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Chart Book December 2014 A Sketch of Community Health Centers
Chart Book December 2014
A Sketch of Community Health Centers
© National Association of Community Health Centers, December 2014
For more information, email [email protected].
Cover picture provided courtesy of Codman Square Health Center in Boston, Massachusetts.
This publication was supported by Grant/Cooperative Agreement Number U30CS16089 from the Health Resources andServices Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely the responsibility of theauthors and do not necessarily represent the official views of HRSA/BPHC.
Preface
Section I: Who Health Centers Serve Figure 1.1: Health Centers Serve… Figure 1.2: Health Center Patients Are Predominately Low Income Figure 1.3: Most Health Center Patients are Members of Racial and Ethnic Minority Groups, 2013 Figure 1.4: Most Health Center Patients are Uninsured or Publicly Insured Figure 1.5: Health Center Patient Mix Is Unique Among Ambulatory Care Providers Figure 1.6: Health Centers Serve Patients Throughout the Life Cycle Figure 1.7: Health Center Patients are Disproportionately Poor, Uninsured, and Publicly-Insured, 2013Figure 1.8: Health Center Patients are Disproportionately Racial/Ethnic Minorities, 2013 Figure 1.9: Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians Figure 1.10: More Health Center Patients Prefer to Be Served in Languages Other than English Every Year
Section II: Health Center Growth Figure 2.1: The Number of Health Centers Receiving Federal Health Center Grants Has Increased Dramatically Figure 2.2: The Number of Health Center Patients Continues to Increase Figure 2.3: The Number of Health Center Patient Visits Continues to Increase Figure 2.4: Health Center Patients by Insurance Status, 2003-2013Figure 2.5: The Number of Health Center Low Income* Patients Is Growing Faster than the Number of Low Income Nationally, 2003-2013 Figure 2.6: The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, 2003-2013 Figure 2.7: The Number of Health Center Uninsured Patients Grew while the Number of Uninsured Nationally Decreased, 2003-2013
Table of Contents
Section III: Access to Care Figure 3.1: Health Centers Have Higher Rates of Accepting New Patients Regardless of Insurance Coverage Compared to Other Primary Care Providers Figure 3.2: Health Center Uninsured Patients Are More Likely to Have Usual Source of Care then Uninsured Nationally Figure 3.3: Health Center Uninsured and Medicaid Patients are More Likely to Have a Usual Source of Care than the U.S. Privately Insured Figure 3.4: Health Center Uninsured Patients are Twice as Likely To Get the Care They Need than Uninsured Nationally Figure 3.5: Percent of Uninsured Served by Health Centers, 2013 Figure 3.6: The Percent of Medicaid Beneficiaries Served by Health Centers, 2013
Section IV: Preventive Services Figure 4.1: Health Centers Provide a Broad Array of Services Figure 4.2: Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental, and Mental Health Care, 2003-2013Figure 4.3: Health Centers Provide More Preventive Services than Other Primary Care Providers Figure 4.4: Health Center Patients with Hypertension Are More Likely to Receive Counseling About Diet, Exercise, and Taking Medications than Their National Counterparts Figure 4.5: Health Center Patients with Hypertension are More Likely to Comply to Counseling About Diet, Exercise, and Taking Medications than their National Counterparts
Section V: High Quality Care and Reducing Health Disparities Figure 5.1: Health Centers Reduce Disparities in Access to Mammograms Figure 5.2: Health Centers Also Reduce Disparities in Access to Pap Tests Figure 5.3: Health Centers Also Reduce Disparities in Access to Colorectal Cancer Screening Figure 5.4: Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. Average Figure 5.5: Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. Counterparts Figure 5.6: Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice PhysiciansFigure 5.7: Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark ScoresFigure 5.8: Health Center Patients Are More Satisfied with Overall Care Received Compared with Low-Income Patients Nationally
Section VI: Cost-Effective Care and Economic Impact Figure 6.1: Health Centers Save $1,263 Per Patient Per Year Figure 6.2: Areas with High Health Center Penetration Spend $926 Less on Medicare Beneficiaries without Compromising Quality of CareFigure 6.3: Economic Impact of Federal Health Center Funding by State, 2012Figure 6.4: Jobs Generated by Federal Health Center Funding by State, 2012
Section VII: Health Centers’ Financial Health Figure 7.1: Health Center Costs of Care Grow Slower than National Health Expenditures, 2003-2013 Figure 7.2: Health Center Funding Per Uninsured Patient is Well Below Total Per Patient CostFigure 7.3: Payments from Third Party Payers Are Less than Cost Figure 7.4: Health Center Operating Margins are Less than Hospital Operating Margins Figure 7.5: Medicaid Revenue is Directly Proportional to Medicaid Patients, 2013 Figure 7.6: Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians Figure 7.7: Federal Health Center Appropriation History, FY2004-2014 Figure 7.8: 32 States Will Provide Funding to Health Centers in SFY2014 Figure 7.9: State Funding to Health Centers, FY14
Section VIII: Staffing/Workforce Figure 8.1: Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013Figure 8.2: Health Centers Medical Providers, Full Time Employees (FTEs), 2013Figure 8.3: Health Centers Dental Services, Full Time Employees (FTEs), 2013 Figure 8.4: Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013 Figure 8.5: Health Centers Enabling Services, Full Time Employees (FTEs), 2013 Figure 8.6: The Number of Health Center Medical Providers Has More Than Doubled Figure 8.7: Health Centers Twice as Likely to Use Non-Physician Clinicians than Other Providers Figure 8.8: Health Centers Use More Non-Physician Clinicians than Other Providers
