A Sketch of Community Health Centers

Chartbook, August 2016

© National Association of Community Health Centers, August 2016

For more information, email research@nachc.org.

Cover picture provided courtesy of Urban Health Plan in Bronx, NY.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00 with 0% of the total

NCA project financed with non-federal sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Preface About this Chartbook

Section I: Who Health Centers Serve Figure 1.1: Health Centers ServeFigure 1.2: Health Center Patients Are Predominately Low Income Figure 1.3: Most Health Center Patients are Members of Racial and Ethnic Minority Groups Figure 1.4: Most Health Center Patients are Uninsured or Publicly Insured Figure 1.5: Health Centers are Serving a Higher Proportion of Uninsured Patients in the U.S.Figure 1.6: Health Center Patient Mix Is Unique Among Ambulatory Care Providers Figure 1.7: Health Centers Serve Patients Throughout the Life Cycle Figure 1.8: Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-InsuredFigure 1.9: Health Center Patients are Disproportionately Members of Racial/Ethnic Minority Groups Figure 1.10: Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians Figure 1.11: Health Centers Continue to Care for Patients Who Prefer to Be Served in Languages Other than EnglishFigure 1.12 Health Centers Serve Many Special Populations

Section II: Growth Among Federally-Funded Health CentersFigure 2.1: Health Center Grantee Organizations and Sites, 2005-2014 Figure 2.2: The Number of Health Center Patients Continues to Increase Figure 2.3: The Number of Health Center Patient Visits Continues to Increase Figure 2.4: Health Center Patients by Insurance Status, 2005-2014Figure 2.5: The Number of Health Center Patients in Poverty is Growing Faster than the Number in Poverty Nationally, 2005-2014Figure 2.6: The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, 2005-2014 Figure 2.7: Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental, and Mental Health Care, 2005-2014

Table of Contents

Section III: Access to Care Figure 3.1: Health Centers Have Higher Rates of Accepting New Patients Regardless of Insurance Coverage Compared to Other Primary Care Providers Figure 3.2: Percent of Uninsured Served by Health Centers, 2014Figure 3.3: Percent of Medicaid Beneficiaries Served by Health Centers, 2014Figure 3.4: Health Centers Provide a Broad Array of Services

Section IV: High Quality Care and Reducing Health DisparitiesFigure 4.1: Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice PhysiciansFigure 4.2: Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark ScoresFigure 4.3: Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low-Income Patients NationallyFigure 4.4: Health Centers Reduce Disparities in Access to MammogramsFigure 4.5: Health Center Women Needing Pap Smears are More Likely to Receive Them than Their Counterparts NationallyFigure 4.6: Health Center Patients Needing Colorectal Cancer Screenings Are More Likely to Receive Them than Their Counterparts NationallyFigure 4.7: Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. AverageFigure 4.8: Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. CounterpartsFigure 4.9: Health Centers Provide More Preventive Services than Other Primary Care Providers

Section V: Cost-Effective Care and Economic ImpactFigure 5.1: Areas with High Health Center Penetration Spend $926 Less per Medicare Beneficiary than Areas with Low Health Center PenetrationFigure 5.2: Health Centers are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other ProvidersFigure 5.3: Economic Impact (in millions) of Federal Health Center Funding by State, 2012Figure 5.4: Jobs Generated by Federal Health Center Funding by State, 2012Figure 5.5: Health Centers are Producing Savings Across the CountryFigure 5.6: Health Centers Save $1,263 Per Patient Per Year

Section VI: Health Centers’ Financial Health Figure 6.1: Health Center Funding Per Uninsured Patient is Well Below Total Per Patient CostFigure 6.2: Payments from Third Party Payers Are Less than Cost, 2014 Figure 6.3: Health Center Operating Margins are Less than Hospital Operating Margins Figure 6.4: Medicaid Revenue is Directly Proportional to Medicaid Patients, 2014 Figure 6.5: Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians Figure 6.6: Federal Health Center Appropriation History, FY2004-2016 Figure 6.7: 29 States Will Provide Funding to Health Centers in State Fiscal Year 2016 Figure 6.8: State Funding to Health Centers, FY16

Section VII: Staffing/Workforce Figure 7.1: Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, 2014Figure 7.2: Health Centers Medical Services Staff, 2014Figure 7.3: Health Centers Dental Services Staff, 2014 Figure 7.4: Health Centers Behavioral Health Services Staff, 2014 Figure 7.5: Health Centers Enabling Services Staff, 2014 Figure 7.6: Growth in Health Center Medical Providers, 2005-2014Figure 7.7: Health Centers Twice as Likely to Use Non-Physician Clinicians than Other Providers Figure 7.8: Health Centers Use More Non-Physician Clinicians than Other Providers Figure 7.9: The Ratio of PA, NP, and CNM FTEs to Physician FTEs Has Increased Rapidly at Health Centers

Section VIII: Remaining Challenges and Unmet Needs Figure 8.1: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013Figure 8.2: Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care NeedsFigure 8.3: Health Center Capital Project Plans and Funding Needs

