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A Sketch of Community Health Centers Chart Book December 2014 National Association of Community Health Centers, December 2014 For more information, Cover picture provided courtesy
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A Sketch of Community Health Centers Chart Book December 2014 National Association of Community Health Centers, December 2014 For more information, Cover picture provided courtesy of Codman Square Health Center in Boston, Massachusetts. This publication was supported by Grant/Cooperative Agreement Number U30CS16089 from the Health Resources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA/BPHC. Preface Table of Contents Section I: Who Health Centers Serve Figure 1.1: Health Centers Serve Figure 1.2: Health Center Patients Are Predominately Low Income Figure 1.3: Most Health Center Patients are Members of Racial and Ethnic Minority Groups, 2013 Figure 1.4: Most Health Center Patients are Uninsured or Publicly Insured Figure 1.5: Health Center Patient Mix Is Unique Among Ambulatory Care Providers Figure 1.6: Health Centers Serve Patients Throughout the Life Cycle Figure 1.7: Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-Insured, 2013 Figure 1.8: Health Center Patients are Disproportionately Racial/Ethnic Minorities, 2013 Figure 1.9: Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians Figure 1.10: More Health Center Patients Prefer to Be Served in Languages Other than English Every Year Section II: Health Center Growth Figure 2.1: The Number of Health Centers Receiving Federal Health Center Grants Has Increased Dramatically 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, Figure 2.5: The Number of Health Center Low Income* Patients Is Growing Faster than the Number of Low Income Nationally, Figure 2.6: The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, Figure 2.7: The Number of Health Center Uninsured Patients Grew while the Number of Uninsured Nationally Decreased, 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: Health Center Uninsured Patients Are More Likely to Have Usual Source of Care then Uninsured Nationally Figure 3.3: Health Center Uninsured and Medicaid Patients are More Likely to Have a Usual Source of Care than the U.S. Privately Insured Figure 3.4: Health Center Uninsured Patients are Twice as Likely To Get the Care They Need than Uninsured Nationally Figure 3.5: Percent of Uninsured Served by Health Centers, 2013 Figure 3.6: The Percent of Medicaid Beneficiaries Served by Health Centers, 2013 Section IV: Preventive Services Figure 4.1: Health Centers Provide a Broad Array of Services Figure 4.2: Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental, and Mental Health Care, Figure 4.3: Health Centers Provide More Preventive Services than Other Primary Care Providers Figure 4.4: Health Center Patients with Hypertension Are More Likely to Receive Counseling About Diet, Exercise, and Taking Medications than Their National Counterparts Figure 4.5: Health Center Patients with Hypertension are More Likely to Comply to Counseling About Diet, Exercise, and Taking Medications than their National Counterparts Section V: High Quality Care and Reducing Health Disparities Figure 5.1: Health Centers Reduce Disparities in Access to Mammograms Figure 5.2: Health Centers Also Reduce Disparities in Access to Pap Tests Figure 5.3: Health Centers Also Reduce Disparities in Access to Colorectal Cancer Screening Figure 5.4: Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. Average Figure 5.5: Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. Counterparts Figure 5.6: Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians Figure 5.7: Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores Figure 5.8: Health Center Patients Are More Satisfied with Overall Care Received Compared with Low-Income Patients Nationally Section VI: Cost-Effective Care and Economic Impact Figure 6.1: Health Centers Save $1,263 Per Patient Per Year Figure 6.2: Areas with High Health Center Penetration Spend $926 Less on Medicare Beneficiaries without Compromising Quality of Care Figure 6.3: Economic Impact of Federal Health Center Funding by State, 2012 Figure 6.4: Jobs Generated by Federal Health Center Funding by State, 2012 Section VII: Health Centers Financial Health Figure 7.1: Health Center Costs of Care Grow Slower than National Health Expenditures, Figure 7.2: Health Center Funding Per Uninsured Patient is Well Below Total Per Patient Cost Figure 7.3: Payments from Third Party Payers Are Less than Cost Figure 7.4: Health Center Operating Margins are Less than Hospital Operating Margins Figure 7.5: Medicaid Revenue is Directly Proportional to Medicaid Patients, 2013 Figure 7.6: Health Centers Revenue Sources Do Not Resemble Those of Private Physicians Figure 7.7: Federal Health Center Appropriation History, FY Figure 7.8: 32 States Will Provide Funding to Health Centers in SFY2014 Figure 7.9: State Funding to Health Centers, FY14 Section VIII: Staffing/Workforce Figure 8.1: Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013 Figure 8.2: Health Centers Medical Providers, Full