Y

X

COMMUNITY HEALTH CENTER CHARTBOOKJANUARY 2019

Note: Front cover image represents a scatterplot of all federally-funded and non-federally funded (“look-alikes”) health center service delivery locations and administrative sites in the contiguous US, based on primary x and y coordinates downloaded from data.HRSA.gov on Nov. 1, 2018.* Includes patients of federally-funded health centers, look-alikes, and expected patient growth for 2018.

About Community Health Centers

The National Association of Community Health Centers (NACHC) is pleased to present the Community Health Center Chartbook,

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 “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 services. No

two health centers are alike, but they all share one common purpose: to provide primary and preventive health care services that

are coordinated, culturally and linguistically competent, and community-directed.

Health centers play a critical role in the U.S. health care system, delivering care to over 28 million* people today. 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, generate taxpayer savings, and deal with a multitude of costly

and significant public health and social problems – including substance use disorder, mental illness, natural disasters, and

homelessness – if they have the resources to do so. Federal and state support, along with adequate third party reimbursement,

are critically important to keep pace with escalating health care needs and rising costs among populations served by health

centers.

Who health centers serve, what they do, and their impressive record of accomplishment in keeping communities healthy are

represented in this chartbook.

About this Chartbook

The Community Health Center Chartbook highlights important research and data on Health Center Program Grantees,

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”). Data and research sources

can be found at the bottom of each figure. Most slides draw from the Uniform Data System (UDS) maintained by the

Bureau of Primary Health Care, HRSA, DHHS. 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. For more

information about UDS data, visit https://bphc.hrsa.gov/uds/datacenter.aspx.

Table of Contents

Section 1: Who Health Centers Serve

1-1 Health Centers Serve…1-2 Health Centers Serve Many Special Populations1-3 Health Centers Serve Greater Amounts of Special Populations1-4 Health Center Patients are Predominately Low-Income1-5 Most Health Center Patients are Publicly Insured or Uninsured1-6 Health Center Patients’ Health Insurance Coverage is Unique Among Ambulatory Care Providers1-7 Health Centers Serve More Medicare and Medicaid Dual Eligibles than Other Ambulatory Care Providers1-8 Health Center Patients are Disproportionately Poor, Uninsured, and Publicly Insured1-9 Health Center Patients are Disproportionately Members of Racial/Ethnic Minority Groups1-10 Most Health Center Patients are Members of Racial/Ethnic Minority Groups1-11 Many Health Center Patients Suffer from Chronic Conditions1-12 Health Centers Serve Patients Throughout the Life Cycle

Section 2: Expanding Access to Care

2-1 Number of Federally-Funded Health Center Organizations, 20172-2 Growth in Health Center Organizations and Sites, 2008 – 20172-3 Growth in Health Center Patients and Visits, 2008 – 20172-4 Health Centers Have Expanded the Types of Services Available to Patients2-5 Health Centers Have Expanded Their Capacity To Provide More Services Onsite

Table of Contents

Section 2: Expanding Access to Care (continued)

2-6 Health Centers Have Higher Rates of Accepting New Patients Compared to Other Providers2-7 The Number of Health Center Patients in Poverty is Growing Faster than the Number in Poverty Nationally, 2006 – 20172-8 The Number of Health Center Medicaid Patients is Growing Faster than the Number of Medicaid Beneficiaries Nationally,

2008 – 20172-9 Percent of Medicaid Beneficiaries Served by Health Centers, 20172-10 Health Center Patients by Insurance Status, 2008 – 20172-11 Even as More Patients Receive Insurance, Health Centers are Serving More of the Nation’s Uninsured2-12 Percent of Uninsured Population Service by Health Centers, 2017

Section 3: High Quality Care and Reducing Health Disparities

3-1 Health Centers Achieve Higher Rates of Diabetes and Blood Pressure Control than the National Average3-2 Many Health Centers Exceed Healthy People 2020 Goals3-3 Health Center Patients are More Satisfied with the Overall Care Received Compared with Low-Income Patients Nationally3-4 Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores3-5 Health Centers Provide More Preventive Services than Other Primary Care Providers3-6 Health Centers Reduce Disparities in Hypertension Treatment3-7 Women at Health Centers are More Likely to Receive Mammograms than Their Counterparts Nationally3-8 Women at Health Centers are More Likely to Receive Pap Smears than Their Counterparts Nationally

Table of Contents

Section 3: High Quality Care and Reducing Health Disparities (continued)

3-9 Health Center Patients are More Likely to Receive Colorectal Cancer Screenings than Their Counterparts Nationally3-10 Health Center Patients Have Fewer Low Birth Weight than Their U.S. Counterparts, 20163-11 Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians3-12 Percent of Health Centers with Patient-Centered Medical Home Recognition, July 2018

Section 4: Cost-Effective Care

4-1 Health Centers’ Average Daily Cost Per Patient is Lower than Other Physician Settings4-2 Health Centers Save $1,263 (or 24%) Per Patient Per Year4-3 Health Centers Save 35% Per Child Compared to Other Providers4-4 Health Centers Save 24% Per Medicaid Patient Compared to Other Providers4-5 Health Centers Have Lower Total Spending Per Medicaid Patient Compared to Other Providers4-6 Health Center Medicaid Revenues as a Percent of Total Medicaid Expenditures, 20174-7 Health Centers are Associated with Lower Total Costs of Care for Medicare Patients Compared to Other Providers4-8 Medicare Spending is Lower in Areas Where Health Centers Serve More Low-Income Residents

Table of Contents

Section 5: Health Center Services and Staffing

5-1 Health Center Care Team Staff Provide a Broad Array of Services5-2 Health Center Medical Services Staff, 20175-3 Health Centers are Hiring Non-Physician Providers at Higher Rates than Physicians5-4 Health Center Enabling Services and Other Programs Staff, 20175-5 Percent of Health Centers Offering Case Management Services Onsite, 20175-6 Health Center Dental Staff, 20175-7 Percent of Health Centers Offering Dental Services Onsite, 20175-8 Health Center Behavioral Health Staff, 20175-9 Percent of Health Centers Offering Behavioral Health Services Onsite, 20175-10 Health Centers Have Responded to an Increasing Need For Substance Use Disorder (SUD) Treatment and Therapy By Building