Section IX: Look Alike Health CentersFigure 9.1: Look-Alike Health Center Patients Are Predominately Low Income Figure 9.2: Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minorities Figure 9.3: Most Look-Alike Health Center Patients are Uninsured or Publicly Insured Figure 9.4: Look-Alike Health Centers Serve Patients Throughout the Life Cycle Figure 9.5: Look-Alike Health Centers Provide a Broad Array of Services Figure 9.6: Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, 2014Figure 9.7: Look-Alike Health Center Medical Services Staff, 2014Figure 9.8: Look-Alike Health Center Dental Services Staff, 2014 Figure 9.9: Look-Alike Health Center Behavioral Health Services Staff, 2014 Figure 9.10: Look-Alike Health Center Enabling Services Staff, 2014

The National Association of Community Health Centers (NACHC) is pleased to present A Sketch of Community Health Centers, an overview of the Health Center Program and the communities they serve. Health centers began over fifty years ago as part of President Lyndon B. Johnson’s declared “War on Poverty.” Their aim then, as it is now, is to provide affordable, high quality, comprehensive primary care to medically underserved populations, regardless of their insurance status or ability to pay for services. A growing number of health centers also provide dental, behavioral health, pharmacy, and other important supplemental services. No two health centers are alike, but they all share one common purpose: to provide primary health care services that are coordinated, culturally and linguistically competent, and community-directed.

Health centers play a critical role in the health care system, delivering care to over 24 million* people. Across the country, health centers produce positive results for their patients and for the communities they serve. They stand as evidence that communities can improve health, reduce health disparities, and deal with a multitude of costly and significant health and social problems – including substance abuse, HIV/AIDS, mental illness, and homelessness – if they have the resources and leadership to do so.

Who health centers serve, what they do, and their impressive record of accomplishment in keeping communities healthy are represented in the following charts. Federal and state support, along with adequate third party reimbursement, are critically important to keep pace with rising costs and escalating health care needs among populations served by health centers.

Preface

*Includes patients of federally-funded health centers, non-federally funded health centers (health center “look-alikes”), and expected patient growth for 2015.

About this Chartbook

This Chartbook highlights data from and research findings on Community, Migrant, Homeless and Public Housing Health Centers, as well as other Federally-Qualified Health Centers (FQHCs). In this document, unless otherwise noted, the term “health center” is

generally used to refer to organizations that receive grants under the Health Center Program as authorized under section 330 of the Public Health Service Act, as amended

(referred to as “grantees”) and Look-Alike organizations, which meet all the Health Center Program requirements but do not receive Health Center Program grants. At the bottom of each figure, readers will find the data and research sources listed. Most slides draw from the Uniform Data System (UDS) maintained by the Bureau of Primary Health Care, HRSA, DHHS. Except for the final section in this Chartbook, UDS data included in this Chartbook

are limited to health centers that meet the federal grant requirements and receive federal funding from the Bureau of Primary Health Care.

Section I Who Health Centers Serve

Figure 1.1

Health Centers Serve:

• 1 in 14 people in the US

• 1 in 6 Medicaid beneficiaries

• 1 in 5 uninsured persons including

- 1 in 3 low income, uninsured

• 1 in 3 individuals below poverty

• 1 in 4 rural Americans Note: Includes patients of federally-funded health centers and non-federally funded health centers.Sources: 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau. Population Estimates. http://www.census.gov/popest/data/national/totals/2014/index.html. Kaiser Family Foundation. Total monthly Medicaid and CHIP Enrollment. December 2014. http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/#. U.S. Census Bureau, Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014. Available at http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf. U.S. Census Bureau, Current Population Reports, P60-252, Income and Poverty in the United States: 2014. Available at http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf. Kaiser Family Foundation. Population distribution by metropolitan status, 2014. Available at http://kff.org/other/state-indicator/metropolitan-distribution/.

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2014 was $19,790. (See https://aspe.hhs.gov/2014-poverty-guidelines). Based on percent known. Percents may not total 100% due to rounding.

Figure 1.2

Health Center Patients are Predominately Low Income

100% FPL and below71%

101-150% FPL15%

151-200% FPL6%

Over 200% FPL8%

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding. *The 62% of health center patients that are members of racial and ethnic minorities is not shown in this figure.

Figure 1.3

Most Health Center Patients are Members of Racial and Ethnic Minority Groups

Asian / Hawaiian / Pacific Islander

5%

Black / African American

23%

American Indian / Alaska Native

1%White67%

More than one race 4%

Hispanic / Latino35%

Non-Hispanic / Latino65%

62% of health center patients are members of racial and ethnic minority groups

*”Other public insurance” may include non-Medicaid CHIP and state-funded insurance programs. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding.

Figure 1.4

Most Health Center Patients are Uninsured or Publicly Insured

Uninsured28%

Medicaid / SCHIP47%

Medicare9%

Other Public Insurance1%

Private Insurance16%

Source: NACHC, 2013 and 2014. Includes all patients of federally-funded health centers, non-federally funded health centers, and expected patient growth. Data on federally-funded health centersfrom Bureau of Primary Health Care, HRSA, DHHS, 2012 and 2014 Uniform Data System (UDS). U.S. Census Bureau, Current Population Reports, P60-245, Income, Poverty, and Health Insurance Coverage in the United States: 2012 and Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014. Available at https://www.census.gov/prod/2013pubs/p60-245.pdf and https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf. Note: Proportion of all US residents does not account for health centers located in U.S. territories.

Figure 1.5

Health Centers are Serving a Higher Proportion of Uninsured Patients in the U.S.

