Massachusetts Community Health Centers Get the Facts

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1 Patients Massachusetts Community Health Centers Get the Facts Massachusetts community health centers care for 951,000 patients of all ages and racial and ethnic backgrounds, and represent a major source of care for medically underserved women and children. In 2014, almost 28% of the state s health center patients were women of child-bearing age (15-44), 20% were children under 18 years of age and 9% were over 65. Eighty-nine percent fell below 200% of the federal poverty level. Forty-nine percent were insured through Medicaid, 26% had subsidized and unsubsidized commercial coverage, another 10% were Medicare beneficiaries and nearly 15% remained uninsured. Thirty-nine percent were better served in another language. Value Health centers locally-accessible, comprehensive and patient-centered approach helps to keep high-need patients engaged in primary care and less reliant on expensive emergency and hospital care. Health centers remain the most integrated of health care providers, offering medical, dental, vision, pharmacy, behavioral health and substance abuse services to anyone in need, regardless of their health coverage status. In addition, Massachusetts health centers support 14,000 jobs across the state, and contribute nearly $2 billion in statewide economic output every year. What s more, because of the impact they have in reducing emergency room visits, hospital stays and the need for highercost specialty care among their patients, health centers help generate more than $1 billion in annual savings for Massachusetts. Comprehensive Focus As early pioneers of the patient-centered care model, health centers remain the most integrated of primary health care providers, offering medical, dental, vision, pharmacy, behavioral health and addiction services to anyone in need regardless of their health coverage status. Health centers work to eliminate the increased risk of serious illness, chronic disease, and mortality experienced among the state s many ethnic and racial groups by hiring multilingual and multicultural staff at every level of their organizations; deploying outreach workers to help patients navigate our complex health system; and assisting residents in enrolling and staying enrolled in critical health care coverage. Quality Community health centers are a recognized solution for reducing health costs and ensuring health care quality in Massachusetts and across the nation. Staffed by board-certified physicians, nurse practitioners, physician assistants, registered nurses, nutritionists, dentists and a range of other of medical and social service providers, community health centers excel at providing preventive care and chronic disease management in lower-cost community settings. Based on recent data from the U.S. Health Resources and Services Administration, Massachusetts health centers continue to exceed national benchmarks on federal measures related to timely prenatal care, hypertension, childhood immunizations and healthy birthweights for newborns.

2 Health Centers Outside of Boston Baystate Medical Center Health Centers, Springfield Brockton Neighborhood Health Center Cambridge Health Alliance Health Centers, Cambridge, Somerville, Malden and Revere Caring Health Center, Springfield Charles River Community Health, Waltham Community Healthlink Community Health Center of Cape Cod, Falmouth, Mashpee and Bourne Community Health Center of Franklin County, Turners Falls, Orange and Greenfield Community Health Connections Family Health Centers, Fitchburg, Gardner and Leominster Community Health Programs, Adams, Great Barrington, North Adams, Pittsfield and Lee Duffy Health Center, Hyannis Edward M. Kennedy Community Health Center, Worcester, Framingham, Clinton and Milford Family HealthCare Center at SSTAR, Fall River Family Health Center of Worcester, Worcester and Southbridge Greater Lawrence Family Health Center, Lawrence and Methuen Greater New Bedford Community Health Center, New Bedford and Wareham Harbor Community Health Center, Hyannis, Harwich and Plymouth HealthFirst Family Care Center, Fall River Hilltown Community Health Centers, Huntington and Worthington Holyoke Health Center, Holyoke and Chicopee Island Health Care, Edgartown, Martha s Vineyard Lowell Community Health Center Lynn Community Health Center Manet Community Health Center, Quincy, Hull and Taunton MGH Community Health Associates, Chelsea, Everett and Revere North Shore Community Health, Peabody, Salem and Gloucester Outer Cape Health Services, Harwich, Orleans, Provincetown, and Wellfleet South Cove Community Health Center, Quincy Springfield Health Services for the Homeless Health Center Health Centers in Boston Boston Health Care for the Homeless Program Bowdoin Street Health Center, Dorchester Brookside Community Health Center, Jamaica Plain Charles River Community Health, Allston-Brighton Codman Square Health Center, Dorchester Dimock Community Health Center, Roxbury DotHouse Health East Boston Neighborhood Health Center Fenway Community Health Center Geiger Gibson Community Health Center, Dorchester Greater Roslindale Medical & Dental Center Harvard Street Neighborhood Health Center, Dorchester Mattapan Community Health Center MGH Community Health Associates, Charlestown Neponset Health Center, Dorchester North End Waterfront Health, North End and Charlestown South Boston Community Health Center South Cove Community Health Center, Chinatown South End Community Health Center Southern Jamaica Plain Health Center Upham s Corner Health Center, Dorchester Whittier Street Health Center, Roxbury

