This review was written by Josh Dufresne of Springfield, CEO of North Star Health, a federally qualified health center with offices in Windsor and Windham counties; Jay Dufresne of Burlington Jeff McKee is CEO of Community Health Centers, a federally qualified health center in Chittenden and Grand Isle There are offices in each county.
It’s funny how sometimes we look back on a period of struggle and challenge as the good old days.
Before the pandemic, federally-qualified health centers that provide primary care and other preventive services to one-third of Vermonters were struggling with workforce shortages, an aging primary care provider workforce and substantial regulatory obligations.
However, we can still expand services to improve the quality of everyday life for Vermonters, especially for those who struggle to afford care, those who manage complex medical and social conditions, and those who have historically been marginalized in our health care system people.
Then in March 2020, the state and country were plunged into a pandemic that lasted more than two years. Federally qualified health centers quickly stepped forward, providing testing, personal protective equipment and vaccines. We’re even using our federal resources to secure additional supplies, which gives the state more flexibility to put resources where and when they’re needed. We also keep dental procedures open to provide emergency and urgent care.
However, as we emerge from the pandemic, workforce challenges have intensified, operating costs have soared, and funding from multiple sources has stagnated or declined. Without help, the gains we’ve made over the past decade to benefit Vermonters will be in jeopardy.
What is at stake? Federally Qualified Health Centers provide the last mile bridge between the most vulnerable and disenfranchised members of our community and services critical to their health and well-being. We are committed to improving health equity by opening clinics in underserved areas, increasing service hours, providing language translation services, and engaging in community education and outreach.
In Burlington, we actively reach out to the homeless, refugees, and New Vermonters. In Springfield, we recently launched our mobile clinic to connect Vermonters who might not otherwise use the health care system. These efforts are at risk.
If the funding trend continues, we can point to other examples of vulnerable services:
- The federally qualified health center is currently the largest provider of dental services in Vermont, providing dental services to the uninsured and Medicaid enrollees. In some areas, federally qualified health centers are the only dental providers who accept Medicaid patients. We also offer discounted rates for uninsured, underinsured and Medicare patients.
- For Vermonters who struggle to afford prescription drugs, federally eligible health centers can provide them at reduced prices.
- We hear about the mental health crisis our young people go through. Federally Qualified Health Centers in Vermont have established school-based mental health programs as well as school-based dental and primary care programs.
- The federally qualified health center has been a leader in addressing the social and environmental drivers that affect people’s health. We develop initiatives to increase access to nutritious food and physical activity, while working to mitigate underlying social and mental health factors that can be barriers. These efforts are at risk.
Furthermore, much of the rhetoric surrounding healthcare reform touts primary care as the foundation of the healthcare system, yet planning for a sustainable system clearly treats primary care as an afterthought. As a result, the foundations are crumbling.
Despite overwhelming evidence that primary and preventive care can improve people’s health, connect them to appropriate care, and reduce overall spending, the investments needed to fully achieve these goals have not yet been realized. Instead, our doctors, nurses and other staff have repeatedly said they are being asked to do more with less.
As a safety net provider, federally eligible medical centers must participate in Medicaid, must provide reduced-price services to those at or below 200% of the federal poverty level, and must admit all patients regardless of insurance status or ability to pay . Because the federal government requires more than 50 percent of our board members to be patients, we engage deeply with our communities to improve health opportunities beyond our four walls.
Based on more than 90 federal regulatory requirements (plus state program quality measures), we have a responsibility to provide high-quality care. We have made great strides in expanding access to comprehensive mental, physical, reproductive and oral health and substance use disorder treatment services.
However, federally eligible health centers face a triple threat: 1) Inflation is growing at three times the rate of our Medicaid rate; 2) Our base federal appropriation, designed to subsidize our reduced fees, has stagnated10 3) The savings we used to get through the federal prescription drug program are dwindling.
Given these threats, we may not be able to preserve the gains that Vermonters have made over the past decade. Adequate funding of federally qualified health centers is not about maintaining an organization; it is about maintaining a commitment to the health of our communities.
We look forward to the Governor’s budget speech this week. We agreed in his inaugural address that we need to more fully integrate physical and mental health and focus on prevention, because that’s what federally qualified health centers do.
But money needs to follow the word. The growing gap between the cost of delivering comprehensive quality care and the funding available is unsustainable.