Reinvest in Primary Care, End Chronic Illness, and Save Federal Dollars
2030 Community Health Center Expansion Plan
Americans continue to struggle to live healthy lives. The United States continues to have the highest rate of people with multiple chronic conditions and is significantly over-indexed in specialty and resource-intensive care, with only 10% of domestic health care spending going to primary care.
Rates of behavioral health issues – including mental health challenges and substance use disorder – are skyrocketing,[1] and yet many communities have no treatment resources.[2] To make America healthy again and address these pressing challenges, the federal government must rebuild our country’s health care infrastructure through a historic investment in community health centers (CHCs).
The CHC model is community-based, high quality, and especially efficient and effective. Patients who are connected to primary care services provided at CHCs experience better outcomes at a lower cost. Research shows that, for every $1 invested in primary care, $13 is saved in downstream costs.[3] The Congressional Budget Office found that care provided at community health centers lowers federal spending for the Medicaid and Medicare populations they serve and lowers spending in emergency departments, inpatient hospital settings, and other outpatient services.[4] CHCs were estimated to save $25.3 billion for the Medicaid and Medicare programs in 2021.[5] Health centers have a lower incidence of specialty, emergency department, and hospitalization visits compared with other primary care providers for complex Medicaid managed care beneficiaries.8
CHCs also serve as economic engines for under-resourced communities and neighborhoods. In 2022, health centers provided almost 285,000 jobs across the country.[6] In 2019, community health centers generated $63.4 billion in total economic activity, of which $32 billion were indirect economic impacts generated from supporting local businesses. A study by Capital Link has shown that, for every dollar of federal funding invested in community health centers, $11 is generated in total economic activity through increased spending on related health service expenses, food services, transportation, construction, and more.[7]
Given this extraordinary return on investment, with an annual funding level of $30B by 2030, a new Administration could generate $475 billion in economic activity and save the Medicare and Medicaid programs over $100 billion annually.
CHCs Are Poised for a Major Expansion
CHCs are locally owned and operated non-profit health providers and have set the gold standard in primary care for nearly 60 years. CHC patients represent all walks of life in rural, urban, suburban, and frontier communities across the country. CHCs serve all who seek care, regardless of insurance status or ability to pay. Of the over 32 million patients CHCs serve, 24.2 million are uninsured or covered by Medicaid and/or Medicare and 90% have incomes at or below 200% of the federal poverty level. Over 9.6 million patients are from rural areas.[8]
Despite this volume, health centers do not provide cookie-cutter care. In fact, health centers specialize in providing care to the most complex patients; the five most common health center patient diagnoses, often co-occurring, are overweight/obesity, hypertension, diabetes, depression and other mood disorders, and anxiety disorders.[9] All patients receive comprehensive, quality, coordinated care, no matter how and when patient health or insurance status changes. As of 2022, 1,058 community health centers (77%) have been certified as Patient-Centered Medical Homes (PCMH), and community health centers have eight times greater odds of attaining PCMH certification than other types of health care practices.[10] The PCMH model enables community health centers to generate strong patient outcomes at lower costs despite treating patients who are often sicker with more complex health care needs.
CHCs have proven their ability to quickly expand care during the ongoing rural health crisis. Between 2010 and 2021, 136 rural hospitals in the United States closed. However, in areas previously served by a rural hospital, there is a higher probability of new community health center service delivery sites post-closure,[11] and these areas are seeing an increase in access to community health centers.[12] CHCs are poised to do more, and it appears they may have to – in over half of the states, 25% or more of the rural hospitals are at risk of closing, and in 9 states, the majority of rural hospitals are at risk.[13].
Furthermore, the care patients receive at a CHC is seen as an upgrade from previous providers. CHCs are among the most accessible providers - nearly all community health centers offer timely appointments (88%) and expanded hours for patients to receive care (93%).[14] According to the most recent Health Center Patient Survey, 97% of patients would recommend their health center to family or friends.[15]
CHCs Can Meet Our Country’s Most Pressing Health Care Needs and Make America Healthy Again
Mental Health and Substance Abuse: In every community across the country, Americans are struggling to find care for themselves or loved ones struggling with mental health or substance use disorder. From children with developmental disabilities to adults with opioid use disorder, lack of access to care can have devastating results. CHCs are poised to meet these needs. Even with limited funding, CHCs have expanded their capacity to meet their communities’ behavioral health needs.
