By David A. Kindig, MD, PhD
Many readers of this blog will not know that I “came of age” professionally as a Social Pediatric resident at the Martin Luther King Jr. Office of Economic Opportunity (OEO) Health Center in the South Bronx in the early 1970s. With vision and funding these health centers provided innovative primary care using interdisciplinary health care teams.
What some may not know (or may have forgotten) is that such centers also provided an array of broader services such as job training, legal advocacy, and school health. We didn’t speak of epidemiology and disparities back then, but we understood that community health depended on more than the availability of healthcare services (and on the health of those who did not access them). I also learned an important policy lesson: grants go away—and when they do, many of the innovative services go with them.
The new Patient Protection and Affordable Care Act (PPACA) calls for a significant expansion of federal community health centers and the National Health Service Corps. In his important June 3 New England Journal of Medicine commentary, Dr. Eli Adashi and colleagues describe the current role and reach of such centers, including the PPACA’s plan to increase the number of patients served (to 40 million annually) while adding 15,000 new primary care providers by 2015.
While applauding this initiative, the authors cite numerous challenges to such an expansion, including state Medicaid cutbacks, lack of capital and information technology infrastructure, governmental administrative issues, and the limited production pipeline of primary care providers.
Last week I reported on a recent meeting at the Federal Reserve which highlighted potential partnerships between Community Health Centers (CHCs) and Community Development Financial Institutions (which address low-income housing, economic development, and other social services such as early childhood education).
Adashi and colleagues briefly mention the CHC role in “a broad swath of needs for coordinated disease prevention and health maintenance.” However, the authors fall short of calling for the broad interventions that the OEO provided and paid for 40 years ago. It is worth noting that one of the authors, Dr. Jack Geiger, successfully ordered groceries from the OEO central pharmacy for his malnourished patients in the Mississippi Delta!
In the end, this tremendous push for expanded healthcare access may require a focused, concerted, all-hands-on-deck approach. But we should keep in mind what the OEO knew in the 1960s--that healthcare is only one determinant of health with no clear accountability for the rest.
Some CHCs continue to offer a broad spectrum of services. With the White House and the Office of Management and Budget championing “place-based” initiatives, perhaps some funds can be set aside for pilot programs. For these pilots, CHCs (defined not only as federally qualified health centers but also community-funded safety net clinics, faith-based clinics, family practice residency programs, rural health centers and free clinics) could lead the integration all health promoting investments. However, without a permanent funding stream, even successful pilots (such as OEO) can regress. If successful, perhaps long-term funding streams from Community Benefit or Accountable Care Organization (ACO) savings could be attempted.
It worked once, but was not sustained. Isn’t it worth another try?
David A. Kindig, MD, PhD, is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.
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