Community Health Centers are medical clinics and so much more. They are consumer-driven and patient-centered medical homes, local economic engines, and trusted

community partners. They form the backbone of America’s health care safety net and play a critical role

in improving health outcomes, lowering costs, and ensuring access to high-quality, integrated care.

By mission and statute, the health center model requires that health centers locate in areas of greatest

need and are led by representatives of the population they serve. In doing so, health centers reach people facing the greatest difficulty accessing or affording health care services, who are at greater

risk of unnecessary hospitalizations or costly health complications. At health centers, everyone is guaranteed

access to timely care regardless of insurance status or ability to pay. All health centers offer a comprehensive

and integrated set of primary care services, including medical care, behavioral health, dental, vision, and

case management, among other services, depending on the needs of the community.

Thanks to continued bipartisan support from federal and state policymakers, health centers currently

serve 28 million patients – or 1 in every 12 people – in every state, territory, and the District of Columbia.1

At the same time, they eliminate waste and excess costs, saving the entire health care system more than $24 billion annually.2

This graphical brief highlights the fundamental reasons why health

centers have grown into America’s largest primary care network

and, in doing so, have become vital health service providers for local,

regional, and national health systems – and most importantly, for the

millions of patients they serve.

Community Health Centers: A Guide to a Vital Network of Care

28 MILLIONPATIENTS IN EVERY STATE, TERRITORY,

AND DC1

HEALTH CENTERS SERVE

MARCH 2019

2 | COMMUNITY HEALTH CENTERS: A Guide to a Vital Network of Care

91% OF PATIENTS ARE LOW-INCOME

(200% Federal Poverty Level or Below)

82% OF PATIENTS ARE UNINSURED

OR PUBLICLY INSURED

91%

63% OF PATIENTS ARE RACIAL OR

ETHNIC MINORITIES

63%

HOMELESS PATIENTS

AGRICULTURAL WORKERS

SCHOOL-BASEDHEALTH CENTER

PATIENTS

1.4 MILLION 970,000+ 800,000+VETERANS

355,000+

Health centers serve those who face the greatest challenges accessing or affording essential health services.

Health Centers Serve: 3,4

82%

49% OF PATIENTS ARE INSURED THROUGH

MEDICAID ALONE

49%

1 in 3 People in Poverty 1 in 5 Rural Residents 1 in 5 Uninsured Persons

1 in 6 Medicaid Beneficiaries 1 in 9 Children

nachc.org | 3

Percent Low Birth Weight Babies, 2017 3

An Indicator of Poor Health Outcomes and Higher Cost

Percent of Adults Who Have Ever Been Told They Have: 3

Percent of Population with Chronic Condition Under Control: 3

■ U.S. POPULATION ■ HEALTH CENTER POPULATION

■ U.S. POPULATION ■ HEALTH CENTER POPULATION

HYPERTENSION

DIABETES DIABETES UNDER CONTROL

Black or AfricanAmerican

Multiracial Asian Hispanic White All Births

13.4%

8.9%7.6%

8.5%7.6% 7.4%

6.6% 7.1% 7.0%8.3% 8.0%

HYPERTENSION UNDER CONTROL

11.7%

Health centers provide high-quality health care, improve health outcomes, and narrow health disparities, even while serving more high-risk, low-income patients.

32% 57%45%

11%21%

63%

57%67%

0% 0%

0% 0%

100% 100%

100% 100%

4 | COMMUNITY HEALTH CENTERS: A Guide to a Vital Network of Care

Nationally, 90% of health centers provide behavioral health services onsite. Percent of Health Centers Offering Behavioral Health Services, Including Substance Use Disorder and Opioid Treatment, 2017 3

What are Enabling Services? Enabling services boost access to primary care and improve the effectiveness of health services. These services set health centers apart from other providers. For example, health centers employ (in full time equivalent, or “FTE”)4 :

8,500 CASE MANAGERS AND CARE COORDINATORS

1,100 TRANSLATION/ INTERPRETATION STAFF

750 TRANSPORTATION STAFF

21,700 TOTAL ENABLING SERVICES STAFF

Health centers provide a wide array of comprehensive services to meet the complex needs of their patients.

