Community health centers (CHCs) are a linchpin of the U.S. primary-care ecosystem, providing essential care for nearly 10 percent of the population, including one-third of all people living in poverty.
These wellness hubs provide accessible dental and vision services, chronic disease care, reproductive health and behavioral health resources, and are a bulwark of public health. During the height of the pandemic, for example, CHCs delivered more than 22 million vaccine doses, with 69 percent of those shots going to people of color.
While CHCs are rooted in high-need communities, the impact of their care ripples outward to everyone. CHCs are responsible for generating nearly $85 billion in broad economic benefits annually, including more than half a million high-quality jobs, and are instrumental in controlling spiraling national healthcare costs.
It’s no wonder, then, that lawmakers from both sides of the aisle are committed to ensuring that CHCs have government funding to continue providing these exceptionally high-value services, particularly in rural areas that are among the hardest hit by deepening clinician shortages, from Georgia to Texas. Without sufficient private primary care providers to serve the region, CHCs are often the only places to seek care within a few hours’ drive.
Both the Senate and the House have put forward bipartisan bills to extend the landmark Community Health Center Fund (CHCF), offering billions in basic funding as well as supplementary investments in staffing, mental healthcare services, and expanded hours.
These actions are an important step forward, but this is also a moment to solidify the role of CHCs in our healthcare system — and recognize that they represent a golden investment. To support CHCs for the long term, we must rethink and strengthen the financial foundations of the health center ecosystem.
Consider CHC funding an investment in the future of communities
Former President George W. Bush, who presided over an expansion of community health centers, described them as a “wise use of taxpayer money.” More than that, they represent an investment with cascading benefits.
During testimony in support of the Senate’s CHCF reauthorization bill, Advocates for Community Health CEO Amanda Pears Kelly cited data stating that health centers save $24 billion in health spending per year through more cost-effective care. Even this remarkable figure gives short shrift to the overall economic benefits of community health centers: every dollar of federal funding invested in CHCs generates a virtuous cycle of economic activity through increased local spending on health services, food services, transportation, construction and more.
We need to shift our perspective on what it means to put money into community health centers. Thus funding is about more than keeping the lights on at specific clinics serving a defined population. It’s a way to meet our moral imperative to care for our neighbors while catalyzing the revitalization of underserved and often disinvested regions — stimulating job markets and supporting the healthy development of the next generation.
Create more opportunities for CHCs to participate in value-based care models
Direct funding is important, but so is opening up doors for longer-term financial sustainability. Value-based care models offer CHCs a promising pathway for enhanced revenue via incentives that reward health centers for the exceptional results they already produce for their patients.
In 2017, three-quarters of CHCs reported that their clinical quality benchmarks would qualify them to receive financial incentives if they had the opportunity to participate in value-based care models, yet only 39 percent participated in accountable care at that time.
Closing that gap by creating more CHC-specific value-based care options, especially for Medicaid patients, could accelerate financial sustainability while continuing to build on CHCs’ proven track record of spending less than other providers while achieving better outcomes.
Several states are already on the leading edge of this trend, including New York and Oregon. Both have implemented sophisticated Medicaid overhauls centering on value-based care, with particular support for CHCs to make the transition.
Support staffing initiatives to attract and retain qualified clinicians
More than 100 million Americans live in primary care shortage areas, and 165 million live in mental healthcare shortage areas. These numbers are likely to increase as the current clinical staffing shortage deepens into a full-blown crisis. CHCs are designed to help combat healthcare deserts with their strategic positioning in underserved areas, but they can’t operate efficiently without incentives to encourage highly qualified clinicians, social workers, and support staff to choose community practice over other career options.
The Senate’s version of the CHCF reauthorization bill includes almost $4 billion to address primary care physician and nurse shortages via educational programs and debt forgiveness, which would be a good start.
Policymakers should also consider supplementing these efforts with additional educational and work-experience opportunities to inspire clinical creativity and offer first-hand insight into how to efficiently and effectively practice in the safety net. Other beneficial initiatives could include expanding on COVID-era telehealth flexibilities that increased access to virtual care in underserved areas and investing in team-based care, such as expanding the role of nurse practitioners, physician assistants, and community health workers to augment the traditional care continuum.
Together, we can build a future where access to quality healthcare is not a privilege but a right enjoyed by all. By viewing CHCs through the lens of the extraordinary value they bring to everyone, we can realize a world in which community health centers stand strong, with their doors open wide and their lights shining brightly, illuminating the path to a healthier nation for all.
Dave A. Chokshi, MD, is a physician at Bellevue Hospital, Sternberg Family Professor of Leadership at the City College of New York, and the former New York City Health Commissioner. He also serves as an independent board member of Yuvo Health, which works with community health centers on value-based care.