A Sketch of Community Health Centers
Chartbook, August 2016
© National Association of Community Health Centers, August 2016
For more information, email [email protected].
Cover picture provided courtesy of Urban Health Plan in Bronx, NY.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00 with 0% of the total
NCA project financed with non-federal sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Preface About this Chartbook
Section I: Who Health Centers Serve Figure 1.1: Health Centers ServeFigure 1.2: Health Center Patients Are Predominately Low Income Figure 1.3: Most Health Center Patients are Members of Racial and Ethnic Minority Groups Figure 1.4: Most Health Center Patients are Uninsured or Publicly Insured Figure 1.5: Health Centers are Serving a Higher Proportion of Uninsured Patients in the U.S.Figure 1.6: Health Center Patient Mix Is Unique Among Ambulatory Care Providers Figure 1.7: Health Centers Serve Patients Throughout the Life Cycle Figure 1.8: Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-InsuredFigure 1.9: Health Center Patients are Disproportionately Members of Racial/Ethnic Minority Groups Figure 1.10: Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians Figure 1.11: Health Centers Continue to Care for Patients Who Prefer to Be Served in Languages Other than EnglishFigure 1.12 Health Centers Serve Many Special Populations
Section II: Growth Among Federally-Funded Health CentersFigure 2.1: Health Center Grantee Organizations and Sites, 2005-2014 Figure 2.2: The Number of Health Center Patients Continues to Increase Figure 2.3: The Number of Health Center Patient Visits Continues to Increase Figure 2.4: Health Center Patients by Insurance Status, 2005-2014Figure 2.5: The Number of Health Center Patients in Poverty is Growing Faster than the Number in Poverty Nationally, 2005-2014Figure 2.6: The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, 2005-2014 Figure 2.7: Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental, and Mental Health Care, 2005-2014
Table of Contents
Section III: Access to Care Figure 3.1: Health Centers Have Higher Rates of Accepting New Patients Regardless of Insurance Coverage Compared to Other Primary Care Providers Figure 3.2: Percent of Uninsured Served by Health Centers, 2014Figure 3.3: Percent of Medicaid Beneficiaries Served by Health Centers, 2014Figure 3.4: Health Centers Provide a Broad Array of Services
Section IV: High Quality Care and Reducing Health DisparitiesFigure 4.1: Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice PhysiciansFigure 4.2: Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark ScoresFigure 4.3: Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low-Income Patients NationallyFigure 4.4: Health Centers Reduce Disparities in Access to MammogramsFigure 4.5: Health Center Women Needing Pap Smears are More Likely to Receive Them than Their Counterparts NationallyFigure 4.6: Health Center Patients Needing Colorectal Cancer Screenings Are More Likely to Receive Them than Their Counterparts NationallyFigure 4.7: Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. AverageFigure 4.8: Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. CounterpartsFigure 4.9: Health Centers Provide More Preventive Services than Other Primary Care Providers
Section V: Cost-Effective Care and Economic ImpactFigure 5.1: Areas with High Health Center Penetration Spend $926 Less per Medicare Beneficiary than Areas with Low Health Center PenetrationFigure 5.2: Health Centers are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other ProvidersFigure 5.3: Economic Impact (in millions) of Federal Health Center Funding by State, 2012Figure 5.4: Jobs Generated by Federal Health Center Funding by State, 2012Figure 5.5: Health Centers are Producing Savings Across the CountryFigure 5.6: Health Centers Save $1,263 Per Patient Per Year
Section VI: Health Centers’ Financial Health Figure 6.1: Health Center Funding Per Uninsured Patient is Well Below Total Per Patient CostFigure 6.2: Payments from Third Party Payers Are Less than Cost, 2014 Figure 6.3: Health Center Operating Margins are Less than Hospital Operating Margins Figure 6.4: Medicaid Revenue is Directly Proportional to Medicaid Patients, 2014 Figure 6.5: Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians Figure 6.6: Federal Health Center Appropriation History, FY2004-2016 Figure 6.7: 29 States Will Provide Funding to Health Centers in State Fiscal Year 2016 Figure 6.8: State Funding to Health Centers, FY16
Section VII: Staffing/Workforce Figure 7.1: Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, 2014Figure 7.2: Health Centers Medical Services Staff, 2014Figure 7.3: Health Centers Dental Services Staff, 2014 Figure 7.4: Health Centers Behavioral Health Services Staff, 2014 Figure 7.5: Health Centers Enabling Services Staff, 2014 Figure 7.6: Growth in Health Center Medical Providers, 2005-2014Figure 7.7: Health Centers Twice as Likely to Use Non-Physician Clinicians than Other Providers Figure 7.8: Health Centers Use More Non-Physician Clinicians than Other Providers Figure 7.9: The Ratio of PA, NP, and CNM FTEs to Physician FTEs Has Increased Rapidly at Health Centers
Section VIII: Remaining Challenges and Unmet Needs Figure 8.1: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013Figure 8.2: Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care NeedsFigure 8.3: Health Center Capital Project Plans and Funding Needs
Section IX: Look Alike Health CentersFigure 9.1: Look-Alike Health Center Patients Are Predominately Low Income Figure 9.2: Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minorities Figure 9.3: Most Look-Alike Health Center Patients are Uninsured or Publicly Insured Figure 9.4: Look-Alike Health Centers Serve Patients Throughout the Life Cycle Figure 9.5: Look-Alike Health Centers Provide a Broad Array of Services Figure 9.6: Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, 2014Figure 9.7: Look-Alike Health Center Medical Services Staff, 2014Figure 9.8: Look-Alike Health Center Dental Services Staff, 2014 Figure 9.9: Look-Alike Health Center Behavioral Health Services Staff, 2014 Figure 9.10: Look-Alike Health Center Enabling Services Staff, 2014
The National Association of Community Health Centers (NACHC) is pleased to present A Sketch of Community Health Centers, an overview of the Health Center Program and the communities they serve. Health centers began over fifty years ago as part of President Lyndon B. Johnson’s declared “War on Poverty.” Their aim then, as it is now, is to provide affordable, high quality, comprehensive primary care to medically underserved populations, regardless of their insurance status or ability to pay for services. A growing number of health centers also provide dental, behavioral health, pharmacy, and other important supplemental services. No two health centers are alike, but they all share one common purpose: to provide primary health care services that are coordinated, culturally and linguistically competent, and community-directed.
