Community Health Centers critical to primary care in medically underserved areas
When it comes to primary care in Arkansas, one of the largest provider systems is Community Health Centers (CHCs). CHCs are unique, employing over 1,000 healthcare workers serving 155,000 patients across Arkansas. CHCs are often the largest employer in the communities they serve and serve as economic engines, injecting $94 million of operating expenditures directly into local economies.
CHCs are non-profit organizations operating with a consumer/patient majority board of directors.
“This model allows for the patients of CHCs to have a voice in their healthcare and in what services are most needed in their health center location,” said Lisa Weaver, chief development officer, with Community Health Centers of Arkansas (CHCA), Arkansas Primary Care Association, which provides umbrella services for the CHCs that include programs to foster access to comprehensive, affordable, accessible, quality primary and preventive healthcare services for underserved Arkansans.
“CHCs deliver a unique approach to healthcare that propels system-wide cost savings, improves patient health, and generates significant local economic returns and provides employment in local rural communities,” said CHCA CEO Sip Mouden.
CHCs provide care to all residents, regardless of insurance status, on a sliding fee scale based on income and federal poverty guidelines. “CHCs are not driven by profits or corporate bottom lines,” Mouden said. “CHCs reinvest any and all revenues into their delivery of patient centered care.”
There are 12 independent non-profit CHC organizations in Arkansas, operating, 75 locations throughout the state in medically underserved areas. CHCs provide a safety net to state residents or services, including primary medical, dental, mental health, pharmacy, support, and preventive services.
With Arkansas experiencing a serious shortage of primary care providers, one of the goals of CHCA and its member CHCs is to expand and offer more services and access points for underserved populations.
“This growth will require appropriate collaborations with key partners and resources which include, but are not limited to funding, greater access to trained providers, providers willing to serve in underserved areas, and greater use of mid-level providers who can practice at the ‘top’ of their licensures,” said CHCA Workforce Development Manager Richard Berthelot. “In addition, Arkansas needs more local and community-based training programs for residents and medical school students. This training should include rotating these students and residents through CHCs, which will expose them to ‘team based care’ and what it is like to practice in underserved areas. CHCs and many healthcare organizations struggle with filling vacant provider positions. Additional medical schools are needed across the U.S. and in Arkansas.”
Berthelot said the expansion of “home grown” providers may help alleviate issues since those providers may be more likely to stay in Arkansas and practice close to home.
“Building a pipeline of future physicians and nurses needs to begin in junior high and high school,” Berthelot said. “Arkansas needs more training programs that emphasize the field of family medicine and that promote students working back in their own local communities.”
Recently, the Health Resources and Services Administration, Bureau of Primary Health Care, awarded three grants to open new locations in Melbourne (operated by ARcare), Yellville (operated by Boston Mountain Rural Health Center), and Helena/West Helena (operated by East Arkansas Family Health Center).
These locations will be open within 120 days from the notice of grant award. Additionally, in the coming months, four health center locations, which include a mix of community and school based health centers, are set to open.
Mouden said healthcare reform and payment transformation require CHCs and other providers to adjust their model and services to accommodate new patients, and new payment methodologies.
“Through CHCA’s close ties with its members, CHCA is able to provide the necessary support services for CHCs to prepare for the new healthcare environment and assure that CHCs are in the forefront on these new healthcare initiatives,” Mouden said. “With the passage of the Patient Protection and Affordable Care Act, new initiatives around Patient Centered Medical Home (PCMH), Meaningful Use, Payment Transformation, Health Insurance Benefits Exchange, and HIT/HIE, the healthcare environment is changing rapidly. However, CHCA, working with its member CHCs, are exemplifying leadership in addressing these new initiatives. One such example is the current active engagement of Arkansas CHCs in the CHCA Patient Centered Medical Home Collaborative aimed at moving CHCs toward the National Committee for Quality Assurance PCMH Level 3 Recognition. PCMH is an innovative quality improvement program for re-designing and improving primary care.”
The re-designing of the delivery system includes developing standards and criteria for organizing care around patients, working in teams, and coordinating and tracking care over time.
“The PCMH innovative model facilitates partnerships between individual patients, personal physicians, and when appropriate, the patient’s family,” CHCA Quality Director Rachel Wallis said.
Critical to this model is that care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get the indicated care when and where they need it and in a culturally and linguistically appropriate manner.
“Arkansas CHCs are determined to reach the highest PCMH standard possible within the next year,” Mouden said. “Some Arkansas CHC locations have already received recognition.”
Over the past couple of years, CHCA has worked with its CHC members to assist CHCs in purchasing and implementing Electronic Health Records (EHRs). CHCs have accomplished 100 percent implementation of EHRs and attainment of “Meaningful Use”.
“Through use of EHRs, CHCs can provide more accurate and complete information about the patient’s health which will create the ability to better coordinate care, demonstrate improvement in quality, safety and efficiency and improve chronic disease management,” Mouden said. “It will also assist in clinical decision making, reduce medical errors, and provide safer care at lower costs.”
In an effort to ensure quality and timely data and information reporting, CHCA created a data warehouse, which allows for “real time” data collection and reporting on key quality and financial measures, said Chris Hughes, communications/IT manager for CHCA. “The expansion of this data warehouse will allow for CHCA and its members to use data to inform decisions around quality improvement areas and demonstrate quality of care.”
Hughes said Arkansas CHCs stand ready to carry on their bipartisan expansion efforts to reach more underserved communities and to lead efforts to transform the healthcare delivery system to be more efficient and cost effective.
CHC are more than “places” to access care for many underserved populations.
“CHCs strive to remove persistent barriers to care, meet their community needs, and meet unique cultural needs while assuring that patients receive the highest quality and cost effective comprehensive care possible,” Hughes said.