Community Health Center Chartbook 2020 - NACHC

1 CommunityHealthCenterChartbook2020*Inclu despatientsoffederally-fundedhealthcente rs,look-alikes, Community Health CentersTheNationalAssociationofCommunity HealthCenters( NACHC )ispleasedtopresentth eCommunityHealthCenterChartbook, s WaronPoverty. Theiraimthen,asitisnow,istoprovideafford able,highquality,comprehensiveprimarycar etomedicallyunderservedpopulations, ,behavioralhealth,pharmacy, ,buttheyallshareonecommonpurpose:toprovi decoordinated,culturallycompetent, ,deliveringcareto29million* , ,reducehealthdisparities, ,includingsubstanceusedisorder,mentalill ness,naturaldisasters,andhomelessness ,alongwithadequatethirdpartyreimbursemen t, ,whattheydo, this ChartbookTheCommunityHealthCenterChartbo okhighlightsimportantresearchanddataonHe althCenterProgramGrantees,aswellasotherF ederally-QualifiedHealthCenters(FQHCs).I nthisdocument,unlessotherwisenoted,thete rm healthcenter isgenerallyusedtorefertoorganizationstha treceivegrantsundertheHealthCenterProgra masauthorizedundersection330ofthePublicH ealthServiceAct,asamended(referredtoas grantees ).

2 (UDS)maintainedbytheBureauofPrimaryHealt hCare,HRSA, , of ContentsSection 1: Who Health Centers Serve1-1 Health Centers Serve 1 in 12 People in the Centers Serve Many Special Populations1-3 Health Centers Serve Greater Proportions of Special Populations1-4 Health Center Patients are Predominately Low-Income1-5 Most Health Center Patients are Uninsured or Publicly Insured1-6 Health Center Patients Health Insurance Coverage is Unique Among Ambulatory Care Providers1-7 Health Centers Serve More Medicare and Medicaid Dual Eligiblesthan Other Ambulatory Care Providers1-8 Health Center Patients are Disproportionately Poor, Uninsured, and Publicly Insured1-9 Health Center Patients are Disproportionately Members of Racial/Ethnic Minority Groups1-10 Health Center Patients Suffer from Chronic Conditions at Higher Rates than the General Population1-11 Health Center Patients are Growing Increasingly Complex, with Higher Rates of Chronic Conditions than in Previous Years1-12 Health Centers Serve Patients Throughout the Life Cycle1-13 Health Center Patients Ages 65 and Older are the Fastest Growing Age GroupSection 2: Expanding Access to Care2-1 Number of Federally-Funded Health Center Organizations by State, 20182-2 Growth in Health Center Organizations and Sites, 2009 20182-3 Growth in Health Center Patients and Visits, 2009 20182-4 Health Centers Have Expanded Their Capacity To Provide More services Onsite2-5 Health Centers Have Higher Rates of Accepting New Patients Compared to Other Primary Care ProvidersTable of ContentsSection 2: Expanding Access to Care ( )2-6 Health Center Patients by Insurance Status, 2009 20182-7 Percent of Medicaid Beneficiaries Served by Health Centers, 20182-8 Percent of Uninsured Population Served by Health Centers, 2018 Section 3.

3 High Quality Care and Reducing Health Disparities3-1 Health Centers Achieve Higher Rates of Hypertension and Diabetes Control than the National Average, Despite Serving More At-Risk Patients3-2 Many Health Centers Exceed Healthy People 2020 Goals3-3 Health Center Patients Have Lower Rates of Low Birth Weight than Their Counterparts, Despite Serving More At-Risk Patients3-4 Health Center Patients are More Satisfied with Care Received Compared to Low-Income Patients Nationally3-5 Enabling services are a Defining Characteristic of Health Centers and Help Improve Access to Care and Patient Satisfaction3-6 Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores3-7 Health Centers Provide More Preventive services than Other Primary Care Providers3-8 Women at Health Centers are More Likely to Receive Mammograms than Their Counterparts Nationally3-9 Women at Health Centers are More Likely to Receive Pap Smears than Their Counterparts NationallyTable of ContentsSection 3.

4 High Quality Care and Reducing Health Disparities ( )3-10 Health Center Patients are More Likely to Receive Colorectal Cancer Screenings than Their Counterparts Nationally3-11 Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians3-12 Health Centers Provide More Value-Driven Care Compared to Private Practices3-13 Percent of Health Centers with Patient-Centered Medical Home Recognition, July 2019 Section 4: Cost-Effective Care4-1 Health Centers are Increasingly Participating in New Payment and Delivery System Models4-2 Health Centers Save 24% Per Medicaid Patient Compared to Other Providers4-3 Health Centers Have Lower Total Spending Per Medicaid Patient Compared to Other Providers4-4 Health Center Medicaid Revenues as a Percent of Total Medicaid Expenditures4-5 Health Centers are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other Providers4-6 Medicare Spending is Lower in Areas Where Health Centers Serve More Low-Income Residents4-7 Health Centers Save 35% Per Child Compared to Other Providers4-8 Health Centers Save $1,263 (24%) Per Patient Per Year4-9 Health Centers Average Daily Cost Per Patient is Lower than Other Physician Settings4-10 Health Centers are Economic Drivers by Promoting Growth in Local and State EconomiesTable of ContentsSection 5.