The number of visits for mental health issues at CHCs rose by 19% from 2019 to 2021. There was a particularly notable increase in the number of patients experiencing anxiety disorders; in 2021, three million patients, or 10% of all community health center patients, had an anxiety disorder diagnosis, an increase of 17% from 2019. The number of patients receiving medication-assisted treatment (MAT) for opioid use disorder also increased substantially; in 2021, more than 180,000 patients received MAT, representing an increase of 29% from pre-pandemic levels. A survey of community health centers in 2021 found that roughly two-thirds (64%) of community health centers added a new mental health or SUD service, including services that community health centers were newly able to provide via telehealth. In 2021, community health centers served 2.7 million patients with mental health needs and provided substance use disorder services to 286,000 patients. Community health centers had an increase of 138,000 patients seeking mental health and substance use disorder services between 2020 and 2021.[16]
This care is cost-effective and high quality. Integrating behavioral health staff at community health centers improves care and reduces costs. Each additional full-time equivalent National Health Service Corps (NHSC) behavioral health staff member was associated with a savings of $3.55 per visit in community health centers; in rural areas, there were even greater savings of $7.95 per visit.[17] Similarly, health centers have seen high-quality gains in adopting tele-mental health. A 5-year study from the Patient-Centered Outcomes Research Institute found that rural community health centers deploying telehealth for mental health services saw “substantially and statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life.[18]”
Food and Nutrition Services: Food insecurity reached its highest point in nearly a decade last year, with 18 million households in the U.S., or 13.5% of U.S. households, struggling at some point to secure enough food, according to a recent Department of Agriculture report.[19] Health centers have their finger on the pulse of these issues, as the majority regularly collect information from their patients on pressing social needs.[20]
In response, many anti-hunger organizations are partnering with CHCs – 80% in a recent survey[21] – to deliver community-tailored interventions to increase regular access to healthy foods. More and more CHCs are co-locating food pantries at their service sites, as food insecurity can often prevent patients from regaining and maintaining health. By providing this “one-stop shop,” CHCs are meeting the needs of their communities every day. For example:
Evara Health, a CHC based in Tampa, FL, has leveraged partnerships with Feeding Tampa Bay and funding from Humana to develop a “food prescription” program. Each prescription provides the patient with vouchers to use at the Evara Food Rx Pharmacy, where staff assist the patient in choosing from a prescribed option set. In addition to pantries, patients can redeem their vouchers at Feeding Tampa Bay’s “Groceries on the Go” bus, which parks at community locations throughout the week.
Mountain Comprehensive, a CHC serving eastern Kentucky, has developed a “Farmacy,” through which eligible patients can redeem food “prescriptions” at local farmers markets. The CHC’s registered dietitian provides nutrition education, recipes, and taste-testing opportunities at the farmer's markets and is also available at each clinic for nutritional counseling.
Maternity Care: The United States has the highest rate of maternal deaths of any high-income nation. In 2022, there were approximately 22 maternal deaths for every 100,000 live births in the U.S., far above rates for other high-income countries.[22][23] CHCs are working to address this concern, serving patients across the continuum of care, from prenatal services to labor and delivery to postpartum care. In 2023, health centers served 585,000 prenatal patients, representing a 6% increase from 2020, and supported 172,000 deliveries, a 2% increase from 2020.26
CHCs Can Train Tomorrow’s Health Care Workforce
HRSA’s National Center for Health Workforce Analysis estimates a projected shortage of 35,260 primary care physicians—including family medicine, general internal medicine, geriatrics, and pediatrics—by 2035. These shortages are projected to be particularly acute in rural areas.[24] CHCs provide one of the best training grounds imaginable for the health care workforce, giving exposure to highly complex patients and experience in comprehensive, patient-centered care.
Over 58,000 skilled professionals received training or education at a community health center in 2022.[25] CHCs have trained thousands of new primary care physicians through the Teaching Health Center Graduate Medical Education program and provide first-class experiences to thousands of new physicians through the National Health Service Corps every year. A recent survey of the health center workforce found a lower burnout rate and a higher well-being rate than most other health care settings.[26]
Commwell Health, a CHC serving multiple counties in North Carolina, has developed a multi-faceted workforce development program known as The Eagle Excellence Program,[27] designed by CommWell Health colleagues for CommWell Health colleagues. One component, Flight School, features a two-year curriculum on the foundations of health center leadership and has led to significant gains in retention and worker satisfaction.
By bringing the total investment in CHCs to $30 billion annually by 2030, CHCs would be able to significantly expand the primary care workforce, including clinical and frontline staff necessary to deliver high-quality, comprehensive care.
