NORTH CAROLINA S COMMUNITY HEALTH CENTERS VITAL TO A HEALTHY NORTH CAROLINA WHAT ARE COMMUNITY HEALTH CENTERS? Community health centers are not-for-profit health care practices that provide comprehensive, patientcentered primary care. Community health centers: Serve medically underserved populations, Provide appropriate, necessary services with fees adjusted based on patients ability to pay, Demonstrate sound clinical and financial management, and Are governed by a board, a majority of which must include health center patients. THE COMMUNITY HEALTH CENTER DIFFERENCE Serving federally-designated medically underserved areas and populations, Community health centers (CHCs) provide coordinated primary and preventive services that promote reductions in health disparities for low income individuals, racial and ethnic minorities, rural communities and other underserved populations. CHCs help people overcome barriers to care by providing a comprehensive array of enabling services that a typical private practice physician would not, facilitating access to health care. Primary medical care Dental care* Behavioral/mental health care* Prescription drugs Health insurance outreach and enrollment Enabling services: case management, health education, translation, WIC programs, transportation, etc..* *SERVICE AVAILABILITY VARIES BY HEALTH CENTER. North Carolina CHC Patient Visits by Type of Service 1 1 Bureau of Primary Care, HRSA, DHHS, 2014 Uniform Data System (UDS).
Health Centers Are a Vital Part of the Healthcare System CONTINUITY OF CARE FOR NORTH CAROLINA S UNINSURED N.C. health centers serve significantly more uninsured patients than health centers nationally. More than 7 in 10 N.C. health center patients live at or below 200% of the poverty line, an annual income less than $23,850 for a family of four (in 2014). 1 THE RIGHT CARE AT THE RIGHT TIME FOR THE RIGHT COST 2 $141 Medical cost per medical visit 1 $192 Dental cost per dental visit 1 $644 Total annual cost per patient 1 $1,233 Median cost per hospital ED visit 2 Health center patients spend 62% less. Total annual health expenditures were 62% less for patients served in North Carolina s community health centers than for patients receiving care in other ambulatory care settings. In dollars, NC CHC patients experienced an average savings of approximately $3,400 dollars. 3 That is money in North Carolinians pockets. 1.BPHC, HRSA, DHHS, 2014 Uniform Data System (UDS). 2.Median charge for 10 most common outpatient conditions in ED. Caldwell N., Srebotnjak T., Wang T., Hsia R. (2013) How Much Will I Get Charged for This? Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS ONE 8(2): e55491. Available: http://www.plosone.org/article/info%3adoi%2f10.1371%2fjournal.pone.0055491. 3.Richard P., Shin P., Vasilkovska K., Rosenbaum S. (2011). Bending the health care cost curve in North Carolina: The Experience of Community Health Centers. http://www.rchnfoundation.org/wp-content/uploads/2013/01/geigergibson_ncaug92011-final.pdf
Community Health Centers Create Jobs HEALTH CENTER ECONOMIC IMPACT Analysis of North Carolina Community Health Centers showed for every grant dollar CHCs receive, they generate four dollars in economic activity. 1 $1.00 $4.00 In 2014, North Carolina Community Health Centers brought $110 million in federal and private grants to communities across the state, leading to a potential economic impact of approximately $440 million in underserved communities $110 Million $440 Million Health centers help make communities healthier and more economically viable by creating jobs in underserved communities. Health sector jobs withstand economic downturns and are expected to be one of the fastest growing job sectors in the next decade. 2 [Community health] centers create good jobs, with career ladders, at all levels of capability and educational attainment, which in itself promotes the health of the community. 3 NC HEALTH CENTER FTES IN 2014 4 Total FTEs 3,165 includes: 6 N.C. Education Programs Attract Providers 1,110 Medical FTEs 208 Dental FTEs 178 Pharmacy FTEs 70 Mental Health/Substance Abuse FTEs 329 Enabling Services FTEs The three Teaching Health Center Graduate Medical Education programs in North Carolina are a valuable investment for the long-term viability of the safety net and access to care in underserved communities. Graduates from these programs are almost twice as likely as residents from other family medicine residency programs to practice in settings primarily associated with underserved populations. 5 1.The Economic Impact of North Carolina s Federally Qualified Health Centers (2011). Capital Link, Inc. 2.Aging America creates demand for health-care workers. Feb 1, 2012. Reuters: http://www.reuters.com/article/2012/02/01/us-usa-economy-jobs-outlookidustre8102ft20120201. 3.Kotelchuck R., Lowenstein D. & Tobin J. (2011.) Community health centers and community development financial institutions: Joining forces to address determinants of health. Health Affairs 30(11): 2090-2097. 4.BPHC, HRSA, 2014 Uniform Data System (UDS). 5.Bazemore A et al. Graduates of Teaching Health Centers are More Likely to Enter Practice in the Primary Care Safety Net. American Family Physician. 2015;94(4), November 15, 2015.