3 COMMUNITY HEALTH CENTERS More than Medicine Background In December of 1965, physician activists H. Jack Geiger and Count D. Gibson Jr. pioneered a new model of accessible, affordable and high-quality health care when they founded the first community health center in Dorchester, MA. The idea was to improve the overall health of neighborhoods by approaching care holistically, understanding and addressing the specific cultural, social and economic conditions affecting residents. This revolutionary approach introduced concepts that form the foundation of healthcare today: population health, prevention and wellness, chronic disease management, and an integrated, patient-centered structure. It has succeeded in 1,200 health centers across the U.S. serving 23 million Americans, including more than 951,000 patients here in MA or one in seven state residents. Impact The community health center response to our opioid crisis is a prime example of our industry-leading care model. Working at the front lines of the crisis, health centers have developed new models for identifying and treating at-risk patients over time. From using data to understand risk and develop early interventions, to supporting patients with integrated care that addresses both the physiological and psychological needs of addiction treatment and ensuring through a team approach that referrals turn into appointments and relationships, our community health centers are setting an example for all healthcare providers. Massachusetts community health centers also continue to look for new ways to support healthy living for our patients. Health-center based initiatives like fitness and wellness centers, farmers markets, safe walking routes to school, community job training institutes, cooking demonstration kitchens and even patient hiking trails located behind a health center in Western MA all of these continue to challenge long-held notions about what it means to deliver effective healthcare. Our health centers support 14,000 jobs across the state, and contribute nearly $2 billion in statewide economic output every year. What s more, because of the impact we have in reducing emergency room visits, hospital stays and the need for highercost specialty care among our patients, health centers help generate more than $1 billion in annual savings for Massachusetts. This economic impact also has a real impact on health at the local level. For anyone who might question the relationship between economic health and physical health, consider making a choice between focusing on safe housing, seeking employment or putting food on the table, and calling to make an appointment for a health screening. By providing education and jobs in their communities, health centers are far more than care providers. The immediate challenge is how to sustain health center innovation as our health system undergoes radical transformation and competition for healthcare workers intensifies. The Massachusetts League of Community Health Centers is leveraging support from state, business, and healthcare industry partners to address this need. From public-private loan forgiveness programs for health center primary care providers, to health-center-based residency training programs, to community leadership programs designed to cultivate the next generation of physician and administrative leaders, health centers continue to lead the industry forward. 40 Court Street, 10th Floor, Boston, MA ph

4 mlchc.medical home_layout 1 4/7/16 5:26 PM Page 1 COMMUNITY HEALTH CENTERS Community-Based Medical Homes & Background Since passage of Massachusetts 2006 health care reform law, the state s health centers have been actively engaged in transforming their care approach to the more team-based, patient-centric model that is now a cornerstone of both state and national health reform efforts. Massachusetts health centers have found early success with the transformation to this new approach, which moves from a single provider care model to integrated clinical teams focused on patient care coordination. The Patient-Centered Medical Home (PCMH) model offers benefits to both patients and caregivers. Patients gain more one-on-one time with their physicians and care teams and are challenged to become better engaged in their long-term health goals. At the same time, caregivers work more collaboratively in addressing patients needs and in coordinating and monitoring their care. Ultimately, this approach improves health outcomes and lowers costs. Impact Massachusetts health centers are demonstrating improved access for patients through timely appointments for routine and episodic care, and proactively planning care with patients who are identified as having chronic illnesses or other health issues that require active management. Other efforts include implementing standardized procedures for following up with patients who use the emergency room for non-emergent health needs and adding patients to health center performance improvement teams to enhance patient care and patient knowledge. These efforts in combination with ongoing health technology development at health centers will have a major impact on patient health outcomes and costs by reducing unnecessary ER visits, hospitalizations, and overall utilization of expensive specialty care. Currently, 89 percent of Massachusetts health centers have achieved official PCMH recognition through an accredited organization, including the National Committee for Quality Assurance and the Joint Commission on Accreditation of Health Care Organizations. Like all health care providers in Massachusetts and across the country, community health centers are being asked to change the way they organize and deliver care. Although health centers remain at the forefront of patient-centered care initiatives, they have limited access to financial resources for building and sustaining the workforce, health information technology upgrades, and other infrastructure enhancements necessary for meeting practice transformation requirements under health care payment reform. State investments that strengthen health center business practices, workforce training and health information systems will ensure that health centers can effectively meet the challenges of improved patient health outcomes, decreased utilization of high-cost care and increased health equity. 40 Court Street, 10th Floor, Boston, MA ph

