Community health clinics serve specific roles in care delivery

Key Points

HEALTH CLINICS' ROLE in the delivery system is likely to increase as previously uninsured individuals gain access to care. Not only will the delivery system need these sites to absorb pent-up demand, health clinics can also serve as integrated care providers in the community.

Health clinics already face an increasing demand for services as more uninsured and self paying patients seek care. The demand could eventually create a crisis in some communities.

"We expect demand for health clinics to double in the next three to four years at the same time that federal funding is being cut," says Joyce Converse, senior vice president, Soyring Consulting in St. Petersburg, Fla. "If people can't access care in the community, many will wait until things get bad enough to go to the emergency room."

Lisa Green, DO, the clinic's CEO, says that the financial climate has increased the number of Medicaid recipients, uninsured, and self paying patients the clinic sees. In fact, over the past few years, self paying patients have increased from just 1% of all patients to 9%.

Even as clinics like Family Christian Health Center work through the issues they face today, they still need to determine how things will change once healthcare reform takes hold.

"These times are very challenging because we are kind of in limbo," says Dr. Green.

Still, she is optimistic about the role health clinics can play in the future of healthcare. The staff is uniquely positioned to understand the community and the social and economic environments that impact patients' healthcare decisions, she says. That advantage allows the staff to care for the patients more effectively.

Specifically, this community-based approach is particularly well suited to thrive as payment shifts from numbers of patients and procedures to performance-based outcomes that focus on healthier patients.

Because many health clinics have had to be many things to many people, they can be well positioned to provide integrated care. For example, health clinics that augment physicians and nurses with a dispensing pharmacy, nutritionists, social workers, clinical pharmacists and other healthcare professionals are well positioned to manage the total care of a particular patient.

"With these resources for patients to utilize, the health clinic becomes a one-stop shop," says Robert Trenschel, senior vice president and administrator of ambulatory care services for Harris County Hospital District. "The ultimate goal is to provide highest quality care in the lowest cost environment."

Utilizing non-physician resources to provide care, including case managers, nutritionists, clinical pharmacist and midlevel providers, such as physicians assistants and nurse practitioners, rather than relying on expensive physician resources, is one of the ways clinics are integrating care and shoring up the bottom line.

"You want everyone working at the top level of their license," says Trenschel.

This type of integrated care could help achieve a key goal for healthcare reform, which is to reduce costs through better chronic disease management. For example, community health clinics provide more options for a patient with diabetes to seek care consistently and not just when their blood glucose levels are elevated, they need to refill a prescription, or they suffer complications.

"The best case scenario is a situation that allows proactive management of the patient and the condition to keep this type of chronic disease under control and avoid secondary and tertiary complications that have a huge financial impact," says Trenschel.

Another element of integration involves the two separate healthcare spheres. One sphere encompasses the primary care system, including the clinic system, community health centers and other community-based providers. The other is hospital based and includes inpatient beds, acute care, trauma care, surgery and so on.