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This commentary is by Josh Dufresne of Springfield, CEO of North Star Health, a federally qualified health center with locations across Windsor and Windham counties; and Jeff McKee of Burlington, CEO of Community Health Centers, a federally qualified health center with locations across Chittenden and Grand Isle counties.
It is funny how sometimes we look back on a period of struggle and challenges as the good ole days.
Prior to the pandemic, federally qualified health centers, which provide primary care and other preventive services to a third of Vermonters, struggled with workforce shortages, an aging cohort of primary care providers, and substantial regulatory obligations.
Yet, we could still expand services to improve the quality of Vermonters’ daily lives, especially to those struggling to afford care, those managing complex medical and social conditions, and those who historically have been marginalized in our health care system.
Then in March 2020, the state and country were launched into a more than two-year pandemic. Federally qualified health centers promptly stepped forward to provide testing, personal protective equipment, and vaccines. We even tapped into our federal sources for additional supplies, which gave the state greater flexibility to put resources where and when they were needed. We also kept our dental operations open for urgent and emergent care.
However, as we emerge from the pandemic, workforce challenges have gotten substantially worse, operational costs have spiked, and funding across multiple sources is stagnant or declining. The gains we have made to benefit Vermonters over the last decade are in jeopardy without help.
What exactly is at stake? Federally qualified health centers bridge that last mile between the most vulnerable and disenfranchised members of our community and the services fundamental to their health and well-being. We are committed to increasing health equity and to do so have opened clinic sites in underserved areas, increased hours of availability, provided language interpretation services, and engaged in community education and outreach.
In Burlington, we actively reach out to people experiencing homelessness, to refugees, and to new Vermonters. In Springfield, we recently launched our mobile clinic to connect with Vermonters who may not otherwise use the health care system. These efforts are at risk.
We can point to other examples of vulnerable services if funding trends continue:
- Federally qualified health centers are currently the largest providers of dental services for Vermont’s uninsured and Medicaid enrollees. In some regions, federally qualified health centers are the only dental providers accepting Medicaid patients. We can also offer discounted rates to uninsured, underinsured, and Medicare patients.
- For those Vermonters struggling to afford their prescription drugs, federally qualified health centers can offer these drugs at a lower price.
- We hear about the mental health crisis experienced by our youth. Federally qualified health centers across Vermont have established school-based mental health programs as well as school-based dental and primary care programs.
- Federally qualified health centers have been leaders in addressing the social and environmental drivers affecting people’s wellness. We have developed initiatives that increase access to nutritional food and physical activities while trying to mitigate the underlying social and mental health factors that can act as barriers. These efforts are at risk.
Furthermore, a lot of the rhetoric around health care reform has touted primary care as the foundation of the health care system, but planning for a sustainable system has clearly left primary care as an afterthought. As a result, the foundation is crumbling.
Despite overwhelming evidence that primary and preventive care improves people’s health, connects them to appropriate care, and reduces overall spending, the investments necessary to fully realize these goals have not materialized. Instead, our doctors, nurses, and other staff have repeatedly expressed that they are being asked to do more with less.
As safety net providers, federally qualified health centers must participate in Medicaid, must offer reduced fees to those at or below the 200% federal poverty level, and must take all patients regardless of insurance status or ability to pay. Due to the federal requirement that over 50% of our board of directors are patients, we are deeply engaged with our communities to improve wellness opportunities outside our four walls.
With over 90 federal regulatory requirements (plus quality measures from state-based programs), we are held accountable for high quality care. We have made great strides in expanding access to integrated mental, physical, reproductive, and oral health and substance use disorder treatment services.
However, federally qualified health centers face a triple threat: 1) inflation is increasing three times as fast as our Medicaid rates; 2) our base federal grants, intended to subsidize our reduced fees, have been stagnant for over 10 years; and 3) our savings historically gained through a federal prescription drug program are eroding.
In light of these threats, we may not be able to hold onto our gains for Vermonters that have marked the last decade. Adequate funding of federally qualified health centers is not about sustaining an organization; it is about sustaining a commitment to the health in our community.
We look forward to the governor’s budget address this week. His comments during his inaugural address, stating we need to integrate physical and mental health more fully and to focus on prevention, are words we echo because federally qualified health centers do just that.
However, funds need to follow the words. The growing gap between the cost of providing integrated high-quality care and the funds available is unsustainable.
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