Health centers serve 1 in 12 people in the United States, and they do so without regard to a patient’s ability to pay.
Prior to the Covid-19 pandemic, these centers, which are funded by federal and state governments — as well as free clinics, which are largely supported by donors and serve about 2 million people annually — form the frontlines of health care in the U.S., helping the most vulnerable populations receive a full spectrum of medical care, including primary, vision, dental, and behavioral health. Some centers also run a pharmacy, employ nutritionists, and offer care geared towards women and children.
These centers reduce costs across the health care system by diagnosing and managing conditions, especially chronic ones like diabetes and hypertension, before these ailments worsen and require ER visits, which cost, on average, $1,389 in 2017. The Covid-19 outbreak has seen ER rooms around the world flooded with patients seeking care for respiratory symptoms.
Beyond this, health centers operate more efficiently, saving 24% per Medicaid patient compared to other office-based physicians, according to the 2020 Community Heath Center Chartbook, which was researched by the National Association of Community Health Centers.
The costs saving for all patients is $1,263 per patient per year. These centers also generate more than $54 billion of economic activity annually, according to the NACHC report.
Despite this value, health centers operated on less than half of the margin of hospitals in 2016, the last year for which such data was available. The margins are compounded by a care gap for $1.5 billion for uninsured individuals they treated.
Many centers have been impacted by the pandemic, with some forced to let go or furlough staff. In Illinois, that state’s primary health care association said community health centers would see 4,350 layoffs during the next three months, without additional funding. The $2 trillion stimulus package includes $1.3 billion for 1,362 health care centers.
But to save money and keep staff safe, health centers have been employing a variety of tactics. Many have transitioned to telehealth when possible, though in-person visits remain a necessity in some cases, such as managing chronic conditions and dealing with paperwork.
Here are dispatches from three centers in Missouri, Michigan and California:
Northwest Health Services Downtown Health Center, St. Joseph, Missouri
This clinic was built in less than a month for $42,000. It serves a largely homeless community, which faces dramatically higher rates of respiratory problems, even in the best of times. Since the outbreak, they’ve shifted a lot of their operations to teleheath, but in-person visits are still necessary for urgent health issues.
Tiffani Bradbury is a nurse practitioner who works at that site, which has a staff of six:
“It’s been pretty different, we started out at the beginning the month of March and it was business as usual. Then we started hearing about cases coming from the east and west coast, but being in the middle of America, everybody was pretty skeptical that it was going to hit here. And about in the middle of the month, we had people stop coming in. People got more standoff-fish… after the governor put a stay-at-home order, we’ve had few patients at all.
“With a stay-at-home order, homeless patients don’t have a home, so they stay at a shelter. They’ve taken it pretty seriously. We started implementing telehealth pretty quickly for medication refills and other appointments.
“We’ve gotten more accustomed to doing visits over the phone, and we’re currently training for video appointments for patients that actually need eyes on them. It’s a lot of very big transitions, big changes, changes coming down it seems like almost hourly in how we’re supposed to approach everything.”
Despite having move to telehealth for most patients, Bradbury said some patients still need to come in.
“ID’s, birth certificates, they’re the first step in not being homeless anymore. You can’t apply for a job, can’t apply for help without them. Our case manager is still seeing as many patients as she can, while trying to keep social distancing and trying to help them.”
She explained that the social security administration will accept documentation from a doctor who has cared for a patient over a period of time as an acceptable document to establish identity. Bradbury said about 80% of her patients are experiencing homelessness.
“If we weren’t there, Mosaic’s [the only local hospital] ER would be overrun right now. They said having us here has significantly reduced ER visits. Plus, they’re [patients] getting chronic health care management here, instead of the ER.”
To help keep people in the community connected, Bradbury said people have organized “cruises” or car parades through the main drag, as well as scavenger hunts for kids, which she said helps people, especially children who are home from school, feel connected.