Their Capacity and Integrating Care5-11 Health Centers Have Responded to an Increasing Need for Substance Use Disorder (SUD) Treatment and Therapy by Seeing More

Patients5-12 Percent of Health Centers with Staff Authorized To Provide Medication-Assisted Treatment (MAT) for Opioid Use Disorder, 20175-13 Percent of Health Centers Offering Vision Services Onsite, 20175-14 Percent of Health Centers Offering All Five Services Onsite, 2017 5-15 Growth in Health Center Clinical Staff, 2008 – 2017

Table of Contents

Section 6: Expanding Accessibility with Telehealth

6-1 Health Centers are Using Telehealth to Expand Services That May Not be Readily Available In their Locality6-2 Percent of Health Centers Using Telehealth, 20176-3 Percent of Health Centers Using Telehealth for Behavioral Health Services, 20176-4 Percent of Health Centers Using Telehealth for Specialty Services, 20176-5 Percent of Health Centers Using Telehealth to Manage Patients’ Chronic Conditions, 20176-6 Percent of Health Centers Using Telehealth for Primary Care Services, 20176-7 Percent of Health Centers Using Telehealth for Services Other than Primary Care, Specialty Care, Behavioral Health, or

Monitoring Patients’ Chronic Conditions, 20176-8 Percent of Health Centers Using Telehealth for Two or More Service Types, 2017

Section 7: Challenges in Meeting Demand for Care

7-1 Payments from Third Party Payers are Less than Cost7-2 Federal Health Center Appropriation History, FY10 – FY197-3 Health Center Operating Margins are Less than Hospital Operating Margins7-4 Health Center Funding Per Uninsured Patient Is Well Below Total Per Patient Cost7-5 Health Centers Experience Difficulty Recruiting Many Clinical Staff7-6 Health Centers Have Unique Challenges Recruiting and Retaining Staff7-7 Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 20137-8 Health Centers Face Barriers to Offering Telehealth Services7-9 Health Center Capital Project Plans and Funding Needs, 2015

SECTION 1

WHO HEALTH CENTERS SERVE

Sources: NACHC, 2018. Based on 2017 Uniform Data System data on federally-funded and look-alike health centers, estimates for annual patient growth, and national data sources. Health Center Fact Sheet. Bureau of Primary Health Care, HRSA, DHHS.

Health Centers Serve…

Figure 1-1

* Health center population defined as residents of public housing include all patients served in a health center located in or immediately accessible to a public housing site.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Graphics by Gan Khoon Lay, Ed Harrison, Eric Lamar Pearine, and B Farias for The Noun Project.

Health Centers Serve Many Special Populations

Figure 1-2

*

802,630School-Based Health Center

Patients

972,251Agricultural

Worker Patients

3,466,074Public Housing

Patients*

1,361,675Homeless Patients

355,648Veterans

* Health center population defined as residents of public housing include all patients served at a health center located in or immediately accessible to a public housing site.Sources: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Legal Services Corporation: Agricultural-Worker Population Estimates, Final Estimates, July 2016. U.S. Department of Housing and Urban Development. The 2017 Annual Homeless Assessment Report (AHAR) to Congress, December 2017. U.S. Department of Housing and Urban Development. Picture of Subsidized Households Dataset, 2017. U.S. Census Bureau. Quick Facts, Population Estimates, July 2017.

Health Centers Serve Greater Proportions of Special Populations

Figure 1-3

0.9%0.2%

0.6%

4%

5%

13%

Migratory / Seasonal Farmworkers Homeless Persons Residents of Public Housing*

U.S. Population Health Center Population

Note: FPL = federal poverty level. Percentages of health center patients in each category are based on patients with known income.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Center Patients are Predominately Low-Income

Figure 1-4

100% FPL and Below

69%

101 - 150% FPL

15%

151 - 200% FPL

7%

Over 200% FPL

9%

91% of health center patients are in or near poverty.

Note: Figures may not add to 100% due to rounding. Percentage for “Other Public Insurance” includes non-Medicaid CHIP, or coverage where states contract CHIP through private third-party payers and not Medicaid.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Most Health Center Patients are Publicly Insured or Uninsured

Figure 1-5

18%

1%

9%

23%

49%

Private Insurance

Other Public Insurance

Medicare

Uninsured

Medicaid

82% of health center patients are uninsured or publicly insured.

Notes: Percentages may not add to 100% due to rounding and private physician and emergency dept. Numbers allow for more than one category to be indicated. Dual eligible patient visits were removed from the Medicaid category in NAMCS/NHAMCS data for private physicians and emergency dept. visits. This was done to be more comparable with conventional groupings of Medicare and Medicaid patients when reporting UDS data for health centers.Sources: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. National Ambulatory Medical Care Survey, 2015. Table 7. Expected Sources of Payment at Office Visits. United States, 2015. National Center for Health Statistics. National Hospital Ambulatory Survey, 2015. Table 6. Expected Sources of Payment at Emergency Department Visits: United States, 2015.

Health Center Patients' Health Insurance Coverage

Is Unique Among Ambulatory Care Providers

Figure 1-6

49%

31%

14%

23%

10%

5%

1%

15%

8%

9%

18%

27%

18%

34%

56%

Health Center Emergency Department Private Physician

Private Insurance

Medicare

Other / Unknown

Uninsured

Medicaid

* Based on estimates from the Current Population Survey (CPS), Annual Social and Economic Supplement, 2018. CPS counts coverage at any time during the previous year, and it is possible this is an overestimate due to some beneficiaries having Medicaid coverage at a different time than when he or she had Medicare coverage.Sources: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. National Hospital Ambulatory Survey, 2015. Table 6. Expected Sources of Payment at Emergency Department Visits:United States, 2015. National Center for Health Statistics. National Ambulatory Medical Care Survey, 2015. Table 7. Expected Sources of Payment at Office Visits: United States, 2015. National Centerfor Health Statistics.

Health Centers Serve More Medicare and Medicaid Dual Eligibles

Than Other Ambulatory Care Providers

Figure 1-7

41%

20%

7%0%

100%

Health Center Emergency Department Private Physician

Medicare Only Patients

Dual Eligible Patients

Tota

l Me

dic

are

Pat

ien

tsNationally, 11% of the

U.S. Medicare population are also

enrolled in Medicaid.*

Note: FPL = federal poverty level.* Medicaid and not in combination with other insurance.Sources: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau, 2017 American Community Survey 1-Year Estimates, Tables B17002, S2701, S2704.