Health Centers Innovate and Lead in Healthcare Delivery HEALTH CENTERS LEAD INNOVATIVE, COST-SAVINGS MODELS Recognizing the complex needs of their patient population, CHCs have to be on the cutting edge of care delivery in order to provide the range of services their patients need without regard to ability to pay. CMHN Health Center Controlled Network (HCCN) Carolina Medical Home Network s Health Center Controlled Network is providing health information technology support to more than 30 Community Health Center members. Through this program, Community Health Centers are providing more targeted care and identifying ways to lower cost, while improving care. CMHN Accountable Care Organization (ACO) Six NC Community Health Centers are participating in a Medicare Shared Savings Program ACO. CMHN ACO is leveraging enhanced access to clinical and claims data to drive population health management and improve health outcomes for Medicare beneficiaries. Receiving ACO Investment Model funding from the CMS Innovation Center in 2016, CMHN ACO is expanding its care management infrastructure to better meet the needs of NC Medicare patients. Improving Patient Experience CMHN Independent Practice Association (IPA) 27 NC Community Health Centers participate in this partnership, created in in 2012, to contract with commercial payers and progress toward clinical and financial integration, leading the way to success in valuecentric reimbursement models across multiple healthcare payers. LEADING CONNECTIVITY TO THE NC HEALTH INFORMATION EXCHANGE Health centers led efforts to connect to the NC HIE, bringing in safety-net partners like rural health centers and school-based health centers, as well as other providers and health systems. All CHCs have Electronic Health Records and will be able to communicate with other community providers and their patients to improve health and reduce unnecessary testing.
The High Quality Healthcare Option Health centers will continue to be an integral part of the healthcare system because they provide high-quality services to an ever-growing segment of the population. Today, Community Health Centers serve 24 million patients nationally. In North Carolina, they serve 8% of all Medicaid beneficiaries. HEALTH CENTERS OUTPERFORM OTHER PRIMARY CARE PROVIDERS Health centers have been reporting data to the federal government on an annual basis since 1998, allowing for the analysis and tracking of health center performance. CHCs provided recommended care more frequently for 14/18 quality measures, including management of heart disease, asthma treatment, smoking cessation counseling, diet and exercise counseling, appropriate screening for chronic diseases, and medication management in the elderly. 1 HEALTH CENTERS ARE ON TRACK TO MEET OR EXCEED HEALTHY PEOPLE 2020 GOALS 2 North Carolina Community Health Centers already exceed or are on track to meet important Healthy People 2020 goals in these areas: 83% of patients receive tobacco use screening and counseling 71% of pregnant patients begin prenatal care in 1st trimester 4 71% of diabetic patients have their disease under control 61% of patients have blood pressure under control 80% of all child patients receive appropriate immunizations 2015 COMMUNITY HEALTH CENTER QUALITY IMPROVEMENT AWARD In 2015, North Carolina Community Health Centers received 29 Quality Improvement Awards from HRSA totaling $1,383,436. 1.Goldman L.E., Chu P.W., Tran H., and Stafford R. Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine 2012 Aug;43(2):142-9. 2.BPHC, HRSA, DHHS, 2014 Uniform Data System (UDS); Healthy People 2020 data available online: https://www.healthypeople.gov/2020/datasearch/search-the-data
Unique Services Improve Access to Care SPECIAL POPULATIONS Community health centers receive funding to support populations with unique barriers to or need for health care access. These populations include individuals experiencing homelessness, public housing residents, migrant farmworkers, and veterans. To serve these populations, North Carolina has 11 migrant health centers, 10 healthcare for the homeless grantees, and 3 public housing primary care grantees. ENABLING SERVICES Community Health Centers are more than just primary care providers. They provide a broad array of services to improve patient access to care, to address external impacts on the individuals health, and provide whole-person care. Some of the enabling services health centers provide to meet these needs include: Interpretation services Case management WIC programs Migrant outreach programs Health education, including nutrition counseling Insurance enrollment assistance INSURANCE ENROLLMENT ASSISTANCE The strongest predictor of completing the application process was receiving help with enrollment from a navigator or application assister, which increased the probability of obtaining coverage by nearly 10 percentage points. 