Federally qualified health centers—community health centers governed by the Health Resources and Services Administration—were created as part of President Lyndon Johnson’s “war on poverty” to improve public health and wellness among underserved groups. By law, more than half of their board members must actively receive care from them.
To find these consumer representatives, some health centers host community meetings where patients can nominate candidates, on whom the board then votes. Other boards have a nominating committee to recruit members or rely on centers’ clinical teams to select patients who could fill the role.
The model, when executed correctly, ensures organizational strategy is aligned with the needs of the broader community, said Megan Douglas, associate professor of community health and preventive medicine at Morehouse School of Medicine in Atlanta. It also helps health centers tailor solutions and services to locals’ needs, she said.
“We can be smart and have all this data and technology, but if there is no buy-in [from patients], then it is not going to work,” she said.
The structure creates a layer of accountability, said Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, a nonprofit dedicated to medical professionalism and physician leadership.
“It changes the conversation when you have patients that represent the community [on boards]—not just the bankers,” Wolfson said.
Consumer representatives on the board at East Boston Neighborhood Health Center, which serves nearly 120,000 patients throughout the city’s eastern and southern neighborhoods, usually steer the conversation to access issues, President and CEO Greg Wilmot said.
For example, during its annual needs assessment last year, the board identified demand for behavioral health capacity in East Boston. The board directed the executive team to construct an urgent care center specifically for behavioral health needs, which will operate with extended hours and be connected to the health center’s emergency department, Wilmot said.
“It was a recognition that behavioral health was a chronic issue that was exacerbated during COVID, and the data showed that,” Wilmot said. “The board said we need to be doing something about this, and it led to a decision to make a multi-million-dollar investment to create that service.”
Rita Sorrento, a consumer member and retired teacher who serves as board chair, began working with the center after seeking counseling services for her students. She said the board comprises people with various backgrounds, including government, law enforcement, education and social services.
“We all bring different aspects to the conversation,” Sorrento said. Her perspective as a teacher, for example, led her to urge the center to prioritize pediatric mental health.
Compliance with the federal regulation does not always equal true representation, said Brad Wright, chair of the department of health services policy and management at University of South Carolina.
Federally qualified health centers typically serve low-income and underinsured patients, who may not be able to expend the time and energy needed to help steer the organization on a volunteer basis. Many of their consumer board members, by contrast, have higher incomes, Wright said.
Health center boards find it particularly difficult to appoint representatives from underserved populations, such as agriculture workers or people experiencing homelessness, said Rachel Gonzales-Hanson, interim president and CEO of the National Association of Community Health Centers. Once on the board, consumer representatives can experience further barriers to participating, potentially resulting in high turnover.
Health center boards must often work to recruit and retain individuals by offering flexible meeting schedules and access to transportation and technology, Gonzales-Hanson said.
HealthLinc, a health center in northern Indiana, tries to reduce costs and make meetings accessible, CEO Beth Wrobel said. The center provides laptops and in-home internet access for its consumer board members, along with conducting some meetings virtually.
“We want them to be involved so they can improve care for our patients, and we make it easier for them to do it,” she said.