Health Center Patients are

Disproportionately Poor, Uninsured, and Publicly-Insured

Figure 1-8

23%

49%

69%

91%

9%

15%

13%

31%

Uninsured

Medicaid*

At or Below 100% FPL

Under 200% FPL

U.S. Population Health Center

Sources: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau, 2017 American Community Survey 1-Year Estimates, Table B03002.

Health Center Patients are

Disproportionately Members of Racial/Ethnic Minority Groups

Figure 1-9

1.4%

3.5%

5%

22%

36%

0.8%

3.3%

6%

13%

18%

American Indian /Alaska Native

Multiracial

Asian / Hawaiian /Pacific Islander

African American /Black

Hispanic / Latino

U.S. Population Health Center

41%

1%

3%

5%

22%

36%

White, Non-Hispanic

American Indian / Alaska Native

Multiracial

Asian / Hawaiian / Pacific Islander

Black / African American

Hispanic / Latino

* Calculated using the Reference Guide for UDS Data Reports Available to Health Centers, CY 2016, Bureau of Primary Health Care, HRSA, DHHS. Note: Figures may not add to 100% due to rounding and patients of Hispanic ethnicity can identify with any racial category. Based on known race and/or ethnicity.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Most Health Center Patients are

Members of Racial/Ethnic Minority Groups

Figure 1-10

63% of health center patients are of racial/ethnic minorities.*

32%

36%

14%11%

18%

45%42%

21% 21%

42%

Hypertension High Cholesterol Asthma Diabetes* Health is Fairor Poor

U.S. Population Health Center

* Other than during pregnancy.Note: Includes only adult population ages 18 and older.Sources: 2014 Health Center Patient Survey. Bureau of Primary Health Care, HRSA, DHHS. Kaiser Family Foundation. Health Status Indicators. 2015. Note: Used for High Cholesterol, Hypertension,Diabetes, and Self-Reported Health Status. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. BRFSS Prevalence Trends and Data. 2016. Note: Used for Asthma;estimate is the median crude prevalence rate for all U.S. States, Territories, and D.C.

Health Center Patients Suffer from Chronic Conditions

At Higher Rates than the General Population

Figure 1-11

Percent of Adult Population who Report Ever Being Told They Have:

Percent of Adult Population

Reporting:

Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Centers Serve Patients Throughout the Life Cycle(Selected Age Groups, Represented Two Ways)

Figure 1-12

Under 1831%

Ages 18-4436%

Ages 45-6424%

Ages 65+9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Ages 45 - 6424%

Ages 65+9%

Ages 20 - 4433%

Ages 18 - 193%Ages 13 - 17

8%Ages 5 - 12

14%

Under 59%

SECTION 2

EXPANDING ACCESS TO CARE

Figure 2-1

Notes: National figure includes health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

16

DC

8

DE

3

MA

39

MD

17

NH

11

NJ

23

RI

8

VT

11

Number of Federally-Funded Health Center Organizations, 2017

Nationally, there are 1,373 health center organizations.

Source: 2008 - 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Growth in Health Center Organizations and Sites, 2008 – 2017

Figure 2-2

1,0801,131 1,124 1,128

1,198 1,2021,278

1,375 1,367 1,373

8,320

7,257 6,9497,621

8,912 9,170 8,801

9,75410,404

11,056

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

0

200

400

600

800

1,000

1,200

1,400

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Serv

ice

De

live

ry S

ite

s

He

alth

Ce

nte

r G

ran

tee

Org

aniz

atio

ns

Grantees

Sites

Source: 2008 - 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Growth in Health Center Patients and Visits, 2008 – 2017

Figure 2-3

17.118.8 19.5 20.2

21.1 21.722.9

24.325.9

27.2

66.973.8

77.1 80.083.8 85.6

90.497.0

104.1110.4

0

20

40

60

80

100

120

0

5

10

15

20

25

30

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Tota

l Vis

its

(In

Mill

ion

s)

Tota

l Pat

ien

ts (

In M

illio

ns)

Total Patients

Total Patient Visits

* The Bureau of Primary Health Care defines enabling services as “a wide range of services that support and assist primary care and facilitate patient access to care” (2017 UDS Reporting Manual, p.113, Bureau of Primary Health Care, HRSA, DHHS). Examples of enabling services include case managers, transportation staff, interpretation staff, community health workers, and patient education specialists. Note: M = Million.Sources: 2010 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Centers Have Expanded the Types of Services

Available to Patients(Total Patient Visits in 2017 and Growth Since 2010)

Figure 2-4

110.4MVisits

11.1MVisits

15.7MVisits

74.3MVisits

6.3MVisits

0.9MVisits

43%Growth

27%Growth

33%Growth

70%Growth

111%Growth

116%Growth

Total Visits Enabling Services* Medical Dental Behavioral Health Vision

110.4MVisits

11.1MVisits

15.7MVisits

74.3MVisits

6.3MVisits

0.9MVisits

Sources: 2010 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Centers Have Expanded Their Capacity

To Provide More Services Onsite(Number of Health Centers Employing Staff for Selected Services)

Figure 2-5

1,053

828 857

199 163

1,361

1,234

1,113

339 307

Enabling Services Behavioral Health Dental Vision All Four Services

2010 (1,124 total) 2017 (1,373 total)

29% Increase49% Increase

30% Increase

70% Increase 88% Increase

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

Health Centers Have Higher Rates of Accepting New Patients

Compared to Other Primary Care Providers

Figure 2-6

81%

97%

96%

98%

39%

66%

76%

93%

New Uninsured Patients

New Medicaid Patients

New Medicare Patients

New Patients

Other Primary Care Providers Health Centers

Note: Represents individuals below 100% Federal Poverty Level.Sources: 2006 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau, Historical Poverty Tables, Table 2: Poverty Status of People by Family Relationship,Race, and Hispanic Origin.

The Number of Health Center Patients in Poverty is GrowingFaster Than the Number of People in Poverty Nationally, 2006 - 2017

Figure 2-7

9%Growth

64%Growth

Low-Income Nationally Health Center Low-Income

Sources: 2008 and 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Kaiser Family Foundation. Medicaid Enrollment Snapshot: December 2013: Table A-2: Total Medicaid Enrollment by State, December 2006-2013. Kaiser Family Foundation. Total Monthly Medicaid and CHIP Enrollment. December 2017.

