For our country to truly achieve health equity, all people must have a fair and just opportunity to be healthy without impediment. Achieving health equity means removing the barriers that prevent people from being healthy – systemic racism, poverty, and lack of access to economic mobility.
Inside health centers, we strive for organizational equity, which includes staff that reflect the populations served, and governance that includes anti-racist policies and procedures. We also strive for equity in care delivery, which means patients receive care that is culturally appropriate and based in trust. Ultimately, we seek a nation where we no longer have disparities in health outcomes by race and ethnicity.
We envision a health care funding structure where the 340B program works exactly as it was designed and enables health centers to invest dollars back into care for vulnerable patients. Federally qualified health centers (FQHCs) are the linchpin of our nation’s health care safety net, serving as health care homes for nearly 30 million people every year. These characteristics were part of the program’s original design. In order to qualify for section 330 community health center grant funding from the federal government, health centers must commit to serving all individuals in their service area, regardless of insurance status or ability to pay. Part of the health center model is to help connect their patients and community with enabling services and a variety of supports to ensure ongoing access to quality health care, which is often accomplished by providing those services on a sliding fee scale. For millions of Americans every year, their community health center is their lifeline—providing services irrespective of their employment status, insurance status, or current financial situation. While the health center program expanded with investment from the Affordable Care Act, the current reach of community health centers would not be possible without the 340B program.
In today’s health care environment, FQHCs depend on the 340B program to meet their mission, putting every dollar received back into the communities they are serving. Numerous external evaluators have found that payer reimbursement rates consistently fail to cover the cost of the comprehensive services provided in the community health center environment. In fact, when Congress created the program in 1992, they recognized this reality – that the 340B drug pricing program would allow these providers to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.” By allowing the purchase of drugs at a discounted price, the 340B program enables health centers to serve more patients, at a higher level of complexity, than they otherwise could. Effectively, health center use and engagement in the 340B program exemplifies the intent behind its creation: to maximize federal investment and expand care to underserved communities as effectively as possible.
The COVID-19 pandemic has only made health centers more vital as the nation grapples with economic insecurity and the severe implications of the pandemic across a broad spectrum of social determinants of health. Throughout the pandemic, health centers have administered more than 13 million vaccines and 12 million COVID tests—the majority of which were delivered to BIPOC (Black, Indigenous and people of color) communities—and these numbers continue to climb daily. It has long been our mission to help communities in need, and now we need our country’s leaders to take action to help us.
COVID-19 has had long-term impacts – both in patients who suffer lasting effects, as well as health centers who have had to change the way they care for their communities. ACH supports a broad range of policy changes that are meant to build from lessons learned from the pandemic and improve care delivery into the future.
Over the past decade, the federal government has started to reimburse for health care through a value-based payment structure. This shift will drive a more financially-sustainable, affordable, and efficient system. Unfortunately, health centers have not participated as fully as their capacity and expertise would allow. Policymakers can and should prioritize these safety net providers, both due to the size of the population served—nearly 29 million patients in 2020—and their ability to connect value-based care to the shared goal of health equity. FQHCs are ready to lead the way to a more equitable, holistic approach to care for the underserved, through patient-centered, value-based care.
We envision a health care system and a network of health centers with a robust and diverse workforce reflective of the patients and communities they serve. Further, we see health centers as a centerpiece in creating an abundant pipeline of skilled professionals who have the infrastructure necessary to provide exceptional care to patients. As a professional home for this skilled and diverse workforce, access to professional development and mental health services, systems to maintain a sustainable workload, and pathways for growth must be in place. We believe community health centers should have a culture of continuous learning and growth at every level in their organizations.
Serving nearly 30 million patients annually, we are ready to ambitiously pursue innovative solutions that improve the health outcomes of the communities we serve. Already our members exemplify innovation in population health, health information technology, behavioral health, emergency response, and specialty care. With the current pandemic, there is even greater need for investments in innovations that make our workforce more efficient, while maintaining a high quality of care.
We believe that community health centers are poised to lead the way in building a community-based continuum of care that can change how we deliver services to patients in need. To do so, we will need more sophisticated analytics, recognizing health outcomes and operational excellence, and tools that can drive innovation.