Section IX: Remaining Challenges and Unmet Needs Figure 9.1: Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care Needs Figure 9.2: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013Figure 9.3: Without Community Health Centers: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013Figure 9.4: More than a Third of Health Centers Need to Build or Purchase Additional Facilities, 2008-2015
Section X: Look Alike Health CentersFigure 10.1: Look-Alike Health Center Patients Are Predominately Low Income Figure 10.2: Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minorities, 2013 Figure 10.3: Most Look-Alike Health Center Patients are Uninsured or Publicly Insured Figure 10.4: Look-Alike Health Centers Serve Patients Throughout the Life Cycle Figure 10.5: Look-Alike Health Centers Provide a Broad Array of Services Figure 10.6: Payments from Third Party Payers Are Less than CostFigure 10.7: Medicaid Revenue is Directly Proportional to Medicaid Patients for Look-Alike Health Centers, 2013 Figure 10.8: Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013Figure 10.9: Look-Alike Health Centers Medical Providers, Full Time Employees (FTEs), 2013Figure 10.10: Look-Alike Health Centers Dental Services, Full Time Employees (FTEs), 2013 Figure 10.11: Look-Alike Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013 Figure 10.12: Look-Alike Health Centers Enabling Services, Full Time Employees (FTEs), 2013
About this Chartbook
This Chartbook includes data and research from Community, Migrant, Homeless, and Public Housing Health Center, also known as Federally-Qualified Health Centers (FQHCs). Unless otherwise specified, this Chartbook utilizes data from the Bureau of Primary Health Care, HRSA, DHHS, Uniform Data System (UDS). Except for the final section in this Chartbook, 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.
This Chartbook now includes a separate section highlighting data on Health Center Program look-alikes. Just like Health Center Program grantees, Health Center Program look-alikes, which do not receive federal health center grant funds, support the health of the nation’s underserved communities and vulnerable populations by increasing access to primary health care services. As of 2013, there were 100 Look Alikes across the United States.
The National Association of Community Health Centers (NACHC) is pleased to present A Sketch of Community Health Centers, an overview of the Health Center Program and the communities they serve. Health Centers began fifty years ago as part of President Lyndon B. Johnson’s declared “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 supplemental services. No two health centers are alike, but they all share one common purpose: to provide primary health care services that are coordinated, culturally and linguistically competent, and community-directed.
Health centers play a critical role in the health care system as the health care home to over 23 million* people. 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, and deal with a multitude of costly and significant health and social problems – including substance abuse, HIV/AIDS, mental illness, and homelessness – if they have the resources and leadership to do so.
Who health centers serve, what they do, and their impressive record of accomplishment in keeping communities healthy are represented in the following charts. Federal and state support, along with adequate third party reimbursement, are critically important to keep pace with rising costs and escalating health care needs among populations served by health centers.
Preface
*Includes patients of federally-funded health centers, non-federally funded health centers (health center “look-alikes”), and expected patient
growth for 2014.
Section I: Who Health Centers Serve
Figure 1.1
Health Centers Serve:• 1 in 7 Medicaid beneficiaries
• 1 in 7 uninsured persons including:
• 1 in 5 low income, uninsured
• 1 in 3 individuals below poverty
• 1 in 3 minority individuals below poverty
• 1 in 3 children below poverty
• 1 in 7 rural Americans
Source: NACHC, 2014. Includes patients of federally-funded health centers and non-federally funded health centers.
Figure 1.2
Health Center Patients are Predominately Low Income
Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2013 was $19,530. (See http://aspe.hhs.gov/poverty/13poverty.shtml). Based on percent known. Percents may not total 100% due to rounding.
72% are 100% FPL and
below
15% are 101-150% FPL
6% are151-200%
FPL
7% are over 200% FPL
Figure 1.3
62 Percent* of Health Center Patients are Members of Racial and Ethnic Minority Groups, 2013
EthnicityRace
Asian / Hawaiian / Pacific Islander
5%
Black / African American24%
American Indian / Alaska Native
1%
White66%
More than one race 4%
Hispanic / Latino35%
Non-Hispanic / Latino65%
Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding. *The 62% of health center patients that are members of racial and ethnic minorities is not shown in this figure.
Figure 1.4
Most Health Center Patients are Uninsured or Publicly Insured
*”Other public insurance” may include non-Medicaid CHIP and state-funded insurance programs. Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Percents may not total 100% due to rounding.
35% Uninsured
41%Medicaid / SCHIP
8%Medicare
2%Other Public
Insurance
14%Private
Insurance
Figure 1.5
Health Center Patient Mix Is Unique Among Ambulatory Care Providers
Notes: Other public includes non-Medicaid SCHIP and other state-funded insurance programs.* Combined total of individual sources exceeds “All visits” because more than one may be reported per visit.Sources: Based on Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System (UDS). Private Physicians from 2010 NAMCS (CDC National Center for Health Statistics, 2010). Hospital Outpatient from 2010 NHAMCS (CDC National Center for Health Statistics, 2010).
41%
11%
26%
35%
3%
5%
8%
23%
20%
14%
57%41%
5% 8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Centers Private Physicians Hospital Outpatient Depts.