5 Health Center Staffing and Services5-1 Growth in Health Center Clinical Staff, 2009 20185-2 Health Center Care Team Staff Provide a Broad Array of Services5-3 Health Center Medical services Staff, 20185-4 Health Centers are Hiring Non-Physician Providers at Higher Rates than Physicians5-5 Health Center Enabling services and Other Programs Staff, 20185-6 Percent of Health Centers Offering Case Management services Onsite, 20185-7 Health Center Dental Staff, 20185-8 Percent of Health Centers Offering Dental services Onsite, 20185-9 Health Center Behavioral Health Staff, 20185-10 Percent of Health Centers Offering Behavioral Health services Onsite, 20185-11 Health Centers Have Responded to an Increasing Need For Substance Use Disorder (SUD) Treatment and Therapy By Building Their Capacity and Integrating Care5-12 Percent of Health Centers with Staff Authorized to Provide Medication-Assisted Treatment (MAT) for Opioid Use Disorder, 20185-13 Health Centers Have Responded to an Increasing Need for Substance Use Disorder (SUD) Treatment and Therapy by Seeing More Patients5-14 Percent of Health Centers Offering Vision services Onsite, 20185-15 Percent of Health Centers Offering Pharmacy services Onsite, 20185-16 Percent of Health Centers Offering Four or More services Onsite, in Addition to Medical Care Table of ContentsSection 5: Health Center services and Staffing ( )5-17 Percent of Health Centers Using Telehealth5-18 Health Centers are Using Telehealth to Expand Access to Needed Services5-19 Health Centers are Adopting Innovative Telehealth services at Higher Rates than Other Primary Care Providers5-20 Percent of Health Centers Using Telehealth for Interacting with Patients, 20185-21 Percent of Health Centers Using Telehealth for eConsultswith Other Providers, 2018 Section 6.

6 Challenges in Meeting Demand for Care6-1 Payments from Third Party Payers are Less than Cost6-2 Federal Health Center Appropriation History, FY10 FY196-3 Health Center Operating Margins are Less than Hospital Operating Margins6-4 Health Center Funding Per Uninsured Patient Is Well Below Total Per Patient Cost6-5 Health Centers Experience Difficulty Recruiting Many Clinical Staff6-6 Health Centers Have Unique Challenges Recruiting and Retaining Staff6-7 Health Centers Face Barriers to Offering Telehealth Services6-8 Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians6-9 Health Center Capital Project Plans and Funding NeedsSection 1 Who Health Centers ServeSources:(1) NACHC , ,estimatesforannualpatientgrowth,andnati onaldatasources.(2) Centers Serve1 in 12 People in the 1-11 in 7 Racial/Ethnic Minorities1 in 9 Children1 in 5 Uninsured Persons1 in 5 Medicaid Beneficiaries1 in 3 People in Pover ty995,232 Agricultural Worker ,HRSA, Centers Serve Many Special PopulationsFigure 1-26,706,410 Patients Best Served in a Language Other than English4,415,160 Public Housing Patients819,177 School-Based Health Center Patients1,413,256 Patients Experiencing Homelessness385,222 Veterans* :(1)2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA,DHHS.

7 (2)LegalServicesCorporation:Agricultural -WorkerPopulationEstimates,FinalEstimate s,July2016.(3) (AHAR)toCongress,December2018.(4) , Centers Serve Greater Proportions of Special PopulationsFigure WorkersIndividuals Experiencing HomelessnessResidents of Public Housing* PopulationHealth Center PopulationNotes:FPL= :2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, Center Patients are Predominately Low-Income Figure 1-4 100% FPL and Below68%101 -150% FPL16%151 -200% FPL8%Over 200% FPL9%91% of Health Center patients are in or near :Percentagefor OtherPublicInsurance includesnon-MedicaidCHIP, :2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, Health Center Patients are Uninsured or Publicly InsuredFigure 1-548%23%10%1%18%MedicaidUninsuredMedica reOther Public InsurancePrivate Insurance82% of Health Center patients are uninsured or publicly :Percentagesmaynotaddto100% :(1)2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA,DHHS.(2)NationalAmbulatoryMedic alCareSurvey, , (3)NationalHospitalAmbulatorySurvey, :UnitedStates, Center Patients Health Insurance CoverageIs Unique Among Ambulatory Care ProvidersFigure 1-648%34%14%23%8%3%10%18%25%1%16%8%18%32 %60%CHCE mergency DepartmentPrivate PhysicianPrivate InsuranceOther / UnknownMedicareUninsuredMedicaidSources: (1)2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA,DHHS.

