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FQHCs in the COVID era

Monday, April 19, 2021

When the Covid-19 pandemic hit 13 months ago every aspect of life changed. In addition to people dying in great numbers from the novel coronavirus SARS Cov-2, the pandemic also revealed wider economic gaps, racial injustices, and climate crises. It no longer had to be business as usual because many spheres of life were disrupted and systems, as well as individuals, had to adapt to these challenges and find new ways of leveraging existing resources to remain resilient despite the trying times. The recently concluded North Carolina Community Health Center Association (NCCHCA) virtual conference held a session focused on assessing the role of Federally Qualified Health Centers (FQHCs) in mitigating the effects of this global pandemic.

 “The pandemic hit our poorest and most vulnerable communities the hardest and community health centers were uniquely positioned for purpose to be an answer and voice of our most impoverished and vulnerable communities,” said Chris Shank, the NCCHCA President, and CEO during a panel discussion on the role of FQHCs in the public space during the pandemic. The panelists represented the public health sector in government and non-profit organizations.

Ben Money, the Deputy Secretary for Health Services at North Carolina Department of Health and Human Services said community health centers have demonstrated speed and the ability to act unilaterally. Also, FQHCs have deep ties with the communities that they serve, making their role even more important, noted Money.  “Community health centers have patient governed boards and that’s critical. Community health centers work very closely with HRSA, state, and county government but they can act in ways that in many instances government entities cannot. And, they’re also able to hire quickly and deploy staff rapidly. So, that was critical in our covid response,” explained Money.

In addition, CHCs were in a position to test populations in harder to reach areas for Covid. “The need for community health centers to have community health workers and other individuals from the communities that they serve employed to engage these populations is also a critical feature that many health centers have embarked upon” explained Money. In addition to providing comprehensive health care services, community health centers provided crucial patient education that focused on preventing Covid-19 in the early phases of the pandemic.  They distributed PPE and now they’re equally active during the vaccination efforts.  “I think the advent of the federal vaccine effort through HRSA where allocations are provided directly to FQHCs is really making a huge impact in terms of being able to get more vaccines into the state,” Money said.

Additionally, the CEO of South Carolina Primary Health Care Association and Chair of the National Association of Community Health Centers Board, Lathran Woodard, observed that FQHCs in North Carolina were more actively involved in mitigating the effects of the pandemic from the start of the pandemic.  Different states prioritized CHCs differently in the COVID response, explained Woodard. In addition, testing for their workforce was hard. 

“We went from mass testing for volumes to realize that there were population groups and communities of color that were not being reached because they don’t have the transportation to come to these big football field testing sites,” said Woodard. One of the most important roles that FQHCs played during this pandemic was to address the challenge of vaccine hesitancy, which was also prevalent among workers, said Woodard. They did this by using trusted community leaders and community health center staff to address the hesitancy.

“We in the south and southeast don’t have deep pockets but we have a lot of patients who need the care.  We had health crises before and if you look prior to Covid we still were dealing with the opioid issues, hypertension issues, infant mortality, and all of that, and then this goes on top of it. We know how to reach the community, we know how to reach those who are vulnerable populations and who trust us but we need the backing and resources to do it,” said Woodard.

Going forward, FQHCs will need to have a population focus looking at their patient panels and service areas, added Money. “Covid has allowed us to address some of the cultural inhibiting factors that exist across our state system,” explained Money.  In addition, he noted that North Carolina has a decentralized public health structure with only a few exceptions. “Local health departments are county governed. But the capacity of local health departments is largely dependent upon the level of county investment and so more economically distressed counties are less able to adequately fund their local public health infrastructure,” said Money.  While Money covered things from a state health perspective, there was also a panelist from HRSA to cover the national view.

Angela Powell, a Director in the Office of Health Center Program Monitoring of the Bureau of Primary Health Care also noted the crucial role community health centers play in the country, adding that FQHCs have always ‘been high profile and they receive a lot of recognition’. For example, when the Affordable Care Act was enacted in 2010, health centers were at the forefront. “It certainly was no surprise that health centers were called to the forefront once again during the response to Covid19,” she said. The challenge now is to ensure that FQHCs not only get to reach many people but that the outcomes of the services they provide will be worth every dollar injected into FQHC programs. 

“The good work that we do with that ensures that the funding will keep coming and that when the next crisis hits, folks will know that the return on investment in the health center program is one that yields a good outcome,” said Powell. Echoing similar sentiments, Brian Toomey, the CEO of Piedmont Health said: “Financial challenges have been the father of creativity for health centers. That’s a challenge to us but we have to make the best investment of those dollars to show that we really are everything that we said that we are and everything that we can be”. On addressing future public health challenges, Money concluded: “I envision a future in which some necessary public health resources are for core public health services such as the accessibility to data scientists and epidemiologists that are going to be so critical to mitigating future pandemics. 

The NCCHCA Communications and Emergency Preparedness Coordinator, Leslie Wolcott agrees that the pandemic indeed revealed the important role CHCs play in the community.

“This has been a year for Community Health Centers to shine, but all the attention to their work will also bring more scrutiny. Whatever role CHCs play in the future of public health, they will continue to deliver great care for a great value—and do extensive and detailed data reporting and collection as they go. CHCs must continue to reach underserved populations moving forward from COVID, in order to best prepare their patients for the health challenges of the future,” said Wolcott. The theme for this year’s virtual conference was “Positioned for purpose: mission and service in 2021”.

People standing in a hospitalChr

NCCHCA President and CEO Chris Shank, far right, with Piedmont Health Staff in 2019.

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