1 FQHCs have dedicated, expert staff who educate their communities about health insurance options and help people enroll in coverage. Their assistance goes beyond enrollment including helping people understand their options, access care, and get connected to other needed health and social resources In some counties, especially rural ones, FQHCs are one of the only sources of free in-person enrollment help. Since 2013, North Carolina FQHCs have trained more than 300 staff to provide education to over 178,000 North Carolinians 2. 1 The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas. Sommers BD, Maylone B, Nguyen KH, et al. Health Aff. 2015 Jun;34(6):1010-8. 2 North Carolina Community Health Center Association
Closing the Coverage Gap for North Carolina s Uninsured INCREASING ACCESS TO HEALTH INSURANCE IS GOOD FOR PUBLIC HEALTH AND GOOD FOR NORTH CAROLINA S ECONOMY. People without health insurance are sicker and poorer 1, making it more difficult for these individuals to contribute to the economy. More drastically, numerous studies show that people without health insurance are more likely to die in the course of a year than people with insurance. 2 HARD-WORKING, LOW-INCOME INDIVIDUALS NEED ACCESS TO INSURANCE Adults without children (ages 19-64) with incomes below 100% of Federal Poverty Guidelines (FPG), or $11,670 annually for an individual, CANNOT access subsidized insurance or Medicaid in NC. Increasing insurance access to those below 100% FPG would create jobs in NC and increase personal income. 4 Closing the insurance coverage gap for this population would create and 43,000 by 2020. N.C. could leverage federal dollars to help our current Medicaid program transition to value-based payment. Federal funding was set aside to increase insurance coverage for the Coverage Gap population. Choosing not to do so will mean North Carolina loses $21 billion in federal funds between 2016 and 2020. 4 Choosing not to Close the Gap will greatly weaken NC s safety-net system. Community health centers are facing a 70% cut in federal grant dollars starting October 1, 2018 due to the assumption that there would be fewer uninsured Americans. PAIR INSURANCE COVERAGE WITH COMMUNITY HEALTH CENTERS TO SAVE N.C. MONEY CHCs have extensive experience caring for vulnerable patients and have developed a range of services to meet patients needs. They provide integrated behavioral health services and many have on-site dental and pharmacy services. CHCs also provide enabling services to facilitate access to care. CHCs continue to care for North Carolinians who cycle between Medicaid coverage and uninsurance. Providing continuity of care and ongoing case management reduces Medicaid costs when individuals cycle back onto Medicaid coverage. CHCs utilize the 340b Drug Pricing Program to provide significant prescription drug savings to both the Medicaid program and recipients. Medicaid patients in health centers are less likely to utilize expensive hospital care and more likely to receive recommended preventive services. 5-6 1.Rhoades JA, Cohen SB. The Long-Term Uninsured in America:, 2008-2011: (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65. Statistical Brief #424. November 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st424/stat424.pdf 2.Institute of Medicine, 2009. America s Uninsured Crisis: Consequences for Health and Health Care. Washington, DC: National Academies Press. p. 60-63. 3.Ku, L., Bruen, B., Steinmetz, E., Steinmetz, E. (December 2014). The Economic and Employment Costs of Not Expanding Medicaid in North Carolina: A County-Level Analysis. Center for Health Policy Research, The George Washington University. Cone Health Foundation and Kate B. Reynolds Charitable Trust. Retrieved from: http://www.conehealthfoundation.com/foundation/initiatives/nc-medicaid-expansion/. 4.Rothkopf J., Brookler K., Wadhwa S. et al. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Aff July 2011 30:1335-1342. 5.Goldman L.E., Chu P.W., Tran H., and Stafford R. Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine 2012 Aug;43(2):142-9.
