Play PodcastPlay Download PodcastDownload

Transcription:

Robin Kish: Nearly 30 million people in the US rely on a special place to stay healthy, a place where they can receive a wide range of services all under one roof regardless of their ability to pay. There are nearly 1400 of these special places across the country, and they are a key component in the fight against COVID-19. What are they? We'll explain on this edition of Here For Your Health.

Welcome to the Health Care District of Palm Beach County's podcast Here For Your Health. I'm your host, Robin Kish.

The Health Care District of Palm Beach County is a unique healthcare system located in South Florida. The public health care system provides county residents access to primary care, skilled nursing and hospital care, registered nurses in nearly all of the county's public schools and overseeing the county's trauma system, including operating two life-saving Trauma Hawk air ambulances. Through all of these programs, the Health Care District serves as the healthcare safety net for Palm Beach County.

On this edition of Here For Your Health, we take a closer look at federally qualified community health centers and how they're making a difference in the health of residents in your neighborhood.

Our guest today is Ben Browning, Vice President of the Florida Association of Community Health Centers. Welcome, Ben.

Ben Browning: Good to be here, Robin. Thank you for having me.

Robin Kish: Ben, for those who may have never heard of federally qualified community health centers before, FQHCs as they're known, what are they?

Ben Browning: That is a great question, Robin. The community health centers, they're often known, but not as often recognized. And so what I mean by that is that they're often called the "best kept secret," but I believe the secret is out as over 1.6 million Floridians currently receive their primary medical, dental, mental health, pharmacy and a host of other care services at over 600 locations rooted in communities that are across the state.

The health centers, they're medical homes for anyone. The insured, uninsured, underinsured and really anyone in person between that seeks care. The centers are not free clinics, but as mentioned, they do provide care based on a patient's ability to pay. And in addition to providing direct care to those that come through their doors, health centers are also connective tissues with resources and agencies throughout their communities, helping patients to find insurance coverage, getting connected with food pantries, assisting with transportation needs and really a host of other things that lead to strengthening the health, the wellbeing, and the overall condition for all individuals.

Robin Kish: Well, I imagine that these places, these special places, are so important to folks, especially now when times are so challenging. But for those who have access to medical care through their health benefits at work who can afford to pay for concierge care or have Medicare, they may think they don't need to visit a community health center. So how do they benefit from community health centers?

Ben Browning: If I may, I'd like to disagree with a part of the question, part of the premise, in that the health centers are able to offer the services that are just as good, if not better than many of those options that you just mentioned. Health centers are able to offer many services within the same network, many times even under the same roof. And all of that leads to the improved quality of care provided that others may not be able to offer.

But to your question, there are the societal benefits of a healthier population. You know, health centers provide care to everyone. And looking at this from a health perspective or a societal perspective, they're able to positively impact all aspects, which lend to stronger economies, a more educated citizenry, and healthier populations that have established homes to receive care from other than just emergency rooms. So not only do the FQHC patients benefit from FQHC services, but really everyone does. And it's not so much that the individuals you identified don't need to go to a health center. I think it's more that they should want to, because the quality of comprehensive care that the health centers offer, it's great.

Robin Kish: Well, you talked about how valuable these services are that are provided, who are the patients that community health centers serve?

Ben Browning: Well, it's really anyone. Anyone can receive services at community health centers, regardless of their ability to pay, again. I mean that's a big thing. there are currently 30 million community health center patients across America as mentioned, and 1.6 million in Florida. And in Florida, the patients are-- you know, one in three are children. One in three are uninsured. One in three are enrolled in Medicaid or CHIP. But you know, that means two out of three are either uninsured or Medicaid. The other third of the patients have private coverage, TriCare or some other form of insurance coverage. Seventy-two percent of the patients do live at or below a hundred percent of the poverty rate, which is why the sliding fee scale is so valuable to those that come to the centers.

Twenty percent of the patients are on private insurance, so making up the difference there. And there's a wide variety of other special populations that the health center see. They see 90,000 homeless patients, you know, 50,000 agricultural workers and they're in schools all over Florida. They serve as, you know, the nurses and the folks in the clinics at the schools. And there's over 70,000 students that are seen at school-based centers.

Robin Kish: Well, many of the groups that you mentioned are underserved. Is it correct to say that these patients are more sick and come from a lower income base than patients in traditional healthcare settings?

Ben Browning : Many of these individuals do face deeper challenges in maintaining their health. We refer to the social determinants of health, which really speaks to the socioeconomic conditions that lead to health outcomes. So for example, oftentimes these patients face difficulties in securing reliable transportation, especially in rural areas. You know, in other cases, living in food deserts, where there may only be a single grocery within many miles or maybe only even just a corner store within walking distance. And that reduces the opportunity to access the affordable, healthy foods, such as fruits and vegetables. And that impacts their health outcomes.

