Insight into Community Health Centers

1. Insight intoCommunity Health Centers

2. Slides from the National Association of Health Centers’ A Sketch of Community Health Centers were especially selected for this presentation.

3. Preface The National Association of Community Health Centers (NACHC) is pleased to present A Sketch of Community Health Centers, an overview of the federal Health Center Program and the communities they serve. Community Health Centers began over forty years ago as part of President Lyndon B. Johnson’s declared “War on Poverty.” Their aim then, as it is now, isto provide affordable, high quality and comprehensive primary care to medically underserved populations, regardless of their insurance status or ability to pay. A growing number of health centers also provide dental, behavioral, pharmacy, and other needed supplemental services. No two health centers are alike but they all share one common purpose: to provide primary health care services that are coordinated, culturally and linguistically competent, and community-directed. Health centers play a critical role in the health care system as the health care home to 18 million* people. Across the country health centers produce positive results for their patients and for the communities they serve. They stand as evidence that communities can improve health, reduce health disparities, and deal with a multitude of costly and significant health and social problems – including substance abuse, HIV/AIDS, mental illness, and homelessness – if they have the resources and leadership to do so. Although the Health Center Program has been very successful over the years in providing vital health care services to those in need, the program faces many looming challenges. Rising costs, narrowing revenue streams, and steady increases of newly uninsured and chronically ill patients threaten health centers’ ability to meet growing need. Federal and state support is critically important to keep pace with rising costs and escalating health care needs. Who health centers serve, what they do, and their impressive record of accomplishment in keeping communities healthy, is represented in the following charts. *Includes patients of federally-funded health centers, non-federally funded health centers (health center “look-alikes”), and expected patient growth for 2008.

4. OUTLINE • Section I: • Who Health Centers Serve • Section II: • Economic Costs and Benefits of Health Centers • Section III: • Current Status and Projected Growth of Health Centers to include ACCESS for ALL

5. Section I: Who Health Centers Serve

6. 56 Million People Are Medically Disenfranchised Percent of State Population Without Access to a Primary Care Provider, 2005 DE DC 40% or greater 20 - 39.9% 19.9 -10% Less than 9.9% National Average = 19.4% FIGURE 1

7. Health Centers serve large numbers of the nation’s most vulnerable, including • 1 in 8 Medicaid beneficiaries • 1 in 7 uninsured persons, including • 1 in 5 low income uninsured persons • 1 in 3 individuals below poverty • 1 in 4 minority individuals below poverty • 1 in 7 rural Americans • 936,000 migrant farm workers • 1,044,000 homeless persons

8. Of the 18.4 million patients currently served by community health centers • 7.2 million are uninsured (38.9%) • 6.5 million have Medicaid (35.4%) • 1.4 million have Medicare (7.6%) • 2.9 million have private insurance (15.5%) • 478,000 have other public insurance coverage (including non-Medicaid expanded SCHIP) (2.6%) • 400,000 are kids enrolled in SCHIP (2.2%) (and another 35,000 adults with SCHIP_ • 13 million are below poverty (70.4%) • 16.8 million are low income (below 200% poverty) (91.4%) • 8.1 million are rural (44%)

9. Percent of Low Income, Uninsured Served by Health Centers, 2007 DE DC 40% or greater (9 States and D.C.) 30-39 % (6 States) 20-29 % (18 States) 19% or less (1 States) National Average = 20% FIGURE 2

10. FIGURE 3

11. Health Center Patients vs. U.S. Population, 2007 FIGURE 4

12. The Number of Health Center Patients Preferring Care in Languages Other than English Has Risen 64% Number in Millions FIGURE 5

13. Section II: Economic Costs and Benefits of Community Health Centers

14. Economic Costs and Benefits of Community Health Centers Leading the Way in Quality of Care • Quality Care Services and Patient Satisfaction • Reduced Cost • Culturally Sensitive Environment

15. Health Center Uninsured Patients Are Half as Likely to Go Without Care FIGURE 6

16. Nearly All Health Center Patients Report that They Have a Usual Source of Care, 2002 FIGURE 7

17. Economic Costs and Benefits of Community Health Centers • Provide quality care for $1.55 per day (or $562 annually per patient) • Annual medical expenses for health center patients are 41% lower compared to patients seen elsewhere which saves the health care system between $9.9-17.6 billion dollars a year. As the health centers continue to grow, so will the health care system savings • Nationally, health centers generate $12.6 billion in economic benefits for their predominantly low income, rural, and inner-city communities and produces 143,00 jobs

18. Economic Costs and Benefits of Community Health Centers Reducing Cost of Overall Health Care System by providing quality primary and preventive health care services

19. The Numbers of Patients with Chronic Conditions Is Rapidly Rising Percent Increase 2000-2007 FIGURE 8

20. Health Center Patients are Generally More Likely to Have a Chronic Illness than Patients of Office-Based Physicians FIGURE 9

21. Economic Costs and Benefits of Community Health Centers • Both the Institute of Medicine and the General Accountability Office have recognized Community Health Centers as effective models for reducing health disparities and for managing the care of people with chronic conditions such as diabetes, cardiovascular disease, and HIV.

22. Health Center Uninsured Patients are Twice as Likely To Get the Care They Need than Other Uninsured FIGURE 10

23. Economic Costs and Benefits of Community Health Centers Community Health Care Centers have improved health outcomes and simultaneously lowered the costs of treating patients with chronic illnesses by providing cost-effective, primary, and preventive health services thus reducing the need for more expensive emergency room, hospital in-patient, and specialty care. This reduces overall health care spending and positive health care outcomes.