Other / Unknown
Private
Medicare
Uninsured
Medicaid
2%
Under 510%
Ages 5-1214%
Ages 13-1910%
Ages 20-247%
Ages 25-4427%
Ages 45-6424%
Ages 65+7%
Figure 1.6
Health Centers Serve Patients Throughout the Life Cycle
Note: Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Figure 1.7
Health Center Patients Are Disproportionately Poor, Uninsured, and Publicly-Insured, 2013
Note: Health Centers: Based on Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System. U.S.: Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Based on Census Bureau's March 2013 Current Population Survey (CPS: Annual Social and Economic Supplements).
35%
72%
93%
15% 17% 20%
40%
Uninsured Medicaid At or Below 100% ofPoverty
At or Below 200% ofPoverty
Health Centers
United States
41%
Figure 1.8
Health Center Patients are Disproportionately Members of Racial and Ethnic Minority Groups, 2013
Note: Percents may not total 100% due to rounding. Sources: Based on 2013 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. Source for State and US Population for Race and Ethnicity: U.S. Census Bureau, Population Division: “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States, States, and Counties: April 1, 2010 to July 1, 2012” Released June 2013.
35%
24%
5%
1%
17%
13%
5%
1%0%
5%
10%
15%
20%
25%
30%
35%
40%
Hispanic/Latino Ethnicity Black/African American Asian/Hawaiian/PacificIslander
American Indian/AlaskaNative
Health Centers
United States
62% of health center patients are members of racial and ethnic minority groups
Asian/Hawaiian/Other
Pacific Islander
Figure 1.9
Health Centers Are More Likely to Treat Patients with Chronic Illnesses Compared to Other Primary Care Physicians
Note: Statistical significance measures compared to value for private physician offices; *** p < .01 , ** p < .05, * p < .10“Common chronic conditions” include visits where the primary diagnosis listed for the visit is an ICD-9-CM diagnosis code for hypertension, asthma, diabetes, heart disease, and selected psychotic conditions and other psychoses. Excludes visits classified as “pre/post surgical,” all visits to non-primary care physicians, and any visits where the patient did not see a physician. Source: Based on George Washington University analysis from Kaiser Commission on Medicaid and the Uninsured. Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth.(March 2013.) http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8098-03.pdf
13%
18%
Physician OfficesHealth Centers
Percentage of Physician Visits Involving Patients with Common Chronic Conditions
Percentage of Physician Visits Involving Patients with the Specified Chronic Condition
11%*
15%***
8%**
27%
9%11%
7%
25%
Depression Diabetes Asthma Hypertension
Health Centers Private Physician Offices18%
13%
11%*9%
11%
15%***
8%**7%
27%25%
3.7 3.84.1
4.3 4.3 4.44.6 4.7 4.6
4.85.0
0
1
2
3
4
5
6
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
35% Increase Since 2003
Figure 1.10
Health Center Patients Who Prefer to Be Served in Languages Other than English
Source: Federally-funded health centers only. 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Nu
mb
er
of
Pat
ien
ts (
in m
illio
ns)
Section II:Health Center Growth
Figure 2.1
The Number of Health Centers Receiving Federal Health Center Grants Has Increased Dramatically
Source: Federally-funded health centers only. 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
890 914952
1,0021,067 1,080
1,131 1,124 1,1281,198 1,202
0
200
400
600
800
1000
1200
1400
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er
of
Gra
nte
es
35% growth since 2003
Figure 2.2
The Number of Health Center Patients Continues to Increase
Source: Federally-funded health centers only. 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS
12.413.1
14.115.0
16.117.1
18.819.5
20.221.1 21.7
0.0
5.0
10.0
15.0
20.0
25.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number of Patients (in millions)
75% growth since 2003
Nu
mb
er
of
Pati
ents
(in
mill
ion
s)
Figure 2.3
The Number of Health Center Patient Visits Continues to Increase
49.352.3
55.559.2
63.067.0
73.877.1
80.083.8 85.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number of Patient Visits (in millions)
74% growth since 2003
Source: Federally-funded health centers only. 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Nu
mb
er
of
Pati
ent
Vis
its
(in
mill
ion
s)
Figure 2.4
Health Center Patients by Insurance Status, 2003-2013
4.95.3
5.66.0 6.2
6.6
7.2 7.3
8.0
7.6 7.6
4.44.7
5.05.3
5.76.1
6.9
7.5 7.4
8.48.8
1.8 1.92.1 2.3 2.5 2.7 2.7 2.7
2.9 3.0 3.1
0.9 1.0 1.1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8
0.3 0.3 0.3 0.3 0.4 0.5 0.6 0.5 0.5 0.5 0.4
0
1
2
3
4
5
6
7
8
9
10
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Uninsured
Medicaid
Private
Medicare
Other
Source: Federally-funded health centers only. 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Nu
mb
er
of
Pati
ents
(in
mill
ion
s)
Figure 2.5
The Number of Health Center Low Income* Patients is Growing Faster than the Number of Low Income Nationally, 2003-2013
*Patients under 200% of federal poverty level Sources: U.S. Census Historical Poverty Tables. (1970-2013). “Table 5. Percent of People By Ratio of Income to Poverty Level.” http://www.census.gov/hhes/www/poverty/data/historical/people.html2003-2013 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS.
