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Wednesday, Nov. 24, 2010

The Critical Role of Community Health Centers

Ensuring access to health care, not just health insurance

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In the debate over federal health care reform—as well as the future of BadgerCare—most have focused on the expansion of access to affordable health insurance.

But what good is insurance if patients can’t see a doctor?

Enter the federally qualified community health centers, which are a critical component of health care in Milwaukee and around the country.

They exist in high-poverty, high-need areas—sections of the community that the private health care systems have abandoned—and treat everyone who comes through their doors, regardless of their insurance or income.

Community health centers are not allowed to turn away anyone who seeks medical care, making them the safety net in the health care system.

They also take the pressure off of local and very expensive emergency rooms, where uninsured individuals or those without a primary care physician end up when they’re facing a health crisis.

These health care centers are so important that Vermont Sen. Bernie Sanders included funding for them in the 2009 stimulus package, and about $11 billion is earmarked for them in the health care reform package currently being implemented.

“The appropriations that are slated for community health centers is a win for all,” said Milwaukee Health Commissioner Bevan Baker. “It will only make a good system better if we can use these appropriations and grow these services.”

Stimulus funds have allowed Milwaukee’s community health centers to expand their facilities, hire more doctors and staff, and switch from paper to electronic health records.

But there’s still much more that Milwaukee’s community health centers want to do—establish more clinics, hire more staff members, and add more services such as dentistry and behavior health to their practices.

That’s critical because demand for health care services will grow in the coming years as more people have health insurance, whether it’s through a Medicaid program like BadgerCare or through one’s employer or a state-based health insurance exchange.

But with that growth in demand, will private health systems take on these new patients, especially those who are covered by Medicaid programs?

That’s to be determined, said Tom Petri, policy and communications director for Wisconsin Primary Health Care Association (WPHCA). And that’s where community health centers fit into the larger health care puzzle, Petri said.

“What’s unsure and not mandated in health care reform is that health care providers see everyone who has an appointment,” Petri said. “Our overriding concern is, ‘Where are these people going to go?’ We want to be the provider of choice. We already are for so many people.”



Serving the Community

Wisconsin has 17 nonprofit community health centers with about 75 service locations that served 244,000 patients in 2009. Each center is tailored to the needs in its neighborhood and the majority of each organization’s board of directors is made up of its patients. Revenues come from an annual federal grant, patient payments and private donations.

Milwaukee County is home to four organizations that provide primary medical care to almost 80,000 residents with a lack of access to physicians. While anyone can receive care at a community health clinic, patients are typically low-wage earners.

These two factors—poverty and a lack of primary care physicians—go hand in hand, according to a study by the Milwaukee Health Care Partnership. The partnership found that the ZIP codes with the highest levels of poverty have the fewest number of physicians. These areas, which run through the heart of the county from north to south, account for 45% of the county but only 27% of the primary care physicians in practice.

That gap in access means that residents are more likely to go to an emergency room for their general health care needs—an unsustainable use of scarce resources.

However, the county’s four community health centers are filling the need for comprehensive health services in low-income areas:

  • The 16th Street Community Health Center was established in 1971 in a storefront and now has two full-service sites on the city’s near south side. The center has also won federal funds to establish a satellite site in Waukesha, which is scheduled to open next year. In 2009, more than 27,000 individuals—primarily young Hispanic residents and their children—made 139,000 appointments at one of its clinics.


  • On the near north and northwest sides, Milwaukee Health Services Inc. (MHSI) operates two full clinics—a soon-to-be-expanded MLK Heritage Health Center on North Martin Luther King Drive and the Isaac Coggs Heritage Health Center on West Silver Spring Drive—as well as a convenient care clinic in Midtown. Last year, more than 30,000 primarily African-American patients made 115,000 visits to one of MHSI’s clinics.


  • The Westside Healthcare Association (WHA) operates the Lisbon Avenue Health Center and the Hillside Family Health Center on North Seventh Street. An estimated 6,600 patients, primarily African American, made about 20,000 visits to a WHA clinic last year.