The Number of Health Center Medicaid Patients is Growing Faster

Than the Number of Medicaid Beneficiaries Nationally, 2008 - 2017

Figure 2-8

66%Growth

118%Growth

Medicaid Beneficiaries Nationally Health Center Medicaid Beneficiaries

Figure 2-9

Note: National figure excludes health center Medicaid patients in territories and does not include Puerto Rico. Binned by quantile for states and territories shown.Sources: NACHC Analysis of (1) 2017 Uniform Data System (UDS). Bureau of Primary Health Care, HRSA, BPHC. (2) Kaiser Commission on Medicaid and the Uninsured. Monthly Medicaid and CHIP Enrollment, December 2017. Puerto Rico estimate based on NACHC analysis of 2017 UDS and U.S. Census Bureau, 2017 American Community Survey 1-Year Estimates, Table S2704.

CT

29%

DC

39%

DE

8%

MA

22%

MD

12%

NH

14%

NJ

16%

RI

32%

VT

30%

Percent of Medicaid Beneficiaries Served by Health Centers, 2017

Nationally, health centers serve 18% of the Medicaid

population.

Source: 2008 - 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Patients by Insurance Status, 2008 – 2017 (In Millions)

Figure 2-10

6.1

6.9

7.58.0

8.4

8.8

10.7

11.9

12.713.3

6.67.2 7.3 7.4 7.6 7.6

6.45.9 6.1 6.2

2.7 2.7 2.7 2.9 3.0 3.13.6

4.14.4

4.8

1.3 1.4 1.5 1.6 1.7 1.8 2.0 2.2 2.4 2.6

0.5 0.5 0.5 0.5 0.5 0.4 0.3 0.2 0.3 0.3

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Medicaid

Uninsured

Private

Medicare

Other

Sources: 2008 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2008. U.S. Census Bureau, Health Insurance Coverage in the United States: 2017.

Even as More Patients Obtain Insurance, HealthCenters are Serving More of the Nation’s Uninsured

Figure 2-11

Figure 2-12

Note: National figure includes all 1,373 health centers in every state, territory, and D.C. Some Territories are not shown in the map above. Binned by quantile for states and territories shown.Sources: NACHC Analysis of (1) 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. (2) U.S. Census Bureau. 2017 American Community Survey, 1-Year Estimates, Table S2701.

Percent of Uninsured Population Served by Health Centers, 2017

CT

34%

DC

61%

DE

26%

MA

61%

MD

15%

NH

18%

NJ

22%

RI

35%

VT

49%

Nationally, health centers serve 22% of the uninsured

population.

SECTION 3

HIGH QUALITY CARE

AND REDUCING HEALTH DISPARITIES

* To see a comparison of the prevalence of chronic conditions for health center patients, see Figure 1-11. ** Estimated percentage of hypertensive patients with blood pressure < 140/90. *** Estimated percentage of diabetic patients with Hba1c < 9% for diabetes. Sources: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Committee for Quality Assurance, The State of Health Care Quality. Diabetes Care (2016) and Controlling for High Blood Pressure (2016). Bureau of Primary Health Care. 2018. Health Center Program Fact Sheet.

Health Centers Achieve Higher Rates of

Hypertension and Diabetes Control than the National Average,

Despite Serving More At Risk Patients*

Figure 3-1

57% 57%

63%67%

% of Population with HypertensionUnder Control**

% of Population with DiabetesUnder Control***

National Health Center

Note: Healthy People 2020 goals are based on national health objectives to identify and reduce the most significant, preventable threats to health. For more on Healthy People 2020, visit https://www.cdc.gov/dhdsp/hp2020.htmSources: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Office of Disease Prevention and Health Promotion. Healthy People 2020. 2020 Topics and Objectives.

Many Health Centers Exceed Healthy People 2020 Goals

Figure 3-2

92%

61%

55%

49%

46%

Meet or Exceed at Least One Goal

Dental Sealants for Children

Hypertension Control

Access to Prenatal Care

Low Birth Weight

Percent of health centers thatmeet or exceed Healthy People 2020

goal on…

Source: 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.

Health Center Patients are More Satisfied with Care

Received Compared to Low-Income Patients Nationally

Figure 3-3

37%

87%

96% 98%

Satisfied with Hours of Operation Satisfied with Overall Care Received

Low-Income Patients Nationally Health Center Patients

Notes: 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; Pap Tests: share of female patients age 24 – 64 who received Pap test within past three years. 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).

Health Centers Exceed Medicaid Managed Care Organization

High Performance Benchmark Scores

Figure 3-4

79%

73%

81%

71%

63%

54%

Diabetes Control Blood Pressure Control Pap Test

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

62% 62%

72%

Medicaid MCO High Performance Benchmark (75th Percentile)

Sources: Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/Ethnic and Socioeconomic Disparities in Access to Care and Quality of Care for U.S. 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.

Health Centers Provide More Preventive Services

Than Other Primary Care Providers

Figure 3-5

85%

70%

51%

33%

24%

81%

65%

37%

19%

15%

Patient Visits to Other Providers Health Center Patient Visits

Asthma Education forAsthmatic Patients

Tobacco Cessation Educationfor Smoking Patients

Health Education

Immunization for 65 and Older

Pap Smear in the Last 3 Years

Source: Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.

Health Centers Reduce Disparities in Hypertension Treatment(Percent of Medicaid Patients Receiving New Medication for Uncontrolled Hypertension)

Figure 3-6

9%

21%

Private Practice Physicians Health Centers

Private Practice Physicians Health Centers

* Includes women below 100% FPL or at 100% FPL and below. Sources: Health Resources and Services Administration, 2014 Health Center Patient Survey. Female Health Center Patients Aged 40+ Who Had a Mammogram in the Past 2 Years. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Table 70. Use of Mammography Among Women Aged 40 and Over, by Selected Characteristics: United States, Selected Years 1987 - 2015.