1 in 7

1 in 5

0%

5%

10%

15%

20%

25%

2012 2014

* Combined total of individual sources exceeds “All visits” because more than one may be reported per visit.Sources: Based on Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS). Private Physicians from 2012 NAMCS (CDC National Center for Health Statistics, 2012). Hospital Outpatient from 2011 NHAMCS (CDC National Center for Health Statistics, 2011). Notes: Other public includes non-Medicaid SCHIP and other state-funded insurance programs.

Figure 1.6

Health Center Patient Mix is Unique Among Ambulatory Care Providers

47%

13%

35%

28%

5%

7%

9%

25%

20%

16%

60%

39%

1% 5% 6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Health Centers Private Physicians Hospital Outpatient Depts.

Other / Unknown

Private

Medicare

Uninsured

Medicaid

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding.

Figure 1.7

Health Centers Serve Patients Throughout the Life CycleUnder 5

10%

Ages 5-1214%

Ages 13-1910%

Ages 20-247%

Ages 25-4427%

Ages 45-6425%

Ages 65+8%

* Based on percent known.Sources: Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System. Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements).

Figure 1.8

Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-Insured, 2014

28%

47%

71%*

92%*

10%

19%15%

34%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Uninsured Medicaid At or below 100% of Poverty Under 200% of Poverty

Health Centers United States

Note: Percents may not total 100% due to rounding. Sources: Based on 2014 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Source for State and US Population for Race and Ethnicity: U.S. Census Bureau, Population Division: “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States, States, and Counties: April 1, 2010 to July 1, 2014” Released June 2014.

Figure 1.9

Health Center Patients are Disproportionately Members of Racial and Ethnic Minority Groups, 2014

35%

23%

5%

1%

17%

13%

6%

1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Hispanic/ Latino African American/Black Asian/Hawaiian/PacificIslander

American Indian/AlaskaNative

Health Centers

United States

18%

13%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Health Centers Physician Offices

11%*

15%***

8%**

27%

9%11%

7%

25%

0%

5%

10%

15%

20%

25%

30%

Depression Diabetes Asthma Hypertension

Health Centers Private Physician Offices

Figure 1.10

Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians

Note: Statistical significance measures compared to value for private physician offices; *** p < .01 , ** p < .05, * p < .10“Common chronic conditions” include visits where the primary diagnosis listed for the visit is an ICD-9-CM diagnosis code for hypertension, asthma, diabetes, heart disease, and selected psychotic conditions and other psychoses. Excludes visits classified as “pre/post surgical,” all visits to non-primary care physicians, and any visits where the patient did not see a physician. Source: Based on George Washington University analysis from Kaiser Commission on Medicaid and the Uninsured. Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth. (March 2013). http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8098-03.pdf

Percentage of Physician Visits Involving Patients with Common Chronic Conditions

Percentage of Physician Visits Involving Patients with the Specified Chronic Condition

Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 1.11

Health Centers Continue to Care for Patients Who Prefer to be Served in Languages Other than English

4.14.3 4.3 4.4

4.6 4.7 4.64.8

5.05.3

0

1

2

3

4

5

6

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er

of

Pat

ien

ts (

in m

illio

ns)

29% increase since 2005

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 1.12

Health Centers Serve Many Special and Vulnerable Populations

891,796Agricultural

Worker Patients

569,107School-Based Health

Center Patients

1,151,046Homeless Patients

429,251Public Housing

Patients

289,391Veteran Patients

Section IIGrowth Among Federally-Funded

Health Centers

Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 2.1

Health Center Grantee Organizations and Sites,2005-2014

952 1,002

1,067 1,080 1,131 1,124 1,128

1,198 1,202 1,278

5,703 6,139

6,612

8,320 7,257

6,949

7,621

8,912 9,170 8,801

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

-

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

1,300

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er o

f Sites

Nu

mb

er

of

Gra

nte

e O

rgan

izat

ion

s

Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS

Figure 2.2

The Number of Health Center Patients Continues to Increase

14.115.0

16.117.1

18.819.5

20.221.1

21.722.9

0

5

10

15

20

25

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er

of

Pat

ien

ts (

in m

illio

ns)

62% growth since 2005

Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 2.3

The Number of Health Center Patient Visits Continues to Increase

55.559.2

63.067.0

73.877.1

80.083.8 85.6

90.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Pat

ien

t V

isit

s (i

n m

illio

ns)

63% growth since 2005

Source: Federally-funded health centers only. 2005-2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 2.4

Health Center Patients by Insurance Status, 2005-2014

5.66.0 6.2

6.6

7.2

7.3 7.4 7.6 7.6

6.4

5.05.3

5.76.1

6.9

7.58.0

8.48.8

10.7

2.1 2.3 2.5 2.7 2.7 2.7 2.9 3.0 3.13.6

1.1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.0

0.3 0.4 0.4 0.5 0.6 0.5 0.5 0.5 0.4 0.3

0

2

4

6

8

10

12

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er

of

Pat

ien

ts (

in m

illio

ns)

Uninsured

Medicaid

Private

Medicare

Other

*Represents patients/people under 100% of the federal poverty level U.S. Bureau of the Census, Current Population Survey, Annual Economic Supplements. Table 7. Poverty of People, by Sex 1966-2014. https://www.census.gov/hhes/www/poverty/data/historical/people.html. 2005-2014 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Figure 2.5

The Number of Health Center Patients in Poverty is Growing Faster than the Number in Poverty Nationally,

2005-201453%

26%

0%

10%

20%

30%

40%

50%

60%

Health Center Patients in Poverty People in Poverty Nationally

Sources: Bureau of Primary Health Care, Health Resources and Services Administration, DHHS. 2005 and 2014 Uniform Data System. Kaiser Commission on Medicaid and the Uninsured. Monthly Medicaid Enrollment (in thousands), Dec 2005. http://kff.org/medicaid/state-indicator/monthly-medicaid-enrollment-in-thousands/. Total Monthly Medicaid and CHIP Enrollment, Dec 2014. http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/. Note: Federally-funded only.

