WHAT ARE HEALTH CENTERS?
Community health centers are local, non-profit, community-owned health care providers serving low income and medically underserved communities. For over 40 years, Missouri’s health centers have provided high-quality, affordable primary care and preventive services, and often provide on-site dental, pharmaceutical, and mental health and substance abuse services. Also known as Federally-Qualified Health Centers (FQHCs), they are located in areas where care is needed but scarce, and improve access to care for thousands of Missourians regardless of their insurance status or ability to pay. Their costs of care rank among the lowest, and they reduce the need for more expensive in-patient and specialty care, saving taxpayers millions of dollars. In 2010, Missouri’s 21 health centers provided services through 180 delivery sites in both rural and urban communities, which is a 47% increase in site locations since 2005.
WHO DO HEALTH CENTERS SERVE?
Health centers serve as the medical home to 392,785 Missourians with over 1.4 million encounters each year – numbers that are quickly growing. Dental encounters alone have increased 62% since 2005. Health center patients are among Missouri’s most vulnerable populations – people who even if insured would nonetheless remain isolated from traditional forms of medical care because of where they live, who they are, the language they speak, and their higher levels of complex health care needs.
About 50% of health center patients reside in rural areas, while the other half live in urban communities. As Figure 1 (sidebar) demonstrates, 75% of health center patients have family incomes at or below 100% of poverty ($18,310 annual income for a family of three in 2010). Moreover, health centers serve a disproportionate level of uninsured and Medicaid patients as shown in Figure 2 (sidebar), 36% of health center patients are uninsured and another 41% depend on Medicaid, compared to statewide rates of 19% and 14%, respectively (not shown). Slightly under half of health center patients are members of racial and ethnic minorities, as shown in Figure 3 in the side bar.
HOW DO HEALTH CENTERS OVERCOME BARRIERS TO CARE?
Health centers remove common barriers to care by serving communities that otherwise confront financial, geographic, language/cultural and other barriers, making them different from most private, office-based practices. They
- are located in high-need areas identified by the federal and state government as having elevated poverty, higher than average infant mortality, and where few providers practice;
- are open to all residents, regardless of insurance status, and provide reduced cost care based on ability to pay;
- serve residents from all 114 Missouri counties as well as the City of St. Louis;
- tailor their services to fit the special needs and priorities of their local communities, and provide services based on the advice of local residents, businesses, churches, and other organizations; and
- offer services that help their patients access health care, such as transportation, translation, case management, health education, and chronic disease management.
For many patients, the health center may be the only source of health care services available. In fact, the number of uninsured patients at Missouri’s health centers has grown by 32% since 2005, while the number of Medicaid patients has grown 34% since 2005.
HOW DO HEALTH CENTERS MAKE A DIFFERENCE?
Key to health centers’ accomplishments is patient involvement in service delivery. Governing boards – the majority of which must be patients according to grant requirements – oversee health center operations. Board members serve as community representatives and make decisions on services provided. Active patient management of health centers assures responsiveness to local needs, and helps guarantee that health centers improve the quality of life for thousands of patients in the following ways.
- Improve Access to Primary and Preventive Care. Health centers provide preventive services to vulnerable populations that would otherwise not have access to certain services, such as immunizations, health education, mammograms, pap smears, and other screenings. Health centers have also made significant strides in preventing anemia and lead poisoning. Low income, uninsured health center users are also much more likely to have a usual source of care than the uninsured nationally.
- Effective Management of Chronic Illness. Health centers meet or exceed nationally accepted practice standards for treatment of chronic conditions. In fact, the Institute of Medicine (IOM) and the General Accounting Office (GAO) have recognized health centers as models for screening, diagnosing, and managing chronic conditions such as diabetes, cardiovascular disease, asthma, depression, cancer, and HIV. Health centers’ efforts have led to improved health outcomes for their patients, as well as lowered the cost of treating patients with chronic illness.
- Reduction of Health Disparities. Because of their success in removing barriers to care, the IOM and GAO recognized health centers for reducing or even eliminating the health gaps for racial and ethnic minorities, as well as for the poor in the U.S. A recent landmark study found that health centers are associated with reducing racial and ethnic disparities in such key areas as infant mortality, prenatal care, tuberculosis case rates, and death rates. Another major study found that disparities in health status do not exist among health center users, even after controlling for socio-demographic factors, and that the absence of disparities at health centers may be related to their culturally sensitive practices and community involvement – features that other primary care settings may lack.
- Cost-Effective Care. Care received at health centers is ranked among the most cost-effective. Health centers currently care for 14% of the Medicaid population while only accounting for 1% of the Medicaid budget. Several studies have found that health centers save the Medicaid program 33% in annual spending for health center Medicaid beneficiaries due to reduced specialty care referrals and fewer hospital admissions, thereby producing significant savings in combined federal and state Medicaid expenditures. If avoidable visits to emergency rooms were redirected to health centers, over $24 billion in annual health care costs could be saved nationally.
- High Quality of Care. Studies have found that the quality of care provided at health centers is equal to or greater than the quality of care provided elsewhere. Moreover, 99% of surveyed patients report that they were satisfied with the care they receive at health centers.
- Fewer Low Birth Weight Babies. Health centers are important providers of prenatal care for low-income women, accounting for 1 in 6 of all low-socioeconomic status births nationally. Despite being at higher risk, health center patients are consistently below the national average for low birth weight and narrow disparities in low birth weight for all racial and ethnic groups. Health centers offer services that make receiving care possible for many patients, including translation, transportation, home visits, and parenting education. They also coordinate with national and local initiatives such as the Women, Infants, and Children (WIC) program, which is associated with timely receipt of prenatal care and improved birth outcomes.
- Create Jobs and Stimulate Economic Growth. Health centers support 4,511 jobs, including the employment of many local residents. They bolster local business and stabilize neighborhoods by stimulating community development and economic growth, which resulted in an overall economic impact of nearly $416 million in 2010.
WHY IS INVESTING IN HEALTH CENTERS IMPORTANT?
As described above, investing in health centers produces improved health outcomes and quality of life, as well as reductions in health disparities for thousands of Missourians. In addition, investment also leads to reductions in health care spending. As shown in Figure 4, health centers on average receive only 18.5% of their total revenue from federal grants. The largest single source of revenue is Medicaid, representing 45.2% of total revenue and 71% of all patient-related revenue. Another major source (16.1%) of revenue comes from non-federal grants and contracts, the vast majority of which comes from state and local funds. Already cited as one of the most effective programs by the OMB, a continued and expanded investment in health centers will guarantee improved health outcomes for thousands more Missourians and further cost savings.