Since the passage of the Affordable Care Act (ACA) nearly eight years ago, community health centers (CHC) have become a vital part of the health care delivery system. The act itself has called for the development of nearly 250 new such centers across the country, with the aim of increasing access to health care services, especially in rural or underserved areas. However, since 2010, more than 950 centers have opened, bringing the total number of CHCs in the U.S. to 9,800, serving more than 24 million patients.
While managing these centers has always presented unique challenges, community health center leaders are faced with a new set of challenges with the ACA facing possible repeal or major changes.
The Role of the CHC
Since the 1960s, community health clinics have played an important role in the U.S. health care system, one that was increased under the ACA. Today, CHCs often serve as pillars in the communities they serve, providing not only medical services, but also education on healthy living, access to healthy foods and assistance accessing necessary services.
Most importantly, research shows that the CHC model works. Among the benefits attributed to CHCs include:
- Access to additional services. CHCs can provide access to essential services, including vision and oral health services, either onsite or via referrals.
- Better management of chronic disease. Patients who have chronic conditions such as diabetes or asthma have fewer hospitalizations and better management when they use CHCs.
- Better outcomes. Patients who have a “medical home” where they receive consistent, coordinated care are proven to have better outcomes than those patients who do not.
- Reduced costs. Better care coordination, along with preventive care and improved education, help reduce overall health care costs.
However, for all of the benefits of CHCs, there are some significant challenges associated with keeping them open and running efficiently, and chief among them is money.
Fiscal Challenges for CHCs
The vast majority of community health centers are funded via grants from the Affordable Care Act. In 2011, the federal government began issuing Section 330 grants via the Community Health Center Fund, a provision of the Affordable Care Act. Between 2011 and 2014, CHCs across the country were awarded $11 billion and the grants were extended in 2015 to run through this year.
However, with uncertainties in Washington related to the ACA, the future of these funds is in jeopardy. Some lawmakers predict that the Community Health Center Fund will remain intact, since it has already been extended twice and the benefits of the services cannot be understated. Still, the source of the funding (the ACA) is uncertain, so there is concern about what the source of such funds will be if the ACA is repealed, and whether the fund will remain a mandatory part of the federal budget or shift to a discretionary expenditure that needs to be appropriated by Congress every year.
Compounding the insecurity about center funding are continued requirements the continual cuts to Medicaid and Medicare reimbursements, as well as potential changes to Medicaid that would reduce or limit funding. Regardless of the outcome, those proposed changes will only add to another challenge for center leaders: recruiting staff.
According to a National Association of Community Health Centers report, staffing remains a significant barrier to growth and the ability to serve patients. NACHC reports that 95 percent of all CHSs have at least one critical vacancy (i.e. a clinical provider) and that health centers have more physician vacancies than hospitals. Part of the problem is that there are fewer doctors overall, as fewer people are going into medical school to replace retiring physicians. Location is another issue; as many CHCs are in rural areas, it can be challenging to attract doctors who may wish to live in more suburban or urban areas.
However, the major issue is pay. Simply put, CHCs do not have the resources to offer the same competitive salary and benefits packages as larger facilities and systems, and that is often a determining factor for young doctors—especially those carrying hundreds of thousands of dollars in student loans. And again, cutting Medicaid reimbursements makes it even harder to recruit providers, meaning that center leaders are going to need to get creative in the coming years if they want to recruit and retain top talent.
Most experts agree that CHCs are, and will remain, an important part of the U.S. health care system. The question for leaders, though, is how to maintain health centers in the face of these challenges. The answers will likely come in the form of leaders with in-depth knowledge and understanding of Health Care Administration, and innovative problem-solving skills. In light of policy shifts and changes, being able to face these challenges head on is going to become a major focus of for many leaders—and many administrative education programs.