24. FQHC: A Model for Primary Health Care Service Centers • Federally Qualified Health Centers (FQHC’s) are exemplary providers of primary health care in a culturally sensitive way • By federal regulation, at least 51% of the board of directors must be consumers of the health center • Though funded with federal dollars are not required to request proof of legal status • And are required to be located in and serve populations of medically underserved and/or health professional shortage areas

25. Borinquen Health Care Center • BHCC currently serves • 35% Haitian patients • 5% African-American patients • 1% White, Non-Hispanic patients • 59% Hispanic/Latino patients

26. BHCC Board of Directors Racial Composition and Target Population Representation on the Board of Directors • 33% Haitian • 10% White • 57% Hispanic/Latino * Serves 840 HIV clients; 1 Board of Director is an HIV individual

27. BHCC Senior and Middle Management • 25% Haitian • 15% White, Non-Hispanic • 60% Hispanic/Latino

28. BHCC Multilingual Staff • 90% of BHCC staff are bilingual • 5% of BHCC staff are trilingual • The telephone system, literature and signage are printed in three languages (English, Spanish, and Creole)

29. BHCC Advertisements • Advertisements are placed in the language and media depending on the target population, for instance • Haitian population listens to the radio as a prime source of information communication • Hispanic/Latino population watches Hispanic/Latino television networks and/or read newspapers related to their particular country/region of origin

30. Section III: • Current Status and Projected Growth of Health Centers to include ACCESS for ALL

31. Health Center Growth between 2000-2007 • The number of patients treated by health centers increased by 67% • The number of patient visits to health centers increased 64% • The number of low income patients at health centers grew 76% • The number of uninsured patients grew 62%

32. Community Health Centers • Health centers currently provide over 72 million patient visits annually

33. BHCC: A New Generation Community Health Center • Number of Users in 2008 • Male: 6,164 • Female: 9,733 • Patients by Ethnicity in 2008: • Hispanic/Latino: 9,167 • Other: 6,730

34. BHCC: A New Generation Community Health Center • Payor Sources in 2008: • Self-Pay/uninsured: 11,797 • Medicaid: 3,244 • Medicare: 735 • Private Insurance: 121 • Number of Visits by Department in 2008: • Adult Medicine: 23,086 • Pediatrics: 11,471 • OB/GYN: 9,887 • Dental: 7,496 • Behavioral Health: 4,104

35. BHCC: A New Generation Community Health Center • Number of Users EXPECTED in 2009 • Male: 9,300 • Female: 14,500 • Patients by Ethnicity EXPECTED in 2009: • Hispanic/Latino: 15,700 • Other: 8,000

36. BHCC: A New Generation Community Health Center • Payor Sources EXPECTED in 2009: • Self-Pay/uninsured: 16,000 • Medicaid: 5,000 • Medicare: 1,100 • Private Insurance: 1,700 • Number of Visits by Department EXPECTED in 2009: • Adult Medicine: 26,400 • Pediatrics: 18,000 • OB/GYN: 11,100 • Dental: 8,600 • Behavioral Health: 4,800

37. Primary Care Physician Vacancy Rates at Health Centers, 2004 Family Physicians/General Practitioner OBGYN Internist Pediatrician Psychiatrist FIGURE 11

38. Community Health Centers means ACCESS for ALL If funding for Community Health Centers Programs by 15 percent annually for 18 years, by 2015 health centers will serve 30 million patients

39. REFERENCES • Figure 1: The Robert Graham Center. Health Services and Resource Administration (HPSA, MUA/MUP data, 2005 Uniform Data System), 2006 AMA Masterfile, Census Bureau 2005 population estimates, NACHC 2006 survey of non-federally funded health centers. • Figure 2: National data from: Kaiser State Facts. Distribution of the Nonelderly Uninsured by Federal Poverty Level, 2007. http://www.statehealthfacts.org/comparebar.jsp?ind=136&cat=3 . Based on Bureau of Primary Health Care, HRSA, DHHS, 2007 Uniform Data System.

40. REFERENCES • Figure 3: Federally-funded health centers only. 2007 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. • Figure 4: Based on Bureau of Primary Health Care, HRSA, DHHS, 2007 Uniform Data System; U.S.: Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Based on U.S. Census Bureau 2006 and 2007 March Current Population Survey. US Census Bureau, Table 4. Annual Estimates of the Population by Race Alone and Hispanic or Latino Origin for the United States, July 2007, www.census.gov.

41. REFERENCES • Figure 5: Federally-funded health centers only. 2000-2007 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. • Figure 6: Shi, L and Stevens, GD. “The Role of Community Health Centers in Delivering Primary Care to the Underserved.” April-June 2007 JACM 30(2):159-170. • Figure 7: AHRQ, “Focus on Federally Supported Health Centers,” 2002. National Healthcare Disparities Report. http://www.ahrq.gov/

42. REFERENCES • Figure 8: Federally-funded health centers only. 2000-2007 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. • Figure 9: Private Physicians from 2006 NAMCS (CDC National Center for Health Statistics, 2008). Based on Bureau of Primary Health Care, HRSA, DHHS, 2006 Uniform Data System.

43. REFERENCES • Figure 10: Politzer, R., et al. “Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care.” 2001. Medical Care Research and Review 58(2):234-248. • Figure 11: Rosenblatt R, Andrilla H, Curtin T, and Hart G. “Shortages of Medical Personnel at Community Health Centers.” 2006. JAMA, Vol. 295, No. 9: 1042-1049.