Every Thursday morning, I wake up excited for the 14-hour day I’m about to begin. My Thursdays are so long because that’s the day I work a second evening job at a Federally Qualified Health Center (FQHC) that serves New York City’s lesbian, gay, bisexual, transgender, and queer (LGBT+) population. Why am I so happy to work a longer day? Not because I am a glutton for punishment, but because the work is truly satisfying in the way that only feeling completely confident in the care I’m providing can make me feel.
The FQHC I work at provides essential medical and mental health care to an often-vulnerable population. Beyond the stress of being LGBTQ+ in our society, the patients I see are mostly uninsured or on Medicaid. Many have HIV/AIDS, substance use problems, and/or significant mental illness. I see individuals from diverse backgrounds and all age groups, from trans youth struggling with histories of abuse or homelessness, to older gay men who survived the AIDS crisis and lost many loved ones. Each person comes with a painful yet inspiring story, filled with strength, resilience, and love.
And the care provided at this clinic, like most FQHCs – also referred to as Community Health Centers (CHCs) – is not just “good for the safety net.” It is the highest quality; often better than many private practice settings on multiple quality measures. Why is this?
First, the care is truly integrated. I share a single medical record and can easily communicate with my patients’ medical providers. This reduces the chances of errors and conflicting treatments, such as drug-drug interactions. Quality improvement initiatives from the medical clinic apply to the mental health clinic and vice versa.
Second, as federally funded clinics that participate vigorously in the Medicaid program, CHCs are often the first to know about and participate in health systems improvements and innovations. Despite what some private providers might tell you, government does a lot more than add bureaucratic hurdles; it attempts to ensure that health care is delivered in a safe and equitable way, is informed by evidence and guidelines rather than idiosyncratic clinician ideas and habits, and is responsive to public health needs. For instance, CHCs were on the frontline during the AIDS crisis, and are now playing a similar role in responding to the opioid epidemic.
Third, CHCs are often full of passionate, mission-driven clinicians who deeply believe in what they are doing and care about the populations they serve. At the CHC where I work, clinicians are constantly sharing recent evidence, clinical advice, and local resources relevant to the LGBTQ+ population. Wouldn’t you want to be cared for by a group of individuals who are passionate about serving you and continuously communicating about better ways to do so?
Finally, CHCs specialize in providing high quality primary care, which has been shown to produce the best outcomes. They are beacons of well-coordinated, efficient medical care in our specialist-driven and siloed health care system. This translates to better care at a lower cost!
There are more than 10,000 CHCs in the United States, providing care for about one in thirteen Americans (and an even higher proportion in some states). In addition to primary care and behavioral health (i.e., mental health and substance use) services, like those provided where I work, many CHCs also provide dental and vision care. For the reasons above, 86 percent of primary care providers at CHCs are satisfied with their work, and 73 percent of patients who use CHCs as their primary source of medical care feel that it is high quality.
It is therefore not surprising that CHCs have long enjoyed strong bipartisan support. Regardless of your political leanings, CHCs are clearly a rare example of a great deal in American healthcare. However, during recent fights over funding the federal government that resulted in two brief shutdowns, the Community Health Center Fund expired on September 30, 2017, and was not reauthorized until February 9, 2018. The Continuing Resolution that reopened the government in January included funding for the Child Health Insurance Program (CHIP) but not CHCs.
If Congress had not restored funding in the nick of time, the Department of Health and Human Services estimated that about a quarter of CHCs would have had to close, resulting in nine million people losing access to healthcare and 51,000 job losses. Many CHCs had already begun deferring important investments and delaying staff hiring.
This barely averted tragedy has received far too little attention. Let’s not take our CHCs for granted ever again; let’s avoid this kind of near miss in the future.
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