You know, these barriers, they lead to challenges in maintaining positive health and wellbeing. And really that's where the health centers provide their patients an advantage of comprehensive care teams. You know, they include not only the doctor, the dentist, the clinical social worker or the pharmacist, but also the case managers, there's eligibility assisters and community health workers that really pull together the entire whole person care in the patient's single medical home.

And, you know, the medical home, it investigates and responds to the social determinants of health. Again, that's a key word, that's a key phrase there, because really that helps identify what the patient needs and helps the providers and the community health center walk them through what they need as they walk through their doors.

Robin Kish: It really sounds like a coordinated approach to care where a patient can go in and see a primary doctor, a dentist, and maybe get their medications the same day, which leads me to my next question. Health center patients can also receive medications at low or no cost. How is that possible?

Ben Browning: Well, community health centers have been granted authority by congress to participate in the 340B program and that's named after its federal statute. Now the nuances of the program are complex, but, you know, in a nutshell, this program authorizes certain entities like community health centers. They go through rigorous audits and checks and balances to qualify for purchasing medications from manufacturers at reduced or discounted prices.

Now each and every penny that the health centers save through this program is required to be reinvested in care for the patient. So the savings generated are passed onto the patient through lower drug prices at the counter or even other services. And many FQHCs offer sliding fee scales that reduce the cost based on income. But the 340B program allows these discounts to be even bigger for the patients. However, for your listeners, please keep in mind to be eligible for the 340B discounts at centers like Brumback Clinics, it is required that individuals must be established patients of the FQHC first.

Robin Kish: Ben, I'm glad you mentioned the Brumback Clinics. Here in South Florida, the Health Care District of Palm Beach County operates the CL Brumback Primary Care Clinics as federally qualified health centers, thanks in large part to a federal grant from the Health Resources and Services Administration, which is part of the federal government. And that means that tax dollars are supporting the safety net system of primary care, yet these community health centers are said to reduce healthcare costs overall. How?

Ben Browning: Absolutely. And really that is an important aspect about primary care and establishing a patient- centered medical home. If you're able to treat a patient and work with them in a primary care setting to, for example, control their diabetes or get a colorectal cancer screening, then that's small investment upfront in the health center saves thousands and care down the road. Their result from complications or avoidable surgeries or recovery costs. As we all know, time is money. And if someone is recovering or responding to a health crisis and not able to work or even care for other family members, that impacts their bottom line, as well as the bottom line of those around them, including the local economy.

So another thing about primary care though is the movement towards a value-based approach. Through this, the health centers are focusing on providing the best care, not simply the most care. And this is a firm belief in the health center movement that it is more important to provide valuable care that improves long-term health outcomes than to simply treat a patient for what is happening today, and then bring them back for what is happening the next time. It's focusing on who the patient is and how to positively affect their health conditions to control their diabetes or prevent cancer among a host of other conditions like hypertension, you name it.

Robin Kish: I understand that federal funding is also drawn down through entities like the Health Care District of Palm Beach County through a program called the low-income pool, and that those dollars are then distributed to health centers and hospitals. How does that work and how big of a benefit is it to health center patients?

Ben Browning: The low-income pool or LIP for the acronym is an arrangement between the federal government, CMS, Centers for Medicare Medicaid Services and our Medicaid agency, the Agency For Health Care Administration, and that's through their 1115 waiver. And it allows local investments to be made on behalf of local providers that are then matched with federal dollars. And the underlying point is to assist in covering the cost of uncompensated care.

Now, these funds are required to be used to offset uncompensated charity care. And as a core component of the FQHC mission, patients are seen and asked to pay based on their ability. So for those patients whose incomes place them in different categories on a sliding fee scale, there are amounts of that cost that they're not covered. And so this program allows for some of those costs to be covered through the local federal partnership that drives home the point that these services are vital. These primary care services are absolutely vital and necessary to be supported for the betterment of the population.

Now, the Brumback Clinics and the Health Care District are amazing partners to the FQHCs in this program, as they provide dollars on behalf of not just their health center, but also some others in the service area. Now, this not only benefits those centers and the patients for whom they provide care across Palm Beach County, but the FQHC system in Florida as a whole. Since the more local investments are made, the more dollars are able to be drawn down for everyone through the match.

Robin Kish: You know, let's go back a second to what you had said a little bit ago regarding value-based approach. How are health centers able to track and measure that the care the physicians, the medical staff are providing is actually working in keeping patients healthy?

