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Health Care Centers Face Demands

POSTED: April 16, 2011, 12:00 am

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Community health centers serve 20 million people every year, and that number is expected to double by 2015, thanks to an $11 billion infusion from the health-care overhaul and $2 billion in federal stimulus funds.

If you're a middle-income worker with health insurance through your job, chances are these centers have been under your radar, since their target clients are low-income and uninsured people. But as the number of uninsured has risen to 50 million, more people than ever are struggling to get and pay for health care, and community health centers are an affordable option. As they expand, they're adding new services and new locations nationwide.

Although their mission is to provide a primary-care safety net for people in underserved areas, no one is ever turned away from a community health center. People with incomes up to 200 percent of the federal poverty level ($44,700 for a family of four in 2011) pay on a sliding scale; uninsured people with higher incomes pay the full cost of care, which is generally comparable to costs in the private sector. The centers accept Medicaid and Medicare in addition to many private insurance plans.

The new health care law is full of incentives to encourage doctors to provide "medical homes" for their patients, with coordinated care and close patient monitoring to stay on top of necessary preventive services. But community health centers have always taken this approach, say experts.

"It's necessity on their part," says Laurie Felland, a senior health researcher at the Center for Studying Health System Change. "Because of the difficulty low-income people face in getting services, … community health centers over time have tried to add them."

In addition to primary care, many community health centers have behavioral health providers, pharmacies, and preventive and restorative dental services on site. Some have pediatric centers, reflecting the fact that more than a third of their patients are children.

At the William F. Ryan Community Health Center on Manhattan's Upper West Side, the new women and children's center is decorated in slate gray with bright primary color accents. The building has banks of windows looking down on the street and is so expansive that staff members carry around tablet computers to keep tabs on patients, says Jessica Sessions, director of pediatrics. "Patients are happier here," she says.

A Commonwealth Fund survey of 800 community health centers last year found that 29 percent of them had all five medical-home indicators it measured, including usually providing same- or next-day appointments, off-hours clinical advice, tracking of test results, tracking of patient referrals to specialists, and being able to generate lists of patients by diagnosis. Another 55 percent of centers had three or four indicators.

Still, arranging for specialty care can be tough, the survey found. Ninety-one percent of centers said they had trouble getting their uninsured patients in to see a specialist, while 71 percent said that was the case for Medicaid patients, and 49 percent reported difficulty scheduling their Medicare patients with specialists.

Wait times are another problem at many centers. In part, because they don't turn anyone away, getting an initial appointment can take months. Once someone becomes a patient at a center, wait times for appointments aren't generally as long, but they still exist.

Mark Cushman says he generally waits two to three weeks for a non-urgent appointment at the community health center near his home in Medford, Ore. Laid off from his job selling ads for a local newspaper, he has a part-time position at a local car dealership that doesn't provide health insurance.

Cushman, 54, recently visited the health center for blood work and to refill his prescription for a statin drug to keep his cholesterol in check. His bill for the office visit was $28, the prescription $4, and the blood work a few dollars more. "It's great," he says of the center. "What a relief to have this."

You'd never know it wasn't a private clinic, he says, except for the less-than-luxe waiting room. And that will change soon, says Peg Crowley, the center's executive director. Under the health-care overhaul, the center received nearly $2 million to renovate its facility. The money will allow officials to spruce up the aged facility, but more important, redesign it for better workflow and efficiency. Continued federal funding for community health centers faces some obstacles. House Republicans have suggested they may trim the government's contributions as part of the party's effort to cut spending.

In keeping with their focus on preventive care, an increasing number of community health clinics are emphasizing wellness services. At the Petaluma Health Center, in California's Sonoma County, patents are receiving evidence-based care that melds Eastern and Western medicine. An eight-week chronic-pain group, for example, introduces participants to a variety of integrative approaches to managing pain, including acupuncture, meditation and Qigong, and helps show them how nutrition and sleep habits contribute to pain, says Fasih Hameed, a physician there.

Rebecca Langenfeld participated in one of the center's pain groups. Langenfeld, 59, has Sjogren's syndrome, an autoimmune condition that causes dryness of the body's mucous membranes as well as joint and muscle pain and fatigue. Langenfeld says the pain group and the acupuncture sessions she's had at the clinic have helped.

"I wish that every clinic would do this stuff," she says.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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