A little over a week ago, we had the opportunity to attend the National Association of Community Health Centers’ annual Community Health Institute (CHI) and EXPO in Chicago, Illinois. The focus of this year’s conference, "Shaping the Future of Health Care Delivery," was quite fitting - as we believe FQHCs have a distinct, and imperative, role to play in the ever-evolving U.S. healthcare landscape.
Unlike most medical groups, Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) are concentrated on providing high-quality medical care to their communities regardless of a patient’s insurance status or objective ability to pay. These centers cater to underserved rural and urban communities and especially vulnerable individuals, offering comprehensive lists of medical services ranging from primary care to behavioral health and dental care. These organizations are also incredibly unique in that their governing boards are patient-heavy. In fact, it’s federally mandated that the majority of an FQHC board be comprised of patients (51% or greater).
Here are our four major takeaways from the insightful conversations we had with FQHC leaders at the conference:
1. FQHCs and CHCs face an undeniable no-show problem.
Patients missing their appointments is not a new phenomenon. As we mentioned in a previous post, “The No-Show Epidemic,” there are several factors associated with skipped appointments: long hold times (both in-office and waiting days, if not weeks, for open slots on a provider’s calendar), unproductive cancellation fees, lack of reliable transit, etc. Yet, FQHCs seem to be more susceptible to high no-show rates, where the national average sits around 30%. In part, this can be attributed to practice behavior: only leaving a few slots open for same-day appointments and having patients book too far in advance, is predictive of more missed appointments (and is a trend that’s translatable to other specialties as well). However, more generally, higher no-show rates have been linked to low-income patients and medicaid recipients. One recent study of 10 CHCs, also found that prior missed appointments, cell phone ownership, tobacco use and the number of days since last appointment were indicative of likelihood of no-show.
And while some simply dismiss this trend as “the nature of the business,” other groups are seeking to understand why, and are turning to new methods to ensure patients make their appointments, and patient access and experience is as prioritized.
2. Digital engagement is a priority for these groups.
The zeitgeist of healthcare consumerism is not absent in FQHCs and CHCs. More and more FQHCs are becoming aware of the benefits of omni-channel communications and are adding health IT to their repertoire for patient engagement. In 2018, Pew Research Center reported that of the 96% of American adults who own a cell phone of some sort, 81% had a smartphone. Digital engagement, whether it be online or mobile, is a means of allowing for transparency and bridging the connection between a patient and their healthcare provider. This stands to benefit a large majority of individuals. Digital engagement fosters communication and can serve as a tool for easier access and reminders of appointments, treatment plans for at-risk individuals, and health information patients are searching for online.
At the same time, the NACHC has admitted that there are challenges involved which have hampered digital health transformation; “health centers face a delicate balancing act: a desire to meet patient communication preferences and leverage the benefits of social media versus the health center’s risk management obligations to keep such communications secure, appropriately documented, and useful to the health center enterprise.”
3. FQHCs and CHCs are fulfilling the widespread demand for the more “affordable” care role.
The U.S. Department of Housing and Urban Development estimates that in the United States today there are greater than 500,000 homeless individuals, and a whopping 27.5 million uninsured patients. And sadly, this number is up almost 2 million since 2017. For this reason, low-income patients often delay care or avoid it entirely. Without an insurance card, patients face a critical lack of healthcare options.
FQHCs and CHCs will serve an all time high of close to 30 million patients within the next year, according to the NACHC. The demand for health centers is growing exponentially, reflecting a widespread need for more affordable care - especially among rural patients and Veterans. From 2017 to 2018, CHCs provided primary and preventative care services to over 6 million uninsured patients, over 13 million Medicaid patients, 385,000 Veterans and 1.4 million homeless patients. Beyond standard primary care services, these health centers also play a huge role in support during natural disasters, and epidemics like the opioid crisis.
These centers are vital in supporting these communities, and providing, “Some Place to Go When There’s No Place to Go.”
4. The funding FQHCs and CHCs receive is of the utmost importance.
CHCs rely primarily on Medicaid Revenue and funding from Section 330 or the “330 Grant” to provide accessible care to their patient populations. The Community Health Center Fund (CHCF), established by the Affordable Care Act in 2010, accounts for 72% of the funding within Section 330, and is a much needed source of supplemental funds to the other annual grant funding health centers receive from Congress.The CHCF enables CHCs to open their doors, and yet it is set to expire next week (September 30th). Without Congressional renewal, centers will be confronted with funding uncertainty and subsequent decisions around the possible need for lay-offs, closures, and reductions in services offered.
Health centers are incredible organizations which support some of the most in-need patients has and communities nationwide. The adoption of digital health will likely make these centers even more successful in expanding outreach to patients in need of more affordable primary care and preventative services. But above all else, we hope to see the funding from Section 330 upheld to enable these centers to continue serving their missions. To learn more about funding uncertainty, as well as the specific positive impacts of health centers on their communities, please visit the NACHC website here.