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Opinion: Community Health Centers Left Out In The Cold

While health care is rightfully an issue of national relevance, the manner in which that care is funded and delivered is a much more local issue, with individual states making important budget decisions that impact how and where their residents can receive care.

Here in Connecticut, more than 417,000 of our residents — or about 11 percent of our state's total population — have their health care needs met by a community health center, commonly known as a federally qualified health center, or FQHC. With more than 250 locations across Connecticut, every corner of our state is served by one of these health centers, and served well. They provide care for Connecticut residents suffering from mental health disorders, substance abuse, developmental disabilities, homelessness, domestic violence and more.

Unfortunately, in a budget proposal from the Connecticut Legislature's Appropriations Committee, there is not nearly enough funding to support community health centers working to care for some of the most vulnerable populations in our state. Taking recent drastic inflation levels into account, this results in a major cut in funding for community providers, as their expenses skyrocket through no fault of their own but public funding fails to keep up. Offsetting these rising costs in order to adequately meet the needs of providers would require a 9 percent state funding increase in 2024 and a 7 percent increase in 2025, with indexing in order to offset the last two years of inflation.

To better understand the very real need of community providers and their patients, I want to share the scope of our work and experience at InterCommunity, Inc., where I am proud to serve as president and chief executive officer.

InterCommunity is a nonprofit community health center that provides primary care, mental health care, and addiction recovery services to more than 10,000 individuals annually in Hartford, East Hartford and South Windsor. We pride ourselves in our commitment to equity and inclusion, and we strive to advance health outcomes that ensure everyone is treated within a respectful and supportive health care system.

In recent years, InterCommunity has seen a critical and increased need for behavioral health and addiction recovery services in Hartford and its surrounding areas. As a longtime care provider and partner to the city and region, we understand the true shape and scope of this problem, because we work directly with Hartford area patients each and everyday offering cost-effective, lifesaving addiction recovery services to people from all walks of life. In short, there has never been a greater need in our state's history for these services, but providing them means they need to be properly funded.

Like other nonprofit providers, for years we have been on the front lines of the raging opioid epidemic, the worst drug epidemic in modern American history. Throughout the pandemic, our doors stayed open at our detoxification center and residential drug and alcohol treatment programs. Our staff served thousands of individuals suffering from addiction to opioids, and we continue to offer comprehensive addiction recovery treatment to anyone who requests it, regardless of their insurance status or ability to pay. We have done this despite years of chronic underfunding because the people in our community hit hardest by the opioid epidemic deserve no less.

Now, overdose deaths continue to rise in 2023, along with a steep increase in mental health disorders, suicidal ideation, and suicide attempts in children and adults. Increasing funding to meet these needs would allow us to expand our resources within our facilities, so that we can offer more integrated primary care and behavioral health care clinic for residents in the North End of Hartford and beyond. It will mean better access to safe, secure, high quality services for more patients, including those who are low-income, underinsured, or uninsured.

The current budget proposals from the governor and the legislature fall well short of that need. They would be devastating to organizations like InterCommunity, and to other providers across Connecticut.

As the end of the legislative session soon approaches, it is our hope that lawmakers — many of whom have visited our campus and clearly understand the important work of community providers — will make the important funding changes in the state budget to support Connecticut patients.

Kim Beauregard is president and CEO of InterCommunity, Inc.

MLK Community HealthcareCalifornia

Overview

When MLK Community Healthcare – a hospital and health system – opened in South Los Angeles in 2015, its leadership made a bold promise: to deliver a state-of-the-art facility with talented and culturally-aligned clinicians and staff in one of the nation's most marginalized communities. As its founding mission, MLK Community Healthcare provides quality collaborative care to its patients. Its vision is to improve the health of the entire community.

Today, MLK Community Healthcare provides inpatient care that includes highly specialized services, including award-winning diabetes care and maternity care its all-digital, 131-bed hospital. Its nonprofit physician group, MLK Community Medical Group, provides community-based care through a network of outpatient practice sites, offering the kind of primary and specialty care, behavioral health, and education that residents throughout South Los Angeles have historically lacked to address chronic conditions that are prevalent at three times the state average.

"For MLK Community Healthcare, delivering quality care is an act of social justice."

