Community Health Centers Play Major Role in Protecting Safety Net

March 23, 2016 01:37 pm Michael Laff Washington, D.C. –

Manny Lopes, CEO of the East Boston Neighborhood Health Center, said during a recent event in Washington, D.C., that community health centers are crucial to the neediest patients.

Community health centers (CHCs), sometimes seen as the last stop for individuals who cannot afford medical care, are emerging as the first stop for innovative approaches in patient care and employee engagement.

Three clinic executives discussed that innovation recently at an event to release "Staffing the Safety Net: Building the Primary Care Workforce at America's Health Centers,"( a report from the National Association of Community Health Centers (NACHC).

Nationally, 1,400 CHCs provide service at 10,000 sites. They care for 24 million patients in underserved areas regardless of insurance status -- a figure that has doubled since 2000 -- and 71 percent of these patients live at or below the poverty level. So before staff members can address physical health, they often have to find ways to deal with concerns about where a patient will obtain food and shelter.

Story Highlights
  • Three executives recently discussed innovation at community health centers (CHCs) at an event to release a report from the National Association of Community Health Centers.
  • Two big challenges for CHCs are recruitment and retention, and nearly 70 percent of them reported having an open position for a family physician.
  • Nationally, 1,400 CHCs provide service to 24 million patients across 10,000 sites in underserved areas.

"We have to be social workers, community outreach workers and housing advocates," said Vince Keane, president and CEO of Unity Health Care in Washington, D.C.

The task is especially difficult because funding has not kept pace with the rising demand for services in the communities they serve. For instance, the East Boston Neighborhood Health Center has had to hire staff to provide mental health care, a need that nationwide costs $57 billion a year, on par with cancer costs.

"Reimbursement is still a challenge," said Manny Lopes, CEO of the East Boston Neighborhood Health Center. "Recruitment and retention is a challenge. Scalability continues to be a challenge."

Those challenges foster creative solutions, Lopes said.

Some solutions may lie in technology. Lopes is a strong advocate for wider use of telemedicine, arguing that it could make it easier for patients to get appointments with subspecialists. A cardiologist visits his center only once a week, for instance, but telemedicine could allow cardiology consults every weekday.

At Unity Health Care, one physician built a database to rank all the parks in Washington, D.C., in terms of safety and cleanliness. Now the staff can use that technology to advise patients about good places to get exercise.

Other solutions come in the form of non-traditional funding, as when Unity Health Care looked for a way to treat its high ratio of hepatitis C patients. The center participated in a trial of ledipasvir-sofosbuvir (Harvoni), which had a 93 percent cure rate. And it set up a donation program to give patients access to the drug despite its cost of $1,000 per pill. The program would have cost about $55 million at full price for 600 patients, which the center and its patients could not afford.

"If 550 patients are saved, that saves the Medicaid system," Keane said.

CHCs also innovate to recruit and retain staff members, especially family physicians. In an examination of recruitment needs at CHCs across the country, the NACHC report showed that family physicians are in greatest demand. Nearly 70 percent of CHCs had an open position for a family physician and 51 percent said their highest priority vacancy was for a family physician. Salary was ranked as the largest obstacle to recruitment and retention.

Part of the retention strategy at the Family HealthCare Network in Visalia, Calif., said Kerry Hydash, the network's president and CEO, is sometimes to even pay moving expenses for employees' parents. When a child is born to a staff member, the center may pay expenses for the new grandparents to move to the area rather than watch the employee move away to be closer to family.

Related AAFP News Coverage
Sense of Community: CHCs Offer Way to Battle Health Disparities, Social Injustice