“We’re a work-together community. Holding onto these community feelings, and one day at a time, is going to help all of us get through it.”
Community Health and Social Services (CHASS) Center, Detroit, Michigan
CEO Dr. Felix Valbuena spent the past week working out of Henry Ford Hospital, which announced that more than 700 of its staff members had tested positive for Covid-19.
“CHASS is currently only seeing essential visits (OB patients, newborns through 15-month well-child visits, urgent dental, and some hospital follow-ups and chronic disease patients that are deemed urgent; pharmacy and lab services are full-service hours.)
“All other visits are being done virtually. We have implemented telehealth for behavioral health and medical visits.
“Our main message is to have people stay home and only come out for food medicine and emergency room if they are short of breath.
“The drive-through testing is honestly a very frustrating initiative for me. The testing should be for sick people in the hospital and healthcare workers to see who can work. But, otherwise no one else should be out. Unfortunately, the marketing for testing does not include those details.
“We will not reach the peak of this for a few more weeks and the only way we can significantly decrease the spread is to stay home. Stay safe.”
Saban Community Clinic, Los Angeles, California
Saban Clinic in LA serves a diverse range of clients, from out-of-work Hollywood producers to people experiencing homelessness and otherwise unable to seek care elsewhere.
A recent Direct Relief shipment has buoyed their supply of personal protection equipment, but every day brings new uncertainty. In order to make sure their health care providers have enough PPE, they have been forced to divert it from other important offerings, such as their free shower program for the homeless.
Saban Clinic has set up a triage tent out front, and have directed most of their patients to do telemedicine — and over 80% of their patients have made that transition. Like the other clinics, they are still seeing patients with acute issues, those who don’t have the ability to manage those chronic conditions from home, and those who need physicals for employment.
In line with state guidance, the health center has suspended routine dental services. To further help maintain social distancing and expand access to care, they have offered their patients free delivery of their medications and waived all copays for self-pay and uninsured patients.
Registered Nurse Supervisor Adahli Tapia:
“It is pretty scary because we don’t know which patients are coming in, as walk-ins. We don’t know if they have it, since people can be asymptomatic. You never really know, every single day, when you go to work, what’s going to happen… We don’t know, every day, if any of the patients had the virus and if we were exposed.”
“Our masks we were running low, but we had some donated by Direct Relief, so we’re okay as of right now. But we’re still running low on sanitizers. A lot of our staff wouldn’t want to come to work if we had a mask shortage.
“We’re still running through PPE every day and our supplies aren’t coming in quick enough. Will we have enough for tomorrow? Next week? We’re scrambling to find where can we find this [PPE].
“One thing is definitely fear of the unknown, but also we all feel supported relying on each other, knowing that between us, we’ll be okay, but everything is always changing.
“There’s fear, we’re not freaking out or anything. But is it today that we’ll be exposed? It’s about being ready for anything at this point. We’re going ahead and doing what we have to do.”
Adam Friedman, Chief Marketing Officer:
“We’ve been a community health provider for over 50 years and have weathered many different health crisis event in the history of the clinic and I don’t think anybody has experienced anything like this before.
“But as an organization, we’re proud to be on the front lines and really feel a duty and responsibility to the community we serve, especially with patients who have issues with access to healthcare for whatever reason.”
Friedman said the clinic undergoes a yearly training for emergencies ranging from a nuclear attack to an active shooter.
“We all sort of do it begrudgingly like when would this ever happen to us, but what that’s done is really prepare us as an organization is prepare for those exercises and do what we’re doing now, like triage tents sent up at every site to screen people for any signs of the virus.”
“We’re obviously trained for it, emergency preparedness, anything and everything, but then it happened and it’s a reality check, and you jump into this emergency preparedness mode. It’s definitely something different and seeing it every day and exposing yourself.
“Preparing and actually doing it is two different things.”
With all the changes and this new reality, Tapia said that she and peers have maintained their resolve.
“We’re going ahead and doing what we have to do.”