Health centers play a critical role in the health care system, delivering care to over 24 million* people. Across the country, health centers produce positive results for their patients and for the communities they serve. They stand as evidence that communities can improve health, reduce health disparities, and deal with a multitude of costly and significant health and social problems – including substance abuse, HIV/AIDS, mental illness, and homelessness – if they have the resources and leadership to do so.
Who health centers serve, what they do, and their impressive record of accomplishment in keeping communities healthy are represented in the following charts. Federal and state support, along with adequate third party reimbursement, are critically important to keep pace with rising costs and escalating health care needs among populations served by health centers.
Preface
*Includes patients of federally-funded health centers, non-federally funded health centers (health center “look-alikes”), and expected patient growth for 2015.
About this Chartbook
This Chartbook highlights data from and research findings on Community, Migrant, Homeless and Public Housing Health Centers, as well as other Federally-Qualified Health Centers (FQHCs). In this document, unless otherwise noted, the term “health center” is
generally used to refer to organizations that receive grants under the Health Center Program as authorized under section 330 of the Public Health Service Act, as amended
(referred to as “grantees”) and Look-Alike organizations, which meet all the Health Center Program requirements but do not receive Health Center Program grants. At the bottom of each figure, readers will find the data and research sources listed. Most slides draw from the Uniform Data System (UDS) maintained by the Bureau of Primary Health Care, HRSA, DHHS. Except for the final section in this Chartbook, UDS data included in this Chartbook
are limited to health centers that meet the federal grant requirements and receive federal funding from the Bureau of Primary Health Care.
Section I Who Health Centers Serve
Figure 1.1
Health Centers Serve:
• 1 in 14 people in the US
• 1 in 6 Medicaid beneficiaries
• 1 in 5 uninsured persons including
- 1 in 3 low income, uninsured
• 1 in 3 individuals below poverty
• 1 in 4 rural Americans Note: Includes patients of federally-funded health centers and non-federally funded health centers.Sources: 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau. Population Estimates. http://www.census.gov/popest/data/national/totals/2014/index.html. Kaiser Family Foundation. Total monthly Medicaid and CHIP Enrollment. December 2014. http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/#. U.S. Census Bureau, Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014. Available at http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf. U.S. Census Bureau, Current Population Reports, P60-252, Income and Poverty in the United States: 2014. Available at http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf. Kaiser Family Foundation. Population distribution by metropolitan status, 2014. Available at http://kff.org/other/state-indicator/metropolitan-distribution/.
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2014 was $19,790. (See https://aspe.hhs.gov/2014-poverty-guidelines). Based on percent known. Percents may not total 100% due to rounding.
Figure 1.2
Health Center Patients are Predominately Low Income
100% FPL and below71%
101-150% FPL15%
151-200% FPL6%
Over 200% FPL8%
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding. *The 62% of health center patients that are members of racial and ethnic minorities is not shown in this figure.
Figure 1.3
Most Health Center Patients are Members of Racial and Ethnic Minority Groups
Asian / Hawaiian / Pacific Islander
5%
Black / African American
23%
American Indian / Alaska Native
1%White67%
More than one race 4%
Hispanic / Latino35%
Non-Hispanic / Latino65%
62% of health center patients are members of racial and ethnic minority groups
*”Other public insurance” may include non-Medicaid CHIP and state-funded insurance programs. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding.
Figure 1.4
Most Health Center Patients are Uninsured or Publicly Insured
Uninsured28%
Medicaid / SCHIP47%
Medicare9%
Other Public Insurance1%
Private Insurance16%
Source: NACHC, 2013 and 2014. Includes all patients of federally-funded health centers, non-federally funded health centers, and expected patient growth. Data on federally-funded health centersfrom Bureau of Primary Health Care, HRSA, DHHS, 2012 and 2014 Uniform Data System (UDS). U.S. Census Bureau, Current Population Reports, P60-245, Income, Poverty, and Health Insurance Coverage in the United States: 2012 and Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014. Available at https://www.census.gov/prod/2013pubs/p60-245.pdf and https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf. Note: Proportion of all US residents does not account for health centers located in U.S. territories.
Figure 1.5
Health Centers are Serving a Higher Proportion of Uninsured Patients in the U.S.