5 The Health Center Workforce: Building Wellness & Innovation Sustaining health center innovation through healthcare s radical economic transition is essential for advancing the health of communities. Massachusetts community health centers remain committed to workforce development both as an organizational strategy to build capacity and innovation, and as a means for increasing educational and economic benefits to the communities they serve. A strong workforce provides the foundation for such innovation and local impact. Disparities in Healthcare Salaries Competition for healthcare workers particularly primary care providers is intensifying. Community health center physician salaries remain 25 to 30 percent below entry level salaries at many hospitals. In addition to physicians, the pay for all other clinical positions at health centers is less than that provided by both hospital and private physician practices. Overall, health centers pay 5 percent less than office practices, and 11 percent less than hospitals. For nursing positions as a whole, health center pay is 19 percent below nursing pay in hospitals. The widest disparity exists for registered nurses, who earn an average of 32.6 percent more working in hospital settings. Comparison of Average Compensation Position Title MA Health Centers MA MD Offices MA Hospitals Nurse Practitioner $42.20 $49.15 $54.54 Physician Assistant $46.16 $50.10 $50.57 Registered Nurse $30.39 $32.86 $45.07 Social Worker/LICSW $19.21 Unknown $33.67 Nutritionist $26.94 Unknown $28.86 LPN $24.35 $25.23 $19.13 Med. Asst./Nurse Aide $15.48 $18.02 $17.24 Radiology Technologist $33.81 $29.77 $30.73 Phlebotomist $15.97 $16.07 $17.90 Biller/MD Biller $17.82 $18.55 $19.84 Clinic Secretary $15.32 $17.40 $17.87 Med. Record Clerk $15.08 $15.99 $16.46 Source: 2016 Salary and Compensation Study, conducted by Gallagher Surveys for the Massachusetts League of Community Health Centers, under contract to the Massachusetts Department of Public Health, July Court Street 10th Floor Boston, MA phone

6 Recruitment & Retention of Critical Providers Growing demand for health center services over the last several years has led to some new approaches for recruiting and retaining primary care workforce professionals at community health centers. The League s Community Health Center Primary Care Provider Loan Repayment Program was launched in 2007 and offers loan repayment to physicians, advanced practice nurses (APNs) and physician assistants (PAs) who make a two-year commitment to full or part-time work at an eligible community health center. The maximum award is $50,000 for full-time physicians and $30,000 for APNs and PAs. As of October 2016, the program supports 172 providers serving over 290,000 patients. Of these awards, 124 have been made to physicians, 47 to advanced practice nurses and one to a physician assistant. In 2015, the League had twice as many applicants for loan repayment than could be supported by the program. Although the state has made recent investments in the program, the League estimates an ongoing vacancy rate of at least two primary care providers per Massachusetts health center. In addition, the concentration of teaching institutions and the relatively high number of physicians in Massachusetts results in scoring that continues to prevent the state from accessing more placements from the federal National Health Service Corps program. Retention of providers is equally critical. The League estimates a 25 percent turn-over rate by physicians at health centers. Health center hiring staff say they are challenged by the fact that pay raises for health center physicians have not kept pace with those for physicians practicing in hospitals and private practices.while salary is an obvious component to retention, professional development opportunities are also a factor. In response, the League developed a Special Projects program in 2010 to allow health center clinicians to undertake professional initiatives such as short-term fellowships, teaching engagements and research opportunities. The program has developed into a significant retention tool and provides six awards per year to physicians, APNs, and dentists. Historically, only one-third of annual applicants have been able to secure this funding. Expansion of the program could ensure greater workforce stability and continuity of care for patients at health centers. Teaching Health Centers Health centers have remained committed to training generations of providers for practice in underserved communities since the 1960s. This approach has been successful in attracting providers to work at community health centers, but comes at a significant financial cost to their organizations. Currently, one Massachusetts health center has its own accredited Family Practice Residency program; another participates as a Family Practice residency site for the University of Massachusetts Medical School; and 15 others serve as Continuity Residency sites for Harvard and Boston University medical schools. Directing more state resources to expand these programs will go far training the state s future primary care clinician-leaders. With further investments to grow public-private loan forgiveness programs for health center primary care providers, develop more professional leadership programs, and expand health-centerbased residency training programs, health centers can continue their hallmark grassroots efforts to lead the primary care industry forward.