Investment in CHCs Would Transform the Health Care Landscape
With $30 billion invested in CHCs by 2030, a new Administration could fully scale and support a reimagining of American primary care infrastructure, including:
Serving 40 million patients
Training 25,000 additional providers
Increasing the percentage of community health centers reaching national clinical benchmarks by 25%
Increasing the percentage of community health centers participating in value-based care by 20%
Conclusion
At present, health centers save the system $25.3 billion annually. As a network of primary care providers, health centers annually generate approximately $63.4 billion in total economic activity, of which $32 billion is indirect economic impacts generated from supporting local businesses. Imagine what a concerted and visionary investment in this program could mean for the health of Americans - who would gain access to this high-quality, cost-effective care - and for the rural and under-resourced communities who stand to gain tens of thousands of jobs and millions of dollars put back directly into the local economy.
Community health centers are community-owned and operated, with a 51% consumer majority board, guaranteeing the pulse and needs of the local community are a part of the governance of the health center directly. Health centers are required to serve every patient who walks through their doors, regardless of their insurance status or ability to pay. Most importantly, health centers are poised to do more, but to do so, they need an investment from the federal government that matches communities' needs – health and economic. This comprehensive, culturally, and linguistically competent care also requires a strong community health center workforce.
Building on the legacy of the Poor Counties Initiative under former President George W. Bush, it is critical that we reinvest in the Health Center Program to address the ever-increasing need in communities across the nation and allow them to expand and offer more people their high-quality, low-cost services. Health centers have proven they can do a great deal with limited resources, but they could do even more with a meaningful investment. Community health centers are poised to care for all those in need nationwide, innovate and drive new models of care, produce healthier patients and communities, and save scarce resources for our health care system. The Trump Administration has the opportunity to set this vital health care system on the right course for the future. Whether measured in lives or dollars, there is no better health care investment than the Health Center Program.
About Advocates for Community Health
Advocates for Community Health is a nonpartisan national membership organization of community health centers focused on visionary policy and advocacy initiatives to affect positive change for the Health Center Program, the patients they serve, and the nation’s health care system. Rooted in community health, our members are among the largest health centers in the nation. They are forward-thinking, leading the way in comprehensive, integrated primary care and cutting-edge innovation to help shape a rapidly evolving health care landscape.
Contact: Stephanie Krenrich, Senior Vice President for Policy and Government Affairs: skrenrich@advocatesforcommunityhealth.org.
[1] Insel, T. (2023, December 8). America’s mental health crisis. https://www.pewtrusts.org/en/trend/archive/fall-2023/americasmental-health-crisis
[2] Livingston, K., Green, M., Norman, J., Berkowitz, B., Ghebremedhin, S., Ross, K., & May-Corsini, A. (2022, May 18). America’s mental health care deserts: Where is it hard to access care? ABC News. https://abcnews.go.com/Health/americasmental-health-care-deserts-hard-access-care/story?id=84301748
[3] Gelmon, S., Wallace, N., Sandberg, B., Petchel, S., Bouranis, N., OHSU & PSU School of Public Health and Mark O. Hatfield School of Government, & Portland State University. (2016). Implementation of Oregon’s PCPCH Program: Exemplary practice and program findings. https://www.oregon.gov/oha/HPA/dsi-pcpch/Documents/PCPCH-Program-Implementation-Report-FinalSept-2016.pdf
[4] Congressional Budget Office. (2024). CBO’s cost estimates explained, CBO describes its Cost-Estimating Process, Glossary. https://www.cbo.gov/system/files/2024-02/s2840.pdf
[5] Nocon, Robert. Kaiser Permanente Bernard J. Tyson School of Medicine. Testimony on Community Health Centers: Saving Lives, Saving Money before the United States Senate Committee on Health, Education, Labor and Pensions Committee. March 02, 2023. Retrieved from https://www.help.senate.gov/imo/media/doc/Testimony-Nocon-CHCs%202023-0228_Final.pdf. 8 Pourat, N., Chen, X., Lu, C., Zhou, W., Yu-Lefler, H., Benjamin, T., Hoang, H., & Sripipatana, A. (2023). Differences in health care utilization of High-Need and High-Cost patients of federally funded health centers versus other primary care providers. Medical Care, 62(1), 52–59. https://doi.org/10.1097/mlr.0000000000001947
[6] National Association of Community Health Centers. (2024). Community Health Centers: Providers, partners and employers of choice 2024 Chartbook. https://www.nachc.org/wp-content/uploads/2024/07/2024-2022-UDS-DATA-Community-HealthCenter-Chartbook.pdf
[7] National Association of Community Health Centers (2024). Health Centers Provide Cost Effective Care, 2015. http://nachc.org/wpcontent/uploads/2015/06/Cost-Effectiveness_FS_2015.pdf.