1 in 7
1 in 5
0%
5%
10%
15%
20%
25%
2012 2014
* Combined total of individual sources exceeds “All visits” because more than one may be reported per visit.Sources: Based on Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS). Private Physicians from 2012 NAMCS (CDC National Center for Health Statistics, 2012). Hospital Outpatient from 2011 NHAMCS (CDC National Center for Health Statistics, 2011). Notes: Other public includes non-Medicaid SCHIP and other state-funded insurance programs.
Figure 1.6
Health Center Patient Mix is Unique Among Ambulatory Care Providers
47%
13%
35%
28%
5%
7%
9%
25%
20%
16%
60%
39%
1% 5% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Centers Private Physicians Hospital Outpatient Depts.
Other / Unknown
Private
Medicare
Uninsured
Medicaid
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding.
Figure 1.7
Health Centers Serve Patients Throughout the Life CycleUnder 5
10%
Ages 5-1214%
Ages 13-1910%
Ages 20-247%
Ages 25-4427%
Ages 45-6425%
Ages 65+8%
* Based on percent known.Sources: Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System. Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements).
Figure 1.8
Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-Insured, 2014
28%
47%
71%*
92%*
10%
19%15%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Uninsured Medicaid At or below 100% of Poverty Under 200% of Poverty
Health Centers United States
Note: Percents may not total 100% due to rounding. Sources: Based on 2014 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Source for State and US Population for Race and Ethnicity: U.S. Census Bureau, Population Division: “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States, States, and Counties: April 1, 2010 to July 1, 2014” Released June 2014.
Figure 1.9
Health Center Patients are Disproportionately Members of Racial and Ethnic Minority Groups, 2014
35%
23%
5%
1%
17%
13%
6%
1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hispanic/ Latino African American/Black Asian/Hawaiian/PacificIslander
American Indian/AlaskaNative
Health Centers
United States
18%
13%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Health Centers Physician Offices
11%*
15%***
8%**
27%
9%11%
7%
25%
0%
5%
10%
15%
20%
25%
30%
Depression Diabetes Asthma Hypertension
Health Centers Private Physician Offices
Figure 1.10
Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians
Note: Statistical significance measures compared to value for private physician offices; *** p < .01 , ** p < .05, * p < .10“Common chronic conditions” include visits where the primary diagnosis listed for the visit is an ICD-9-CM diagnosis code for hypertension, asthma, diabetes, heart disease, and selected psychotic conditions and other psychoses. Excludes visits classified as “pre/post surgical,” all visits to non-primary care physicians, and any visits where the patient did not see a physician. Source: Based on George Washington University analysis from Kaiser Commission on Medicaid and the Uninsured. Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth. (March 2013). http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8098-03.pdf
Percentage of Physician Visits Involving Patients with Common Chronic Conditions
Percentage of Physician Visits Involving Patients with the Specified Chronic Condition
Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 1.11
Health Centers Continue to Care for Patients Who Prefer to be Served in Languages Other than English
4.14.3 4.3 4.4
4.6 4.7 4.64.8
5.05.3
0
1
2
3
4
5
6
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
of
Pat
ien
ts (
in m
illio
ns)
29% increase since 2005
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 1.12
Health Centers Serve Many Special and Vulnerable Populations
891,796Agricultural
Worker Patients
569,107School-Based Health
Center Patients
1,151,046Homeless Patients
429,251Public Housing
Patients
289,391Veteran Patients
Section IIGrowth Among Federally-Funded
Health Centers
Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 2.1
Health Center Grantee Organizations and Sites,2005-2014
952 1,002
1,067 1,080 1,131 1,124 1,128
1,198 1,202 1,278
5,703 6,139
6,612
8,320 7,257
6,949
7,621
8,912 9,170 8,801
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
-
100
200
300
400
500
600
700
800
900
1,000
1,100
1,200
1,300
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er o
f Sites
Nu
mb
er
of
Gra
nte
e O
rgan
izat
ion
s
Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS
Figure 2.2
The Number of Health Center Patients Continues to Increase
14.115.0
16.117.1
18.819.5
20.221.1
21.722.9
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
of
Pat
ien
ts (
in m
illio
ns)
62% growth since 2005
Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 2.3
The Number of Health Center Patient Visits Continues to Increase
55.559.2
63.067.0
73.877.1
80.083.8 85.6
90.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Pat
ien
t V
isit
s (i
n m
illio
ns)
63% growth since 2005
Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 2.4
Health Center Patients by Insurance Status, 2005-2014
5.66.0 6.2
6.6
7.2
7.3 7.4 7.6 7.6
6.4
5.05.3
5.76.1
6.9
7.58.0
8.48.8
10.7
2.1 2.3 2.5 2.7 2.7 2.7 2.9 3.0 3.13.6
1.1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.0
0.3 0.4 0.4 0.5 0.6 0.5 0.5 0.5 0.4 0.3
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
of
Pat
ien
ts (
in m
illio
ns)
Uninsured
Medicaid
Private
Medicare
Other
*Represents patients/people under 100% of the federal poverty level U.S. Bureau of the Census, Current Population Survey, Annual Economic Supplements. Table 7. Poverty of People, by Sex 1966-2014. https://www.census.gov/hhes/www/poverty/data/historical/people.html. 2005-2014 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.