Figure 2.6

The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries

Nationally, 2005-2014112%

64%

0%

20%

40%

60%

80%

100%

120%

Health Center Medicaid Medicaid Nationally

Note: Mental health does not include substance abuse. Percent Increase is calculated using actual patient and patient visit numbers, not with rounded numbers presented in this chart. Source: 2005- 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

0.26 – 1.1 million

1.3 – 5.6 million

37.8 – 61.1 million

11 – 18.6 million

Figure 2.7

Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental,

and Mental Health Care, 2005-2014

57% 52%

104%115%

206%214%

0%

50%

100%

150%

200%

250%

Patients Patient Vistis

Medical

Dental

Mental

12.4 – 19.5 million

42.0 – 63.8 million

2.3 – 4.8 million

5.6 – 11.9 million

.41 – 1.3 million

1.98 – 6.2 million

Section IIIAccess to Care

Source: Hing E, Hooker RS, Ashman JJ. Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 June; 36(3): 406-13.

Figure 3.1

Health Centers Have Higher Rates of Accepting New Patients Compared to Other Primary Care Providers

98% 97% 96% 97%93%

66%

76%

89%

0%

20%

40%

60%

80%

100%

120%

New Patients New Medicaid Patients New Medicare Patients New Uninsured

Health Center Other Primary Care Providers

31%

39%

12%39%

12% 19%

15%

29% 11%

17%

17%

18%23%

41%27%

25%

28%

14%

14%

18%

11%

25%

19%

22%

18%35%

41%24%

31%

7%22%

27% 19%

13%

18%13%

16%

22%

25%

12%22%

33%

% of Uninsured Served by HCs

< 14.8%

14.8 – 20.8%

20.8 – 27.4%

27.4 – 35.2%

> 35.2%

VT – 29%NH – 17%MA – 36%RI – 40%CT – 25%NJ – 16%DE – 23%MD – 18%DC – 72%

Figure 3.2

Percent of Uninsured Served by Health Centers, 2014

Source: Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System. Kaiser Family Foundation. Distribution of the Nonelderly Uninsured, 2014. http://www.statehealthfacts.org/comparebar.jsp?ind=136&cat=3 . U.S. Census American Fact Finder. Health Insurance Coverage Status, 2010-2014 American Community Survey 5-year Estimates, Puerto Rico.

16%

32%

VT – 27%NH – 15%MA – 21%RI – 31%CT – 27%NJ – 16%DE – 23%MD – 14%DC – 37%

> 9.4%

9.4 – 13.8%

13.8 – 20.2%

20.2 – 26.2%

> 26.2%

% Medicaid Patients Served by HCs

25% 28%22%

22%

16%

16%14%

18%14%

16%

14%

14%

16%

14%

20%

15%

7%

6%9%

4%

8%

9%7%

8%

13%13%

11%

8%

12% 11%

12%

6%

13%

20%

28%

6%13%

10%

13%

8%

12%

Figure 3.3

Percent of Medicaid Beneficiaries Served by Health Centers, 2014

32%

Source: 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Kaiser Family Foundation. Total Monthly Medicaid and CHIP Enrollment. Dec 2014. CMS, Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports: February 2014 - November 2015 (preliminary), as of January 27, 2016. See http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/#. Mach AL. Congressional Research Service. Puerto Rico and Health Care Finance: Frequently Asked Questions. Nov 2015. www.crs.gov

16%

Note: Encounters for enabling services include visits to case managers and health educators. Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Figure 3.4

Health Centers Provide a Broad Array of Services

71%

13%

8%

6%2% 1%

Medical Care

Dental

Behavioral Health

Enabling Services

Other ProfessionalServices

Vision

Percent of Patient Visits for:

Total90,379,441 patient

visits in 2014

Section IVHigh Quality Care and

Reducing Health Disparities

Source: Goldman, L.E., Chu, P.W., Tran, H., Stafford, R.S. 2012. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine, 43(2):142-149.

Figure 4.1

Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

93%

84%

86%

47%

44%

37%

99%

91%

90%

59%

57%

51%

0% 20% 40% 60% 80% 100% 120%

No electrocardiogram screening in low-risk patients

No use of benzodiazepines in depression

Blood pressure screening

β-Blocker use in coronary artery disease

Aspirin use in coronary artery disease

Ace inhibitor use in congestive heart failure

Health Centers Private Practice Physicians

79%73%

81%

71%

63%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Diabetes Control Blood Pressure Control Pap Test

Shar

e o

f P

atie

nts

Me

etin

g Q

ual

ity

Be

nch

mar

k

Average Rate in High-Performing Health Centers Average Rate in All Health Centers

Figure 4.2

Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores

Source: Shin P, Sharac J, Rosenbaum S, Paradise J. Quality of care in community health centers and factors associated with performance. Kaiser Commission on Medicaid and the Uninsured Report #8447 (June 2013), available at http://kff.org/medicaid/issue-brief/quality-of-care-in-communityhealth-centers-and-factors-associated-with-performance/.Note: Quality Measures include control of diabetes: share of patients with diabetes with HbA1c between 7% and 9%; Control of hypertension: share of patients with hypertension with blood pressure < 140/90 mm Hg; Pap Tests: share of female patients age 24 – 64 who received Pap test within past three years.