Ben Browning: Another great question. You know, it's one thing to say you're focused on improving health outcomes and it's another to be able to track it and determine if you're actually making a difference. As part of every health center's electronic medical record or EMR, tracking tools are built in to follow the progress of various health conditions ranging from like the diabetes we talked about before or, you know, the annual well visits, medication adherence, you know, making sure folks are picking up and taking their medications, dental checkups and really so much more.

Now, HRSA, the Health Resources and Services Administration, they require centers to report these data, rolled up, so not individual patients of course, to allow them to measure the progress on that wide range of measures. Managed care and insurance plans also track how care is being delivered and how well the outcomes are improving.

So having the tools is one key part of this and using them is another. And that is where the FQHCs exce in that they're able to collect and analyze the data both at the provider level when a patient comes in to see a doctor or on an aggregate level, when reporting the overall statistics each year to the federal government. All the while the data are being reviewed to ensure quality and progress are moving in the right direction for the patients.

Robin Kish: How were community health centers on the front lines of the COVID 19 pandemic then?

Ben Browning: Well, they are testing, testing and testing, and in doing more testing, whether it's on location at their brick-and-mortar sites or they're traveling with their mobile units or they're doing pop-up testing in neighborhoods that would otherwise be difficult to reach. They're also working in partnership with their state and local governments at mass testing sites. The Brumback Clinics alone in Palm Beach County, a hundred thousand COVID tests and more have been provided in the community. And that number grows daily across their seven testing sites, you know.

And as the vaccine begins to be rolled out, the safety nets reached to get vaccines into those same communities will be imperative to success. FQHCs are identified in both the federal and the state plans as key providers that will be able to administer vaccines. As in the mission of the centers, the vulnerable and the uninsured will be the focus of the FQHCs in the state plan. But of course, all are going to be welcome. Now, please keep in mind of course, there is a plan, but no vaccine has been officially released yet. I think we've got a couple that are really close. So a timeline on when this will be is still in the works. However, when the vaccine is available, I'm sure Brumback Clinics and all the FHQCs will make sure to get the word out, as they have been doing for months on the COVID testing.

And if I may, one other thing I wanted to touch on was the opioid crisis, which has seen a resurgence during the pandemic. FQHCs like Brumback Clinics are on the front lines of care in combating this crisis as well. You know, in 2019, which is the most recent full year of data we have available, health centers screened and identified across the country 1.4 million people for substance use disorder and ultimately provided medication-assisted treatment to nearly 143,000 patients nationwide. And in also in 2019, 96% of health centers provided mental health counseling and treatment and 76% of health centers provided substance use disorder services. So as you can see, the health centers have been and will continue to be a strong part of both the solution to the opioid crisis and the COVID-19 pandemic.

Robin Kish: That's so true. And here at the Health Care District, we see the Brumback Clinics as being the front door of our safety net healthcare system. And of course you have a front door, you want folks to enter. So Ben, how do you find your nearest health center?

Ben Browning: Absolutely. There's a couple different ways. You can visit the Florida Association of Community Health Centers website, FACHC.org, and search under the find a health center. Or if you prefer, you can visit findahealthcenter.HRSA.gov and just type in your ZIP code.

Robin Kish: And that's find a health center, one word, dot HRSA dot gov?

Ben Browning: Yes, ma'am. Absolutely, Robin.

Robin Kish: So Ben, before we wrap up, could you offer a tip or two on the best way to stay healthy, especially during these challenging times?

Ben Browning: First, make sure you have an established medical home. And as we've touched on a few times, it's imperative. Your primary care provider can not only help you stay healthy, but also provide you those additional resources to keep you and your family strong during these times. And second, please wear a mask. It's an individual choice. And I completely respect that. But as the CDC has recently clarified masks not only protect others, but they also protect you. And this is said by the medical experts to be the single most effective measure that folks can take to reduce and prevent the spread of the virus. So everybody has their own choice as to what they want to do, but I would simply ask please consider masking up.

Robin Kish: Well, excellent advice and insight, Ben. Appreciate you taking the time to talk to us.

Ben Browning: Well, thank you for having me on. It's been great to be here and I do wish the best of health to all of your listeners.

Robin Kish: Well, thanks and thanks to all of our listeners. If you find this podcast helpful, share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcast.org. Let us know what you think. Your review helps us reach more people just like you. And if you have a suggestion about a future podcast topic, have questions or some feedback, call (561) 804-4111.

Today's podcast is brought to you by the CL Brumback Primary Care Clinics, which offer women's health services, medication-assisted treatment for patients with substance use disorders, as well as primary care, dental services, behavioral health and pharmacy services for adults and children. Call (561) 642-1000 to make an appointment or visit www.brumbackclinics.org.