Number of Health Centers Offering Selected Services Onsite, 2010 vs. 20173 (In Addition to Medical Care)

EnablingServices

Behavioral Health

Dental Vision All Four Services

1,053

828

1,234

857

1,113

119

339163

307

1,361

■ 2010 (1,124 TOTAL) ■ 2017 (1,373 TOTAL)

65–82%

83–90%

91–99%

100%

WA93%

AK89%

AL67%

MS65%

GA80%

AR67%

AZ90% NM

100%

CA97%

CO80%

FL83%

HI100%

IA71%

ID93%

IL98%

IN88%

KS89% KY

88%

LA85%

ME100%

MI100%

MN100%

MO97%

MT94%

NC75%

ND75%

SD100%

NE100%

NV86%

OH92%

OK70%

OR100%

PA88%

PR100%

SC91%

TN 83%

TX89%

UT92% VA

92%

WI94%

WV100%

WY83%

NY95%

CT100%

MA85%

NJ74%

DC100%

MD88%

RI100%

DE100%

NH100%

VT91%

nachc.org | 5

Percent Growth in Health Center Staff for Select Services, 2007–20174

(In Full Time Equivalent, or “FTE”)

In West Virginia, the state with the highest rate of opioid-related overdose deaths,5 health centers

are ramping up behavioral health visits.

In Alabama, the state with the highest rate of

heart disease mortality,6 health centers provide

more visits to treat chronic conditions.

VISITS FOR SELECTED SERVICES AND DIAGNOSES† IN WV 4

VISITS FOR SELECTED SERVICES AND DIAGNOSES† IN AL4

* Vision staff were not recorded in the Uniform Data System until 2010. The figure above shows the percent increase for vision staff in the full time equivalent since 2011.

† A list of the selected services is available in the “Sources and Endnotes” to NACHC’s “State Fact Sheets.” Available from www.nachc.org/research-and-data/state-level-data-maps/.

Preventive CareChronic Conditions

Behavioral HealthOral Health

290,000478,000

460,000106,000

Preventive CareChronic Conditions

Behavioral HealthOral Health

225,000326,000

130,000115,000

Health centers respond to changing and pressing needs of the communities they serve. They are on the front lines of the opioid epidemic, responding to public health emergencies, and addressing chronic disease.

300%

250%

200%

150%

100%

50%

0%2007 2009 2011 2013 2015 2017

Behavioral Health

Dental

Vision*

Pharmacy

Total FTEs

Medical

Enabling Services & Other Programs

AL

WV

254%

Since 2007GROWTH

6 | COMMUNITY HEALTH CENTERS: A Guide to a Vital Network of Care

Health centers launch innovations to improve care, reduce costs, and boost access for patients.

Health centers are quickly adopting telehealth7 to provide timely and cost-effective access to care for patients.Percent of Primary Care Practices Using Telehealth, 20164,8

Percent of Health Centers Using Telehealth for Specific Services, 20164

(Note: Percentages Include Only Health Centers Using Telehealth in 2016)

Health Centers*

All Primary Care Physicians (Interacting with Patients)

All Primary Care Physicians (Interacting with Health Professionals)

38%

13%

8%

Behavioral Health Services

Primary Care Services

Specialty Care Services

Other Services

Managing Chronic Conditions

Oral Health Services

49%

25%

24%

22%

21%

4%

Health centers are finding effective ways to get patients in the door — even by utilizing

ride-sharing networks and apps.

Health centers were among the earliest adopters of electronic health records (EHRs), and today,

health centers have a nearly universal (over 99%) EHR adoption rate.4

*Telehealth utilization for health centers includes any type of interaction, including interactions with patients and health professionals.

nachc.org | 7

Health centers promote growth in their local economies, often serving as the largest employer, and deliver cost-savings to the health care system.