Medicaid MCO High Performance Benchmark (75th percentile)

62% 62%

72%

Figure 4.3

Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low-Income

Patients Nationally

Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.

96% 98%

37%

87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Satisfied with Hours of Operation Satisfied with Overall Care Received

Health Center Patients Uninsured Patients Nationally

Figure 4.4

Health Centers Reduce Disparities in Access to Mammograms

Note: Rates calculated for women over the age of 50 receiving a mammogram over the last 2 years. All categories are statistically significant at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.

81% 82%78%

63%66% 66%

63%

45%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Hispanic African American Medicaid Uninsured

% R

ece

ivin

g M

amm

ogr

am

Health Centers Low Income Nationally

Figure 4.5

Health Center Women Needing Pap Smears are More Likely to Receive Them than Their Counterparts

Nationally

Note: Rates calculated for pap smear screening in last 3 years. Health Center rate significantly lower at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 21–64, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.

89% 92% 92%

79%79% 81% 80%

70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hispanic African American Medicaid Uninsured

Health Centers Nationally

% R

ece

ivin

g P

ap S

me

ar

Figure 4.6

Health Center Patients Needing Colorectal Cancer Screenings Are More Likely to Receive Them than Their

Counterparts Nationally

Note: Health Center rate significantly lower at the p < 0.05 level except for Hispanic where there is no significance.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for individuals, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.

40%

62% 60%

34%29%

44%

35%

18%

0%

10%

20%

30%

40%

50%

60%

70%

Hispanic African American Medicaid Uninsured

Health Centers Low Income Nationally

% R

ece

ivin

g C

olo

rect

al C

ance

r Sc

ree

nin

g

Sources: U.S. rates from National Center for Health Statistics (NCHS). Bureau of Primary Health Care, HRSA, DHHS, 2006-2014 Uniform Data System.

8.3%8.2% 8.2% 8.2%

8.1%

7.9%8.0% 8.0% 8.0%

7.7%7.8%

7.6%

7.3%7.4% 7.4%

7.1%

7.3% 7.3%

6.4%

6.6%

6.8%

7.0%

7.2%

7.4%

7.6%

7.8%

8.0%

8.2%

8.4%

2006 2007 2008 2009 2010 2011 2012 2013 2014

United States Health Centers

Figure 4.7

Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. Average

Figure 4.8

Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. Counterparts

Source: Shi, L., et al. “America’s health centers: Reducing racial and ethnic disparities in prenatal care and birth outcomes.” 2004. Health Services Research, 39(6), Part I, 1881-1901.

7.7% 7.5%

13.0%

6.5% 6.8%

8.2%7.5%

14.9%

6.0%

9.1%

7.5%6.6%

10.7%

5.6%

7.4%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Total Asian Black Hispanic White

US US Low Income Health Center

Source: Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians' Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.

Figure 4.9

Health Centers Provide More Preventive Services than Other Primary Care Providers

15%

19%

81%

65%

37%

24%

33%

85%

70%

51%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Asthma Education for Asthmatic Patients

Tobacco Cessation Education for Smoking Patients

Pap Smears in the last 3 years

Immunizations for 65 years and older

Health Education

Health Center Patients Visits Patient Visits to Other Providers

Section VCost-Effective Care and

Economic Impact

$8,616

$9,542

$9,222

$8,100

$8,400

$8,700

$9,000

$9,300

$9,600

$9,900

High Health Center Penetration Area Low Health Center Penetration Area All Areas

Source: Sharma R, Lebrun-Harris L, Ngo-Metzger Q. Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents. Medicare & Medicaid Research Review. 2014; 4(3):E1-E17.Notes: High health center penetration corresponds to 54% health center penetration rate among low-income residents; Low health center penetration corresponds to 3% health center penetration rate among low-income residents; Average health center penetration rate among low-income residents was 21%.

Figure 5.1

Areas with High Health Center Penetration Spend $926 Less per Medicare Beneficiary than Areas with Low Health Center Penetration

10% Lower Medicare Spending in Areas with High Health

Center Penetration

Tota

l Me

dic

are

Co

st p

er

Be

nef

icia

ry

$2,370

$2,667

$3,580

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

Health Centers Physician Offices Outpatient Clinics

Figure 5.2

Health Centers Are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other Providers

Source: Mukamel DB, White LM, Nocon RS, et al. Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings. Health Serv Res. 2015 July.

10% lower than physician office patients and 30% lower than outpatient clinic patients

Figure 5.3

Economic Impact (in millions) of Federal Health Center Funding by State, 2012

Note: Economic impact of federal health center funding only, by state. Economic impact includes direct impact, such as money generated in the community, and indirect impact, such as goods and services purchased and additional economic stimulus generated.Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.

National Economic Impact

$4,360,479,127

Figure 5.4

Jobs Generated by Federal Health Center Funding by State, 2012

Note: Jobs generated by federal health center funding only.Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.