Figure 2.5
The Number of Health Center Patients in Poverty is Growing Faster than the Number in Poverty Nationally,
2005-201453%
26%
0%
10%
20%
30%
40%
50%
60%
Health Center Patients in Poverty People in Poverty Nationally
Sources: Bureau of Primary Health Care, Health Resources and Services Administration, DHHS. 2005 and 2014 Uniform Data System. Kaiser Commission on Medicaid and the Uninsured. Monthly Medicaid Enrollment (in thousands), Dec 2005. http://kff.org/medicaid/state-indicator/monthly-medicaid-enrollment-in-thousands/. Total Monthly Medicaid and CHIP Enrollment, Dec 2014. http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/. Note: Federally-funded only.
Figure 2.6
The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries
Nationally, 2005-2014112%
64%
0%
20%
40%
60%
80%
100%
120%
Health Center Medicaid Medicaid Nationally
Note: Mental health does not include substance abuse. Percent Increase is calculated using actual patient and patient visit numbers, not with rounded numbers presented in this chart. Source: 2005- 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
0.26 – 1.1 million
1.3 – 5.6 million
37.8 – 61.1 million
11 – 18.6 million
Figure 2.7
Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental,
and Mental Health Care, 2005-2014
57% 52%
104%115%
206%214%
0%
50%
100%
150%
200%
250%
Patients Patient Vistis
Medical
Dental
Mental
12.4 – 19.5 million
42.0 – 63.8 million
2.3 – 4.8 million
5.6 – 11.9 million
.41 – 1.3 million
1.98 – 6.2 million
Section IIIAccess to Care
Source: Hing E, Hooker RS, Ashman JJ. Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 June; 36(3): 406-13.
Figure 3.1
Health Centers Have Higher Rates of Accepting New Patients Compared to Other Primary Care Providers
98% 97% 96% 97%93%
66%
76%
89%
0%
20%
40%
60%
80%
100%
120%
New Patients New Medicaid Patients New Medicare Patients New Uninsured
Health Center Other Primary Care Providers
31%
39%
12%39%
12% 19%
15%
29% 11%
17%
17%
18%23%
41%27%
25%
28%
14%
14%
18%
11%
25%
19%
22%
18%35%
41%24%
31%
7%22%
27% 19%
13%
18%13%
16%
22%
25%
12%22%
33%
% of Uninsured Served by HCs
< 14.8%
14.8 – 20.8%
20.8 – 27.4%
27.4 – 35.2%
> 35.2%
VT – 29%NH – 17%MA – 36%RI – 40%CT – 25%NJ – 16%DE – 23%MD – 18%DC – 72%
Figure 3.2
Percent of Uninsured Served by Health Centers, 2014
Source: Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System. Kaiser Family Foundation. Distribution of the Nonelderly Uninsured, 2014. http://www.statehealthfacts.org/comparebar.jsp?ind=136&cat=3 . U.S. Census American Fact Finder. Health Insurance Coverage Status, 2010-2014 American Community Survey 5-year Estimates, Puerto Rico.
16%
32%
VT – 27%NH – 15%MA – 21%RI – 31%CT – 27%NJ – 16%DE – 23%MD – 14%DC – 37%
> 9.4%
9.4 – 13.8%
13.8 – 20.2%
20.2 – 26.2%
> 26.2%
% Medicaid Patients Served by HCs
25% 28%22%
22%
16%
16%14%
18%14%
16%
14%
14%
16%
14%
20%
15%
7%
6%9%
4%
8%
9%7%
8%
13%13%
11%
8%
12% 11%
12%
6%
13%
20%
28%
6%13%
10%
13%
8%
12%
Figure 3.3
Percent of Medicaid Beneficiaries Served by Health Centers, 2014
32%
Source: 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Kaiser Family Foundation. Total Monthly Medicaid and CHIP Enrollment. Dec 2014. CMS, Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports: February 2014 - November 2015 (preliminary), as of January 27, 2016. See http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/#. Mach AL. Congressional Research Service. Puerto Rico and Health Care Finance: Frequently Asked Questions. Nov 2015. www.crs.gov
16%
Note: Encounters for enabling services include visits to case managers and health educators. Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 3.4
Health Centers Provide a Broad Array of Services
71%
13%
8%
6%2% 1%
Medical Care
Dental
Behavioral Health
Enabling Services
Other ProfessionalServices
Vision
Percent of Patient Visits for:
Total90,379,441 patient
visits in 2014
Section IVHigh Quality Care and
Reducing Health Disparities
Source: Goldman, L.E., Chu, P.W., Tran, H., Stafford, R.S. 2012. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine, 43(2):142-149.
Figure 4.1
Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians
93%
84%
86%
47%
44%
37%
99%
91%
90%
59%
57%
51%
0% 20% 40% 60% 80% 100% 120%
No electrocardiogram screening in low-risk patients
No use of benzodiazepines in depression
Blood pressure screening
β-Blocker use in coronary artery disease
Aspirin use in coronary artery disease
Ace inhibitor use in congestive heart failure
Health Centers Private Practice Physicians
79%73%
81%
71%
63%
54%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Diabetes Control Blood Pressure Control Pap Test
Shar
e o
f P
atie
nts
Me
etin
g Q
ual
ity
Be
nch
mar
k
Average Rate in High-Performing Health Centers Average Rate in All Health Centers
Figure 4.2
Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores
Source: Shin P, Sharac J, Rosenbaum S, Paradise J. Quality of care in community health centers and factors associated with performance. Kaiser Commission on Medicaid and the Uninsured Report #8447 (June 2013), available at http://kff.org/medicaid/issue-brief/quality-of-care-in-communityhealth-centers-and-factors-associated-with-performance/.Note: Quality Measures include control of diabetes: share of patients with diabetes with HbA1c between 7% and 9%; Control of hypertension: share of patients with hypertension with blood pressure < 140/90 mm Hg; Pap Tests: share of female patients age 24 – 64 who received Pap test within past three years.
