Community health centers have been ahead of the curve

50 years after model introduced, the rest of US health care is catching up

HEALTH CARE PROVIDERS across the country are struggling to adapt to the team-oriented, patient-centered approach to care that makes up the foundation of Affordable Care Act era health care delivery. This more coordinated model, sometimes known as the patient-centered medical home (PCMH), emphasizes a critical shift to staying well, not just getting better, as well as better management of the higher-risk patients with chronic needs who account for so much of our overall healthcare spending.

In December of 1965, physician-activists H. Jack Geiger and Count D. Gibson Jr. pioneered this new model to provide accessible, affordable and high-quality health care when they founded two community health centers, the first here in Massachusetts, in the Columbia Point section of Dorchester, and the second in Mound Bayou, Mississippi.

This community health center approach introduced concepts that form the very foundation of modern health care: population health, prevention and wellness, chronic disease management, and an integrated, patient-centered structure. Community health centers seek to improve the overall health of entire neighborhoods by approaching care holistically, understanding and addressing the specific cultural, social, and economic conditions affecting their patients. It has succeeded in 1,200 health centers across the US serving 23 million Americans in urban, suburban, and rural communities, including more than 935,000 patients here in Massachusetts—that’s one in seven state residents.

But bringing the rest of the health care system in line with this approach requires a strong culture shift, changes to provider infrastructure around records and referrals, strong training for clinicians and office staff, and new tactics for motivating patients to set long-term health goals.

It is a challenge that many feel will take years to fully evolve. How can we possibly link primary care, behavioral health, specialty programs for chronic diseases, resources for seniors and niche populations, vision, dental, nutrition, in-school programs, pharmacy services,  patient education and provider training?

Massachusetts community health centers are living in that future today. Community health centers are at the leading edge, having planted those first seeds 50 years ago.

The community health center response to our opioid crisis is a prime example. Working at the front lines of the crisis, health centers in Boston, Fall River, Cape Cod and across the Commonwealth have developed new models for identifying and treating at-risk patients over time, and successfully deployed innovative strategies like combining detox, inpatient treatment, and Suboxone, a drug used to treat addiction. Their approach is succeeding because it is holistic. There is no silver bullet solution. Gains come instead from understanding population trends and meeting patients where they are at every stage. From using data to understand risk and develop early interventions, to supporting patients with integrated care that addresses both the physiological and psychological needs of addiction treatment and ensuring through a team approach that referrals turn into appointments and relationships, our community health centers are setting an example for all health care providers.

Massachusetts community health centers also continue to look for new ways to support healthy living for our patients. Health-center-based initiatives like fitness and wellness centers, farmers’ markets, safe walking routes to school, cooking demonstration kitchens and even patient hiking trails located behind a health center in Western Massachusetts – all of these continue to challenge long-held notions about what it means to deliver effective health care. Fixing our broken health care system cannot only be about helping patients to get better—it has to be about helping them to stay well in the first place.

Our health centers support 14,000 jobs across the state, and contribute nearly $2 billion in statewide economic output every year. What’s more, because of the impact we have in reducing emergency room visits, hospital stays and the need for higher-cost specialty care among our patients, health centers help generate more than $1 billion in annual savings for Massachusetts.

This economic impact also has a real impact on health on the local level. For anyone who might question the relationship between economic health and physical health, consider making a choice between focusing on safe housing, seeking employment, or putting food on the table, and calling to make an appointment for a health screening. By providing education and jobs in their communities, health centers are far more than care providers.

The immediate challenge is how to sustain health center innovation through the radical economic transition health care is undergoing. Competition for health care workers, particularly primary care providers, is intensifying. The Massachusetts League of Community Health Centers is leveraging support from the Legislature, business, and health care industry partners to address this need. From public-private loan forgiveness programs for health center primary care providers, to health-center-based residency training programs, to community leadership programs designed to cultivate the next generation of physician and administrative leaders, health centers continue their hallmark grassroots efforts to lead the industry forward. More recently, the League has begun development of a new outreach program to educate secondary school students about the opportunities for careers in community health care.

Meet the Author

Meet the Author

Even as we celebrate the 50th anniversary of our nation’s first health center, we are looking to the next 50 years—and we know the nation is looking to us. Let’s make sure we continue to deliver.

James W. Hunt, Jr. is president and CEO of the Massachusetts League of Community Health Centers. Antonia McGuire is board chair of the League and president and CEO of the Edward M. Kennedy Community Health Center in Worcester.