Total Jobs Generated

31,860

Fig. 5.5

Health Centers Are Producing Savings Across the Country

Sources: Mundt C, Yuan S. An evaluation of the cost efficiency of Federally Qualified Health Centers (FQHCs) and FQHC look alikes operating in Michigan. Oct 2014. The Institute for Health Policy at Michigan State University. California Primary Care Association. Value of community health centers study: Partnership HealthPlan of California case study. Jan 2013. Available at http://cpca.org. Rothkopf J, et al. Medicaid patients seen at federally qualified health centers use hospitals services less that those seen by private providers. Health Aff. 2011 July; 30(7): 1335-42. Texas Association of Community Health Centers. Comparative costs of community health centers and other usual sources of primary care: The Texas story. 2011. Available at www.tachc.org. Richard P, et al. Bending the cost curve in North Carolina: The experience of community health centers. Policy Research Brief #24. August 2011. Geiger Gibson/RCHN Community Health Foundation Collaborative at the George Washington University. Rust G, et al. Presence of a community health center and uninsured emergency department visits in rural counties. J Rural Health. 2009 Winter: 25(1): 8-16.

Figure 6.5

Health Centers Save $1,263 Per Patient Per Year

$4,043

$5,306

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Health Center Users Non-Health CenterUsers

Hospital EmergencyDepartment

Hospital Inpatient

Ambulatory

Other Services

Source: NACHC analysis based on Ku L et al. Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs.

GWU Department of Health Policy. Policy Research Brief No. 14. September 2009.

Fig. 5.6

Section VIHealth Centers’ Financial Health

Figure 6.1

Health Center Funding Per Uninsured Patient Is Well Below Total Per Patient Cost

Note: Not adjusted for inflation. Federal appropriations are for consolidated health centers under PHSA Section 330.Source: Federally-funded health centers only. 2005 - 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

$270 $267 $270 $281 $271 $273 $312

$344 $374

$504 $515 $538 $562 $588 $600

$630 $654 $687

$721 $763

$-

$100

$200

$300

$400

$500

$600

$700

$800

$900

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Annual Federal Health Center Funding per Uninsured Patient Annual Health Center Cost per Patient

Figure 6.2

Payments from Third Party Payers Are Less than Cost, 2014

Note: Health centers are non-profits, and thus charges are a proxy for costs. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

81%

63%60%

57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Medicaid Medicare Other Public Insurance Private Insurance

Pe

rce

nt

of

Ch

arge

s C

olle

cte

d f

rom

Th

ird

Par

ty

Pay

ers

, 20

14

Figure 6.3

Health Center Operating Margins are Less than Hospital Operating Margins

* Note: Operating margin data for “Hospitals” in 2014 is unavailable.Source: Avalere, Health analysis of American Hospital Association Annual Survey Data, 2013 for community hospitals. Available at http://www.aha.org. Trendwatch Chartbook 2015, Supplementary Data Tables, Trends in Hospital Financing. Federally-funded health centers only. 2003 - 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

3.3% 3.6% 3.7% 4.0% 4.3%

3.3%

4.4%

5.5% 5.5%

6.5%5.7%

1.8%

3.4%4.7% 3.4%

1.6%

3.02%

0.5% 0.9% 1.0%0.2%

0.8%-0.1%

-1.1%

-2.4%

-0.2%

1.6%

1.1%

2.63%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Hospital

Health Centers with American Recovery and Reinvestment ACT (ARRA) Funds

Health Centers without American Recovery and Reinvestment ACT (ARRA) Funds

Figure 6.4

Medicaid Revenue is Directly Proportional to Medicaid Patients, 2014

Notes: Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

46.7% 42.4%

8.6%6.1%

1.3%1.5%

15.6%

8.2%

27.9%

5.2%

36.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Patients' Insurance Status Health Center Revenue

Grants/Contracts/Other

Uninsured

Private Insurance

Other Public Insurance

Medicare

Medicaid

Figure 6.5

Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians

Note: Private Physicians does not equal 100% due to reporting in NAMCS. Source: Private Physician data: 2010 National Ambulatory Medical Care Survey (Summary Table 5). Based on Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System.

66.9%

12.70%

9.6%

24.90%

2.4%

2.90%

12.9%

60.20%

8.3%

4.80%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Health Center Private Physicians

Self-Pay/Uninsured

Private Insurance

Other Public Insurance

Medicare

Medicaid/SCHIP

Figure 6.6

Federal Health Center Appropriation History, FY2004-FY2016

Note: Federal appropriations are for consolidated health centers under PHSA Section 330. Federally funded health centers only .

$1.78 $1.99 $2.07 $2.19 $2.19

$2.60 $2.78

$2.99

$3.69

$5.1 $5.1

$-

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16

Ap

pro

pri

atio

ns

(in

bill

ion

s)

MA

AK

AL

AZ

CA

DC

DE

GA

ID

KY

LA

MD

ME

MI

MT

OR

PR

SD

TX

WA

WY

IA

VTND

NVUT

RI

PA

MN

IL

VA

OH

NH

OK

MS

NE CT

KS

NC

WI

TN

HI

MO

WV

AR SCNM

INCO

FL

NJ

NY

None

Less than $2 million$2 million - $15 million

$30 million - $80 million

Figure 6.7

29 States Will Provide Funding to Health Centers in State Fiscal Year 2016

Source: NACHC, 2015. State Fiscal Year 2016 Funding for Community Health Centers, State Policy Report #58. http://www.nachc.com/client//funding%20brief%203%2021%2016.pdfNo Data Available

$16 million - $29 million

Figure 6.8

State Funding to Health Centers, FY16• 29 states will receive a total of $335 million

• Down from $350 million in FY15.