Total Economic Impact from Health Centers by State, 20179

(M/B = Millions/Billions of Dollars)

Nationally, every $1.00 of federal Health Center Program funding generates $5.73 of economic activity for low-income and underserved communities.

In total,

Health centers care for 1 in 6 Medicaid beneficiaries nationally 3 and deliver major savings to the Medicaid Program at 24% lower cost compared to other providers.10

Total Annual Cost of Care for Medicaid Beneficiaries who Receive Primary Care at Health Centers vs. Non-Health Centers:10

WA2.4B

AK583M

AL362M

MS336M

GA759M

AR310M

AZ1.2B NM

566M

CA12B

CO1.4B

FL2.5B

HI372M

IA328M

ID340M

IL2.4B

IN761M

KS297M KY

741M

LA659M

ME364M

MI1.3B

MN418M

MO1B

MT225M

NC940M

ND71M

SD99M

NE160M

NV179M

OH1.3B

OK358M

OR1.3B

PA1.5B

SC855M

TN 613M

TX2.8B

UT290M VA

509M

WI619M

WV627M

WY53M

53M–327M

328M–618M

619M–1.1B

1.2B–12B

NY4.9B

24%

LOWER TOTAL

SPENDING

NON-HEALTH CENTERS HEALTH CENTERS

$54.6in economic activity.

HEALTH CENTERS GENERATE

BILLION

CT797M

MA2.3B

NJ755M

DC352M

MD766M

RI343M

DE71M

NH197M

VT290M

TOTAL SPENDING

$9,889TOTAL SPENDING

$7,518

© National Association of Community Health Centers, Inc.

7501 Wisconsin Ave, Suite 1100WBethesda, MD 20814301-347-0400 www.nachc.org

For more information, email research@nachc.org.

@NACHC

Facebook.com/nachc

Sources:1 NACHC estimates based on 2017 Uniform Data System for federally-funded and look-alike health centers and estimates for annual patient growth. 2 Ku et al. Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs. GWU Department of Health Policy.

Policy Research Brief No. 14. September 2009.3 NACHC. Community Health Center Chartbook. January 2019. 4 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Unless otherwise indicated, all data refers to the 2017 Uniform Data System. 5 National Institute on Drug Abuse. Opioid Summaries by State. February 2018. 6 National Center for Health Statistics. Heart Disease Mortality by State. January 2019.7 The Health Resources and Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunication technologies to support and promote

long-distance clinical health care, patient and professional health-related education, public health and health administration.” 8 Kane, C. K and Gillis K. The Use of Telemedicine by Physicians: Still the Exception Rather than the Rule. Health Affairs 13(12). December 2018. 9 Leavitt Partners in collaboration with NACHC. Based on Bureau of Economic Analysis RIMS II Industry-Specific Multipliers for Ambulatory Health Care Services. December 2018. 10 Nocon et al. Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings. AJPH 106(11). November 2016.

Note: Non-Health Centers include private physician offices and outpatient clinics.

Acknowledgements:

The National Association of Community Health Centers thanks all of the health centers and advocates who shared their photos for this brief.

Cover photo credits (in alphabetical order): (1) Charles B. Wang Community Health Center, Inc., New York, NY; (2) Columbia Basin Health Association, Othello, WA; (3) Community Health Center, Inc., Middletown, CT; (4) Finger Lakes Community Health, Penn Yan, NY; (5) Hackley Community Care Center, Muskegon, MI; (6) Health Care for the Homeless, Baltimore, MD; (7) Med Centro, Ponce, PR; (8) Neighborhood Health Clinics, Inc., Fort Wayne, IN; (9) Omni Family Health, Bakersfield, CA; (10) PCC Community Wellness Center, Oak Park, IL; (11) Promise Community Health Center, Sioux Center, IA; (12) Sea Mar Community Health Centers, Seattle, WA; (13) Whitman-Walker Health, Washington, DC.