Time Employees (FTEs), 2013 Figure 8.3: Health Centers Dental Services, Full Time Employees (FTEs), 2013 Figure 8.4: Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013 Figure 8.5: Health Centers Enabling Services, Full Time Employees (FTEs), 2013 Figure 8.6: The Number of Health Center Medical Providers Has More Than Doubled Figure 8.7: Health Centers Twice as Likely to Use Non-Physician Clinicians than Other Providers Figure 8.8: Health Centers Use More Non-Physician Clinicians than Other Providers Section IX: Remaining Challenges and Unmet Needs Figure 9.1: Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care Needs Figure 9.2: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013 Figure 9.3: Without Community Health Centers: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013 Figure 9.4: More than a Third of Health Centers Need to Build or Purchase Additional Facilities, Section X: Look Alike Health Centers Figure 10.1: Look-Alike Health Center Patients Are Predominately Low Income Figure 10.2: Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minorities, 2013 Figure 10.3: Most Look-Alike Health Center Patients are Uninsured or Publicly Insured Figure 10.4: Look-Alike Health Centers Serve Patients Throughout the Life Cycle Figure 10.5: Look-Alike Health Centers Provide a Broad Array of Services Figure 10.6: Payments from Third Party Payers Are Less than Cost Figure 10.7: Medicaid Revenue is Directly Proportional to Medicaid Patients for Look-Alike Health Centers, 2013 Figure 10.8: Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013 Figure 10.9: Look-Alike Health Centers Medical Providers, Full Time Employees (FTEs), 2013 Figure 10.10: Look-Alike Health Centers Dental Services, Full Time Employees (FTEs), 2013 Figure 10.11: Look-Alike Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013 Figure 10.12: Look-Alike Health Centers Enabling Services, Full Time Employees (FTEs), 2013 About this Chartbook This Chartbook includes data and research from Community, Migrant, Homeless, and Public Housing Health Center, also known as Federally-Qualified Health Centers (FQHCs). Unless otherwise specified, this Chartbook utilizes data from the Bureau of Primary Health Care, HRSA, DHHS, Uniform Data System (UDS). 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. This Chartbook now includes a separate section highlighting data on Health Center Program look-alikes. Just like Health Center Program grantees, Health Center Program look-alikes, which do not receive federal health center grant funds, support the health of the nation s underserved communities and vulnerable populations by increasing access to primary health care services. As of 2013, there were 100 Look Alikes across the United States. Preface 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 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 as the health care home to over 23 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. *Includes patients of federally-funded health centers, non-federally funded health centers (health center look-alikes ), and expected patient growth for 2014. Section I: Who Health Centers Serve Figure 1.1 Health Centers Serve: 1 in 7 Medicaid beneficiaries 1 in 7 uninsured persons including: 1 in 5 low income, uninsured 1 in 3 individuals below poverty 1 in 3 minority individuals below poverty 1 in 3 children below poverty 1 in 7 rural Americans Source: NACHC, Includes patients of federally-funded health centers and non-federally funded health centers. Figure 1.2 Health Center Patients are Predominately Low Income 6% are % FPL 7% are over 200% FPL 15% are % FPL 72% are 100% FPL and below Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2013 was $19,530. (See Based on percent known. Percents may not total 100% due to rounding. Figure Percent* of Health Center Patients are Members of Racial and Ethnic Minority Groups, 2013 Race Ethnicity White 66% Hispanic / Latino 35% American Indian / Alaska Native 1% Black / African American 24% More than one race 4% Asian / Hawaiian / Pacific Islander 5% Non-Hispanic / Latino 65% Source: Federally-funded health centers only 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 1.4 Most Health Center Patients are Uninsured or Publicly Insured 14% Private Insurance 35% Uninsured 2% Other Public Insurance 8% Medicare * Other public insurance may include non-medicaid CHIP and state-funded insurance programs. Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding. 41% Medicaid / SCHIP Figure 1.5 Health Center Patient Mix Is Unique Among Ambulatory Care Providers 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2% 14% 8% 35% 41% 5% 8% 57% 23% 3% 11% Notes: Other public includes non-medicaid SCHIP and other state-funded insurance programs. * 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, 2013 Uniform Data System (UDS). Private Physicians from 2010 NAMCS (CDC National Center for Health Statistics, 2010). Hospital Outpatient from 2010 NHAMCS (CDC National Center for Health Statistics, 2010). 