By: Anna King

The health center movement is more than 60 years in the making. During the past year and a half, 1,400 health centers showed up as public health emergency responders in treating and preventing COVID-19. This required vast amounts of adaptability, fortitude, and resourcefulness. Health center staff are truly heroes!

Working with community-based health centers is truly an honor for Integrated Work. These phenomenal organizations have hearts for health equity and care deeply about their patients and the communities in which they reside. They provide whole-person, high-quality healthcare to all.

We recently developed a needs assessment for peer learning teams that are sponsored by the Bureau of Primary Health Care (BPHC). If you are not familiar with the “peer learning team” concept, it is a 20 year old program that convenes healthcare stakeholders from around the country to collaborate on the highest priority issues in health and healthcare. Program participants share their expertise, resources, innovations, and vulnerabilities with one another. The program is a powerful example of joining forces around shared topics for greater impact.

The recent needs assessment identified top focus areas and healthcare needs that health centers face. These are highlighted below and delineate where health centers and other healthcare providers will focus their attention in the year ahead.

Building structure and culture that supports emergency preparedness. The need for increased emergency preparedness became clear as healthcare systems and providers met the vast challenges associated with COVID-19. Secretary Becerra indicates strengthening national preparedness for the next public health emergency is a key priority.[i] Effective emergency preparedness is characterized by having designated individuals devoted to leading the organization’s preparedness and management efforts; all staff having a baseline understanding of how emergency operations will unfold within their organization and the various roles they may be asked to play; being prepared for a variety of emergencies; increasing preparedness within every organizational division or function from information technology to patient care and operations; and updating approaches and policies based on lessons learned.

Increasing health equity and addressing social and environmental determinants of health. Racial and identity-based health and healthcare inequities remain prevalent in the U.S. According to several studies, the percentage of non-elderly adults who did not see a doctor based on cost during one calendar year were 11 percent Asian, 14 percent white, 21 percent Black, and 24 percent Hispanic.[iv] According to a recent report from United Health Foundation, “Persistent and growing disparities in maternal mortality, including ongoing disparities among Black mothers who face a maternal mortality rate that is 3.4 times higher than Hispanic mothers. Rates of maternal mortality increased 55 percent for white mothers, 23 percent for Hispanic mothers, and 22 percent for Black mothers between 2005-2009 and 2015-2019.” Community partnerships and addressing systems level barriers are promising practices as it relates to increasing health equity and improving health across the country.

Decreasing and preventing opioid use disorder (OUD) and other substance use disorders (SUDs). On average, 130 Americans die every day from an opioid overdose.[xi] In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was six times higher than in 1999. Continuing the upward trend, drug overdose deaths were up 4.6 percent in 2019 according to the Centers for Disease Control and Prevention (CDC) totaling 70,980, with 70 percent of these involving opioids.[xii] A separate report from the CDC issued in July 2020 indicated 6.6 percent of women self-reported using an opioid pain reliever while pregnant with one in five reporting misusing opioids.[xiii] Integrating behavioral into primary care settings, utilizing team-based care models, and engaging the entire community are critical strategies in decreasing and preventing SUDs.

Helping decrease healthcare workforce gaps. A report from 2018 estimates that the U.S. will need 2.3 million more healthcare workers to serve the population by 2025.[xix] Another study estimates shortages of more than 12,500 adult psychiatrists and 11,500 addiction counselors by 2030.[xx] The gap for physicians and surgeons in 2025 is estimated at 11,000. However, this gap may be addressed through improvements in the care model (e.g., shifting to team-based care).[xxi]

Increasing diversity among healthcare leaders and providers. The civil unrest during the past year and a half has illuminated the great need for increases in diversity, equity, and inclusion. In the health workforce space, a Bureau of Health Workforce study from 2017 found that there are significantly different amounts of diversity by healthcare occupation. However, all minority groups except for Asians were underrepresented in Health Diagnosis and Treatment occupations such as physicians, dentists, nurse practitioners, occupational therapists, chiropractors, respiratory therapists, etc.[xxii]

Integrating paraprofessionals to increase capacity. Incorporating paraprofessionals into team-based care models is another important strategy in increasing health center patient care capacity. Over time, the number of paraprofessional roles is increasing. Professionals such as community health workers, medical assistants, dental assistants, and peer coaches expand the healthcare delivery system’s provider capacity to care for more patients. Barriers to leveraging paraprofessionals include the inability to reimburse for their time in many instances, difficulties with integrating them into care teams effectively, and turf wars with existing professions (e.g., dental hygienists resisting dental assistants).