Medicaid MCO High Performance Benchmark (75th percentile)
62% 62%
72%
Figure 4.3
Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low-Income
Patients Nationally
Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
96% 98%
37%
87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Satisfied with Hours of Operation Satisfied with Overall Care Received
Health Center Patients Uninsured Patients Nationally
Figure 4.4
Health Centers Reduce Disparities in Access to Mammograms
Note: Rates calculated for women over the age of 50 receiving a mammogram over the last 2 years. All categories are statistically significant at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
81% 82%78%
63%66% 66%
63%
45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Hispanic African American Medicaid Uninsured
% R
ece
ivin
g M
amm
ogr
am
Health Centers Low Income Nationally
Figure 4.5
Health Center Women Needing Pap Smears are More Likely to Receive Them than Their Counterparts
Nationally
Note: Rates calculated for pap smear screening in last 3 years. Health Center rate significantly lower at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 21–64, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
89% 92% 92%
79%79% 81% 80%
70%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hispanic African American Medicaid Uninsured
Health Centers Nationally
% R
ece
ivin
g P
ap S
me
ar
Figure 4.6
Health Center Patients Needing Colorectal Cancer Screenings Are More Likely to Receive Them than Their
Counterparts Nationally
Note: Health Center rate significantly lower at the p < 0.05 level except for Hispanic where there is no significance.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for individuals, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
40%
62% 60%
34%29%
44%
35%
18%
0%
10%
20%
30%
40%
50%
60%
70%
Hispanic African American Medicaid Uninsured
Health Centers Low Income Nationally
% R
ece
ivin
g C
olo
rect
al C
ance
r Sc
ree
nin
g
Sources: U.S. rates from National Center for Health Statistics (NCHS). Bureau of Primary Health Care, HRSA, DHHS, 2006-2014 Uniform Data System.
8.3%8.2% 8.2% 8.2%
8.1%
7.9%8.0% 8.0% 8.0%
7.7%7.8%
7.6%
7.3%7.4% 7.4%
7.1%
7.3% 7.3%
6.4%
6.6%
6.8%
7.0%
7.2%
7.4%
7.6%
7.8%
8.0%
8.2%
8.4%
2006 2007 2008 2009 2010 2011 2012 2013 2014
United States Health Centers
Figure 4.7
Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. Average
Figure 4.8
Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. Counterparts
Source: Shi, L., et al. “America’s health centers: Reducing racial and ethnic disparities in prenatal care and birth outcomes.” 2004. Health Services Research, 39(6), Part I, 1881-1901.
7.7% 7.5%
13.0%
6.5% 6.8%
8.2%7.5%
14.9%
6.0%
9.1%
7.5%6.6%
10.7%
5.6%
7.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Total Asian Black Hispanic White
US US Low Income Health Center
Source: Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians' Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
Figure 4.9
Health Centers Provide More Preventive Services than Other Primary Care Providers
15%
19%
81%
65%
37%
24%
33%
85%
70%
51%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Asthma Education for Asthmatic Patients
Tobacco Cessation Education for Smoking Patients
Pap Smears in the last 3 years
Immunizations for 65 years and older
Health Education
Health Center Patients Visits Patient Visits to Other Providers
Section VCost-Effective Care and
Economic Impact
$8,616
$9,542
$9,222
$8,100
$8,400
$8,700
$9,000
$9,300
$9,600
$9,900
High Health Center Penetration Area Low Health Center Penetration Area All Areas
Source: Sharma R, Lebrun-Harris L, Ngo-Metzger Q. Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents. Medicare & Medicaid Research Review. 2014; 4(3):E1-E17.Notes: High health center penetration corresponds to 54% health center penetration rate among low-income residents; Low health center penetration corresponds to 3% health center penetration rate among low-income residents; Average health center penetration rate among low-income residents was 21%.
Figure 5.1
Areas with High Health Center Penetration Spend $926 Less per Medicare Beneficiary than Areas with Low Health Center Penetration
10% Lower Medicare Spending in Areas with High Health
Center Penetration
Tota
l Me
dic
are
Co
st p
er
Be
nef
icia
ry
$2,370
$2,667
$3,580
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
Health Centers Physician Offices Outpatient Clinics
Figure 5.2
Health Centers Are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other Providers
Source: Mukamel DB, White LM, Nocon RS, et al. Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings. Health Serv Res. 2015 July.
