Community health centers refers to a national network of community-based primary care sites that includes more than 1,100 centers that provide care to more than 17 million low income residents.  The federal Health Resources and Services Administration has supported the creation of this safety net through the development and ongoing support of community health centers.

Community health centers are community-based and run by a board comprised of a majority of consumer/patient members.  The centers are committed to providing treatment regardless of an individual’s income or insurance coverage and must establish a sliding fee scale based on family income and size. 

Health centers serve the homeless, residents of public housing, migrant farm workers and others with emergent and chronic health care needs, and who have limited resources to secure treatment through traditional channels.

The broad categories of community health centers include grant-supported Federally Qualified Health Centers (FQHCs) or 330s (so called because of the statutory authorization under Section 330 of the Public Health Service Act).   These grant supported centers include: Community Health Centers, which serve underserved areas or populations; Migrant Health Centers, which serve seasonal agricultural workers; Healthcare for the Homeless Programs, which serve homeless individuals and families; and Public Housing Primary Care Programs, which serve residents of public housing developments.  HRSA also certifies community health centers as Federally Qualified Health Center Look-Alikes.  These are centers that meeting the definition of a 330 health center but do not receive grant funding.  Federal designation also includes outpatient health programs and facilities operated by tribal organizations or urban Indian organizations. 

Community health centers have benefited from a cost-based, payment system under the Medicare and Medicaid programs. This provided them with adequate reimbursement so that federal grants could be targeted to serving uninsured patients.  However, many state governments found this preferential reimbursement system to be problematic as they were required to pay FQHCs a higher rate than other providers.  This approach was criticized by many state level policymakers for its lack of accountability and disincentives for improving efficiency and controlling costs.  Some of the cost concerns have been mitigated by states as many of them have revamped their Medicaid programs through 1115 waivers and have eliminated cost-based reimbursement for FQHCs while contracting with Managed Care Organizations for the care of Medicaid beneficiaries. 

Upham's Corner Health Center: 

The Upham's Corner Health Center is committed to providing high quality, low cost, culturally sensitive, community-based health and social services to the residents of Dorchester, MA.  Its goal is to provide comprehensive health and social services of the highest quality that are affordable, physically and culturally accessible, delivered in a dignified manner, and have a positive effect upon the client's well - being.

The Upham's Corner Health Center is one of eight Boston neighborhood health centers affiliated with Boston Medical Center. One outstanding advantage of this affiliation with the network is assurance that economics of scale are realized. Within the network, those aspects of care which most efficiently can be handled at the neighborhood level are provided, and conversely certain program components are handled centrally.  In addition, Boston Medical Center provides the major hospital support for specialty consultation and inpatient care. The health center physician follows his patients in need of hospitalization and participates in treating hospitalized, acute care.

Location: Dorchester, MA

Industry: Health Services Delivery

Scale: Community-Based

East Boston Neighborhood Health Center has operated in the community for over 35 years. It is organized as an independent, non-profit organization. The center provides easily accessible, high-quality health care to all who live and work in and the surrounding communities, without regard to age, income, insurance status, language, culture, or social circumstances.

They are a leading health care provider and among the largest community health centers in the country. The center provides more than 300,000 patient visits per year—more than any other ambulatory care center in New England. They have strong relationships with our neighbors and a governing board composed of leaders from the community, most of whom are also patients. They have collaborative relationships with local civic organizations and faith and social service agencies.

The center provides a full array of primary and specialty services and operates emergency room and an on-site pharmacy. They offer interpreters, transportation, and outreach and have programs to help address the health and well-being of community members with specific needs, including HIV/AIDS, chronic diseases, children with multiple disabilities, childhood obesity, and also operate an Elder Service Plan.

Location: East Boston, MA

Industry: Health service delivery

Scale: Community-based

Community health centers predominantly serve low income patients (70% are at or below poverty).  A significant number are uninsured (40%), nearly one-half are covered by public programs (Medicare, Medicaid, SCHIP), and nearly one-third do not speak English as a primary language. 

CHCs provide care to populations that might otherwise not be able to afford it.  By doing so, they help reduce or eliminate the need for more costly care provide through emergency room visits and avoid hospital stays. This in turn generates significant savings to the entire health care system.

Some health centers operate as free-standing, unaffiliated organizations, governed by a board of directors.  They are able to negotiate directly with pubic programs and private insures and raise philanthropic support for their services.

Other health centers are affiliated with larger health systems and operate under the license of hospitals or health systems.  They may receive in-direct or direct support and subsidy from these organizations for their services.

The sliding fee schedules of community health centers are influenced by the financial resources of the center.

Transparency Across Multiple Pricing And Reimbursement Strategies

• Community health centers are committed to providing services regardless of ability to pay.  They typically have fee schedules that are posted publicly and readily known in their communities.

Anticipation of Out Of Pocket Revenue and Expenses for Providers and Consumers

• Patients at community health centers are generally screened for public programs, provided assistance in applying for those programs and informed of existing financial assistance.  These patients are typically informed of what a community health center visit or service will cost them out of pocket.

Healthcare as a Public Good Leading to New Social Contracts

• Community health centers receive significant public funding for the services that they provide so as to eliminate barriers to care and ensure the even those with limited resources are able to access health care service when needed.