Strengthening the safety net: Community health centers form partnerships to increase capacity, improve service

Policy brief looks at centers in four U.S. regions, including Los Angeles ​Community health centers, the leading providers of primary health care to the nation’s poor and uninsured populations, need strong partnerships and effective strategies to strengthen the current health care safety net, and to prepare for what may happen in the future, according to a new policy brief by the UCLA Center for Health Policy Research.

The brief looks at a selection of Federally Qualified Health Centers, referred to as community health centers, in Atlanta, Houston, Los Angeles and New York state that collaborate with other regional centers, local hospitals and health departments to improve and expand care, or work with legislators and advocacy groups to push for changes in health policy.

Their proactive strategy is a blueprint for community health centers nationwide, given the current administration’s proposed plans to cut billions of dollars in federal Medicaid benefits to vulnerable Americans, said Steven P. Wallace, associate director at the UCLA Center for Health Policy Research and co-author of the report.

“These centers are working to do their best in the current environment,” Wallace said. “But all centers will also need a robust Plan B if resources provided by the Affordable Care Act are stripped away.”

The brief, based on findings from UCLA’s REmaining Uninsured Access to Community Health Centers project, looks at specific strategies community health centers in the four regions undertook to increase capacity and improve service after the Affordable Care Act was enacted. Among the findings:

Streamlining referrals in Atlanta: One center set up a shared electronic medical records system with a local public hospital to more easily admit patients to the hospital and improve post-hospital care; the hospital granted admitting privileges to the center’s physicians.

Pooling regional resources in Houston: Four centers collaborated to strengthen regional service, with center directors regularly meeting to share ideas and resources. The centers’ partners set up and funded shared pharmacy services and a position for a shared psychiatrist that no single center could support alone.

Collaborating with Los Angeles County policymakers: The Los Angeles County Board of Supervisors in 2014 signed a contract with 204 centers in the county to establish a no-cost, primary care program for low-income uninsured county residents who did not qualify for other public health insurance, without regard to citizenship status. Supervisors authorized a $61 million annual budget for the centers to serve as many as 146,000 people.

Advocating for health policy change in New York state: Community health centers in New York state speak out on behalf of their patients both directly and indirectly. Examples include having leadership staff participate in local councils and committees, encouraging patients to attend local government meetings, and engaging with law enforcement agencies to change practices to protect center patients. Center leaders in the state said they maintain contact with local, state and federal policymakers as well as stakeholders involved in transportation, immigration, housing and other policy areas that have health implications.

“We found community health centers are being more than just practical when forming new partnerships,” said Maria-Elena Young, graduate student researcher at the UCLA Center for Health Policy Research and lead author of the brief. “They’re taking creative and innovative steps and thinking outside of the box to improve the safety net.”

Having a shared mission, understanding the political environment, incubating partnerships, and highlighting the benefits of aligning with community health centers were all factors that led to the success of each partnership strategy, according to the policy brief.

Authors recommend a series of steps that other community health centers can take to develop partnerships, such as having the centers include partnership-fostering as part of their long-term strategic plan; formalizing such partnerships; asking foundations to provide small grants to centers to build new collaborations; educating local hospitals on the value centers’ primary care services bring in lowering hospital readmission rates; and providing funding for staff dedicated to developing community partnerships and advancing advocacy efforts.

The policy brief is supported by the Commonwealth Fund.