10% lower than physician office patients and 30% lower than outpatient clinic patients
Figure 5.3
Economic Impact (in millions) of Federal Health Center Funding by State, 2012
Note: Economic impact of federal health center funding only, by state. Economic impact includes direct impact, such as money generated in the community, and indirect impact, such as goods and services purchased and additional economic stimulus generated.Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
National Economic Impact
$4,360,479,127
Figure 5.4
Jobs Generated by Federal Health Center Funding by State, 2012
Note: Jobs generated by federal health center funding only.Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
Total Jobs Generated
31,860
Fig. 5.5
Health Centers Are Producing Savings Across the Country
Sources: Mundt C, Yuan S. An evaluation of the cost efficiency of Federally Qualified Health Centers (FQHCs) and FQHC look alikes operating in Michigan. Oct 2014. The Institute for Health Policy at Michigan State University. California Primary Care Association. Value of community health centers study: Partnership HealthPlan of California case study. Jan 2013. Available at http://cpca.org. Rothkopf J, et al. Medicaid patients seen at federally qualified health centers use hospitals services less that those seen by private providers. Health Aff. 2011 July; 30(7): 1335-42. Texas Association of Community Health Centers. Comparative costs of community health centers and other usual sources of primary care: The Texas story. 2011. Available at www.tachc.org. Richard P, et al. Bending the cost curve in North Carolina: The experience of community health centers. Policy Research Brief #24. August 2011. Geiger Gibson/RCHN Community Health Foundation Collaborative at the George Washington University. Rust G, et al. Presence of a community health center and uninsured emergency department visits in rural counties. J Rural Health. 2009 Winter: 25(1): 8-16.
Figure 6.5
Health Centers Save $1,263 Per Patient Per Year
$4,043
$5,306
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
Health Center Users Non-Health CenterUsers
Hospital EmergencyDepartment
Hospital Inpatient
Ambulatory
Other Services
Source: NACHC analysis based on Ku L et al. Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs.
GWU Department of Health Policy. Policy Research Brief No. 14. September 2009.
Fig. 5.6
Section VIHealth Centers’ Financial Health
Figure 6.1
Health Center Funding Per Uninsured Patient Is Well Below Total Per Patient Cost
Note: Not adjusted for inflation. Federal appropriations are for consolidated health centers under PHSA Section 330.Source: Federally-funded health centers only. 2005 - 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
$270 $267 $270 $281 $271 $273 $312
$344 $374
$504 $515 $538 $562 $588 $600
$630 $654 $687
$721 $763
$-
$100
$200
$300
$400
$500
$600
$700
$800
$900
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Annual Federal Health Center Funding per Uninsured Patient Annual Health Center Cost per Patient
Figure 6.2
Payments from Third Party Payers Are Less than Cost, 2014
Note: Health centers are non-profits, and thus charges are a proxy for costs. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
81%
63%60%
57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Medicaid Medicare Other Public Insurance Private Insurance
Pe
rce
nt
of
Ch
arge
s C
olle
cte
d f
rom
Th
ird
Par
ty
Pay
ers
, 20
14
Figure 6.3
Health Center Operating Margins are Less than Hospital Operating Margins
* Note: Operating margin data for “Hospitals” in 2014 is unavailable.Source: Avalere, Health analysis of American Hospital Association Annual Survey Data, 2013 for community hospitals. Available at http://www.aha.org. Trendwatch Chartbook 2015, Supplementary Data Tables, Trends in Hospital Financing. Federally-funded health centers only. 2003 - 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
3.3% 3.6% 3.7% 4.0% 4.3%
3.3%
4.4%
5.5% 5.5%
6.5%5.7%
1.8%
3.4%4.7% 3.4%
1.6%
3.02%
0.5% 0.9% 1.0%0.2%
0.8%-0.1%
-1.1%
-2.4%
-0.2%
1.6%
1.1%
2.63%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Hospital
Health Centers with American Recovery and Reinvestment ACT (ARRA) Funds
Health Centers without American Recovery and Reinvestment ACT (ARRA) Funds
Figure 6.4
Medicaid Revenue is Directly Proportional to Medicaid Patients, 2014
Notes: Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
46.7% 42.4%
8.6%6.1%
1.3%1.5%
15.6%
8.2%
27.9%
5.2%
36.5%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Patients' Insurance Status Health Center Revenue
Grants/Contracts/Other
Uninsured
Private Insurance
Other Public Insurance
Medicare
Medicaid
Figure 6.5
Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians
Note: Private Physicians does not equal 100% due to reporting in NAMCS. Source: Private Physician data: 2010 National Ambulatory Medical Care Survey (Summary Table 5). Based on Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System.
66.9%
12.70%
9.6%
24.90%
2.4%
2.90%
12.9%
60.20%
8.3%
4.80%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Health Center Private Physicians
Self-Pay/Uninsured
Private Insurance
Other Public Insurance
Medicare
Medicaid/SCHIP
Figure 6.6
Federal Health Center Appropriation History, FY2004-FY2016
Note: Federal appropriations are for consolidated health centers under PHSA Section 330. Federally funded health centers only .
$1.78 $1.99 $2.07 $2.19 $2.19
$2.60 $2.78
$2.99
$3.69
$5.1 $5.1
$-
$1.00
$2.00
$3.00
$4.00
$5.00
$6.00
FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16
Ap
pro
pri
atio
ns
(in
bill
ion
s)
MA
AK
AL
AZ
CA
DC
DE
GA
ID
KY
LA
MD
ME
MI
MT
OR
PR
SD
TX
WA
WY
IA
VTND
NVUT
RI
PA
MN
IL
VA
OH
NH
OK
MS
NE CT
KS
NC
WI
TN
HI
MO
WV
AR SCNM
INCO
FL
NJ
NY
None
Less than $2 million$2 million - $15 million
$30 million - $80 million
Figure 6.7
29 States Will Provide Funding to Health Centers in State Fiscal Year 2016
Source: NACHC, 2015. State Fiscal Year 2016 Funding for Community Health Centers, State Policy Report #58. http://www.nachc.com/client//funding%20brief%203%2021%2016.pdfNo Data Available
$16 million - $29 million
Figure 6.8
State Funding to Health Centers, FY16• 29 states will receive a total of $335 million
• Down from $350 million in FY15.
