The old proverb states, “Necessity is the mother of invention.” Nowhere does that ring more true than in our nation's healthcare system following the implementation of the Affordable Care Act.
While the ACA is proving to be a tremendous benefit to millions of previously uninsured people, our existing national network of healthcare providers is being stressed as never before, requiring innovation that achieves the triple aim of improved health for populations served, better patient experience and lower costs—all in the face of significant challenges.
In California, we have a diverse network of community clinics and health centers that has driven innovations in quality, access and cost for decades. And because of the scope and size of our healthcare program, we welcome the opportunity to share our progress with our peers nationwide, as we all work to meet the healthcare needs of our communities.
Then, like now, California health centers' ingenuity was born of necessity. For generations, healthcare in California and much of the nation has been a two-tier system: those who have insurance coverage and those who do not. The mainstream healthcare system of private physicians and hospitals were largely responsible for those with coverage, while community clinics and health centers stretched scarce financial resources to serve those without.
Those days are over, but we still remember the hard lessons we learned while living our mission: to care for everyone regardless of their ability to pay.
Those lessons taught us the importance of prudent fiscal stewardship and common-sense care. We learned the importance of cultural competency, social determinants of health, food insecurity, housing status and our patient's financial well-being. We understand that health is not just what happens in the exam room, but is total sum of a patient's life and experience.
And while we continue to innovate, we are now tasked with applying our lessons learned to the 14 million people who are now enrolled in California's Medicaid program, Medi-Cal, and its insurance exchange. With such high stakes, it is incumbent upon us to ensure our progress is not in vain, but is indeed improving quality, access and cost of care. According to three trusted sources, we are succeeding.
In February, Blue Shield of California Foundation's report “Delivering on a Promise: Advances and Opportunities in health care for low-income Californians,” found that community clinic and health center patients are as satisfied with their care as those seeing private doctors. Key to their success is their ability to establish greater connectedness with their patients, understand cultural competence and providing social service referrals—which is likely why clinics and health centers in the state have seen an 11% increase in overall patient satisfaction since the foundation started measuring it in 2011. The report also noted that community health centers are moving in the right direction, taking patient engagement and experience seriously, and showed that they outperformed other types of facilities by establishing greater connectedness with their patients.
Clinics and health centers have also proven that they are ahead of the curve in integrating other types of services such as behavioral health into primary-care visits. With the current changes in how behavioral-health services are provided under the ACA, health centers are being praised for their common-sense approach to integrated care. In a recent Wall Street Journal article, Louise Radnofsky wrote, “California community-health centers are also gaining acclaim for their efforts to merge primary-care and behavioral-health services under one roof, which often ensures that many aspects of mental health can be addressed by providers other than psychiatrists.”
The UCLA Center for Health Reporting shared similar thoughts in its January report “One-Stop Shopping: Efforts to Integrate Physical and Behavioral Health Care in Five California Community Health Centers,” in which they found “(Community health centers) are an integral source of care for many low-income populations and have been at the forefront of (physical and behavioral healthcare) integration efforts.”
These findings show what we in the health center movement have known for years—that community clinics and health centers are the best-kept secret in healthcare. For us, the ability to improve quality, access and cost has always been a necessity that requires constant innovation.
Carmela Castellano-Garcia is CEO of the California Primary Care Association.