69%
18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Health Center Low Income Low Income Nationally
Pe
rce
nt
Incr
eas
e
19%
Figure 2.6
The Number of Health Center Medicaid Patients Grew Faster than the Number of Medicaid Beneficiaries Nationally, 2003-2013
Sources: Bureau of Primary Health Care, Health Resources and Services Administration, DHHS. 2003 and 2013 Uniform Data System. Kaiser Commission on Medicaid and the Uninsured. Medicaid Enrollment: June 2003 and June 2013 Snapshots.
99%
39%
0%
20%
40%
60%
80%
100%
120%
Health Center Medicaid Medicaid Nationally
Pe
rce
nt
Incr
eas
e
Figure 2.7
The Number of Health Center Uninsured Patients Grew while the Number of Uninsured Nationally Decreased, 2003-2013
Source: Health Center: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2003 - 2013 Uniform Data System. U.S: Smith, J. and Medalia, C. (September 2014). “Health Insurance Coverage in the United States: 2013.” U.S. Census- Current Population Reports. Retrieved from, https://www.census.gov/content/dam/Census/library/publications/2014/demo/p60-250.pdf, Figure 1. U.S: DeNavas-Walt, C., Proctor, B., and Smith, J. (September 2013). “Income, Poverty, and Health Insurance Coverage in the United States: 2012.” U.S. Census- Current Population Reports. Retrieved from, http://www.census.gov/prod/2013pubs/p60-245.pdf, Table C1- Page 67.
55%
-7%-10%
0%
10%
20%
30%
40%
50%
60% 55%
-7%Health Center Uninsured
Uninsured Nationally
Section: IIIAccess to Care
Figure 3.1
Health Centers Have Higher Rates of Accepting New Patients Regardless of Insurance Coverage Compared to Other Primary Care Providers
Source: Hing E, Hooker RS, Ashman JJ. Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 June; 36(3): 406-13.
Figure 3.2
Health Center Uninsured Patients Are More Likely to Have a Usual Source of Care than the Uninsured Nationally
Source: Shi, L and Stevens, GD. “The Role of Community Health Centers in Delivering Primary Care to the Underserved.” April-June 2007 JACM 30(2):159-170.
96%
82%
60%68%
0%
20%
40%
60%
80%
100%
120%
Has Usual Source of Care At least 1 Primary Care Visit in the Past Year
Health Center Uninsured US Uninsured
Figure 3.3
Health Center Uninsured and Medicaid Patients are More Likely to Have a Usual Source of Care than the U.S. Privately Insured
% R
ep
ort
ing
They
Hav
e a
Usu
al S
ou
rce
of
Car
e
Sources: Health center data from Shi, L and Stevens, GD. “The Role of Community Health Centers in Delivering Primary Care to the Underserved.” April-June 2007 JACM 30(2):159-170. National data from Kaiser Commission on Medicaid and the Uninsured analysis of 2010 NHIS data. Found in “5 Basic Facts on the Uninsured” (2012)
96%99%
55%
0%
20%
40%
60%
80%
100%
Health Center Uninsured Health Center Medicaid US Privately Insured
Figure 3.4
Health Center Uninsured Patients are Twice as Likely To Get the Care They Need than Uninsured Nationally
25%
16%12%
55%
30%24%
0%
20%
40%
60%
Delayed Care Due toCost
Went Without NeededCare
Could Not Fill Rx
Health Center Uninsured Uninsured Nationally
Source: Politzer, R., et al. “Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care.” 2001. Medical Care Research and Review 58(2):234-248.
Percent of Uninsured Served by Health Centers, 2013
Source: National data from: Kaiser State Facts. Distribution of the Nonelderly Uninsured, 2012, http://www.statehealthfacts.org/comparebar.jsp?ind=136&cat=3 . Based on Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System.
Figure 3.5
The Percent of Medicaid Beneficiaries Served by Health Centers, 2013
Source: 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Kaiser Family Foundation, State Health Facts Online. Monthly Medicaid Enrollment (in thousands)-June-2013: Compiled by Health Management Associates (HMA) from state Medicaid enrollment reports for the Kaiser Commission on Medicaid and the Uninsured (KCMU). See http://kff.org/other/state-indicator/monthly-medicaid-enrollment-in-thousands-june/
Figure 3.6
Section IV:Preventive Services
Figure 4.1
Health Centers Provide a Broad Array of Services
Note: Encounters for enabling services include visits to case managers and health educators.Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Medical Care , 71%
Dental, 13%
Behavioral Health, 8%
Enabling Services, 6%
Other Professional Services, 2%
Vision, 1%
Total = over 85.6 million patient visits in 2013
Figure 4.2
Health Centers Have Experienced Tremendous Growth in the Number of Patients and Visits for Medical, Dental, and Mental Health Care, 2003 - 2013
Note: Mental health does not include substance abuse. Percent Increase is calculated using actual patient and patient visit numbers, not with rounded numbers presented in this chart.Source: 2003- 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
69% 62%
136% 147%
327% 334%
0%
50%
100%
150%
200%
250%
300%
350%
400%
Patients Patient Vistis
Medical
Dental
Mental
Pe
rce
nt
Incr
eas
e, 2
00
3-2
01
3
0.26 – 1.1 million
1.3 – 5.6 million
37.8 – 61.1 million
11 – 18.6 million
4.5 - 11 million
1.9 – 4.4 million
Figure 4.3
Health Centers Provide More Preventive Services than Other Primary Care Providers
Source: Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US 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.