Women at Health Centers are More Likely to Receive MammogramsThan Their Counterparts Nationally

Figure 3-7

30%

52%

61%

70%

63%

69%

76%

82%

Uninsured In Poverty* Hispanic Black

National Health Centers

* Includes women below 100% FPL or at 100% FPL and below. Sources: Health Resources and Services Administration, 2014 Health Center Patient Survey. Female Health Center Patients Aged 18+ Who Had a Pap Smear in the Past 3 Years. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Table 71. Use of Pap Smears Among Women Aged 18 and Over, by Selected Characteristics: United States, Selected Years 1987 – 2015.

Women at Health Centers are More Likely to Receive Pap Smears Than Their Counterparts Nationally

Figure 3-8

57%63%

75%

69%

76%82%

89%92%

Uninsured In Poverty* Black Hispanic

National Health Centers

*Includes individuals below 100% FPL or at 100% FPL and below. Sources: Health Resources and Services Administration, 2014 Health Center Patient Survey. Health Center Patients Aged 50+ Who Ever Had a Colonoscopy. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017. Table 72. Use of Colorectal Tests or Procedures Among Adults Aged 50-75, by Selected Characteristics: United States, Selected Years 2000 - 2015.

Health Center Patients are More Likely to Receive Colorectal Cancer Screenings Than Their Counterparts Nationally

Figure 3-9

43% 44%

56%57%55% 55%

In Poverty* Hispanic Black

National Health Centers

Sources: 2017 Uniform Data Sysem, Bureau of Primary Health Care, HRSA, DHHS. NACHC analysis of CDC WONDER. Data downloaded November 28, 2018.

Health Center Patients Have Lower Rates ofLow Birth Weight than Their U.S. Counterparts,

Despite Health Centers Serving More At Risk Patients

Figure 3-10

8.3%

7.1% 7.4%8.3% 8.5% 8.9%

13.4%

8.0%

7.0% 6.6%

7.9% 7.6% 7.6%

11.7%

All Births White Hispanic American Indian /Alaska Native

Asian Multiracial Black or AfricanAmerican

National Health Center

Source: Goldman, L. E. et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2): 142. * Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Center and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.

Health Centers Perform Better on Ambulatory Care Quality

Measures than Private Practice Physicians

Figure 3-11

18%

51%

57%

59%

90%

91%

99%

16%

37%

44%

47%

86%

84%

93%

Private Physician Health Center

No Electrocardiogram Screening InLow-Risk Patients

No Use of BenzodiazepinesIn Depression

Blood Pressure Screening

β-Blocker Use in CoronaryArtery Disease

Aspirin Use in CoronaryArtery Disease

Ace Inhibitor Use inCongestive Heart Failure

Prescription of New Antihypertensive Medication for Uncontrolled Hypertension*

Figure 3-12

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Source: Communication with the Bureau of Primary Health Care, HRSA, DHHS, September 11, 2018.

CT

94%

DC

88%

DE

67%

MA

95%

MD

59%

NH

100%

NJ

83%

RI

100%

VT

100%

Percent of Health Centers with

Patient-Centered Medical Home Recognition, July 2018

Nationally, 75% of health centers have earned

Patient-Centered Medical Home recognition.

SECTION 4

COST-EFFECTIVE CARE

Sources: 2014 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS., Agency for Healthcare Research and Quality. Medical Expenditure Survey. Table 8.1a: Office-based Medical Provider Services-Mean and Median Expenses per Person with Expense and Distribution of Expenses by Source of Payment: United States, 2014. Visits to physicians only.

Health Centers’ Average Daily Cost Per Patient is

Lower Than Other Physician Settings

Figure 4-1

$3.06

$2.09

All Physician Settings Health Centers

All Physician Settings Health Centers

Sources: NACHC analysis based on Ku 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.

Health Centers Save $1,263 (or 24%) Per Patient Per Year

Figure 4-2

Non - Health Center Users Health Center Users

Hospital EmergencyDepartment

Hospital Inpatient

Ambulatory

Other Services

$5,306

$4,043

Source: Bruen B, Ku L. Community Health Centers Reduce the Costs of Children’s Health Care. Geiger Gibson/RCHN Community Health Foundation Research Collaborative. Policy Research Brief #48. June 20, 2017.

Health Centers Save 35% Per Child Compared to Other Providers

Figure 4-3

$320

$697

$1,751

$163

$418

$1,133

Prescription Drugs Ambulatory Total

Other Providers Health Centers

35% Lower Spending

49% Lower Spending

40% Lower Spending

Note: Non-health centers include private physician offices and outpatient clinics. Source: Nocon et al. Health care use and spending for Medicaid enrollees in federally qualified health centers versus other primary care settings. AJPH. November 2016. 106(11): 1981-1989.

Health Centers Save 24% Per Medicaid Patient

Compared to Other Providers

Figure 4-4

$244

$1,845 $2,047

$2,948 $2,704

$9,889

$216

$1,430 $1,496$1,964

$2,324

$7,518

Emergency Room Primary Care Inpatient Care Other Outpatient Care Rx Drug Spending Total Spending

Non-Health Centers Health Centers

24% Lower Total Spending

14% Lower Spending

33% Lower Spending27% Lower

Spending23% Lower Spending

11% Lower Spending

Notes: Other Providers (or “non-health centers”) include private physician offices and outpatient clinics. MT was included in the national-level analyses but did not have a large enough sample size to be included in the adjusted state-level analyses. Source: Nocon et al. Health care use and spending for Medicaid Enrollees in Federally Qualified Health Centers Versus other Primary Care Settings. AJPH. November 2016. 106(11): 1981-1989.

Health Centers Have Lower Total Spending Per Medicaid Patient

Compared to Other Providers

Figure 4-5

63%Lower

22%Lower 26%

Lower

19%Lower

32%Lower

27%Lower

27%Lower

19%Lower

29%Lower

22%Lower

15%Lower 18%

Lower

AL CA CO CT FL IA IL MS NC TX VT WV

Figure 4-6

Note: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown.Sources: NACHC analysis of (1) 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Medicaid and CHIP Payment Access Commission. Medicaid Spending by State, Category, and Source of Funds, FY 2017. MACStats: Medicaid and CHIP.

CT

2.9%

DC

4%

DE

0.5%

MA

1.7%

MD

1.4%

NH

0.9%

NJ

0.9%

RI

3.5%

VT

2.5%

Health Center Medicaid Revenues as a Percent

Of Total Medicaid Expenditures, 2017

Nationally, health center Medicaid revenues account for 1.9% of total Medicaid expenditures...