FY16 Funding:• Increased in 10 states

(GA, KS, MD, MA, MN, NE, NM, NY, TN, and VA)

• Decreased in 13 states(AR, CO, CT, FL, IN, IA, MS, NH, NJ, OK, TX, UT, and WV)

• Remained level in 6 states •(MI, MO, NC, SC, VT, and WI)

• No funding in 16 states and the District of Columbia(AL, AK, AZ, AR, CA, DC, IA, ID, LA, ME, MT, NV, OR, PA, RI, TX, WA)

• Pending• (HI, ID, IL, and OH)

Source: NACHC, 2015. State Fiscal Year 2016 Funding for Community Health Centers, State Policy Report #58. http://www.nachc.com/client//funding%20brief%203%2021%2016.pdf

Section VIIStaffing/Workforce

Physicians10%

Nurse Practitioners/Physician

Assistants/Certified Nurse Midwives

8%

Dental Services12%

Mental Health and Substance Abuse Services

7%Nurses

13%Pharmacy Personnel - 3%

Other Professional Services

1%

Enabling Services16%

Other Programs/Services5%

Other Medical Personnel 24%

Figure 7.1

Health Centers Utilize Multiple Health Professional with Varied Skills to Increase Capacity, 2014

Note: Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System.

Total Health Professionals = 108,570

Full Time Equivalents

Figure 7.2

Health Center Medical Services Staff, 2014

Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS)

Total Medical Personnel = 60,893 Full Time Equivalents

Total Physicians = 11,203 Full Time Equivalents

Family Physicians

46%

General Practitioners

4%

Internists16%

Obstetricians/Gynecologists

10%

Pediatricians21%

Other Speciality Physicians

3%

Physicans18%

NPs/PAs/CNMs 15%

Nurses24%

Other Medical Personnel

43%

Figure 7.3

Health Center Dental Services Staff, 2014

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Percents may not total 100% due to rounding.

Total = 12,877 Full Time Equivalents

Dentists29%

Dental Hygienists

13%

Dental Assistants,

Aides, Techs58%

Figure 7.4

Health Centers Behavioral Health Services Staff, 2014

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.

Licensed Clinical Social Workers

28%

Other Licensed Mental Health Providers

21%Other Mental Health Staff24%

Substance Abuse Services12%

Psychiatrists7%

Licensed Clinical Psychologists

8%

Total = 7,270 Full Time Equivalents

Figure 7.5

Health Center Enabling Services Staff, 2014

Source: Federally-funded health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.

Total = 17,250 Full Time Equivalents

Case Managers, 33%

Patient/Community Education Specialists,

14%Outreach Workers,

15%

Transportation Staff, 3%

Eligibility Assistance Workers

27%

Interpretation Staff , 5%

Other Enabling Services, 3%

Figure 7.6

Growth in Health Center Medical Providers, 2005 - 2014

Note: NP, PA, CNM stand for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, respectively. Behavioral Health Staff includes Substance Abuse.Total Medical Care Providers includes physicians, NPs, PAs, CNMs, nurses, and other medical personnel. Laboratory and X-Ray Personnel are not included in the total. Source: Bureau of Primary Health Care, HRSA, DHHS, 2005 and 2014 Uniform Data System (UDS)

7,097

3,973

8,212

2,810

5,650

11,203

9,092

14,330

7,270

12,877

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Physicans NPs/PAs/CNMs Nurses Behavioral Health Staff Dental Staff

2005 2014

Figure 7.7

Health Centers Are Twice as Likely to Use Non-Physician Clinicians than Other Providers, 2014

Note: Statistically Different (p < .01)Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413.

88%

44%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Health Center Other Primary Care Provider

Figure 7.8

Health Centers Use More Non-Physician Clinicians than Other Providers, 2014

Note: Statistically Different (p < .01)Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413

3.4

2.5

0

0.5

1

1.5

2

2.5

3

3.5

4

Health Center Other Primary Care Provider

Nu

mb

er

of

No

n-P

hys

icia

n C

linic

ian

s

Fig. 7.9

The Ratio of Physician Assistant, Nurse Practitioner, and Certified Nurse Midwife FTEs to Physician FTEs Has

Increased Rapidly at Health Centers

0.540.55

0.540.55

0.560.57

0.590.61

0.63

0.66

0.700.72

0.4

0.5

0.6

0.7

0.8

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Rat

io o

f FT

Es

Notes: PA, NP, and CNM stand for Physician Assistant, Nurse Practitioner, Certified Nurse Midwife, respectively. FTE stands for Full-Time Equivalent.Source: Proser M, Bysshe T, Weaver D, Yee R. Community health centers at the crossroads: Growth and staffing needs. JAAPA. 2015 Apr; 28(4): 49-53.