FY16 Funding:• Increased in 10 states
(GA, KS, MD, MA, MN, NE, NM, NY, TN, and VA)
• Decreased in 13 states(AR, CO, CT, FL, IN, IA, MS, NH, NJ, OK, TX, UT, and WV)
• Remained level in 6 states •(MI, MO, NC, SC, VT, and WI)
• No funding in 16 states and the District of Columbia(AL, AK, AZ, AR, CA, DC, IA, ID, LA, ME, MT, NV, OR, PA, RI, TX, WA)
• Pending• (HI, ID, IL, and OH)
Source: NACHC, 2015. State Fiscal Year 2016 Funding for Community Health Centers, State Policy Report #58. http://www.nachc.com/client//funding%20brief%203%2021%2016.pdf
Section VIIStaffing/Workforce
Physicians10%
Nurse Practitioners/Physician
Assistants/Certified Nurse Midwives
8%
Dental Services12%
Mental Health and Substance Abuse Services
7%Nurses
13%Pharmacy Personnel - 3%
Other Professional Services
1%
Enabling Services16%
Other Programs/Services5%
Other Medical Personnel 24%
Figure 7.1
Health Centers Utilize Multiple Health Professional with Varied Skills to Increase Capacity, 2014
Note: Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System.
Total Health Professionals = 108,570
Full Time Equivalents
Figure 7.2
Health Center Medical Services Staff, 2014
Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS)
Total Medical Personnel = 60,893 Full Time Equivalents
Total Physicians = 11,203 Full Time Equivalents
Family Physicians
46%
General Practitioners
4%
Internists16%
Obstetricians/Gynecologists
10%
Pediatricians21%
Other Speciality Physicians
3%
Physicans18%
NPs/PAs/CNMs 15%
Nurses24%
Other Medical Personnel
43%
Figure 7.3
Health Center Dental Services Staff, 2014
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Percents may not total 100% due to rounding.
Total = 12,877 Full Time Equivalents
Dentists29%
Dental Hygienists
13%
Dental Assistants,
Aides, Techs58%
Figure 7.4
Health Centers Behavioral Health Services Staff, 2014
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.
Licensed Clinical Social Workers
28%
Other Licensed Mental Health Providers
21%Other Mental Health Staff24%
Substance Abuse Services12%
Psychiatrists7%
Licensed Clinical Psychologists
8%
Total = 7,270 Full Time Equivalents
Figure 7.5
Health Center Enabling Services Staff, 2014
Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.
Total = 17,250 Full Time Equivalents
Case Managers, 33%
Patient/Community Education Specialists,
14%Outreach Workers,
15%
Transportation Staff, 3%
Eligibility Assistance Workers
27%
Interpretation Staff , 5%
Other Enabling Services, 3%
Figure 7.6
Growth in Health Center Medical Providers, 2005 - 2014
Note: NP, PA, CNM stand for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, respectively. Behavioral Health Staff includes Substance Abuse.Total Medical Care Providers includes physicians, NPs, PAs, CNMs, nurses, and other medical personnel. Laboratory and X-Ray Personnel are not included in the total. Source: Bureau of Primary Health Care, HRSA, DHHS, 2005 and 2014 Uniform Data System (UDS)
7,097
3,973
8,212
2,810
5,650
11,203
9,092
14,330
7,270
12,877
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Physicans NPs/PAs/CNMs Nurses Behavioral Health Staff Dental Staff
2005 2014
Figure 7.7
Health Centers Are Twice as Likely to Use Non-Physician Clinicians than Other Providers, 2014
Note: Statistically Different (p < .01)Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413.
88%
44%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Center Other Primary Care Provider
Figure 7.8
Health Centers Use More Non-Physician Clinicians than Other Providers, 2014
Note: Statistically Different (p < .01)Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413
3.4
2.5
0
0.5
1
1.5
2
2.5
3
3.5
4
Health Center Other Primary Care Provider
Nu
mb
er
of
No
n-P
hys
icia
n C
linic
ian
s
Fig. 7.9
The Ratio of Physician Assistant, Nurse Practitioner, and Certified Nurse Midwife FTEs to Physician FTEs Has
Increased Rapidly at Health Centers
0.540.55
0.540.55
0.560.57
0.590.61
0.63
0.66
0.700.72
0.4
0.5
0.6
0.7
0.8
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rat
io o
f FT
Es
Notes: PA, NP, and CNM stand for Physician Assistant, Nurse Practitioner, Certified Nurse Midwife, respectively. FTE stands for Full-Time Equivalent.Source: Proser M, Bysshe T, Weaver D, Yee R. Community health centers at the crossroads: Growth and staffing needs. JAAPA. 2015 Apr; 28(4): 49-53.