Dyan SublettPresident, MLK Community Health Foundation

MLK Community Healthcare was established through a public-private partnership unique in the state of California. Largely due to its private management organizational structure, the hospital is able to innovate, respond nimbly to patient needs, invest in cutting-edge technology, and maintain high-quality standards. MLK Community Healthcare has earned multiple awards and distinctions for its commitment to quality care, including a HIMMS level 7 rating for its use of health information technology and a five-star rating for quality from the Centers for Medicare & Medicaid Services (CMS). Notably, only 6.4% of hospitals in the nation are at HIMMS 7. In addition, only 13% of all hospitals receive a CMS five-star rating; it is even more rare among hospitals whose patient populations are predominantly covered by Medicaid or Medi-Cal.

Patient–Payer Mix

As a Metropolitan Anchor Hospital (MAH), MLK Community Healthcare continues to be guided by the belief that all patients – no matter their insurance status – deserve access to high-quality primary and specialty care services. MLK Community Healthcare is located in federally designated Medically Underserved and Healthcare Professional Shortage Areas, and it experiences a challenging patient-payer mix. Ninety-six percent of MLK Community Healthcare patients are publicly insured or uninsured, placing an extreme burden on the finances of a health system unable to crosss-ubsidize with commercial insurance.

MLK Community Healthcare serves one of the most diverse communities in the state—94% of its patients in 2022 were Black or Brown. Decades of systemic racism and neglect are reflected in the community's disproportionately high health and social needs. For example, life expectancy in MLK Community Healthcare's service area is ten years lower than the rest of California and the median per capita income is $16,927—less than half of the state average.

Chronic health conditions are disproportionately prevalent in the MLK Community Healthcare service area. The rate of diabetes is three times that of the rest of the state, while mortality from diabetes is 72% higher. Amputations and diabetic wound care are among the most commonly performed procedures at the hospital. In 2022, the prevalence of substance use disorder among MLK Community Healthcare patients was three times the state rate, and the number of patients with heart failure was twice as high as the statewide average. This high prevalence of chronic conditions means that MLK Community Healthcare's patients are at an increased risk for complications, including severe symptoms from COVID-19. During the height of the pandemic, MLK Community Healthcare saw more COVID-19 patients than hospitals three to four times its size throughout Los Angeles County and was included by Becker's Review among the 14 most highly impacted hospitals for COVID-19 in the nation.

MLK Community Healthcare's Unique Approach to Care

MLK Community Healthcare offers numerous programs to promote equal access to care and address community members' basic and emergent health care needs:

Emergency Department

Given the lack of health care resources outside the walls of MLK Community Healthcare, community members often come to the Emergency Department to receive basic services. Even women seeking routine pregnancy-related services are cared for—and given follow-up appointments— to ensure their health and recovery. The hospital is also renowned for its triage services. Due to the use of MLK Community Healthcare's ED for both urgent and primary care services, a department designed for 40,000 patients each year has stretched its resources to serve up to 116,000 patients annually. Yet, this has not compromised its performance. Due to process innovations, wait times are less than two hours and the Left Without Being Seen rate is the lowest among all hospitals in the area.

Investment in a Service-Oriented Health Care Workforce

Wealthy communities in Los Angeles have ten times the number of physicians located in the community than that which MLK Community Healthcare serves. To bridge this gap, MLK Community Healthcare secured over $20 million in private philanthropy to subsidize doctors' and nurses' salaries – helping attract a strong, service-oriented workforce, including specialists in the chronic health conditions that are disproportionately prevalent among MLK Community Healthcare's patients.

Disease Management

For many MLK Community Healthcare patients living with multiple chronic conditions, health care services must extend beyond primary care. That's why MLK Community Healthcare has invested in the creation of a Diabetes Center of Excellence, implementing a range of services designed to prevent avoidable ED visits and slow the progression of disease through self-management, specialized education, peer support, and a fresh produce program for food insecure patients.

Integrated Behavioral Health

An average of 10,000 patients come to the MLK Community Healthcare ED with behavioral health needs each year. With philanthropic support, MLK Community Healthcare tested an innovative pilot program integrating medical and behavioral health care in the emergency and inpatient environment with long-term follow-up treatment in the outpatient environment. The pilot program was successful and is now a signature approach for effective behavioral health care.

