Community Health Clinics

What is a Federally Qualified Health Center?

Federally qualified health centers (FQHCs) are clinics that provide primary medical care and some specialty care. FQHCs may also be called community clinics or safety net clinics. FQHCs are typically not-for-profit, community based, outpatient health centers focused on treating specific, underserved populations regardless of the patients’ ability to pay. FQHCs make great library partners as they often serve the same community areas, have overlapping missions and functions, and are focused on underserved populations. Because FQHCs are nonprofit and operate under certain Federal requirements, they may be more willing and available to partner with public libraries than private medical practices.

Table of Contents

• Objectives and Goals
• Where Do They Operate?
• Services Offered
• Constituents and Clients
• Funding and/or Sources of Revenue
• Staff
• Leadership Structure
• National and Regional Organizational Structure
• Key Metrics Used
• Key Terms
• Potential Partnership Ideas
• Find Your Local FQHC
• Take a Colleague to Coffee

Objectives & Goals

• To eliminate health disparities
• To provide healthcare to those who can’t afford it 

Where Do They Operate?

• FQHCs are community-specific organizations.
• They are focused on underserved populations and populations where many individuals may not be able to afford healthcare and thus are usually located in “medically underserved areas.”
• Some FQHCs focus on specific populations such as migrants and the homeless.
• Some FQHCs are focused on and operate as Native American Outpatient Centers.

Services Offered

• FQHCs are required by law to offer a full spectrum of primary care for all age groups. This includes services such as those in the accompanying box. Public libraries might work with their local FQHCs to create awareness in the community about specific health services (such as immunizations) or issues (such as breast cancer). Clinics can send patients to the public library to research and learn more about their health issues, while public libraries can refer patrons who need health services to the local clinic.

   

  FQHCs must also provide access to some services either directly or through arrangement with other community providers. These include dental care, mental health services, substance abuse services, transportation services necessary for adequate patient care, and hospital and specialty care. Not every FQHC will offer these services, but all FQHCs are mandated to help patients access them.

   

  There are some services FQHC patients need that are specifically NOT covered by insurance or federal funding for FQHCs, such as eyeglasses, hearing aids, and preventive dental services. This also includes group or mass information programs, health education classes, or group education activities, including media productions and publications. Public libraries might help local FQHCs provide group health education programs using their resources and facilities.

Constituents & Clients

• FQHC patients consist primarily of those on Medicare (elderly and/or disabled) or Medicaid (low income).
• Many patients are uninsured or unable to afford healthcare and thus seek care at FQHCs because of their sliding payment scales.
• Some FQHCs are meant to serve specific populations, such as Native Americans or individuals experiencing homelessness.

• FQHC patients generally are “underserved” and face hardships such as poverty, low literacy, language barriers, and more. Public libraries have free access to information and technology, and they provide supports such as librarians and digital literacy training that can help patients access information. 

Funding and/or Sources of Revenue

• Federally Qualified Health Centers cannot operate as for profit organizations.
• Patient Payments: Patients pay what they can afford based upon their incomes, and no patient can be turned away because of inability to pay. A sliding scale is used to determine the discount level based upon income and is a key requirement of being a FQHC (see an example sliding scale). The sliding scale generally applies to individuals and families up to 200% of the Federal Poverty Line. Patients must provide applicable insurance and financial information in order to qualify for discounts.  This may require proof of identification (for all patients in the family), proof of residency, and proof of income (for all family members).
• Government Funding:
  • Because FQHCs take primarily public insurance programs, they are mostly reimbursed from the Centers for Medicare and Medicaid Services and related state government agencies such as state Medicaid or Health departments.
  • The Bureau of Primary Health Care of the US Health Resources and Services Administration offers grants on a competitive basis for the establishment of new health centers and the re-competition of existing health centers.
• Private Donors: As nonprofit organizations, many clinics seek grant money from a variety of foundations and private donors.

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  FQHCs may be competition for local funding, particularly from private donors and individuals. But clinics and libraries who partner on grant applications can show funders that they have cross-community support and are leveraging other resources.

Staff

• Each clinic or clinic system will be led by an administrative staff member (typically CEO or Executive Director) and a Medical Director (typically a physician). 
• Clinics may be stand alone, single site clinics or large networks of clinics spread out over a city or region.  The larger the clinic system, the more likely that it has a central office that has additional administrative staff, such as fundraising staff, quality management staff, marketing staff, etc.
• A health center maintains a core staff as necessary to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals. Those staff typically include Primary Care Physicians and Physicians Assistants, Nurses and Nurse Practitioners, Medical Assistants, Dentists and Dental Hygienists, Pharmacists, and Behavioral Health Specialists including psychiatrists, social workers, counselors and psychologists.
• Because FQHCs are nonprofit and receive most of their payments for medical services through Medicare and Medicaid (which pay healthcare providers less than private insurance), staff at FQHCs may not be paid as well as their counterparts at private medical practices. Also, some FQHCs may not be able to afford as many staff (for instance, fewer nursing staff to support the physicians), or staff with advanced educations (for instance, medical assistants rather than nurses).

