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Lauren Sullivan/MEDILL


Private, non-profit operations filling health-care gap

by Lauren Sullivan
March 08, 2010


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Lauren Sullivan/MEDILL

Chicago Family Health Center demographics and economic profile.

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Lauren Sullivan/MEDILL

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Chicago Family Health Center

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Lauren Sullivan/MEDILL

Sylvia Wills has high blood pressure, a hearing impairment, diabetes and other medical problems that leave her ineligible for health insurance. Despite that, a 45-minute bus ride gets her the high-quality health care she needs.

For three years she’s been taking that bus ride to the Chicago Family Health Center, a federally qualified community health center on the South Side. Health reform may be stuck in limbo in D.C., but community health centers like the one Wills visits are filling some of the access gaps. 

“We serve everyone,” said Kathryn McLain, director of external affairs for the Chicago Family Health Center. “Community health centers provide services and fill gaps in under-resourced communities, targeting the uninsured and populations living at or below 200 percent poverty.” 

Community health centers like McLain’s are private, non-profit operations that fill a gap between for-profit health systems and free public health clinics. There are 36  of these federally qualified health centers in Illinois. Financial support comes from federal funds, Medicare, Medicaid, state programs, private insurance and philanthropies.

“Often private physicians will not take Medicaid,” she said. “And if they do, only limited numbers. They often cannot offer sliding-fee scales or see uninsured patients at all.” 

Community health centers cover everyone, which helps combat disparities in the broader health care system.   

“So if you have a family,” McLain said, “with an undocumented and uninsured uncle, a kid on KidCare – which is Medicaid – a grandma on Medicare and a wage-earner with coverage that’s just for the wage-earner – we can serve the whole family.”

In 2008 Illinois’ community health centers served more than 1 million people. Nationally, 1,100 community health centers served 17.1 million patients and provided 67 million patient visits.  

Chicago’s network of health centers is one of the best in the nation, Susan Greene said.  

“Chicago was aggressive early on in going after the federal dollars to set up health centers,” said Greene, owner of Susan Greene & Associates, an Evanston-based company that helps health systems and physicians develop strategies to increase access to health care.  

“The majority have been around for a long time and work well together,” she said. “Chicago has a very mature market of health centers.”

The mission

Since their inception in the mid-1960s, federally qualified health centers have sought to increase access to care and provide comprehensive primary care to uninsured patients.  

“On the national level, this is the only program that is available to help communities address the primary care needs of the uninsured,” Greene said. 

“Close to 60 percent of our patient population is uninsured,” said Dr. Muhammad Paracha, the director of the Asian Human Services Family Health Center, the only Asian-based community health center in the Midwest. “That’s higher than the state or national averages.” 

Paracha’s health center in West Ridge started as a volunteer-based clinic and in 2004 became a full-fledged federally qualified health center. Last year the health center saw more than 5,700 patients.

“It’s a big achievement,” Paracha said. “6,000 patients in six years is a big number for us.” 

But the real goal of these centers is education and outreach, McLain said. 

“Community health centers are not free clinics,” she said. “We try to educate our patients to be partners with us in the provision of their own health care.” 

McLain’s health center has been serving South Side communities for more than 36 years. The center’s four locations offer primary care health services, routine checkups, immunizations, dental services, mental services, prevention services and chronic disease management. 

“We want our patients to take responsibility for their health and their families’ health,” McLain said. “Learning about diet, nutrition and exercise. And to make healthy lifestyle choices – wearing your seatbelt and avoiding things like excessive alcohol use and smoking – in order to achieve wellness and maintain well-being.” 

Top-notch physicians

Many physicians spend their residencies in the community health system and jump ship after graduation. But for some, community health is exactly the medicine they want to practice.  

“Lots of people where I grew up were poor,” said Dr. Nina Rogers. “I went to WIC when I was a kid and had free lunches. Part of me is related to these people in saying ‘Look, I’ll keep you healthy. You stay in school. Then you can go on to become a doctor or whatever you want to do.’” 

Rogers was a resident at the Chicago Family Health Center while attending the University of Chicago’s Pritzker School of Medicine. She chose to come back after graduation, and now works at the center as a family physician.  

“It’s a patient-centered medical home,” she said. “There’s walk-in everyday if you need an emergency looked at by a doctor. There’s continuity – lots of family doctors who can treat you and your children.” 

The extensive services offered make the health center a quality place to work, say those who work there. 

“There are specialists, so I’m able to refer my patients to someone who’s in the same clinic that they’re familiar with,” she said. “We have this great auxiliary staff that help to take care of everyone.” 

“Medical home” is the key phrase for members of Chicago’s health center community. 

“They are a good example of a medical home,” Greene said. “One organization managing all of your health care needs because they have a lot of services available.” 

The result: Top-notch physicians staff Chicago’s health centers. 

“Our physicians have gone to the best medical schools,” McLain said. “Our providers are all board certified or eligible. A lot of people have the perception that it’s second-class medicine. But it isn’t at all.” 


Barriers

Community health centers provide expansive medical care, but when it’s time for specialty services, Cook County’s splintered system becomes an issue.  

“We send our patients for further services to Cook County,” Rogers said. “But I cannot tell my patients they’ll be seen in a month. It could take six months or a year.” 

Health center physicians have a hard time handing patients over to the county hospital system, especially when the next step is nebulous. 

“It’s our facility’s biggest challenge,” Paracha said. “We can’t refer these patients to specialty care services. If you send them to Cook County, they have to wait six months to get an appointment. If you send them for a crisis or emergency, they wait a full day before seeing a physician. The Chicago public health system is broken.” 

The federal government decides what services health centers offer. And specialty care isn’t an option. 

“Policy is set at the federal level,” Greene said. “The big unfunded gap is access to specialty care. Cook County has excellent physicians and high-quality services, but the wait times are long because they are so back-logged.”   

Reform

Community health centers are popular among Democrats and Republicans alike.  

Former President George W. Bush passed the Health Center Growth initiative in 2001. President Obama allocated nearly $600 million from the stimulus plan to fund health centers. And the proposed health care bill will quadruple the size of the health center program.  

“It is the most efficient system in terms of what you get for the investment,” Greene said. “That’s why it’s attracted philanthropic and governmental funding. Because it’s not your typical free clinic.” 

Health center employees and advocates are counting on reform to expand health center services.  

“There is a need for more community health centers,” Paracha said. “Let alone overall reform.” 

“Health reform has to pass,” Greene said.