Metropolitan Anchor Hospitals Need Support

Since its opening, MLK Community Healthcare has provided consistent, quality care to individuals in the historically underserved communities of South Los Angeles. Serving 1.3 million residents, MLK Community Healthcare continues to be guided by the unwavering belief that all communities deserve equal access to quality care and services. Its five-star CMS rating, cutting-edge technology, culturally aligned staff and renowned medical professionals demonstrate its commitment to this principle of health equity.

The costs of treating highly complex patients without supplemental payments necessary to adequately cover their care exacerbate the heightened financial challenges MLK Community Healthcare faces from rising labor costs and inflation – threatening its ability to invest in new technologies, attract staff through competitive compensation packages, and offer much-needed preventive and specialized care services.

While MLK Community Healthcare is committed to providing a high standard of care and is taking steps to halt decades-long trends of neglect and poor health outcomes, a federal Metropolitan Anchor Hospital designation and more adequate, sustained financial support are critical to realizing this mission.

Florida Health Care Providers Are Pausing Gender-affirming Care For Adults

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Health care organizations including Planned Parenthood are suspending gender-affirming medical care in Florida to comply with a new state law that bans transition-related care for transgender minors and places heavy restrictions on care for adults.

Florida Gov. Ron DeSantis (R), who is expected to enter the 2024 presidential race next week, on Wednesday signed legislation immediately prohibiting health care professionals from administering puberty blockers, hormone replacement therapy and surgeries to transgender minors.

Those who violate the law risk being convicted of a third-degree felony crime, punishable by up to five years in prison, according to Florida's criminal code.

The new law places additional restrictions on adult access to gender-affirming health care, despite being billed by Republicans in the state legislature as a measure to protect young children from making medical decisions they may later regret. 

The legislation substantially reduces the number of providers able to administer care by allowing only physicians to provide gender-affirming services, meaning other health care professionals — including physician assistants, nurse practitioners and certified nurse midwives — are unable to provide care that is considered medically necessary by most major medical organizations.

Gender-affirming health care for adults, according to the new law, may only be administered once an informed consent form is signed, but the state medical boards tasked with drafting the forms have not yet done so, forcing health care providers across the state into a difficult position.

"It's clear that the law was designed not only to restrict care for adults, but to cause an immediate gap in access — providers across the state are being forced to pause services because the law took effect immediately, and the state hasn't promulgated the required consent forms needed to comply," a spokesperson for Planned Parenthood told The Hill on Friday.

The organization has initiated a temporary pause on gender-affirming health care in the state, they said. Care is likely to resume in mid-June.

In an emailed statement, Planned Parenthood of South, East, and North Florida (PPSENFL) said the pause will be used to make "operational adjustments to comply with the new law, which now forbids our skilled and competent nurse practitioners from providing gender-affirming care."

"We will have to reorganize physician schedules, develop new consent forms with language that complies with the new requirements of the law, and change the delivery of that care as we are only allowed to offer telehealth for some appointments," the organization said. "Our commitment to providing high-quality, compassionate care to our gender-affirming hormone therapy patients remains unwavering. We will navigate these changes together."

Patients who have had their appointments canceled because of the pause will be contacted to reschedule by June 12, PPSENFL said.

The new Florida law appears to have driven other, smaller providers to halt the administration of adult gender-affirming care, too.

"As a result of SB 254, and to meet the requirements set out by the State of Florida, it is with deep regret that we are no longer able to provide Hormone Replacement Therapy (HRT), surgical clearance letters and gender marker letters to our transgender, gender nonbinary, and gender nonconforming patients," reads a statement posted Wednesday by 26Health, an LGBTQ health center in Orlando.

"While we are unable to provide these services at this time, 26Health firmly believes that our transgender, gender nonbinary, and gender nonconforming community members deserve to live fully and openly as their truest selves," the statement continues. "We will continue to provide care to our gender diverse community members including primary care and mental health services, which are incredibly important during this difficult climate."

Folx Health, an online-only provider, announced this week after Senate Bill 254 was signed that it would no longer be able to legally prescribe gender-affirming hormone therapy to patients, as the new law requires consent forms to be signed during an in-person visit with a doctor.

The group said it is working to hire more physicians "who are licensed and living in Florida" and open in-person locations in "major hubs across the state."

"You will hear from us again as soon as we have information about how to set up in person care or take other necessary steps, as the legal implications become clearer," the announcement states. "We are here for you and are so sorry your healthcare rights are at stake."

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