering with a host of groups to make sure everyone who is eligible is covered: faith-based organizations, local pharmacies, Head Start programs, unemployment offices, school districts, and much more.

The biggest news with O & E is that there have been (if you have been reading newspapers) substantial price hikes on premiums. Experts say this is because insurance companies started out initially charging premiums that were too low and are adjusting, and also because some insurers are pulling out of the exchanges, according to published reports. Consumers should also be aware that if they smoke or use tobacco they can be charged higher premiums for coverage.

What is really important is that consumers shop around for the best plan (which may not necessarily be the cheapest), and also learn if they qualify for a subsidy to help cover the cost of premiums. According to the U.S. Department of Health and Human Services, if a consumer qualifies, he or she can earn extra savings on out-of-pocket health care costs. But only if they enroll in a plan in the Silver category. 

More than 90 percent of Americans now have health insurance, according to the White House. Health centers have provided over 18 million assists with enrollment since 2013.

Helpful links:

NACHC resource page

Health Resources and Services Administration (HRSA) O & E Assistance

Cultural Competency 101

cultural-competencyOur guest blogger today is Gianna Ramos, a GE-National Medical Fellowship Primary Care Leadership Program (PCLP) Scholar. As a PCLP Scholar, Ramos had the opportunity to examine the challenges and rewards of working in primary care in Community Health Center. While working at Matthew Walker Comprehensive Health Center in Nashville, TN, Ramos focused on the needs of adolescent patients. 

Cultural competency has been an increasingly popular topic in medical school because of the diverse society in which we live and work.  At the David Geffen School of Medicine at UCLA, my current institution, there have been lectures and workshops on how to adequately address the cultural needs of patients. Certainly more education is needed, but the hands-on experience I had outside of my home institution was perhaps the most meaningful lesson in cultural competency.   I traveled to Nashville, TN, during the summer in between my first and second year of medical school, a long way from Los Angeles, and worked in a Community Health Center —  the Matthew Walker Comprehensive Health Center (MWCHC), as part of the General Electric and National Medical Fellowships Primary Care Leadership Program (PCLP).

Immersion, in my own experience, is the best way to develop the skills needed to become a culturally competent physician, and this program helped me do just that. Every day MWCHC serves mostly low income African American and Hispanic patients.  I worked in the pediatric department seeing patients that came in for anything from a well baby check up to STI screening. I worked alongside nurse practitioner students, and other medical students, to gain clinical experience in the exam room, listening to heart and lung sounds, checking for developmental milestones, talking about concussions and sports safety, and addressing childhood obesity. Previously, I had seen many diverse patients in my limited experience as a medical student in the LA County hospital system, but this was not the same.  Medicine in the south, and medicine in the west are surprisingly much different in practice.  For instance, I quickly learned that many parents stayed in the exam room throughout the entirety of their son or daughter’s visit, while in Los Angeles, we often ask parents of patients over the age of 13 to leave for a portion of the interview. In Nashville, patients were more respectful, but also engaged less in shared decision making, and took my word as authority without much questioning. It was these experiences that opened my eyes to the differences in how medicine is practiced and how necessary it is to always accommodate the culture of the patients.

I was able to conduct a small project as part of PCLP, which allowed me to gain a better understanding of what adolescent patients wanted from their healthcare provider, by attending a community health fair and asking attendees to participate in a survey. The health fair was a lot different than the ones I had volunteered at in Los Angeles. There was live reggae and rap music performed by community members at the health fair, something I had not seen before. This laid-back environment with a lot of community participation made it easy to survey the community at the health fair and get valuable feedback from the adolescent population. Ultimately, I was able to use the feedback to inform providers about services that adolescents wanted more of, like sex education, and in what ways the care they received was excellent.

PCLP was a great opportunity to not only immerse myself in another community, but to learn how, even within the United States, we can have such diverse patients and providers, and how important it is to be aware of our cultural differences and work toward a better mutual understanding and acceptance of one another.