Tip Sheets

Community health centers increasingly go beyond primary care

By Mary Otto

Factors including the passage of the Affordable Care Act and the expansion of Medicaid in a number of states have contributed to rising revenues and burgeoning caseloads for community health centers. During this boom, many clinics have broadened their primary care programs to include dental and mental health services, researchers at the Henry J. Kaiser Family Foundation found.

“Over a two-year period, health centers were able to add 2.6 million patients – an increase of more than 10 percent – and expand services such as oral health and mental health treatment, for which there is a great need,” noted the authors of a 2017 Kaiser issue brief.

The expansion of dental and mental health care was particularly pronounced among clinics located in Medicaid expansion states, the authors concluded.

In spite of challenges to the ACA, centers have continued to build mental health and dental capacity, Kaiser found in a 2018 follow-up brief.

The innovative work unfolding at community clinics has not been going unnoticed. A Commonwealth Fund series, launched in April 2019, is taking a look at the trend.

The first case study provides a detailed account of the ways that one health center, Philadelphia’s 11th Street Family Health Services, has dramatically expanded its primary care program to better meet the needs of a high-risk community.

The nurse-led project, which got its start more than 20 years ago as a free clinic operating out of an unused public housing unit, has grown into a full-service federally qualified health center drawing 6,000 patients from local public housing and beyond. With a guiding focus on “health, not sickness” the clinic has taken a head-on approach to tackling high rates of diabetes, hypertension, obesity, depression and addiction in the area.

“Primary care teams include nurse practitioners, registered nurses, medical assistants, social workers, behavioral health consultants, and a nutritionist,” explain the authors, Martha Hostetter and Sarah Klein.

Patients who come for a checkup can also pick up fresh fruits and vegetables or take a yoga class. The clinic offers traditional behavioral services, art therapy, and a pharmacy. There is oral health care too.

“To encourage more patients to receive regular dental services, 11th Street launched a medical-dental integration program in 2016,” the authors write.

For more information about the nation’s network of community clinics, the National Association of Community Health Centers

offers resources on federally-funded clinics and the communities they serve, such as this 2019 Community Health Center Chartbook.

And for the oral health angle, there is the National Network for Oral Health Access, an organization of oral health safety net providers, which promotes the integration of dental services into primary care clinics nationwi