CHCs defy staff shortage woes, promote healthcare access

Patient care access soars despite staff shortages

For one thing, CHCs, sometimes called federally qualified health centers (FQHCs), don't have enough healthcare providers to manage them.

Seven in 10 CHCs reported general staff shortages, with 77% reporting mental health provider shortages, 70% reporting shortages of primary care physicians, 70% reporting nurse shortages, 69% reporting shortages of enabling services providers and 49% reporting advanced practitioner shortages.

Clinician shortages can stand in the way of healthcare organizations enabling seamless patient access to care. When there aren't enough clinicians to meet patient demand, patients might have to wait longer for an appointment.

Still, CHCs proved able to get patients in for care. Nearly all (93%) said they offer extended clinic hours, which can accommodate patients who cannot make appointments during typical business hours. Another 88% said they offer same- or next-day appointments, and 96% offer primary care via telehealth.

Despite challenges associated with patient broadband access (94% reporting), low or no reimbursement (67% reporting) and expenses related to telehealth platforms (63% reporting), telehealth has been a boon for CHCs. Nearly every CHC said telehealth helped them reach patients who would otherwise forego care, 88% said it improved timeliness of care, 87% said it helped offset losses from the pandemic and 61% said telehealth improved specialty care access.

CHCs orchestrate behavioral health treatment

In addition to primary care, CHCs are the epicenter of behavioral healthcare for traditionally underserved patients. More than three-quarters of CHCs said they screen patients for behavioral health needs, including more than 81% of CHCs in rural settings.

What's more, CHCs help connect patients to behavioral healthcare, often offered within the clinic.

However, staff shortages, reported by 70% of CHCs, stand in the way of long-term behavioral healthcare offered within the clinic.

Currently, 88% of CHCs can offer some sort of short-term mental health counseling in the clinic, but only 70% said they can offer this type of care on a long-term basis. Two-thirds said they offer substance use disorder treatment and 62% said they offer medication-assisted treatment.

Offering clinic-based behavioral health is a key issue for CHCs. Although clinics report their own staff shortages, another 91% recognize a shortage of behavioral health providers in the community. This trend is consistent with previous data showing that more and more behavioral healthcare is being delivered at CHCs.

Access to specialty care lacking

Despite their strengths in primary and behavioral healthcare, health centers struggle to connect patients to specialists and subspecialists.

Three-quarters (73%) of CHCs said it was difficult or very difficult to connect their Medicaid and uninsured patients with specialty care, while 54% said the same of their Medicare patients and 41% said of privately insured patients.

The disparities are likely due to insurance coverage differences. Private payers are more likely to cover specialty services than public payers, stymying CHC efforts to connect low-income patients with the clinical care they need.

CHCs provide comprehensive care

Despite key workforce challenges, CHCs continue to manage to provide comprehensive primary care.

For example, 67% of health centers said they screen their patients for unmet social needs, up from just 40% who said the same in 2018. The specific social needs CHCs screen for include the following:

• Interpersonal safety (69%).
• Housing instability (71%).
• Transportation needs (72%).
• Food insecurity (70%).
• Utility needs (57%).

What's more, CHCs are instrumental in helping to address these social determinants of health (SDOH).

Around half (55%) of CHCs said they provide direct social services. That shakes out to 57% of urban CHCs and 48% of rural CHCs who do so.

More than half (61%) of CHCs said they coordinate patient care with community-based organizations (CBOs). However, coordination is stymied by poor back-and-forth communication with CBOs. Only a quarter of CHCs said they get reports back from CBOs about the patients who access them.

Other services that go beyond the scope of clinical care include the language access services at CHCs. Health centers are required to provide some language services, particularly patient access to medical interpreters, per Title VI of the Civil Rights Act and Executive Order 13166.

According to the Commonwealth Fund, 84% of CHCs offer patients access to trained interpreters, and 67% allow translation assistance from staff. Overall, 87% offer information to patients in multiple languages or modes.

Notably, language services are slightly more common in urban CHCs than rural ones. The Commonwealth Fund said this was likely reflective of the patient population served.

Despite progress, CHCs face headwinds that could be destructive in the future, the Commonwealth Fund researchers said. To avoid upcoming challenges, the report authors recommended reauthorization of the Community Health Center Fund, efforts to supplement the health center workforce, better support for telehealth services and payment reform for CHCs.

Sara Heath has covered news related to patient engagement and health equity since 2015.