7 COMMUNITY HEALTH CENTERS Technology & Background The Massachusetts League of Community Health Centers has taken a strong role in assisting health centers as they work to upgrade their health information technology systems and capacity for using data. In 2006, the League set a goal of reaching 100 percent implementation of Electronic Medical Record (EMR) systems across its membership by 2011 ahead of the state s Chapter 305 goal of That goal has been met, with all 49 health centers having implemented an EMR. Additionally, in 2009, the Massachusetts League of Community Health Centers (the League) launched the first ever data reporting platform for community health centers, DRVS (Data Reporting and Visualization System). The platform measures and monitors health center performance on key clinical, operational and financial metrics. Impact Currently, 29 Massachusetts health centers representing more than 420,000 patients and 1.4 million annual medical visits are using the DRVS platform for both performance benchmarking and producing clinical quality reports related to Patient Centered Medical Home requirements and federal Meaningful Use incentive payments. DRVS is also providing support to several statewide initiatives, including the Prevention and Wellness Trust Fund, Primary Care Payment Reform Initiative (PCPRI) and the Massachusetts Department of Public Health s web-based immunization registry, MIIS. Developed by the League and Azara Healthcare, the reporting system has been launched in 17 other states, representing 150 health centers, 2.5 million patients and 9 million annual visits. DRVS also works with the Department of Public Health to assist with electronic disease surveillance. Health centers are the state s first line of defense in managing chronic disease and spiraling healthcare costs. Because of their focus on quality, maximizing the latest information technology improves the ability of centers to track a range of measurable health statistics in a more data driven way. Nineteen Massachusetts health centers are currently using an electronic referral gateway for linking patients to other community-based service organizations that offer a range of health-focused support services. For example, a physician can order a referral for a patient at risk for diabetes to their local YMCA. That referral can then be retrieved by the YMCA through an encrypted electronic message. When a patient attends a fitness class or, conversely, does not follow through on the referral, that information is sent back to the patient s electronic medical record where it can be retrieved by his or her care team. As health centers work both to support statewide health care data efforts and prepare for future payment reform models, they will require state technology investments that recognize their value as quality, cost-effective providers. State support for technology enhancements at health centers and for the League s reporting platform, DRVS, will enhance innovative care management initiatives and ensure that health centers can meet the long-term technology demands tied to health reform initiatives. 40 Court Street, 10th Floor, Boston, MA ph

8 COMMUNITY HEALTH CENTERS Integrated Care & Background Health centers have a long history of filling critical gaps in our healthcare system. From providing some of the nation s first HIV services, to pioneering models of care for patients suffering with chronic illness, to expanding dental coverage for millions of underserved residents, Massachusetts health centers continue to meet the never-ending challenge of providing access to care for people who, without community health centers, might not have it. Today, health centers are focused on two of the biggest public health challenges of our times: integrating behavioral health and oral health services with patients primary medical care. Impact: Behavioral Health Integration Health centers remain at the forefront of these efforts by co-locating primary care and behavioral health services within their facilities, encouraging communication and coordination among behavioral health and primary care providers, and ensuring that behavioral health treatment plans, including medication lists, are shared among providers. One community health center on the North Shore is using a Peer Advocate program to better engage patients in their mental health care. Another center, located in western Massachusetts, is using a range of technological tools, including telemedicine, to expand their patients access to critically needed behavioral health services. Accelerating the integration of mental health and substance abuse services has become even more critical in light of the nation s growing opiate crisis. In an effort to curtail the opioid crisis in its community, a health center located just north of Boston is working to increase prevention efforts with patients at higher risk for opioid addiction. The Center is identifying, tracking and improving care for patients on opioid therapy for chronic pain management. Impact: Oral Health Integration The number of health center sites providing dental services has increased from 15 to 32 over the last decade or so, but the need for additional oral health services remains high. The League has worked intensely in the last several years in response to adult dental cuts made to the MassHealth program in 2011, with some adult dental benefits being restored in Current oral health integration efforts at health centers include a DentaQuest Foundation grant focused on training primary care providers to screen, assess and refer patients for oral health issues. A second initiative, made possible through a federal grant to the state s Department of Public Health, is a quality improvement project aimed at developing perinatal oral health guidelines at seven health centers. As a direct result of Massachusetts health centers success, the League has been chosen to lead two national grants for coaching and assisting their counterpart organizations (Primary Care Associations) on successful approaches for oral health integration in 28 states. 40 Court Street, 10th Floor, Boston, MA ph