Nearly 30 million people in the United States get their primary care from a community health center. Whether they’re urban or rural — or focus on a specific population such as women or recent immigrants — these centers are a trusted bedrock for many of the country’s marginalized populations.
Now, data is emerging that those centers are outperforming the national average in important healthcare quality measures. This research is putting a spotlight on community health partnerships as a path toward reducing health disparities.
Where are community health centers succeeding?
Take chronic diseases, for example. According to the National Association of Community Health Centers, community health clinics see better diabetes and hypertension control — 63% and 67%, respectively — compared to the national rates of 60% and 57%. Given that these clinics already see a disproportionate share of people with chronic disease, there’s something at play that health systems everywhere can learn from.
Perinatal health is another area where community health centers shine. In a discipline where patients are already feeling mentally and physically vulnerable, culturally sensitive care is crucial. Local clinics not only expand access to prenatal care, but also show lower rates of low birthweight than the national average, reports NACHC.
How local centers reach underserved patient populations
Partnering with successful community centers can expand their models more broadly and help health systems bolster existing outreach, suggests Nkechi Conteh, MD, MPH, Staff Psychiatrist, Massachusetts General Hospital. In a recent article on perinatal mental health for the Harvard Review of Psychiatry, Dr. Conteh and coauthors cite community health center partnerships as a starting point to break down barriers stemming from years of health inequity for pregnant people.
“Federally qualified health centers (FHQCs) provide an obvious target for interventions to improve medical mistrust, clinician cultural sensitivity, structural competency and clinical outcomes in transformational partnerships,” Dr. Conteh and her fellow authors write. These partnerships “are evidence-based to address health disparities, particularly across the perinatal period.”
Empowering community partnerships for equitable care
Community partnerships also encourage “continuous quality and process improvement” by opening opportunities for patients to advise clinic leadership in an immediate, structured way.
But just partnering with a clinic isn’t enough, suggests Dr. Conteh, who also works for a community health center. As COVID-19 has taught us, health disparities are deep-seated and perpetuated systemically. To make the most of these partnerships, healthcare leaders must prioritize investments to a greater extent than ever.
Here’s what Dr. Conteh and other researchers recommend.
1. Commit to healthcare financing
Community health partnerships for perinatal health and other disciplines should go beyond a superficial relationship, Dr. Conteh says. Rather than just having physicians volunteer at the local clinic — which is still a good thing — health systems should “put their money where their mouth is” with healthcare financing.
“Financing is a huge challenge,” she says. “You can make all the services available, but if these services are not covered by insurance, they are not going to be utilized.” The gap widens even more for patients who don’t have insurance.
Besides allowing patients to access health services, financial coverage can also foster care continuity, she adds. For instance, Medicaid only covers up to 60 days postpartum. Without support after that, patients may discontinue care amid one of the most psychologically trying times of their lives.
Funding culturally aligned and evidenced-based services such as community doulas may help to preempt these concerns before, during and after childbirth. When doulas are involved with high-risk pregnant patients, research shows that breastfeeding is more successful, complications go down and the likelihood of a healthy baby increases.
2. Let community members lead
Health centers have the advantage of being deeply embedded within the communities they serve. That advantage positions them perfectly to advise and lead health system partnerships. And yet, that’s not how many of these unions function, Dr. Conteh says.
“It’s something that we as healthcare institutions don’t do well,” she reflects. “We typically operate from the standpoint of a system telling everyone to do as they’re told. But the center — and, more broadly, the community — needs to have input and lead the care. That’s a great way to build trust within these partnerships.”
Initial efforts to mobilize COVID-19 vaccination outreach demonstrated what happens when community members are given the reins. A paper in the American Journal of Medical Quality describes how community liaisons and other strategies to elevate local voices were instrumental in increasing vaccination access among Black and Hispanic patients in New York City.
3. Serve multidisciplinary needs
Health is multidimensional; partnerships with community centers should acknowledge that complexity by offering more services outside the standard, Dr. Conteh says.
In perinatal health, for example, patients need more than an appointment with an obstetrician. Partnerships should also account for psychiatry, cardiology, endocrinology and other specialized care needs to offer patients true comprehensive care.
“We’re talking about a model of collaborative care where you have a team of providers rather than just a psychiatrist working separately from an OB-GYN,” Dr. Conteh says.
In the case of perinatal health — where Black women experience postpartum depression at a rate of 1.6 times that of White women — it’s easy to see how these collaborations make an impact. Dr. Conteh’s paper examines one study from the Seattle-King County Public Health System where participants received 18 months of multidisciplinary care and experienced marked improvements in depressive symptoms and treatment adherence.
4. Learn from past challenges
Despite the promise of community health center partnerships, challenges remain, many of them labor-related. Currently, there aren’t enough physicians to serve community health clinics in the first place and national trends point to looming shortages of primary care providers. Overworked clinicians may have limited time for community care efforts on top of their everyday practice.
Expanding training can help ready physicians for these roles. Healthcare institutions can also encourage providers to engage in community health projects by creating “mentor days” or dedicated learning opportunities for this work.
These and other efforts are imperative to reducing health disparities so that everyone can get the best care, everywhere. Understanding what has worked and what hasn’t can inform future partnership strategies so that community members can have a say while health systems expand their footprints.
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