Community Health Centers – Care for All, Not Just Our Patients – How can they help YOUR employees?

Hi, I’m Sheryl. I’m the CFO at Scenic Bluffs Health Center. I’ve worked there for 19 years. Today, we’re going to talk about how you can work with your community health center. We’re going to discuss what a community health center is, and how they work to make communities healthier, how your organization can partner with and benefit from a health center, and actual health results.

I love the organization I work for. We provide care to everyone in our community, regardless of their ability to pay. We offer medical, dental, behavioral health, chiropractic, massage, therapy, acupuncture, and have an on site pharmacy. Other health centers like us also may offer podiatry dermatology, vision, and lots of other specialty services. I work for a Community Health Center or CHC, which is one of three types of Federally Qualified Health Centers or FQHC. The other two are Migrant Health Centers and Tribal Health Centers.

An FQHC receives federal grant funding through Health Resources and Services Administration or HERSA. The program started in 1965 with 2 health centers. There are now over 1300 health centers across the country and its territories. 112 people are served by a health center. The requirement of the grant program is offering a sliding fee program for services. Any community member with income below 200% of the federal poverty level can receive services at a discounted rate. For family of four, that’s currently $52,400.

At our health center, a patient can receive a medical visit for as low as $20, or a dental visit for as low as $35. Patients are eligible for the sliding fee program, even if they have insurance, which is really helpful for patients with high deductible plans. My CHC provides about a million and a half dollars in discounts to our patients each year.

As an employer, you should locate your local community health center, and reach out to them about how you may be able to partner. Besides the straightforward contracting for services like flu shot clinics, or health screenings, there may be other care needs that you may want to provide to your employees. Immunizations, CDL exams, drug testing.

Our health center also partners with area businesses to provide CPR training and other education opportunities. We also connect with our local schools and provide school nurse services, CLM programs, and behavioral health services. It is important we consider a patient’s other needs besides actual visits for services. We have a team of patient access coordinators that assist patients with transportation, prescription drug assistance, plying for our sliding fee program. Other services that are offered for low income community members such as chair or housing refers referrals. Generally, any need the patient has, where, if resolved, can improve their health, physically, or mentally.

I love that our community outreach allows us to connect with families in a way that wouldn’t happen if we only provided services under the roof of our health center. We are always looking for outreach activities to make our community healthier, even if that doesn’t include regular office visits.

One way we focus on community health is through our annual recycling day. Last year, we collected more than 43,000 pounds of electronics to semi loads. We also host a drug piggyback box where we collect unused medications, and keep them from going into our wastewater systems. Both of these events create healthier communities by keeping our environment cleaner.

Another community outreach is our annual activity program started in 1993 as an incentive to get the community walking during the colder months. The program is now in multiple communities. We partner with the schools in the various communities to provide inside walking opportunities for the entire community. The program was expanded a few years ago to allow participants to also report any activity minutes. There’s no cost to join, and participants are in a t-shirt for reaching 20 hours of activity, and chances to win monthly prizes.

With the wide breadth of services our health center offers, we focus on integrating that care across specialties, treating the whole patient, in addition to the non clinical support we offer patients with our patient access coordinators and health educators We help patients receive all the clinical care they need. We’ve even created some special programs within our health center to address issues we see occurring in our community.

One example is our chronic care patients. While we support the medical needs with medication when appropriate, we also encourage alternative therapies, which includes our chiropractic, massage therapy, and acupuncture. Many patients find more relief in the additional services than using medication with the associated side effects.

Another example relates to our dental patients and behavioral health. Many patients don’t go to the dentist because they have so much anxiety. Perhaps they haven’t been to the dentist in many years, and are worried about how much work is needed or have other trauma. We will schedule visits back to back for them with a behavioral health visit taking them straight in to their dental visit. One patient came back to us after receiving their dental work over the course of a few months to let us know they had gotten a job. Before having the dental work, this patient was too embarrassed to even go to a job interview.

We provide group diabetes visits, we will schedule the group with their one on one check in with their provider, either before or after the group activity, allowing for any labs that need to be done or other follow up care. Then, the entire group comes together for an education session, healthier eating habits, exercise, meditation, whatever opportunities have been identified for the group to help them better take care of their personal needs, so their health needs remain in check.

The unique attribute about receiving the FQHC designation is a different payment structure through Medicaid and Medicare. For most health centers, a prospective payment system or PPS rates is paid for visits. With a PPS payment, when a patient receives services, the health center receives a flat rate for those services, no matter what service was provided.