2016 North Carolina Health Centers by County ALAMANCE Piedmont Health Services ALLEGHANY Appalachian District Health Department ANSON Anson Regional Medical Services ASHE Appalachian District Health Department AVERY High Country Community Health BEAUFORT Metropolitan Community Health Services BERTIE Bertie County Rural Health Association Roanoke Chowan Community Health Center BLADEN CommWell Health BRUNSWICK CommWell Health BUNCOMBE Western NC Community Health Services Appalachian Mountain Community Health Centers Blue Ridge Community Health Services CABARRUS Cabarrus Rowan Community Health Centers CALDWELL West Caldwell Health Council CASWELL Caswell Family Medical Center Person Family Medical Center Piedmont Health Services CATAWBA Gaston Family Health Services CHATHAM Piedmont Health Services CHOWAN Gateway Community Health Centers COLUMBUS Goshen Medical Center Robeson Health Care Corporation CRAVEN Craven County Health Department Goshen Medical Center CUMBERLAND Goshen Medical Center Stedman-Wade Health Services DAVIDSON Gaston Family Health Services DUPLIN Goshen Medical Center DURHAM Lincoln Community Health Center EDGECOMBE Carolina Family Health Centers OIC Family Medical Center Rural Health Group FORSYTH Southside United Health and Wellness Center FRANKLIN Advance Community Health GASTON Gaston Family Health Services GATES Gateway Community Health Center GREENE Greene County Health Care GUILFORD Triad Adult and Pediatric Medicine HALIFAX Rural Health Group HARNETT First Choice Community Health Center HENDERSON Blue Ridge Community Health Services HERTFORD Roanoke Chowan Community Health Center HYDE Ocracoke Health Center IREDELL Gaston Family Health Services JOHNSTON CommWell Health JONES Goshen Medical Center LENOIR Kinston Community Health Center LINCOLN Gaston Family Health Services MADISON Hot Springs Health Program MARTIN Metropolitan Community Health Services MECKLENBURG Charlotte Community Health Clinic C.W. Williams Community Health Center MITCHELL Bakersville Community Medical Clinic MONTGOMERY Robeson Health Care Corporation NASH Carolina Family Health Centers OIC Family Medical Center NEW HANOVER MedNorth Health Center NORTHAMPTON Rural Health Group ONSLOW Goshen Medical Center ORANGE Piedmont Health Services PAMLICO Greene County Health Care PASQUOTANK Gateway Community Health Centers PENDER CommWell Health PERSON Person Family Medical Center PITT Greene County Health Care POLK Blue Ridge Community Health Services RANDOLPH Randolph Family Health Care at MERCE ROBESON Robeson Health Care Corporation ROCKINGHAM Triad Adult and Pediatric Medicine ROWAN Cabarrus Rowan Community Health Centers RUTHERFORD Blue Ridge Community Health Services SAMPSON CommWell Health Goshen Medical Center SCOTLAND Robeson Health Care Corporation TRANSYLVANIA Blue Ridge Community Health Services UNION Anson Regional Medical Services VANCE Rural Health Group WAKE Advance Community Health WARREN Rural Health Group WATAUGA High Country Community Health WAYNE Goshen Medical Center WILSON Carolina Family Health Centers List subject to change. Visit NCCHCA.org for a complete listing of N.C. CHC sites and services.