Figure 4.4
Health Center Patients with Hypertension Are More Likely to Receive Counseling About Diet, Exercise, and Taking Medications than Their National
Counterparts
*p<0.05Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adults, aged 18–64, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
75%82% 84%
91%
67% 69%64%
84%
0%
20%
40%
60%
80%
100%
Diet* Salt* Exercise* Taking Medication*
Health Center Patients Low Income Nationally
Figure 4.5
Health Center Patients with Hypertension are More Likely to Comply to Counseling About Diet, Exercise, and Taking Medications than Their National
Counterparts
*p<0.05Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adults, aged 18–64, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
88%94%
86% 88%
72%
83%
58%
95%
0%
20%
40%
60%
80%
100%
Diet* Salt* Exercise* Taking Medication
Health Center Patients Low Income Nationally
Section V:High Quality Care and Reducing Health
Disparities
81%82%
78%
63%66% 66% 63%
45%
0%
20%
40%
60%
80%
100%
Hispanic African American Medicaid Uninsured
Health Centers Low Income Nationally
Figure 5.1
Health Centers Reduce Disparities in Access to Mammograms%
Rec
eivi
ng
Mam
mo
gram
Note: Rates calculated for women over the age of 50 receiving a mammogram over the last 2 years. All categories are statistically significant at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
Figure 5.2
Health Center Women Needing Pap Smears are More Likely to Receive Them than Their Counterparts Nationally
89%92% 92%
79%79% 81% 80%
70%
0%
20%
40%
60%
80%
100%
Hispanic African American Medicaid Uninsured
Health Centers Nationally
Note: Rates calculated for pap smear screening in last 3 years. Health Center rate significantly lower at the p < 0.05 level.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for adult women, aged 21–64, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
Figure 5.3
Health Center Patients Needing Colorectal Cancer Screenings Are More Likely to Receive Them than Their Counterparts Nationally
Note: Health Center rate significantly lower at the p < 0.05 level except for Hispanic where there is no significance.Source: Health Resources and Services Administration, Health Center Patient Survey. Based on data for individuals, aged 50-74, from 2009 BPHC Patient Survey and National Health Interview Survey, 2008.
40%
62% 60%
34%29%
44%
35%
18%
0%
20%
40%
60%
80%
100%
Hispanic African American Medicaid Uninsured
Health Centers Low-Income Nationally
Figure 5.4
Health Center Patients Have Lower Rates of Low Birth Weight than the U.S. Average
Sources: U.S. rates from National Center for Health Statistics (NCHS). Bureau of Primary Health Care, HRSA, DHHS, 2006-2012 Uniform Data System.
Figure 5.5
Health Center Patients Have Lower Rates of Low Birth Weight than Their U.S. Counterparts
Source: Shi, L., et al. “America’s health centers: Reducing racial and ethnic disparities in prenatal care and birth outcomes.” 2004. Health Services Research, 39(6), Part I, 1881-1901.
7.7% 7.5%
13.0%
6.5% 6.8%
8.2%7.5%
14.9%
6.0%
9.1%
7.5%6.6%
10.7%
5.6%
7.4%
0%
5%
10%
15%
Total Asian Black Hispanic White
U.S. U.S. Low Income Health Center
Source: Goldman, L.E., Chu, P.W., Tran, H., Stafford, R.S. 2012. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine, 43(2):142-149.
Figure 5.6
Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians
Health Centers Exceed Medicaid Managed Care Organization High Performance Benchmark Scores
79%73%
81%
71%63%
54%
0%
20%
40%
60%
80%
100%
Diabetes Control Blood Pressure Control Pap Test
Figure 5.7
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), available at http://kff.org/medicaid/issue-brief/quality-of-care-in-communityhealth-centers-and-factors-associated-with-performance/.Note: 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 mm Hg; Pap Tests: share of female patients age 24 – 64 who received Pap test within past three years.
Medicaid MCO High Performance Benchmark (75th percentile)
Average Rate in All Health CentersAverage Rate in High-Performing Health Centers
62% 62%
72%
Shar
e o
f P
atie
nts
Me
etin
g Q
ual
ity
Be
nch
mar
k
Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low-Income Patients Nationally
96% 98%
37%
87%
0%
20%
40%
60%
80%
100%
Satisfied with Hours of Operation Satisfied with Overall Care Received
Health Center Patients US Low-Income Patients
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.
Figure 5.8
Section VI:Cost-Effective Care and
Economic Impact
Figure 6.1
Health Centers Save $1,263 Per Patient Per Year
$4,043
$5,306
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
Health Center Users Non-Health CenterUsers
Hospital EmergencyDepartment
Hospital Inpatient
Ambulatory
Other Services
Source: NACHC analysis based on Ku L 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.
$8,616
$9,542
$9,222
$8,100
$8,400
$8,700
$9,000
$9,300
$9,600
$9,900
High Health Center PenetrationArea
Low Health Center PenetrationArea
All Areas
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 & Medicaid Research Review. 2014; 4(3):E1-E17.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%.
Areas with High Health Center Penetration Spend $926 Less per Medicare Beneficiary than Areas with Low Health Center Penetration without
Compromising Quality of Care
10% Lower Medicare Spending in Areas with High Health
Center Penetration
Figure 6.2
Tota
l Me
dic
are
Co
st p
er
Be
nef
icia
ry
Figure 6.3
Economic Impact (in millions) of Federal Health Center Funding by State, 2012
Note: Economic impact of federal health center funding only, by state. Economic impact includes direct impact, such as money generated in the community, and indirect impact,
such as goods and services purchased and additional economic stimulus generated.
Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
Figure 6.4
Jobs Generated by Federal Health Center Funding by State, 2012
Note: Jobs generated by federal health center funding only.
Source: Economic impact analysis conducted by Capital Link, Inc. using IMPLAN Version 3, Trade Flows Model, an integrated economic modeling and planning tool and 2012 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
Section VII:Health Centers’ Financial Health
Figure 7.1
Health Center Costs of Care Grow Slower than National Health Expenditures, 2003-2013
* Note: National Health Expenditures per Capita has not been updated for 2013. 57% represents the change from 2002 – 2012. Health Center Costs per Patient have been updated to reflect change from 2003 – 2013.Sources: Centers for Medicaid and Medicare Services, Office of the Actuary . National Health Expenditures; Aggregate and Per Capita Amounts, Annual Percent Change and Percent Distribution: Selected Calendar Years 1960-2012Based on 2003-2013 Uniform Data System, Bureau of Primary Health Care, HRSA, HHS.
51%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Health Center Costs per Patient National Health Expenditures per Capita
Pe
rce
nt
Incr
eas
e
51%57%*
Figure 7.2
Health Center Funding Per Uninsured Patient Is Well Below Total Per Patient Cost
Note: Not adjusted for inflation. Federal appropriations are for consolidated health centers under PHSA Section 330.Source: Federally-funded health centers only. 2003 - 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
$272 $270 $270 $267 $270 $281 $271 $273 $312
$344 $374
$479 $504 $515
$538 $562
$588 $600 $630
$654 $687
$721
$-
$100
$200
$300
$400
$500
$600
$700
$800
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Annual Federal Health Center Funding per Uninsured Patient Annual Health Center Cost per Patient
Figure 7.3
Payments from Third Party Payers Are Less than Cost, 2013
Note: Health centers are non-profits, and thus charges are a proxy for costs. Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
83%
63% 61%57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Medicaid Medicare Other Public Insurance Private Insurance
Pe
rce
nt
of
Ch
arge
s C
olle
cte
d f
rom
Th
ird
Par
ty P
aye
rs, 2
01
3
Figure 7.4
Health Center Operating Margins are Less than Hospital Operating Margins
* Note: Operating margin data for “Hospitals” in 2013 is unavailableSource: Avalere, Health analysis of American Hospital Association Annual Survey Data, 2012 for community hospitals, http://www.aha.org. Trendwatch Chartbook 2013, Supplementary Data Tables, Trends in Hospital Financing. Federally-funded health centers only. 2003 - 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
*
3.3%3.6% 3.7%
4.0%4.3%
3.3%
4.4%
5.5% 5.5%
6.5%
1.8%
3.4% 4.7% 3.4%
1.6%
0.5% 0.9% 1.0%0.2%
0.8%-0.1%
-1.1% -2.4%
-0.2%
1.6%
1.1%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Hospital Health Centers with ARRA Funds Health Centers without ARRA Funds
Figure 7.5
Medicaid Revenue is Directly Proportional to Medicaid Patients, 2013
Notes: Percents may not total 100% due to rounding. Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
40.6% 39.6%
8.4% 6.1%
2.0%2.2%
14.1%7.5%
34.9%
6.1%
Patients' Insurance Status Health Center Revenue
Uninsured
Private Insurance
Other Public Insurance
Medicare
Medicaid
38.5%
Grants/Contracts/Other
Figure 7.6
Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians
Note: Private Physicians does not equal 100% due to reporting in NAMCS. Source: Private Physician data: 2010 National Ambulatory Medical Care Survey (Summary Table 5). Based on Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System.
64.3%
14.1%
9.9%
24.6%
3.6%
6.9%
12.2%
62.6%
10.0%4.3%
Health Center Private Physicians
Self-Pay/Uninsured
Private Insurance
Other Public Insurance
Medicare
Medicaid/SCHIP
Figure 7.7
Federal Health Center Appropriation History, FY2004-FY2014
Note: Federal appropriations are for consolidated health centers under PHSA Section 330. Federally funded health centers only .
$1.62 $1.73 $1.78 $1.99 $2.07
$2.19 $2.19
$2.60 $2.78
$2.99
$3.69
$-
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
$4.00
FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14
Ap
pro
pri
atio
ns
(in
bill
ion
s)
MA
AK
AL
AZ
CA
DC
DE
GA
ID
KY
LA
MD
ME
MI
MT
OR
PR
SD
TX
WA
WY
IA
VTND
NVUT
RI
PA
MN
IL
VA
OH
NH
OK
MS
NECT
KS
NC
WI
TN
HI
MO
WV
AR SCNM
IN
CO
FL
NJ
NY
None Less than $2 million$2 million - $15 million$29 million - $75 million
Figure 7.8
32 States Will Provide Funding to Health Centers in State Fiscal Year 2014
Source: NACHC, 2014. State Fiscal Year 2014 Funding for community Health Centers, State Policy Report #49. www.nachc.com
Pending
Figure 7.9
State Funding to Health Centers, FY14
• 32 states will receive a total of $379 million
$55 million more than reported in FY13.