...While serving 18% of the nation’s Medicaid population.

(see Figure 2-9)

Source: Mukamel, D.B., White, L.M., Nocon R.S., et al. Comparing the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to Other Care Settings. Health Serv Res. April 2016. 51(2): 625-644.

Health Centers are Associated with Lower Total Costs of Care

For Medicare Patients Compared to Other Providers

Figure 4-7

$2,370

$2,667

$3,580

Health Centers

Physician Offices

Outpatient Clinics

Costs for health center Medicare patients are 10% lower than physician office

patients and 30% lower than outpatient clinics.

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%. 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 and Medicaid Research Review. 2014; 4(3):E1-E17.58.

Medicare Spending is Lower in Areas Where Health

Centers Serve More Low-Income Residents

Figure 4-8

$8,616

$9,222

$9,542

High Health CenterPenetration Area

All Areas

Low Health CenterPenetration Area

Areas with high health center penetration have 10% ($926) lower Medicare spending per beneficiary.

SECTION 5

HEALTH CENTER SERVICES AND STAFFING

Note: Percentages may not add to 100% due to rounding.Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Care Team Staff Provide a Broad Array of Services(Total Care Team: 141,478 Full-Time Equivalent)

Figure 5-1

Medical55%

Enabling Services & Other Programs

19%

Dental13%

Behavioral Health9%

Pharmacy4% Other Professional Services

1.1%

Vision0.5%

* Total Care Team is shown in Figure 5-1.Notes: NP/PA/CNM stands for Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives. Other Medical Personnel include, but are not limited to, medical assistants, nurses’ aides, laboratory personnel and X-Ray personnel. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Medical Services Staff, 2017(Total Medical Team: 77,298 Full-Time Equivalent)

Figure 5-2

55%

Share of Total Care Team*

Other Medical Personnel44%

Total Nurses23%

Total NPs/PAs/CNMs

16%

Other Specialty Physicians3.5%

General Practitioners3.5%

OB/GYN10%

Internists15%

Pediatricians22%

Family Physicians46%

Total Physicians17%

Notes: NP, PA, and CNM stand for Nurse Practitioner, Physician Assistant, and Certified Nurse Midwife, respectively. Sources: 2001 - 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Centers are Hiring Non-Physician Providers

At Higher Rates than Physicians

Figure 5-3

2,793 3,170 3,443 3,693 3,973 4,292 4,693 5,138 5,758 6,362 6,933 7,555 8,156 9,092 10,332 11,485 12,6215,176 5,735 6,385 6,680 7,097 7,595 7,994 8,441

9,1259,592

9,93610,445

10,73411,203

11,86712,419

12,8940.54 0.55 0.54 0.55 0.56 0.57 0.59 0.61 0.63

0.660.70

0.720.76

0.810.87

0.920.98

0.0-to-1

0.1-to-1

0.2-to-1

0.3-to-1

0.4-to-1

0.5-to-1

0.6-to-1

0.7-to-1

0.8-to-1

0.9-to-1

1.0-to-1

0

5,000

10,000

15,000

20,000

25,000

30,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Rat

io o

f N

P/PA

/CN

Ms

to P

hys

icia

ns

Full-

Tim

e E

qu

ival

en

t C

ou

nt

NP/PA/CNM Total Physicians Ratio

* Total Care Team is shown in Figure 5-1. Note: Percentages may not add to 100% due to rounding.Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Enabling Services and Other Programs Staff, 2017(27,045 Full-Time Equivalent)

Figure 5-4

19%

Share of Total Care Team*

Patient / Community Education Specialists

10%

Outreach Workers10%

Eligibility Assistance Workers

16%

Other Programs / Services

20%

Case Managers31%

Interpretation Staff4%

Community Health Workers4%

Other Enabling Services2%

Transportation Staff3%

Figure 5-5

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Percentages offering services onsite calculated by including all health centers with more than 0 full-time equivalents for each service. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

81%

DC

75%

DE

100%

MA

85%

MD

88%

NH

91%

NJ

83%

RI

75%

VT

82%

Percent of Health Centers Offering

Case Management Services Onsite, 2017

Nationally, 79% of health centers provide

case management services onsite.

* Total Care Team is shown in Figure 5-1. Note: Percentages may not add to 100% due to rounding.Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Dental Staff, 2017(17,802 Full-Time Equivalent)

Figure 5-6

13%

Share of Total Care Team*

Dental Hygienists14%

Dentists27%Dental Assistants,

Aides, Techs, Other59%

Figure 5-7

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Percentages offering services onsite calculated by including all health centers with more than 0 full-time equivalents for each service. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

100%

DC

75%

DE

100%

MA

85%

MD

65%

NH

82%

NJ

83%

RI

100%

VT

73%

Percent of Health Centers Offering

Dental Services Onsite, 2017

Nationally, 81% of health centers provide dental services onsite.

* Total Care Team is shown in Figure 5-1. Note: Percentages may not add to 100% due to rounding.Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Center Behavioral Health Staff, 2017(12,064 Full-Time Equivalent)

Figure 5-89%

Share of Total Care Team*

Psychiatrists6% Licensed Clinical

Psychologists7%

Substance Use Disorder Services Staff

12%

Other Mental Health Staff

21%Other Licensed Mental

Health Providers23%

Licensed Clinical Social Workers

31%

Figure 5-9

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Behavioral Health includes mental health and substance abuse services. Percentages offering services onsite calculated by including all health centers with more than 0 full-time equivalents for each service.Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

100%

DC

100%

DE

100%

MA

85%

MD

88%

NH

100%

NJ

74%

RI

100%

VT

91%

Percent of Health Centers Offering

Behavioral Health Services Onsite, 2017

Nationally, 90% of health centers provide

behavioral health services onsite.

Sources: 2010 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Federally-funded health centers only.Graphics by Arafat Uddin, Adrien Coquet, Annamarie Kosto, and Chanut for The Noun Project.

Health Centers Have Responded to an Increasing Need For

Substance Use Disorder (SUD) Treatment and Therapy

By Building Their Capacity and Integrating Care

Figure 5-10

Sources: 2010 and 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

Health Centers Have Responded to an Increasing Need for Substance

Use Disorder (SUD) Treatment and Therapy by Seeing More Patients

Figure 5-11

317,518

485,992

1,182,710

73,082

97,913

110,031

1,093,455

2,225,371

2,373,723

310,855

700,789

157,504 Tobacco

Cessation

Alcohol Dependence

Other SUD (Including Opioids)

2010

2017

Patients for SUD Services2010 vs. 2017

Visits for SUD Services2010 vs. 2017

Health centers experienced a nearly five-fold increase in patients

seeking treatment for opioids and other

substance use disorders.