41% 20% 5% 26% Health Centers Private Physicians Hospital Outpatient Depts. Other / Unknown Private Medicare Uninsured Medicaid Figure 1.6 Health Centers Serve Patients Throughout the Life Cycle Ages 65+ 7% Under 5 10% Ages % Ages % Ages % Ages % Ages % Note: Percents may not total 100% due to rounding. Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Figure 1.7 Health Center Patients Are Disproportionately Poor, Uninsured, and Publicly-Insured, 2013 Health Centers 93% United States 72% 35% 41% 40% 15% 17% 20% Uninsured Medicaid At or Below 100% of Poverty At or Below 200% of Poverty Note: Health Centers: Based on Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System. U.S.: Kaiser Family Foundation, State Health Facts Online, Based on Census Bureau's March 2013 Current Population Survey (CPS: Annual Social and Economic Supplements). Figure 1.8 Health Center Patients are Disproportionately Members of Racial and Ethnic Minority Groups, % 35% 30% 25% 20% 15% 10% 5% 0% 35% 17% 62% of health center patients are members of racial and ethnic minority groups 24% 13% Hispanic/Latino Ethnicity Black/African American Asian/Hawaiian/Pacific Asian/Hawaiian/Other Pacific Islander 5% 5% Health Centers United States 1% 1% American Indian/Alaska Native Note: Percents may not total 100% due to rounding. Sources: Based on 2013 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, 2012 Released June 2013. Figure 1.9 Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians 18% 18% Percentage of Physician Visits Involving Patients with Common Chronic Conditions Percentage of Physician Visits Involving Patients with the Specified Chronic Condition Health Centers Private Physician Offices 27% 25% 13% 13% 15%*** 11%* 9% 11% 8%** 7% Health Centers Physician Offices Depression Diabetes Asthma Hypertension 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.) Number of Patients (in millions) Figure 1.10 Health Center Patients Who Prefer to Be Served in Languages Other than English % Increase Since Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Section II: Health Center Growth Number of Grantees Figure 2.1 The Number of Health Centers Receiving Federal Health Center Grants Has Increased Dramatically % growth since ,198 1,202 1,131 1,124 1,128 1,067 1,080 1, Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Number of Patients (in millions) Figure 2.2 The Number of Health Center Patients Continues to Increase % growth since Number of Patients (in millions) Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS Number of Patient Visits (in millions) Figure 2.3 The Number of Health Center Patient Visits Continues to Increase % growth since Number of Patient Visits (in millions) Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Number of Patients (in millions) Figure 2.4 Health Center Patients by Insurance Status, Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Uninsured Medicaid Private Medicare Other Figure 2.5 The Number of Health Center Low Income* Patients is Growing Faster than the Number of Low Income Nationally, Percent Increase 80% 69% 70% 60% 50% 40% 30% 20% 18% 19% 10% 0% Health Center Low Income Low Income Nationally *Patients under 200% of federal poverty level Sources: U.S. Census Historical Poverty Tables. ( ). Table 5. Percent of People By Ratio of Income to Poverty Level Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Figure 2.6 The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, Percent Increase Sources: Bureau of Primary Health Care, Health Resources and Services Administration, DHHS and 2013 Uniform Data System. Kaiser Commission on Medicaid and the Uninsured. Medicaid Enrollment: June 2003 and June 2013 Snapshots. 120% 100% 99% 80% 60% 40% 39% 20% 0% Health Center Medicaid Medicaid Nationally Figure 2.7 The Number of Health Center Uninsured Patients Grew while the Number of Uninsured Nationally Decreased, % 55% 50% 40% 30% 20% 55% 10% 0% -10% Health Center Uninsured Uninsured Nationally -7% Source: Health Center: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, Uniform Data System. U.S: Smith, J. and Medalia, C. (September 2014). Health Insurance Coverage in the United States: U.S. Census- Current Population Reports. Retrieved from, https://www.census.gov/content/dam/census/library/publications/2014/demo/p pdf, Figure 1. U.S: DeNavas-Walt, C., Proctor, B., and Smith, J. (September 2013). Income, Poverty, and Health Insurance Coverage in the United States: U.S. Census- Current Population Reports. Retrieved from, Table C1- Page 67. 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 Source: Hing E, Hooker RS, Ashman JJ. Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health June; 36(3): Figure 3.2 Health Center Uninsured Patients Are More Likely to Have a Usual Source of Care than the Uninsured Nationally 120% Health Center Uninsured US Uninsured 100% 96% 80% 60% 60% 82% 68% 40% 20% 0% Has Usual Source of Care At least 1 Primary Care Visit in the Past Year Source: Shi, L and Stevens, GD. The Role of Community Health Centers in Delivering Primary Care to the Underserved. April-June 2007 JACM 30(2): % Reporting They Have a Usual Source of Care Figure 3.3 Health Center Uninsured and Medicaid Patients are More Likely to Ha
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