FY14 Funding:• Increased in 10 states
(CO, FL, IN, MA, MO, NH, NM, ND, PA, SC)
• Decreased in 14 states(AR, CT, HI, IL, KS, MN, NV, NJ, NY, RI, UT, VT, VA, WV)
• Remained level in 8 states •(IA, MS, NE, NC, OH, OK, TN, WI)
•No funding in 13 states, the District of Colombia, and Puerto Rico(AL, AK, AZ, CA, DC, ID, KY, LA, ME, MT, OR, PR, SD, WA, WY)
(Pending: DE, GA, MD, MI, TX)
Source: NACHC, 2014. State Fiscal Year 2014 Funding for community Health Centers, State Policy Report #49. www.nachc.com
Section VIII:Staffing / Workforce
Figure 8.1
Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013
Note: NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Other Programs/Services includes Enabling Services. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System.
11%
8%
12%
7%
4%1%
20%
24%
Physicians
NP/PA/CNMs
Dental Services
Mental Health and Substance Abuse Services
NursesPharmacy Personnel
Other Medical Personnel
Other Programs/Services
Other Professional Services
Total Health Professionals = 98,830 FTEs
13%
Figure 8.2
Health Center Medical Services Staff, Full Time Employees (FTEs), 2013
Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System (UDS)
Total Medical Personnel = 56,019 FTEs Total Physicians = 10,734 FTEs
Other Medical Personnel 43%
Physicians19%
NPs/PAs/CNMs 15%
Nurses 24%
Pediatricians22%
Other Specialty Physicians
3%
Family Physicians
46%
General Practitioners4%
Internists16%
Obstetricians/Gynecologists
10%
Figure 8.3
Health Center Dental Services Staff, Full Time Employees (FTEs), 2013
Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Percents may not total 100% due to rounding.
Dentists29%
Dental Hygienists
13%
Dental Assistants,
Aides, Techs58%
Total = 11,850 FTEs in 2013
Figure 8.4
Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013
Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.
Psychiatrists7%
Licensed Clinical Psychologists
8%
Licensed Clinical Social Workers
27%
Other Licensed Mental Health
Providers20%
Other Mental Health Staff
25%
Substance Abuse Services
13%
Total = 6,548 FTEs in 2013
Figure 8.5
Health Center Enabling Services Staff, Full Time Employees (FTEs), 2013
Source: Federally-funded health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Percents may not total 100% due to rounding.
Case Managers34%
Patient/Community Education Specialists
15%Outreach Workers
16%
Transportation Staff3%
Eligibility Assistance Workers
22%
Interpretation Staff6%
Other Enabling Services
3%
Total = 14,716 FTEs in 2013
Figure 8.6
The Number of Health Center Medical Providers Has Doubled from 25,780 to 53,227 between 2003 - 2013
Note: NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Total Medical Care Providers includes physicians, NPs, PAs, CNMs, nurses, and other medical personnel. Laboratory and X-Ray Personnel are not included in the total. Source: Bureau of Primary Health Care, HRSA, DHHS, 2003 and 2013 Uniform Data System (UDS)
6,385 3,443
7,764
25,780
10,734 8,156
13,278
53,227
-
10,000
20,000
30,000
40,000
50,000
60,000
Physicans NP, PA, CNM Nurses Total Medical CareProviders
2003 2013
Figure 8.7
Health Centers Are Twice as Likely to Use Non-Physician Clinicians than Other Providers
Note: Statistically Different (p < .01)
Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413.
Figure 8.8
Health Centers Use More Non-Physician Clinicians than Other Providers
Note: Statistically Different (p < .01)
Source: Hing, E., Hooker, R., & Ashman, J. (June, 2011). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Comm Health, 36(3):406-413
Nu
mb
er
of
No
n-P
hys
icia
n C
linic
ian
s
Section IX:Remaining Challenges and
Unmet Needs
Health Centers Are Not Present in at Least a Quarter of the Counties with Unfavorable Primary Care Needs
Note: Counties with Unfavorable Primary Care Needs were identified by being in the either bottom or top quintile depending on the primary needs indicator. Low-Income map presents census tracts, but analysis for this figure was conducted at the county-level. Source: NACHC, Health Wanted 2012. NACHC analysis of data obtained from University of Wisconsin Population Health Institute County Health Rankings 2011; U.S. Census Bureau; and HRSA.
Figure 9.1
Emergency Department Visits
Figure 9.2
Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013
Source: Created by The Robert Graham Center (2014). US Census 2010; HRSA Data Warehouse 2014 HPSA and MUA/P shapefiles; AMA Masterfile 2013; UDS Mapper 2014.
Figure 9.3
Without Community Health Centers: Estimated Percent of County Residents Experiencing Shortages of Primary Care Physicians, 2013
Source: Created by The Robert Graham Center (2014). US Census 2010; HRSA Data Warehouse 2014 HPSA and MUA/P shapefiles; AMA Masterfile 2013; UDS Mapper 2014.
Figure 9.4
More than a Third of Health Centers Need to Build or Purchase Additional Facilities, 2008-2015
Build/Purchase Replacement Facility
36%
Total: $10.5 billion
Build/Purchase Additional Facility
37%
Expand Facility 5%
Renovate Facility 4%
Equipment 8%
Other Major Capital Projects (incl HIT)
10%
Source: NACHC, Community Health Ventures, and Capital Link, Access Capital: New Opportunities for Meeting America’s Primary Care Infrastructure Needs, March 2008, www.nachc.com/research.