Expanding telehealth and other healthcare technology utilization and access. Vast strides were made in the prevalence and use of telehealth since the onset of COVID-19. This includes an increased number of healthcare delivery sites that offer telehealth as well as patients’ comfort with its use. Other healthcare technologies such as wearable remote monitoring devices are gaining prevalence as well. Despite its use, telehealth remains wrought with systems level challenges. Broadband is one barrier, especially in rural communities. U.S. Department of Health and Human Services Secretary Xavier Becerra is supporting permanent telehealth expansion and increased technology accessibility. This also includes a desire to permanently expand payment policies that support use of telehealth as an option in care delivery.[i] These systems level strategies will increase access to telehealth. Utilizing the technology well and having effective health center workflows in place to deliver telehealth is equally important.

Building workforce resiliency. COVID-19 has proven a very heavy burden for health professionals. Many organizations continue to implement burnout prevention strategies to support staff. However, many of these strategies are stopgaps and only provide temporary relief. The real work in building workforce resiliency is looking beyond self-care strategies and giving staff short breaks to building cultures and operational structure that supports staff well-being, growth, and sustainability.

[i] HRSA. (2021) Statement by HHS Secretary Xavier Becerra on the President’s FY 2022 Discretionary Funding Request.
[ii] Forbes. (2020). Healthcare Cybersecurity Continues to Be a Major Concern.
[iii] Emergency Preparedness Learning Team 2020-2021 Participant Survey
[iv] The Advisory Board Company. (2016). Racial and Ethnic Health Care Disparities.
[v] Veterans Administration. (2019). National Veteran Suicide Prevention Annual Report.
[vi] U.S. Census. (2016). New Census Data Show Differences Between Urban and Rural Populations.
[vii] MMWR Surveillance Summary. (2017). Racial/Ethnic Health Disparities Among US Rural Adults 2012–2015.
[viii] United Health Foundation. (2021). New Health Disparities Report Reveals Urgent Need to Address Maternal Mortality, Mental and Behavioral Health, and Food Insecurity in the U.S.
[ix] Grumback, K, et al. (2017). Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010-2016. UCSF. Report #: ARTN E27. http://dx.doi.org/10.5888/pcd14.160469
[x] HRSA. (2021). Ensuring Equity in COVID-19 Vaccine Distribution
[xi] Centers for Disease Control and Prevention, National Center for Health Statistics. (2017). Wide-ranging online data for epidemiologic research (WONDER).
[xii] American Hospital Association. (2020). CDC: Drug overdose deaths up 4.6 percent in 2019.
[xiii] Centers for Disease Control and Prevention. (2020). Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019.
[xiv] Centers for Disease Control and Prevention. Rural Health Policy Brief.
[xv] Hinde, J. et al. (2018). State and Local Policy Levers for Increasing Treatment and Recovery Capacity to Address the Opioid Epidemic: Final Report, Office of the Assistant Secretary for Planning and Evaluation.
[xvi] Spayde-Baker. A, et al. (2021). A comparison of medication-assisted treatment options for opioid addiction: a review of the literature, Journal of Addictions Nursing.
[xvii] Leo P. et al. (2021). A Community Partnership to Improve Access to Buprenorphine in a Homeless Population. Annals of family medicine. 19(1):85. doi:10.1370/afm.2636
[xviii] University of Illinois—Chicago. Shifting from volume based to value based care. Infographic.
[xix] Stevenson, M. (2018). Demand for Healthcare Workers Will Outpace Supply by 2025: An Analysis of the US Healthcare Labor Market. Mercer Health Provider Advisory.
[xx] National Center for Health Workforce Analysis. (2017). Behavioral Health Workforce Projections 2017-2030
[xxi] National Center for Health Workforce Analysis. (2017). Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2011-2015).
[xxii] National Center for Health Workforce Analysis. (2016). National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025.
[xxiii] CHC, Inc. (2020). Readiness to Train Assessment Tool.

[i] Federal Communications Commission. (2021). Emergency Broadband Benefit program.

[i] Becker’s Hospital Review. (2021). HHS Secretary Nominee Pledges Support for Permanent Telemedicine Details.