Section VIII:Remaining Challenges and

Unmet Needs

Figure 8.1

Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013

Source: Created by The Robert Graham Center (2014). US Census 2010; HRSA Data Warehouse 2014 HPSA and MUA/P shapefiles; AMA Masterfile 2013; UDS Mapper 2014. The Medically Disenfranchised and the Shortage of Primary Care: The Role of Health Centers in Improving Access to Care. NACHC. March 2014. http://www.nachc.com/client/documents/MDFS.pdf

62 million people experience inadequate or no access to primary

care because of shortages of physicians

in their communities

Figure 8.2

Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care Needs

Note: Counties with Unfavorable Primary Care Needs were identified by being in the either bottom or top quintile depending on the primary needs indicator. Low-Income map presents census tracts, but analysis for this figure was conducted at the county-level. Source: NACHC, Health Wanted 2012. NACHC analysis of data obtained from University of Wisconsin Population Health Institute County Health Rankings 2011; U.S. Census Bureau; and HRSA.

63%

54%

53%

50%

47%

42%

38%

36%

36%

34%

33%

25%

0% 10% 20% 30% 40% 50% 60% 70%

Rural

Primary Care Provider

Preventable Hospitalizations

Uninsured

Mammography Screening

Emergency Department Visits

Health Status

Diabetes Prevalence

Not English Proficient

Low-Income

Low Birthweight

HIV Prevalence

Figure 8.3

Health Center Capital Project Plans and Funding Needs, 2015

Source: CapLink. Health Center Capital Project Plans and Funding Needs. 2015. www.caplink.org/resources/reports.

• 79% of health centers have plans to initiate capital projects within the next

several years. These plans represent 2,300 capital projects

• These planned projects are estimated to cost $4.6 billion:

• which will result in 12 million square feet of new space,

• accommodating 6,100 new providers• who will serve 5.4 million new patients annually

• However 75% of health centers report funding gaps for these planned projects

Section IX:Look-Alike Health Centers

This section highlights data from a category of Federally Qualified Health Centers (FQHCs), known as look-alikes. Look-Alikes are health centers that have been certified by the Centers for Medicare and Medicaid Services as

meeting all Health Center Program requirements but do not receive federal health center grants from the Bureau of Primary Health Care. As of 2014, there were 81 look-alikes across the United States.

Figure 9.1

Look-Alike Health Center Patients are Predominately Low Income, 2014

Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2014 was $19,790. (See https://aspe.hhs.gov/2014-poverty-guidelines). Based on percent known. Percents may not total 100% due to rounding.

74%100% FPL and below

16%101%-150% FPL

4%151%-200% FPL

7%Over 200% FPL

Figure 9.2

Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minority Groups

Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding.

White 64 %

Asian / Native Hawaiian / Pacific

Islander 7 %

More than One Race 3%

American Indian / Alaska

Native 1%

Black / African American 25 %

Hispanic/Latino 45%

Non-Hispanic 55%

Figure 9.3

Most Look-Alike Health Center Patients are Uninsured or Publicly Insured

*”Other public insurance” may include non-Medicaid SCHIP and state-funded insurance programs. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Percents may not total 100% due to rounding.

Medicaid/SCHIP 54%

Uninsured 25%

Private Insurance 12%

Medicare 8%

Other Public Insurance 1%

Figure 9.4

Look-Alike Health Centers Serve Patients Throughout the Life Cycle

Note: Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Under 510%

Ages 5-1212%

Ages 13-1910%

Ages 20-247%

Ages 25-4427%

Ages 45-6426%

Ages 65+7%

Medical Care77%

Other Professional Services

2%

Dental9%

Vision0%

Behavioral Health7% Enabling Services 5%

Figure 9.5

Look-Alike Health Centers Provide a Broad Array of Services

Note: Encounters for enabling services include visits to case managers and health educators.Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Total = Over 3.1 million patient

encounters

Figure 9.6

Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity

Note: NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Other Programs/Services includes Enabling Services. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS).

Physicians14%

NPs/PAs/CNMs8%

Nurses11%Dental Services

8%

Mental Health and Substance Abuse

Services6%

Pharmacy Personnel3%

Other Medical Personnel

34%

Other Professional Services1%

Other Programs/Services

14%

Total = 3,426 Full Time Equivalents

Figure 9.7

Look-Alike Health Center Medical Services Staff, 2014

Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2014 Uniform Data System (UDS).

Total Health Center Medical Services Staff= 2,319 Full Time Equivalents

Break Out of Total Physicians (FTEs)

Total Health Center Physicians= 481 Full Time Equivalents

Total Medical Services Staff (FTEs)

Total Physicians

21%

NPs/PAs/CNMs12%

Nurses17%

Other Medical

Personnel50%

Family Physicians

46%

General Practitioners3%

Internists22%

Obstetrician/Gynecologi

sts7%

Pediatricians19%

Other Speciality Physicians4%

Figure 9.8

Look-Alike Health Center Dental Services Staff, 2014

Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.

Dentists30%

Dental Hygienists9%

Dental Assistants, Aides, Techs

60%

Total = 273 Full Time Equivalents

Figure 9.9

Look-Alike Health Centers Behavioral Health Services Staff, 2014

Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Notes: Percents may not total 100% due to rounding.

Psychiatrists12%

Licensed Clinical Psychologists

6%

Licensed Clinical Social Workers

33%Other Licensed Mental Health

Providers25%

Other Mental Health Staff18%

Substance Abuse Services

6%

Total = 213 Full Time Equivalents

Figure 9.10

Look-Alike Health Center Enabling Services Staff, 2014

Source: Look-alike health centers only. 2014 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.

Case Managers36%

Patient/Community Education Specialists

18%

Outreach Workers18%

Transportation Staff3%

Eligibility Assistance Workers

20%

Interpretation Staff3%

Other Enabling Services

3%

Total = 438 Full Time Equivalents