Section X:Look-Alike Health Centers
This section highlights data from a category of Federally Qualified Health Centers (FQHCs), known as look-alikes. Look-Alikes are health centers that have been certified by the Centers for Medicare and Medicaid Services as
meeting all Health Center Program requirements but do not receive federal health center grants from the Bureau of Primary Health Care. As of 2013, there were 100 look-alikes across the United States.
Figure 10.1
Look-Alike Health Center Patients are Predominately Low Income
Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2013 was $19,530. (See http://aspe.hhs.gov/poverty/13poverty.shtml)). Based on percent known. Percents may not total 100% due to rounding.
5% are 151-200% FPL
7% are over 200% FPL
74% are 100% FPL
and below
14% are 101-150% FPL
Figure 10.2
Most Look-Alike Health Center Patients are Members of Racial and Ethnic Minority Groups, 2013
EthnicityRace
Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding.
Non-Hispanic62%
Hispanic / Latino38%
White62%
Asian/Native Hawaiian/Pacific
Islander7%
Black / African American 28%
American Indian/ Alaska Native
1%
More than one race2%
Figure 10.3
Most Look-Alike Health Center Patients are Uninsured or Publicly Insured
*”Other public insurance” may include non-Medicaid SCHIP and state-funded insurance programs. Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Percents may not total 100% due to rounding.
Medicaid/SCHIP46%
Uninsured32%
Private Insurance
12%
Medicare8%
Other Public Insurance
2%
Figure 10.4
Look-Alike Health Centers Serve Patients Throughout the Life Cycle
Note: Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Under 510%
Ages 5-1212%
Ages 13-1910%
Ages 20-247%
Ages 25-4427%
Ages 45-6427%
Ages 65+7%
Figure 10.5
Look-Alike Health Centers Provide a Broad Array of Services
Note: Encounters for enabling services include visits to case managers and health educators.Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
Total = Over 3.7 million patient encounters in 2013
Medical Care77%
Other Professional
Services1%
Dental8%
Vision1%
Behavioral Health
8%
Enabling Services5%
Figure 10.6
Payments to Look-Alike Health Centers from Third Party Payers Are Less than Cost
Note: Health centers are non-profits, and thus charges are a proxy for costs. Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
78%
53%57%
54%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Medicaid Medicare Other Public Insurance Private Insurance
Perc
ent
of
Ch
arge
s C
olle
cted
Figure 10.7
Medicaid Revenue for Look-Alike Health Centers is Directly Proportional to Medicaid Patients, 2013
Notes: Percents may not total 100% due to rounding. Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.
46.2% 42.5%
8.1%6.8%
32.0%
4.4%
11.9%
8.3%
35.8%
Patients' Insurance Health Center Revenue
Grant/Contracts/Other
Private
Uninsured/Self-Pay
Other Public Insurance
Medicare
Medicaid
2.2%1.9%
Figure 10.8
Look-Alike Health Centers Utilize Multiple Health Professionals with Varied Skills to Increase Capacity, Full Time Employees (FTEs), 2013
Note: NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Other Professional Services include Vision Services. Other Programs/Services includes Enabling Services. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System (UDS).
Physicians15%
NPs/PAs/CNMs8%
Nurses12%
Dental Services8%
Mental Health and Substance Abuse Services
8%
Pharmacy Personnel
3%
Other Medical Personnel
31%
Other Professional Services
2%
Other Programs/Services
14%
Total = 3,967 FTEs in 2013
Figure 10.9
Look-Alike Health Center Medical Services Staff, Full Time Employees (FTEs), 2013
Note: Total Physicians excludes Psychiatrists and Optometrists. NP, PA, CNM stands for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Other Medical Personnel includes Laboratory personnel and X-Ray personnel. Percents may not total 100% due to rounding. Source: Look-Alike health centers only. NACHC analysis of Bureau of Primary Health Care, HRSA, DHHS, 2013 Uniform Data System (UDS).
Total Health Center Medical Services Staff = 2,598 FTEs in 2013
Break Out of Total Physicians (FTEs)
Total Health Center Physicians= 588 FTEs in 2013
Total Medical Services Staff (FTEs)
Total Physicians
23%
NPs/PAs/CNMs
12%
Nurses18%
Other Medical
Personnel47%
Family Physicians
49%
General Practitioners
3%
Internists22%
Obstetrician/Gynecologists
6%
Pediatricians16%
Other Speciality Physicians
4%
Figure 10.10
Look-Alike Health Center Dental Services Staff, Full Time Employees (FTEs), 2013
Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.
Dentists32%
Dental Hygienists
9%
Dental Assistants,
Aides, Techs59%
Total = 306 FTEs in 2013
Figure 10.11
Look-Alike Health Centers Behavioral Health Services, Full Time Employees (FTEs), 2013
Total = 325 FTEs in 2013 Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Notes: Percents may not total 100% due to rounding.
Psychiatrists10%
Licensed Clinical Psychologists
7%
Licensed Clinical Social Workers
28%
Other Licensed Mental Health
Providers22%
Other Mental Health Staff27%
Substance Abuse Services
6%
Figure 10.12
Look-Alike Health Center Enabling Services Staff, Full Time Employees (FTEs), 2013
Source: Look-alike health centers only. 2013 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Notes: Percents may not total 100% due to rounding.
Case Managers33%
Patient/Community Education Specialists
20%Outreach Workers
11%
Transportation Staff3%
Eligibility Assistance Workers
23%
Interpretation Staff4%
Other Enabling Services6%
Total = 509 FTEs in 2013