We also build commercial insurance plans. This becomes an important revenue stream to offset some of the visits from Medicare, Medicaid, and uninsured patients. Two thirds of our revenue is from patient care. To continue financial viability, it’s important to grow patient revenue to position us to continue to serve our community health needs even if grant funding were to go away. Receiving a PPS rate creates a unique environment for balancing patient care needs and financial stability. The PPS rate is the same across services and can be adjusted if health center services changed significantly. The goal of the health center is to keep the average cost of services close to the PPS rate. This becomes more important as the payer ratio. The ratio of your Medicare, Medicaid, commercial, and uninsured patients skews less commercial.

The interesting factor in calculating cost per encounter is the mix of your services. Some services have a higher cost per encounter than others. As those ratios change, your overall cost per encounter can change. Cost per encounter is a simple calculation of total expenses divided by total visits. Educating all staff at the health center this concept is an interesting piece of orientation to our organization. Visits in the ratio only included if there’s provider interaction with the patient. Ancillary services, like visits when a patient comes in to have labs drawn, receive immunizations, pharmacy services, and visits with our patient access coordinators are included on our cost numerator, but not in the visit denominator.

Some of the decisions we’ve made at our health center include using nurse practitioners, which are less costly than MDs. We have two NPs, an MD, and a DL. Adding in our complementary medicine providers and expands our patient care visits at a lower cost per encounter than a medical visit. Growing our behavioral health practice, which has a strong need in our area, is another way we are reducing the cost per encounter as these visits also have a more fixed, lower cost per encounter than medical visits.

In Wisconsin, CHCs provide most of the dental services for Medicaid patients. As the reimbursement rates for non FQHC dentists are very low, the demand is high. We focus on maintaining clear productivity goals and arrange the schedules based on a general philosophy of quadrant dentistry. Each patient and visit is unique, and we are always keeping the patient’s needs at the forefront. As with any health care provider, no show rates and provider productivity will impact cost per encounter ratio.

At our health center, our care protocols are implemented across the board. We will not treat an uninsured, Medicaid, or Medicare patient differently than a commercial patient. Our fee schedule, the prices we set for services is reviewed annually and compared to regional pricing in our area. To avoid Sherman Act antitrust issues, we purchase a database with a crew data from other organizations in our region based on our three digit zip code prefix. We pull our most used services for the year by type of service, and then compare our current prices on a weighted average to the regional data. A summary is provided to our board for review, with a recommendation from staff on any changes.

Every health center is individual serving their own unique communities. Varied ratios of Medicaid, Medicare, commercial, and uninsured patients, diverse provider types, different state funding in the Medicaid program, philosophy and finances, mission focus, and many other factors.

Another requirement for receiving community health center grant funding is completing an annual report called Uniform Data System or UDs report. This report compiles patient demographic data, visit information, quality measures, staffing, and financial data into one large annual report. There is so much information that goes into this report and many opportunities for data analyzation. The results are available publicly, and can be reviewed at a national, state, or health center size basis.

Some data from the National Association of Community Health Centers 2020 Chartbook, includes health center spend just over $7,500 per Medicaid patient, while all other providers spend on average almost $9,900. For Medicare patients, health center spend an average of $2,370 while physician offices spend $2,667 and outpatient clinics spend $3,580. According the Bureau of Primary Care, in 2018, diabetes patients with [inaudible] less than nine was 60% nationally. At health centers, it was 67%. Patients with controlled blood pressure were at 63% in health centers, and 57% nationally.

Every health center is required to have a community based board of directors. HERSA has specific requirements of the board. More than half the board members must be patients of the health center, and board members that aren’t patients must have knowledge related to the community, business, or other knowledge that would specifically support the health center decision making process. No more than half of these non patient board members may derive more than 10% of their income from health care. Board members may not be direct relations of employees at the health center, which can be tough in small communities. The board must consist of 9 to 25 members.

As a community health center, we focus on the community. This means creating partnerships with local businesses and other organizations. I’ve mentioned our partnerships with area schools and CDL services for local businesses. We also partner with Organic Valley, local banks, credit unions, community organizations, and many others. We’ve sponsored a servant leadership training for the community, in conjunction with the high school in Viterbo University. We host students from all our local technical schools, colleges and universities.

I leave you with a challenge. Find and reach out to your local community health center. You can find it on the HERSA website. Find a way to partner with them. Sponsor one of their activities. Find a service that they could offer your employees. Educate your staff about the health center. Encourage them to consider using the services. Encourage staff to volunteer for the health center. Volunteer yourself. There are so many opportunities to show your support. Please find one. Thank you for your time. Please let me know if there’s any additional information that you would like to learn.