Section VIII:Remaining Challenges and
Unmet Needs
Figure 8.1
Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013
Source: Created by The Robert Graham Center (2014). US Census 2010; HRSA Data Warehouse 2014 HPSA and MUA/P shapefiles; AMA Masterfile 2013; UDS Mapper 2014. The Medically Disenfranchised and the Shortage of Primary Care: The Role of Health Centers in Improving Access to Care. NACHC. March 2014. http://www.nachc.com/client/documents/MDFS.pdf
62 million people experience inadequate or no access to primary
care because of shortages of physicians
in their communities
Figure 8.2
Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care Needs
Note: Counties with Unfavorable Primary Care Needs were identified by being in the either bottom or top quintile depending on the primary needs indicator. Low-Income map presents census tracts, but analysis for this figure was conducted at the county-level. Source: NACHC, Health Wanted 2012. NACHC analysis of data obtained from University of Wisconsin Population Health Institute County Health Rankings 2011; U.S. Census Bureau; and HRSA.
63%
54%
53%
50%
47%
42%
38%
36%
36%
34%
33%
25%
0% 10% 20% 30% 40% 50% 60% 70%
Rural
Primary Care Provider
Preventable Hospitalizations
Uninsured
Mammography Screening
Emergency Department Visits
Health Status
Diabetes Prevalence
Not English Proficient
Low-Income
Low Birthweight
HIV Prevalence
Figure 8.3
Health Center Capital Project Plans and Funding Needs, 2015
Source: CapLink. Health Center Capital Project Plans and Funding Needs. 2015. www.caplink.org/resources/reports.
• 79% of health centers have plans to initiate capital projects within the next
several years. These plans represent 2,300 capital projects
• These planned projects are estimated to cost $4.6 billion:
• which will result in 12 million square feet of new space,
• accommodating 6,100 new providers• who will serve 5.4 million new patients annually
• However 75% of health centers report funding gaps for these planned projects
Section IX:Look-Alike Health Centers
This section highlights data from a category of Federally Qualified Health Centers (FQHCs), known as look-alikes. Look-Alikes are health centers that have been certified by the Centers for Medicare and Medicaid Services as
meeting all Health Center Program requirements but do not receive federal health center grants from the Bureau of Primary Health Care. As of 2014, there were 81 look-alikes across the United States.
Figure 9.1
Look-Alike Health Center Patients are Predominately Low Income, 2014
Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2014 was $19,790. (See https://aspe.hhs.gov/2014-poverty-guidelines). Based on percent known. Percents may not total 100% due to rounding.
74%100% FPL and below
16%101%-150% FPL
4%151%-200% FPL
7%Over 200% FPL
Figure 9.2
Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minority Groups
Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding.
White 64 %
Asian / Native Hawaiian / Pacific
Islander 7 %
More than One Race 3%
American Indian / Alaska
Native 1%
Black / African American 25 %
Hispanic/Latino 45%
Non-Hispanic 55%
Figure 9.3
Most Look-Alike Health Center Patients are Uninsured or Publicly Insured
*”Other public insurance” may include non-Medicaid SCHIP and state-funded insurance programs. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Percents may not total 100% due to rounding.
Medicaid/SCHIP 54%
Uninsured 25%
Private Insurance 12%
Medicare 8%
Other Public Insurance 1%
Figure 9.4
Look-Alike Health Centers Serve Patients Throughout the Life Cycle
Note: Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Under 510%
Ages 5-1212%
Ages 13-1910%
Ages 20-247%
Ages 25-4427%
Ages 45-6426%
Ages 65+7%
Medical Care77%
Other Professional Services
2%
Dental9%
Vision0%
Behavioral Health7% Enabling Services 5%
Figure 9.5
Look-Alike Health Centers Provide a Broad Array of Services
Note: Encounters for enabling services include visits to case managers and health educators.Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Total = Over 3.1 million patient
encounters
Figure 9.6
Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity
Note: NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Other Programs/Services includes Enabling Services. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS).
Physicians14%
NPs/PAs/CNMs8%
Nurses11%Dental Services
8%
Mental Health and Substance Abuse
Services6%
Pharmacy Personnel3%
Other Medical Personnel
34%
Other Professional Services1%
Other Programs/Services
14%
Total = 3,426 Full Time Equivalents
Figure 9.7
Look-Alike Health Center Medical Services Staff, 2014
Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS).
Total Health Center Medical Services Staff= 2,319 Full Time Equivalents
Break Out of Total Physicians (FTEs)
Total Health Center Physicians= 481 Full Time Equivalents
Total Medical Services Staff (FTEs)
Total Physicians
21%
NPs/PAs/CNMs12%
Nurses17%
Other Medical
Personnel50%
Family Physicians
46%
General Practitioners3%
Internists22%
Obstetrician/Gynecologi
sts7%
Pediatricians19%
Other Speciality Physicians4%
Figure 9.8
Look-Alike Health Center Dental Services Staff, 2014
Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.
Dentists30%
Dental Hygienists9%
Dental Assistants, Aides, Techs
60%
Total = 273 Full Time Equivalents
Figure 9.9
Look-Alike Health Centers Behavioral Health Services Staff, 2014
Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Notes: Percents may not total 100% due to rounding.
Psychiatrists12%
Licensed Clinical Psychologists
6%
Licensed Clinical Social Workers
33%Other Licensed Mental Health
Providers25%
Other Mental Health Staff18%
Substance Abuse Services
6%
Total = 213 Full Time Equivalents
Figure 9.10
Look-Alike Health Center Enabling Services Staff, 2014
Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.
Case Managers36%
Patient/Community Education Specialists
18%
Outreach Workers18%
Transportation Staff3%
Eligibility Assistance Workers
20%
Interpretation Staff3%
Other Enabling Services
3%
Total = 438 Full Time Equivalents