Figure 5-12

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

56%

DC

75%

DE

33%

MA

79%

MD

53%

NH

100%

NJ

30%

RI

88%

VT

100%

Percent of Health Centers with Staff Authorized to Provide

Medication-Assisted Treatment (MAT) for Opioid Use Disorder, 2017

Nationally, 43% of health centers have staff authorized to

provide MAT.

Figure 5-13

Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Percentages offering services onsite calculated by including all health centers with more than 0 full-time equivalents for each service. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

44%

DC

38%

DE

33%

MA

67%

MD

6%

NH

18%

NJ

22%

RI

38%

VT

9%

Percent of Health Centers Offering Vision Services Onsite, 2017

Nationally, 25% of health centers provide vision services onsite.

Figure 5-14

* The Bureau of Primary Health Care defines enabling services as “a wide range of services that support and assist primary care and facilitate patient access to care (2017 UDS Reporting Manual, p.113, Bureau of Primary Health Care, HRSA, DHHS).” Examples of enabling services include case managers, transportation staff, interpretation staff, community health workers, and patient education specialists. Notes: National figure includes all 1,373 health centers in every state, territory, and D.C. Some territories are not shown in the map above. Binned by quantile for states and territories shown. Percentages offering services onsite calculated by including all health centers with more than 0 full-time equivalents for each service. Source: 2017 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.

CT

44%

DC

38%

DE

33%

MA

59%

MD

0%

NH

9%

NJ

17%

RI

38%

VT

9%

Percent of Health Centers Offering All Five Services Onsite, 2017 (Medical, Enabling Services*, Dental, Behavioral Health and Vision)

Nationally, 22% of health centers provide all five

service types onsite.

Note: NP, PA, CNM stand for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, respectively. Behavioral health staff includes mental health and substance abuse staff.Sources: 2008 and 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Growth in Health Center Clinical Staff, 2008 – 2017(In Full-Time Equivalent)

Figure 5-15

3,959

5,138

8,441

9,807

7,520

12,06412,621 12,894

17,663 17,802

Behavioral Health Staff NPs, PAs, CNMs Physicians Nurses Dental Staff

2008 2017 137%Increase

53%Increase

80% Increase

146%Increase

205%Increase

SECTION 6

EXPANDING ACCESSIBILITY WITH TELEHEALTH

52%

27%25%

21%

6%

23%

32%

61%

32%

22% 22%

6%

24%

36%

44%

23%27%

20%

6%

23%

27%

Behavioral HealthServices

Specialty CareServices

Manage ChronicConditions

Primary CareServices

Oral Health Services Other Two Or MoreServices

All (600 out of 1,373 Using Telehealth)

Rural (295 out of 608 Using Telehealth)

Urban (305 out of 765 Using Telehealth)

Note: The Health Resources Services Administration (HRSA) defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Centers are Using Telehealth to Expand ServicesThat May Not be Readily Available in their Locality

(Health Center Telehealth Service Offerings by Urban/Rural Status)Note: Percentages include only health centers utilizing telehealth

Figure 6-1

Figure 6-2

Note: For number of health centers in each state, see Figure 2-1. Binned by quantile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

56%

DC

38%

DE

67%

MA

54%

MD

18%

NH

27%

NJ

26%

RI

38%

VT

36%

Percent of Health Centers Using Telehealth, 2017

Nationally, 44% of health centers provide telehealth

services.

Figure 6-3

Notes: Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. Behavioral Health includes mental health and substance abuse services. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quantile for states and territories shown. Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

11%

DC

67%

DE

100%

MA

24%

MD

67%

NH

0%

NJ

17%

RI

0%

VT

50%

Percent of Health Centers Using Telehealth for

Behavioral Health Services, 2017

Nationally, 52% of health centers with a telehealth program used it

to provide behavioral health services.

Figure 6-4

Notes: Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quantile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

78%

DC

33%

DE

0%

MA

43%

MD

0%

NH

33%

NJ

33%

RI

33%

VT

0%

Percent of Health Centers Using Telehealth for

Specialty Services, 2017

Nationally, 27% of health centers with a telehealth

program used it to provide specialty services.

Figure 6-5

Notes: Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quartile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

33%

DC

67%

DE

0%

MA

14%

MD

0%

NH

33%

NJ

33%

RI

0%

VT

0%

Percent of Health Centers Using Telehealth to

Manage Patients’ Chronic Conditions, 2017

Nationally, 25% of health centers with a telehealth

program used it to manage patients’ chronic conditions.

Figure 6-6

Notes: Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quartile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

0%

DC

33%

DE

0%

MA

29%

MD

0%

NH

0%

NJ

33%

RI

33%

VT

0%

Percent of Health Centers Using Telehealth for

Primary Care Services, 2017

Nationally, 21% of health centers with a telehealth

program used it to provide primary care services.

Figure 6-7

Notes: Health centers were able to respond as “other” when asked to report services offered via telehealth. Percentages also include health centers using telehealth for dental services in addition to “other.” Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quantile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

11%

DC

0%

DE

0%

MA

43%

MD

33%

NH

33%

NJ

67%

RI

33%

VT

50%

Percent of Health Centers Using Telehealth for Services Other than Primary Care,

Specialty Care, Behavioral Health, or Monitoring Patients’ Chronic Conditions, 2017

Nationally, 29% of health centers with a telehealth

program used it for other services.

Figure 6-8

Note: Based on percent of health centers using telehealth for any service. For percent of health centers using telehealth by state, see Figure 5-17. National figure includes health centers using telehealth in territories not shown in the map above. Binned by quantile for states and territories shown.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CT

33%

DC

67%

DE

0%

MA

19%

MD

0%

NH

0%

NJ

33%

RI

0%

VT

0%

Percent of Health Centers Using Telehealth for

Two or More Service Types, 2017

Nationally, 32% of health centers with a telehealth

program used it to provide more than 1 type

of service.

