Community Health Centers and the Affordable Care Act in 2011: Increasing Access to Affordable, Cost Effective, High Quality Care

For more than 45 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay.  During that time, community health centers have become the essential primary care medical home for millions of Americans including some of the nation’s most vulnerable populations. 

Community health centers emphasize coordinated primary and preventive services or a “medical home” that promotes reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities, and other underserved populations.  The community health center model also overcomes geographic, cultural, linguistic and other barriers through a team-based approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dental providers,  midwives, behavioral health care providers, social workers, health educators, and many others.  With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act.

The Affordable Care Act: The Essential Role of Community Health Centers

The Affordable Care Act established the Community Health Center fund that provides $11 billion over a 5-year period for the operation, expansion, and construction of health centers throughout the Nation.

• $9.5 billion is targeted to:
  • Support ongoing health center operations.
  • Create new health center sites in medically underserved areas.
  • Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites.

• $1.5 billion will support major construction and renovation projects at community health centers nationwide.

In September, HHS announced the availability of approximately $700 million from this Affordable Care Act funding to help build, expand and improve community health centers across the U.S. to provide needed care to low-income Americans. This announcement has two funding opportunities for community health centers. One will provide approximately $600 million to existing health centers across the country for longer-term projects to expand their facilities, hire more employees and serve more patients. The second funding opportunity emphasizes shorter-term projects and will provide approximately $100 million to existing health centers to address immediate facility needs.

Additionally, in August 2011, $28.8 million was awarded to 67 community health center programs to establish New Access Points across the country.  A New Access Point is a new full-time service delivery site that provides comprehensive primary and preventive health care services.  As community-based and patient-directed organizations, health centers are well positioned to be responsive to the specific health care needs of their community.  Through the use of these grants, health centers expect to develop the capacity to serve an additional 286,000 patients. 

Delivery of Care:  Increased Access to Health Services

Rooted in a commitment to community-based, patient-centered care, community health centers continue to focus on comprehensive services that meet the varying needs of their patient populations including:  disease management and coordination, prevention and patient education activities, and outreach. 

Today, more than 1,100 community health centers operate over 8,100 service delivery sites that provide care to approximately 19.5 million patients in every state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. 

This network of community health centers has created one of the largest safety net systems of primary and preventive care in the country with a true national impact.

• Community health centers, supported by the Health Resources and Services Administration (HRSA), treated approximately 19.5 million people in 2010, nearly two-thirds of whom are members of ethnic and minority groups. Nearly forty percent have no health insurance; approximately one third are children.
  
• One out of every 16 people living in the U.S. now relies on a HRSA-funded clinic for primary care.
  
• Community health centers are an integral source of local employment and economic growth in many underserved and low-income communities. Total health center employment is more than 131,000 individuals nationwide, and health centers added more than 18,600 jobs over the last two years.
  
• Community health centers employ more than 9,600 physicians and more than 6,400 nurse practitioners, physician assistants, and certified nurse midwives in a multi-disciplinary clinical workforce designed to treat the whole patient through culturally-competent, accessible, and integrated care.

Community health center quality of care equals and often surpasses that provided by other primary care providers.  A programmatic emphasis on quality improvement as well as community-responsive and culturally appropriate care has also translated into impressive reductions in health disparities for community health center patients.  Calendar Year 2010 Health Center Program data demonstrate that centers continue to provide high quality care and improve patient outcomes, while reducing disparities, despite serving a population that is often sicker and more at risk than seen nationally:

• In 2010, the percent of low birthweight babies, at 7.4 percent, continues to be lower than national estimates (8.16 percent).  
• The rate of entry into prenatal care in the first trimester increased from 65 percent in 2008 to 69 percent in 2010.
• 71 percent of community health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9.
• 63 percent of hypertensive community health center patients have their blood pressure under control.
• 74 percent of children received all recommended immunizations by 2^nd birthday.

Community health centers also reduce costs to health systems; the community health center model of care has been shown to reduce the use of costlier providers of care, such as emergency departments and hospitals.

Recovery and Reinvestment: Demonstrated Community Health Center Impact 

Enacted in 2009, the American Recovery and Reinvestment Act (ARRA) provided $2 billion for grants to community health centers over a 2-year period; an unprecedented opportunity to serve more patients, retain existing and support new jobs, meet the significant increase in demand for primary health care services among the nation's uninsured and underserved populations and address essential construction, renovation, equipment and health information technology systems needs in community health centers. To date, this $2 billion investment in community health centers has resulted in major increases in access to care while supporting the long term capacity of community health centers to serve even more patients through facility and technology expansions and upgrades, including:

• Preventive and primary health care services for more than 4.3 million patients, 2.4 million of those are uninsured.
  
• The construction, repair and renovation of more than 1,600 community health center sites nationwide, over 650 health centers with new equipment or health information technology systems, and new or enhanced certified electronic health records systems in more than 350 community health centers.

Posted on: August 9, 2011
Last updated: September 9, 2011