Providence Community Health Centers: A Primary Source of Primary Care

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A doctor attends to a patient sitting in an exam room
Photo courtesy of Providence Community Health Centers

If you’re having trouble finding a primary care provider (PCP), you’re not alone. The COVID pandemic greatly increased the stress and burnout of primary care docs (MD), physician assistants (PA), and nurse practitioners (NP) — leading to hastened retirements of many practitioners, along with declining enrollment and training of their replacements. Add to this, the increasing medical needs of an aging population and the dramatic acceleration of behavioral health challenges (ranging from social anxiety to substance use to suicide), and you have a perfect storm that has left many Providence residents desperately searching for a new PCP.

And that’s just the ones with health insurance, cars, connections, and money.

So, how can poor and uninsured Providence residents find access to affordable, quality primary care”? The answer lies in something called Federally Qualified Health Centers (FQHC) — better known (but not well known) locally as the Providence Community Health Centers (PCHC). PCHC may just be the largest non-profit in Providence that you have never heard of. PCHC employs approximately 625 healthcare workers – including more than 100 MDs, PAs, and NPs – who collectively provide affordable, comprehensive, and culturally-sensitive primary care services to more than 80,000 patients from the Providence metropolitan area and nearly 30% of all Providence residents). No other primary care practice comes close to serving that many Providence residents.

PCHC operates eight health centers in the city, as well as a school-based health program, and a dental clinic serving children under the age of 19 and pregnant women. Its services include Family Practice, Internal Medicine, Pediatrics, Obstetrics, Gynecology, Behavioral Health, Optometry, Dental Care, and Express Care (urgent care), as well as selected specialty services such as diabetes, asthma care, and more. Referrals to other specialists are provided as needed. And most importantly, all services are provided to PCHC patients regardless of their ability to pay.

A map of providence with pins indicating a dozen or so locations throughout the city.
Providence Community Health Centers locations

What is an FQHC?

An FQHC is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of income or health insurance status.

When they were first established in the early 1960s, FQHCs were known as Community Health Centers, or Neighborhood Health Centers. They were created as part of President Lyndon Johnson’s War on Poverty. In 1965, Mound Bayou, Mississippi, and Columbia Point, Boston became the first two cities in the US to have a Neighborhood Health Center. Today, there are over 1,100 FQHCs in the United States, serving over 20 million patients a year. FQHCs operate under a consumer Board of Directors governance structure and function under the supervision of the Health Resources and Services Administration (HRSA), which is part of the United States Department of Health and Human Services (HHS).

Originally, FQHCs were established to provide comprehensive health services in order to reduce the patient load on hospital emergency rooms. Currently, their mission is focused on enhancing primary care in urban and rural communities for underserved, underinsured, and uninsured Americans, including migrant workers and non-U.S. citizens. FQHCs provide their services to all persons regardless of ability to pay, and charge for services on a Community Board-approved sliding-fee scale that is based on patients’ family income and size.

PCHC was established in 1968. Today, 90% of its 80,000 patients are considered low-income, which means their family income is less than 200% of the federal poverty level (i.e., under $55,500 for a family of four). Seventy percent of PCHC patients identify as Latino/Hispanic, and 70% are best served in a language other than English. Seventy percent of PCHC patients are covered by Medicaid and 10% by Medicare. Ten percent are uninsured, and 10% have private insurance.

PCHC’s model of patient care is holistic and person-centered, which means that the patient is viewed and treated as a whole person (and not simply as a disease, condition, or body part), and the care that they receive is based on what is most important to them, and not their provider. Relatedly, PCHC’s emerging financial model is focused on value-based care, in which the organization and its medical team are paid and rewarded for having good health outcomes and satisfied patients, rather than volume-based care in which providers are paid more for doing more, regardless of outcomes. To achieve the best possible outcomes for its vulnerable patients, PCHC staff attends not only to the medical needs of its patients, but also to the social needs or “determinants” that affect their patients’ wellbeing, connecting them to services and programs that provide housing, food and nutrition, transportation, employment services, social services, behavioral healthcare, and more.

PCHC patients also have access to same day appointments, off-hours urgent care, round the clock telephone triage, onsite lab work, integrated oral health and behavioral health services and more.

Sounds good? Does your primary care practice offer all this? If not, why not?

The good news is that anyone can be a PCHC patient (Disclosure: I am.) Whether or not you are low-income or uninsured, you can receive primary care that is available where and when you need it — and from salaried healthcare providers who are able to prioritize the wellbeing of their patients rather than the revenue of a for-profit owner. As with most healthcare providers, well-insured patients help to cover the cost of care for those who are under- or uninsured.

Sounds too good to be true? Well, there is just one catch. PCHC is not immune from the national and regional shortage of primary care providers. Despite the fact that access to primary care is widely recognized as producing better health outcomes overall, greater equity in health care access and outcomes, and lower per capita health costs1 our health system generally grants lower salaries, fewer resources, and less professional status to primary care providers than it does to medical specialists such as neurosurgeons, gastroenterologists, and cardiologists, and others who are often perceived as dramatically saving us from death, while primary care providers do the less glamorous and less lucrative work of simply keeping us healthy.

PCHC President and CEO Merrill Thomas observed, “Rhode Island is definitely in the midst of experiencing the national shortage of primary care clinicians, and retaining and recruiting clinicians is currently one of our biggest challenges at Providence Community Health Centers.


1Primary Care in High-Income Countries: How the United States Compares | Commonwealth Fund
Every provider is being recruited by someone and our neighboring states have taken measures to increase pay and loan repayment — things that Rhode Island is not keeping up with. We think we can be the employer of choice for providers who want to make a difference in their communities, and we are making every effort to attract and retain staff at all levels.”

It’s expensive to become a physician – and the cost (and debt) does not vary with the type of specialty that one pursues. That is one reason that federal health professional loan repayment programs offer partial debt relief to primary care providers to work in Health Professional Shortage Areas. (All FQHCs are automatically deemed HPSAs.) But clearly more needs to be done to recruit, educate, support, incentivize, compensate, and respect primary care providers. After all, if even more Providence residents decide that PCHC might just be the best deal in town, there will need to be enough PCPs available to provide them the care that they, and all of us, deserve.

To learn more about the Providence Community Health Centers, go to https://www.providencechc.org/ .

Rick Brooks serves as Director of Healthcare Workforce Transformation for the RI Executive Office of Health & Human Services, where he is responsible for developing policies and programs to prepare, advance, and support a diverse health and human services workforce.  Before coming to EOHHS, Rick served for 4½ years as the Executive Director of the Governor’s Workforce Board and for 17 years as the Executive Director of the United Nurses and Allied Professionals.  Rick is the son of lifelong New York City news reporter, Stan Brooks.