  • Health Care for the Homeless operates five sites and has links to 23 facilities around town to provide health and dental care for about 11,000 of the area’s homeless individuals.


Where would these patients go without the services of the community health centers?

“That would have a large impact on Milwaukee,” said Tito Izard, M.D., interim director of MHSI. “It would totally overwhelm the health systems which are already struggling to maintain hospitals in cities.”

Reducing Costs Systemwide

The advantages of community health centers are many. They reflect the needs of their patients and provide the proper level of care for non-emergency health issues. They provide a “health home” with comprehensive services for patients, whether it’s addressing an earache or virus, learning about living with diabetes, being screened for cervical cancer or getting support for a mental health issue.

This focus on primary, preventative care makes community health centers highly cost-effective because their services reduce the number of emergency, hospital and specialty care visits, saving the health care system an estimated $24 billion a year nationwide.

“People have looked at us and said there’s a low-cost alternative to just building more hospitals,” Petri said.

Milwaukee’s community health clinics have forged relationships with local hospitals, relationships that have been strengthened by a Milwaukee Health Care Partnership initiative to coordinate emergency department care.

Partners are utilizing an electronic health information exchange to share and collect patient data. They’re also sending emergency room visitors to community health centers when it’s appropriate, and can schedule same-day or next-day appointments at the health center directly from the emergency room.

That saves the hospital’s resources while helping the patient find a permanent health home at the center.

“Health homes promote prevention as well as provide integrative care, in contrast to the typical experience, which is very fragmented, with a lack of continuity from provider to provider,” said Joy Tapper, executive director of the Milwaukee Health Care Partnership.

Dr. Izard of MHSI said that community health centers will see any patient, regardless of insurance, which allows patients to receive continuous care throughout the years—even when they’ve lost their employer-provided insurance.

“Because of the recession, many people’s relationships with their health care providers have been broken, but ours haven’t,” Izard said.



Expansion Plans in the Works

Like many community health centers throughout the country, Milwaukee’s centers are in the midst of expanding, whether it’s increasing the square footage of their current clinics, building additional facilities, increasing their hours or providing more services. All four received federal stimulus funding, but only one center—the 16th Street Community Health Center—won additional funding to establish a satellite center, which it will open in Waukesha in 2011.

Yet more plans exist.

For example, the Westside Healthcare Association is ready to expand its Lisbon Avenue site. WHA received $161,000 in stimulus funds because of increased demand for its services, which allowed it to hire another doctor and support staff at its Hillside clinic, as well as expand its operating hours at both of its clinics. WHA also used $442,000 in stimulus funds to switch over to electronic health records, a major upgrade from its paper-based system.

But WHA desperately needs a new clinic on Lisbon Avenue, said Sarah Andritsch, WHA’s fund development and marketing manager. Its current facility is about 8,000 square feet, 80 years old, and was never intended to be a clinic. WHA drew up plans for a new, 54,000-square-foot facility that would double its capacity for dental services and add behavioral health, physical therapy, occupational therapy and radiology to its menu of services. The total cost is about $15 million; WHA had submitted a proposal for an $11 million grant from the stimulus funds for facility expansion.

“We’re ready to put the shovels in the ground,” Andritsch said.

But WHA’s project wasn’t selected.

“We need our building one way or another,” Andritsch said.

The Milwaukee Health Care Partnership is currently studying the centers’ expansion plans and goals. While federal funding through the health care reform bill is still up in the air, another source of funds could come from private donors or the local health care systems, which already contribute to the centers. WPHCA’s Petri said that in other states, hospitals have given large donations for capital expansion to health centers because they know that a high-functioning community health center will reduce a hospital’s expenses in the long run.

“It’s an investment that’s very difficult to make, but at the same time the health centers are not fly-by-night, here-one-day, gone-the-next operations,” Petri said. “That’s maybe what’s holding the health centers back from enormous growth. But without what the hospitals are doing, we would have seen very little growth at all over the last couple of years.”