Crisis in primary health-care access underscores the need for Community Health Centers

Access to primary health care is at a crisis point throughout Minnesota and the United States, and community health centers are a solution. Recent decisions by large health systems in Minnesota to shutter primary care clinics have the potential to disrupt care for thousands of Minnesotans.

A Larry A. Green Center national survey finds that 2 in 5 primary clinicians won’t have enough cash on hand to stay open through August because the COVID-19 pandemic has impeded their ability to bill services. (Larry A. Green Center, COVID-19 Primary Care Survey, Series #15.)

This short-term phenomenon is layered on top of an already under-resourced primary care system in the U.S. The Primary Care Collaborative finds the country spends 6-7% on primary health care services (Primary Care Collaborative, Investing in Primary Care: A State-Level Analysis). This underinvestment in primary care yields more expensive spending in preventable emergency room visits and hospitalizations and poses a significant financial incentive for physicians and other clinicians to choose other career paths than primary care.

Key access points in both urban and rural areas

Fortunately, Minnesota and the United States have a strong network of Community Health Centers (CHCs) whose primary mission is to provide accessible primary care services. CHCs were born out of the 1960s civil-rights movement and for 50-plus years have grown to serve more than 200,000 Minnesotans and nearly 29 million Americans. They’re key access points in both urban and rural areas – nearly 1 in 5 of every rural American receives care at a CHC.

Similar to other primary care providers, our overriding mission is to keep patients healthy, but Health Centers differ slightly in several ways: 1) We’re located in areas of high need; 2) we offer primary medical, dental and behavioral health care services “under one roof;” 3) the Board of Directors of each Health Center is governed by Health Center patients; and, 4) we’re open to everyone regardless of a patient’s ability to pay.

Like other primary care centers, Health Centers have experienced caseload reductions due to the COVID-19 pandemic. Across our 17 Community Health Center network in Minnesota, patient visits dropped over 60% in May. Fortunately, visits are rebounding, helped in large part by our adoption of telehealth services.

Mental health services onsite

Any reduction in primary care is devastating for Minnesotans who experience mental health issues spawned by the stress of COVID-19, job loss, historical trauma and recent civil unrest. All of Minnesota’s CHCs provide behavioral health services onsite and are meeting demand, especially for substance use disorder. Our nimble care model ensures that any patient experiencing a mental health issue as part of a routine medical service can literally “walk down the hall” for mental health services without delay from a referral system.

Community Health Centers are anticipating ongoing cycles of shock to the health care system. Specifically, the stressors of serving Minnesotans who lose employer-sponsored insurance due to economic conditions, and the anticipated repeated waves of COVID-19.

I fear that in the face of cash-strapped government, philanthropic and private resources, more primary care clinics will be forced to make the agonizing decision to shut their doors. Fewer primary care services translates to poorer health and increased health care costs.

These factors combine to underscore the need for community health centers, whose services reduce costs to the federal and state budgets by almost 25 percent. CHCs are open and stand ready to continue our legacy to serve all Minnesotans, and their primary medical, dental and behavioral health care needs, as we have been able to do for five decades.

Jonathan Watson is the CEO of the Minnesota Association of Community Health Centers (MNACHC). MNACHC is a nonprofit membership organization of Minnesota’s Federally Qualified Health Centers (FQHCs). MNACHC works on behalf of its members to promote the cost-effective delivery of affordable, quality primary health care services, with a special emphasis on meeting the needs of low income and medically underserved populations.

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