SECTION 7

CHALLENGES IN MEETING DEMAND FOR CARE

Note: Health centers are non-profits, and thus charges are a proxy for costs.Source: 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Payments from Third Party Payers are Less than Cost

Figure 7-1

79%Collected

58%Collected

57%Collected

56%Collected

0%

100%

Medicaid Medicare Other Public Insurance Private Insurance

Tota

l Ch

arge

s to

Th

ird

Par

ty P

aye

rs

Note: B = Billions.Source: Federal appropriations are for consolidated health centers under PHSA Section 330. Federally-funded health centers only.

Figure 7-2

$2.2B$1.6B $1.6B $1.5B $1.5B $1.5B $1.5B $1.5B $1.6B $1.6B

$1.0B $1.2B $1.5B$2.2B

$3.6B $3.6B $3.6B$3.8B $4.0B

FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19

Community Health Center Fund

Base Discretionary Appropriation

$2.6B

$3.7B

$5.1B $5.1B $5.1B$5.4B

$5.6B

$2.2B

$2.8B$3.0B

Federal Health Center Appropriation History, FY10 – FY19

Note: Operating margin data for hospitals after 2016 are unavailable. Sources: 2008 - 2017 Uniform Data System. Bureau of Primary Health Care, HRSA. DHHS. American Hospital Association. Trendwatch Chartbook 2018: Trends Affecting Hospitals and Health Systems. Supplementary Data Tables. Table 4.1: Aggregate Total Hospital Margins and Operating Margins; Percentage of Hospitals with Negative Total Margins; and Aggregate Non-operating Gains as a Percentage of Total Net Revenue, 1994 – 2016.

Health Center Operating Margins

Are Less than Hospital Operating Margins

Figure 7-3

5.7%

6.4%

7.4%

6.7%

1.6%

3.0%

4.3%

3.1%2.8%

2013 2014 2015 2016 2017

Hospitals

Health Centers

* Calculated by taking the difference between 2017 health center total cost per patient (all patients) and 2017 health center funding per uninsured patient, then multiplying by the number of health center uninsured patients in 2017.Sources: 2008 - 2017 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Center Funding Per Uninsured Patient

Is Well Below Total Per Patient Cost

Figure 7-4

$588 $600$630

$654$687

$721$763

$827

$890$942

$279 $271 $272$294 $307

$334

$463

$599

$713$740

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cost of Care Gap

Health centers cared for over 6.2 million uninsured individuals in 2017, leaving a cost of care gap

of over $1 billion.*

Annual Health Center Total Cost Per Patient (All Patients)

Annual Health Center Funding per Uninsured Patient

Source: NACHC. Staffing the Safety Net: Building the Primary Care Workforce at America’s Health Centers. 2016. Retrieved from: http://www.nachc.org/research-and-data/.

Health Centers Experience Difficulty Recruiting Many Clinical Staff(Percent of Health Centers Reporting a Vacancy for Specific Clinical Positions)

Figure 7-5

6%

6%

7%

8%

9%

13%

16%

16%

16%

18%

19%

23%

31%

37%

38%

41%

48%

50%

69%

95%

Certified Nurse Midwife

Vision Services Staff

Pharmacist

Non-Licensed Mental Health and/or Substance Abuse Staff

Psychologist

OB / GYN

Dental Hygienist

Other Licensed Mental Health and/or Substance Abuse Staff

Physician Assistant

Psychiatrist

Pediatrician

Internist

Licensed Practical Nurse / Licensed Vocational Nurse

Dentist

Licensed Clinical Social Worker

Registered Nurse

Medical Assistant

Nurse Practioner

Family Physician

Any Clinical Vacancy

Source: NACHC. Staffing the Safety Net: Building the Primary Care Workforce at America’s Health Centers. 2016. Retrieved from: http://www.nachc.org/research-and-data/research-fact-sheets-and-infographics/

Health Centers Have Unique Challenges Recruiting and Retaining Staff(Percent of Health Center Reporting Specific Challenges for Recruitment and Retention)

Figure 7-6

Health Information Technology Capacity2%

4%

8%

9%

20%

25%

43% Salary that is Competitive

3%

4%

13%

5%

21%

20%

39%

Community Amenities and Other Health Center Location Factors

Benefits Package that is Competitive

Candidates’ Language Proficiency and/or Cultural Competency

Health Center’s Current Workload and/or Call Schedule

Health Center Facility Condition

RetentionRecruitment

Sources: Created by The Robert Graham Center (2014). U.S. 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. Retrieved from: http://www.nachc.org/wp-content/uploads/2015/11/MDFS.pdf

Estimated Percent of County Residents Experiencing

Shortages of Primary Care Physicians, 2013

Figure 7-7

62 million people experience inadequate or no access to primary

care because of shortages of physicians in their communities.

Note: 844 out of 1,367 health centers did not use telehealth in 2016.Source: Telehealth In Health Centers: Key Adoption Factors, Barriers, And Opportunities. Ching-Ching Claire Lin, Anne Dievler, Carolyn Robbins, Alek Sripipatana, Matt Quinn, and Suma Nair.

Health Affairs 2018 37:12, 1967-1974.

Health Centers Face Barriers to Offering Telehealth Services(Percent of Health Centers that Do Not Use Telehealth Reporting Specific Barriers, 2016)

Figure 7-8

4%

3%

0.6%

5%

6%

5%

16%

15%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

3%

5%

5%

7%

10%

11%

12%

21%

0.0%5.0%10.0%15.0%20.0%25.0%

Cost and Reimbursement

Technical Issues Aside from Broadband

Partners and Providers

Miscellaneous Technical Issues

Patient Accessibility Issues

Broadband

Unclear Barrier

Regulations, Policies, or Scope of Work

UrbanRural

Source: CapLink. Health Center Capital Project Plans and Funding Needs. 2015. Graphic by Hopkins for The Noun Project.

Health Center Capital Project Plans and Funding Needs, 2015

Figure 7-9

These planned projects are estimated to cost $4.6 billion, resulting in:

• 12 million square feet of new space

• Accommodations for 6,100 new providers

• Services for 5.4 million new patients annually

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

© National Association of Community Health Centers For more information, email research@nachc.org.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,375,000 with 0%

financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more

information, please visit HRSA.gov.

Suggested Citation:

National Association of Community Health Centers. Community Health Center Chartbook. January 2019.