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Community Health Centers

Community Health Centers . Thomas J. Staff, MD MPH Assistant Professor of Family Medicine, FSM Medical Director, PCC Austin Family Health Center Tuwanda Williamson, MD April 10, 2007. What is a CHC?. Part of the “safety net” 1965 Jack Geiger, MD Outgrowth of LBJ’s “War on Poverty”.

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Community Health Centers

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  1. Community Health Centers Thomas J. Staff, MD MPH Assistant Professor of Family Medicine, FSM Medical Director, PCC Austin Family Health Center Tuwanda Williamson, MD April 10, 2007

  2. What is a CHC? • Part of the “safety net” • 1965 Jack Geiger, MD • Outgrowth of LBJ’s “War on Poverty”

  3. Safety net • 46.6 million uninsured in 2005 (US Census Bureau) • Other providers: • Local government/DSH • Private/religious organizations, “charity care”, training programs • Volunteer staffed clinics

  4. Federally Qualified Health Centers • CHC = FQHC • Located in MUA/serve a MUP • Non-profit • Comprehensive services • Governing board 51% clinic patients • Sliding fee scale

  5. Renewable, sustainable $$ • 2005, 952 FQHC’s, 5703 sites, >14 million patients • Receive grant $$ for operations and uninsured • Enhanced Medicaid/Medicare reimbursement also major source of $ • Successful program, political win-win

  6. Other FQHC models • “Look alike” clinics (no grant) • Rural Health Clinics • Tribal Health Clinics

  7. Where are they? • MUA/MUP • Index of Medical Underservice • Ratio of primary care providers/1,000 people • Infant Mortality Rate • % of population with income below poverty level • % of the population over age 64

  8. Focus • Increase ACCESS to health care • Reduce DISPARITIES in health care, along racial or SES lines

  9. Services • Comprehensive Primary Care • FM, IM, OB/Gyn, Peds, Psych • Behavioral Health • Dental

  10. Services -2- • Case Management • Transportation • Translation

  11. Services -3- • Outreach--RN’s, Americorps • Eligibility assistance • Health Education

  12. Health Care Providers • Physicians • Family Physicians majority • Advance Practice Nurses • Nurse practitioners, midwives • Dentists, Counsellors, Social Workers, Nurses

  13. Quality • Performance Improvement • Office of Performance Review • Regular cycle • Process and Outcomes measures • Clinical and Financial

  14. Incentives (besides the mission) • NHSC • Scholarship • Loan Repayment • Based on HPSA • J-1 Visa waiver • FTCA malpractice insurance coverage

  15. PCC Community Wellness Center • Chicago’s west side • Austin/Oak Park • Belmont-Craigen • South Oak Park/Berwyn • Melrose Park • Interfaith House/Garfield Park

  16. PCC -2- • Family Medicine Training Model • West Suburban Family Medicine Residency • Maternal Child Health Fellowship • Medical Student rotations • Academic affiliations

  17. Challenges • Bricks & Mortar • Specialty care • Primary care shortages • Medicaid cuts (despite increased funding for FQHC expansion)

  18. References • NHPF Background Paper, 8/31/04, The Fundamentals of Community Health Centers, Jessamy Taylor • JAMA 3/1/06 issue • NACHC website

  19. Thanks for listening.

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