The legacy of community health centers

Collaboration now key to better care, savings

IT HAS BEEN 50 YEARS since the government health care program called Medicaid and the Community Health Center (CHC) movement began bringing quality health care to millions.  Faced with high need and limited budgets, these federal programs in the War on Poverty became accidental incubators for health care innovation.  As we acknowledge their anniversaries, and Massachusetts historic role as the birthplace of CHCs, we should consider how their pioneering strategies can address similar challenges across our current health care system.

Medicaid, created in 1965 to serve the uninsured or underinsured, now provides coverage for nearly 70 million low-income Americans.  Begun in Massachusetts that same year, CHCs were created to serve communities disproportionately affected by poverty, where poor environments had a negative impact on health outcomes and health care providers were scarce.

Segal, Dave

CHCs now represent a thriving network of primary care organizations serving people of all incomes and geographies. The Commonwealth alone has more than 285 access sites across the state and a strong advocate in the Massachusetts League of Community Health Centers.  The CHCs operate within both public and private payer systems, but their original partnership with Medicaid still drives their health care delivery model.  Forced to create strategies that were both efficacious and efficient, CHCs were the first providers to consider the whole patient, addressing the social determinants of health and health prevention.

Well before buzz phrases such as personalized medicine and integrated care management, CHCs were encouraging patients to play a direct role in their health care through health education and prevention.  They also provided a one-stop range of services, often involving integration with behavioral health, which has a widely recognized impact on overall health. Medicaid’s community-based waiver programs encouraged care delivery in community settings that were close to a patient’s home and less costly than institutional care.

With a patient-centered focus on prevention and integration, CHCs are adept at providing high-quality care at low cost. Given the escalation of health care costs in the United States, we should be highly motivated to understand the broader application of these cost-saving practices.

Nowhere is this need more apparent than in chronic disease management.  According to the Centers for Disease Control and Prevention, 85 percent of all health care spending in 2010 was for people with one or more chronic medical conditions.  As of 2012, this constituted about half of all adults—117 million people.  The Institute of Medicine and the Government Accountability Office recognizes CHCs as models for screening, diagnosing, and managing chronic conditions such as diabetes, cardiovascular disease, asthma, and depression.

For the very same reasons, the larger health care system is now embracing strategies that better integrate care and acknowledge and manage the social determinants of a person’s health status.  But silos are difficult to disassemble and if we are to take advantage of new opportunities for cost-savings and better care delivery, we must do a better job at collaboration.

Meet the Author

David Segal

President and CEO, Neighborhood Health Plan
Here, the partnership forged by Medicaid and CHCs provides an enduring lesson in coordination among providers and payers.  Faced with the need to align incentives and synchronize efforts, private sector stakeholders are beginning to merge closer together as is the case with Neighborhood Health Plan and Partners HealthCare.  New guidelines and incentives within the Affordable Care Act are encouraging this alignment, further demonstrating that, for 50 years, the Medicaid and CHC programs have been where health care is going.

David Segal is the President and CEO of Neighborhood Health Plan, created by Community Health Centers in 1986 and now a member of Partners HealthCare.