[8] Sripipatana, A., Health Resources & Services Administration (HRSA), Bureau of Primary Health Care (BPHC), Aria Gray, MPH, Ben Picillo, MPH, Avery League, MPH, & Samantha Cinnick, MPH. (2023). 2022 Health Center program highlights. https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/uds-2022-trends-webinar-slides.pdf
[9] NCQA-National Committee for Quality Assurance. (2016). Trend of uncontrolled diabetes. In DIABETES BRIEF [Report]. https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/diabetes-brief-7.pdf
[10] National Association of Community Health Centers. Community Health Center Chartbook 2022. https://www.nachc.org/wpcontent/uploads/2022/03/Chartbook-Final-2022-Version-2.pdf.
[11] Miller, K. E. M., Miller, K. L., Knocke, K., Pink, G. H., Holmes, G. M., & Kaufman, B. G. (2021). Access to outpatient services in rural communities changes after hospital closure. Health Services Research, 56(5), 788–801.
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[12] Bell, N., Hung, P., Merrell, M. A., Crouch, E., & Eberth, J. M. (2022). Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study. The Journal of Rural Health, 39(1), 291–301. https://doi.org/10.1111/jrh.12691
[13] Center for Healthcare Quality and Payment Reform. (2024). RURAL HOSPITALS AT RISK OF CLOSING. https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf
[14] Health Center Patient Survey. (n.d.). https://data.hrsa.gov/topics/health-centers/hcps
[15] Community health centers’ progress and challenges in meeting patients’ essential primary care needs. (2024). https://doi.org/10.26099/wmta-a282
[16] Pillai, A., Corallo, B., & Tolbert, J. (2024, April 18). Recent trends in community health center patients, services, and financing | KFF. KFF. https://www.kff.org/medicaid/issue-brief/recent-trends-in-community-health-center-patients-services-and-financing/
[17] Han, X., Pittman, P., & Ku, L. (2021). The effect of National Health Service Corps clinician staffing on medical and behavioral health care costs in community health centers. Medical Care, 59(Suppl 5), S428–S433. https://doi.org/10.1097/mlr.0000000000001610
[18] Fortney, J. C., Bauer, A. M., Cerimele, J. M., Pyne, J. M., Pfeiffer, P., Heagerty, P. J., Hawrilenko, M., Zielinski, M. J., Kaysen, D., Bowen, D. J., Moore, D. L., Ferro, L., Metzger, K., Shushan, S., Hafer, E., Nolan, J. P., Dalack, G. W., & Unützer, J. (2021). Comparison of teleintegrated care and telereferral care for treating complex psychiatric disorders in primary care. JAMA Psychiatry, 78(11), 1189. https://doi.org/10.1001/jamapsychiatry.2021.2318
[19] US Department of Agriculture Economic Research Service. “Household Food Security in the United States in 2023.” https://www.ers.usda.gov/webdocs/publications/109896/err-337.pdf?v=262.6
[20] National Association of Community Health Centers. (2024). Community Health Centers: Providers, partners and employers of choice 2024 Chartbook. https://www.nachc.org/wp-content/uploads/2024/07/2024-2022-UDS-DATA-Community-HealthCenter-Chartbook.pdf
[21] New Report Highlights Growing Partnerships Between Anti-Hunger Organizations and Health Care Providers to Combat Food Insecurity - Food Research & Action Center. (2024, July 26). Food Research & Action Center. https://frac.org/news/foodasmedicinereportjuly2024
[22] Insights into the U.S. Maternal Mortality Crisis: An International Comparison. (2024). www.commonwealthfund.org. https://doi.org/10.26099/cthn-st75
[23] UDS Trends Brief. (2024). https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/2023-uds-trends-data-brief.pdf
[24] Teaching Health Center Graduate Medical Education (THCGME): Expanding the primary care workforce | Bureau of Health Workforce. (2024, September 1). https://bhw.hrsa.gov/funding/apply-grant/teaching-health-center-graduate-medical-education
[25] National Association of Community Health Centers (2024), Community Health Centers: Providers, Partners and Employers of Choice, 2024 Chartbook. https://www.nachc.org/wp-content/uploads/2024/07/2024-2022-UDS-DATA-Community-HealthCenter-Chartbook.pdf
[26] Jiri, T. T., Mangione, T. W., & John Snow, Inc. (2023). HRSA Health Center Workforce Well-being National Data Report: Findings from the 2022 HRSA Health Center Workforce Well-being Survey. In HRSA Health Center Workforce Well-being [Report]. HHS/HRSA/OO/OAMP. https://data.hrsa.gov/DataDownload/DD_Files/HRSA%20Health%20Center%20Workforce%20Wellbeing%20National%20Data%20Report.pdf
[27] Commwell Health (2023, May 10). Transformative Culture - CommWellHealth's Values and Mission. Commwellhealth.org.