8 (2)NationalHospitalAmbulatorySurvey, :UnitedStates, (3)NationalAmbulatoryMedicalCareSurvey, :UnitedStates, (4)CentersforMedicareandMedicaidServices Medicare-MedicaidCoordinationOffice, Centers Serve More Medicare and Medicaid Dual EligiblesThan Other Ambulatory Care ProvidersFigure 1-76%21%39%0%100%Private PhysicianEmergency DepartmentCHCT otal Medicare PatientsMedicare OnlyPatientsDual EligiblePatientsNationally, 20% of the Medicare population is dually enrolled in :FPL=federalpovertylevel.* :(1)2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA,DHHS.(2) ,2018 AmericanCommunitySurvey1-YearEstimates,T ablesB17002,S2704, Center Patients are Disproportionately Poor, Uninsured, and Publicly InsuredFigure 1-830%13%15%9%91%68%48%23%Under 200% FPLAt or Below 100% FPLM edicaid* PopulationHealth Center PopulationNotes:Figuresmaynotaddto100% :(1)2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, :Nationalracial/ethnicminorityestimateca lculatedusingtheReferenceGuideforUDSData ReportsAvailabletoHealthCenters,CY2018,B ureauofPrimaryHealthCare,HRSA,DHHS.

9 (2) ,2018 AmericanCommunitySurvey1-YearEstimates, Center Patients are Disproportionately Members of Racial/Ethnic Minority Groups Figure 1-960% , Non-HispanicAmerican Indian / Alaska NativeMultiracialAsian American / Native Hawaiian /Pacific IslanderAfrican American / BlackHispanic / LatinoHealth Center PopulationNationally, 63% of the Health Center patients are members of racial/ethnic minorities compared to 40% of the general population.* :(1) ,HRSA,DHHS.(2) :UsedforHighCholesterol,Hypertension,Dia betes, (3) :UsedforAsthma; ,Territories, Center Patients Suffer from Chronic ConditionsAt Higher Rates than the General PopulationFigure 1-1032%36%14%11%18%45%42%21%21%42%Hypert ensionHigh CholesterolAsthmaDiabetes* Health is Fairor PopulationHealth CenterPercent of Adults who Report Ever Being Told They Have:Percent of Adults Reporting:*COPD=chronicobstructivepulmon arydisease** Center Patients are Growing Increasingly Complex, With Higher Rates of Chronic Conditions than in Previous YearsPercent Growth in Health Center Patients Diagnosed with Selected Chronic Conditions, 2013 -2017 Figure 1-11146%143%73%44%39%30%25%0%25%50%75%10 0%125%150%20132014201520162017 Overweight/ObesityCOPD*Substance Use Disorder**HIVD epressionDiabetesGrowth in Total PatientsSource.

10 2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, Centers Serve Patients Through the Life CycleSelected Age Groups, Represented Two WaysFigure 1-120%10%20%30%40%50%60%70%80%90%100%Und er 59%Ages 5-1214%Ages 13-178%Ages 18-193%Ages 20-4433%Ages 45-6424%Ages 65+9%Ages 65+ (9%)Ages 45-6424%Ages 18-4436%Under 1831%Source:2013&2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, Center Patients Ages 65 and Older Are the Fastest Growing Age GroupNumber of Health Center Patients by Age Group, 2013 -2018 Figure 1-136,885,9068,736,5097,970,45810,145,91 25,254,5396,895,6871,616,0622,601,572201 32018 Ages 18 4427% GrowthUnder 1827% GrowthAges 45-6431% GrowthAges 65+61% GrowthSection 2 Expanding Access to ,territory, :Guam,AmericanSamoa,NorthernMarianaIslan ds,Palau, :2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, of Federally-Funded Health Center Organizations, 2018 Figure 2-1CT16DC8DE3MA39MD17NH10NJ23RI8VT11 Nationally, there are 1,362 federally-funded Health Center :2009-2018 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, in Health Center Organizations and Sites, 2009 -2018 Figure 2-21,1311,1241,1281,1981,2021,2781,3751, 3671,3731,3627,2576,9497,6218,9129,1708, 8019,75410,40411,05611,74402,0004,0006,0 008,00010,00012,00014,00016,000020040060 08001,0001,2001,4001,6002009201020112012 201320142015201620172018 Service Delivery SitesHealth Center Grantee OrganizationsGranteesSitesSource:2009-20 18 UniformDataSystem,BureauofPrimaryHealthC are,HRSA, in Health Center Patients and Visits, 2009 -2018 Figure Visits (In Millions)Total Patients (In Millions)Total PatientsTotal Patient Visits*TheHealthResourcesandServicesAdmi nistration(HRSA)definesenablingservicesa s, non-clinicalservicesthatdonotincludedire ctpatientservicesthatenableindividualsto accesshealthcareandimprovehealthoutcomes .