Leadership Structure

• All FQHCs must have a board of directors, featuring no fewer than 9 and no more than 25 members, that is responsible for:

• Ensuring that the health center is community-based and responsive to the communities needs
• Holding monthly meetings
• Approval of grant applications and budgets
• Selection, dismissal, and evaluation of the CEO
• Selection of services to be provided and hours of operation
• Measuring and evaluating the organization’s progress in meeting its annual and long-term programmatic and financial goals and developing plans for the long-range viability of the organization by engaging in strategic planning, ongoing review of the organization’s mission and bylaws, evaluating patient satisfaction, and monitoring organizational assets and performance
• Establishing general policies for the operation of the health center

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  The Bureau of Primary Health Care sets specific board requirements for FQHCs, to make sure they are truly representative of patients and the community.

• 51% of the board must be comprised of active, registered patients, who are representative of the patients the health center serves.
• Waivers may be issued if the health center focuses on homeless, migrant, or public housing populations.
• The non-patient members must be representative of the community and shall be selected for their expertise.
• Of the non-patient board members no more than half can derive more than 10% of their annual income from the health care industry.
• No board member or member’s family member may be an employee of the health center.
• The clinic’s CEO may serve as non-voting board member.

National and Regional Organizational Structure

• National Association of Community Health Centers (NACHC)
  • The mission of the NACHC is “To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved populations.”  The NACHC provides:[1]
  • Research-based advocacy for health centers and their clients
  • Education to the public about the mission and value of health centers 
  • Training and technical assistance to health center staff and boards
  • Development of alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need
  • Some policy priorities listed on the NACHC web site in 2015 including increasing federal funding for community health centers and outreaching to and enrolling children and families in public health insurance programs.
• The Centers for Medicare and Medicaid Services is a federal government agency that funds the medical insurance programs that FQHCs rely on for payment.
• The Bureau of Primary Health Care of the US Health Resources and Services Administration offers grants on a competitive basis for the establishment of new health centers and the re-competition of existing health centers.
• Many clinics and clinics systems belong to state and regional associations.  These may be organized under different names such as primary care associations, primary health care associations, community health networks, alliances of health centers, etc. The NACHC web site lists the major state and reginal primary care associations.

Key Metrics Used

FQHCs are responsible for many key metrics that are used to evaluate quality of care and must report these to the federal government and use them for grant and funding applications. Typical metrics are below along with some suggestions for how libraries and other community partners can help address them. More information on key metrics can be found Health Resources and Services Administration web site.

Key Metrics Used

Key Terms

• Health Resources and Services Administration (HRSA) – the primary federal agency, a division of the US Department of Health and Human Services, for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.
• Section 330 of the Public Health Service Act – defines the Federal Health Center Program as the funding organization for organizations that provide care to underserved populations.
• Bureau of Primary Health Care – the organization through which HRSA funds are dispersed
• Health Center Program Grantee – Health centers that receives grant funding from the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care
• FQHC Look-Alike - health centers that have been certified by the federal government as meeting all the Health Center Program requirements, but do not receive funding under the Health Center Program.  (Clinics may choose to do this because they can’t meet all the requirements of an FQHC, but want to be considered a nonprofit serving the underserved like an FQHC).
• Centers for Medicare and Medicaid Services (CMS) - government agency that oversees and processes the Medicare and Medicaid claims files by FQHCs

Potential Partnership Ideas

• FCHQs do not get reimbursements from Medicare and Medicaid to support public education campaigns or group health education. Libraries could serve as resources for mass education of patients in a setting they are already using to get health information.
• FCHQs are pushed to cut costs and operate as efficiently as possible, as a result patients don’t get all of the attention they need. Libraries can fill this void through formal partnerships aimed on informing patients about health conditions, healthy behaviors, ancillary community services, and more.
• The government pushes FCHQs to improve metrics, many of which involve proper education about lifestyle factors and proper diets.  Libraries should work to educate these individuals, as well as connect them with other resources and partners that can help them manage their health.
• Literacy plays an important role in getting and staying healthy.  Patients who cannot read the doctor’s orders, use books or the Internet to learn  about their condition, or follow prescription information struggle.  Libraries can help with literacy and digital literacy.
• FQHCs play a large role in the health insurance registration process for underserved communities. Libraries can be very helpful in this process by helping to connect individuals to information on their options, as well by providing the technology needed to enroll.

Finding Your Local FQHCs

• Use the HRSA FQHC Locator to find your local FQHCs.  Data on all FQHC grantees and FQHC look-alikes can be found through the HRSA web site here.

Take a Colleague to Coffee

Reach out to the CEO/Executive Director or Medical Director of a local FQHC clinic or clinic network and invite them to coffee. Here are five questions you might ask your colleague who works at an FQHC to inspire conversation about how the public library and the FQHC might partner.

1. What are some of the major health problems you see facing our community? Are there any health problems that seem to be more prevalent in our community than others?
2. Are there any services you wish you could provide to your patients to help them get and stay healthy? Even if they are not health services?
3. Is there any programming your clinic runs that you would like to see reach more people?
4. Where do your patients find information about health and diseases, and do you think they are finding good information?
5. What do you want your patients to see and do in the community between appointments to keep themselves healthy? 

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