Faces of Public Health: NewPublicHealth Q&A with Dr. Ronald Yee, NACHC
Community Health Centers serve more than 22 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and have become needed health centers in particular for people newly insured under the Affordable Care Act (ACA) who have not previously had relationships with healthcare providers.
The National Association of Community Health Centers (NACHC) was organized in 1971 and works with a network of state health center and primary care organizations to serve health centers in several ways, including to:
- Provide research-based advocacy for health centers and their clients.
- Educate the public about the mission and value of health centers.
- Train and provide technical assistance to health center staff and boards.
- Develop alliances with private partners and key stakeholders to foster the delivery of primary health care services to communities in need.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health centers and their new roles under the Affordable Care Act.
NewPublicHealth: What field of medicine did you practice before taking on your new role?
Ronald A. Yee: I am a family physician. I worked for 20 years at a community migrant health center in Fresno County. I basically practiced full-scope family medicine including obstetrics, so I was delivering babies up until October of last year when I came to NACHC. So I was on the frontlines doing patient care and I was also the chief medical officer for our health center. I got involved earlier in my career with NACHC on a state and then national level, was on the board and then became chief medical officer.
NPH: Who is most likely to use the services of a community health center?
Yee: Health centers provide about one quarter of all the primary care visits for low-income populations, which include about one in seven people who are uninsured, or one out of every 15 Americans. With the roll out of the Affordable Care Act we’re seeing a big surge in demand among the newly insured, whether that’s through Medicaid expansions or the health insurance exchanges. Many of our patients who previously paid on a sliding scale basis are now covered through the ACA, which is helping us extend the funding we have.
And there is often a misconception that health centers are only for poor people or the uninsured. We hear that often. We do and we want to take care of everybody. I’ve had patients with insurance and people covered by state and federal programs. Often when people come to a health center for the first time, they’re amazed at the often modern, spacious and nice facilities and the professionalism of the professionals and other staff.
And I think people are often surprised to learn that we’re required to have our governing boards made up 51 percent or more of patients and local residents. And that’s huge because from a personal standpoint that really keeps the care patient-focused. If something is not going right or they need a service, they’ll come to the board meeting to address it, such as a new service clinic flow. And board members who are patients also really are considerate of the employees. So, any time any topic came up about employee benefits or how you treat the employees, the board members were very supportive because they know these are the people that take care of them.
NPH: What has the patient population been at community health centers since coverage under the ACA began?
Yee: It depends on the locality. Some patients are switching over from being uninsured to getting Medicaid. Others are coming because they just found out about the health centers through our outreach or other avenues. In rural areas word of mouth is really one of the biggest marketing tools of people coming to our health centers. When they receive high-quality, patient-focused heath care they tell their family members, their friends, neighbors and the people they work with.
NPH: Are the clinics involved in enrolling patients as the deadline to get coverage under the ACA approaches?
Yee: They are heavily involved in enrolling. That has been a big focus of the health centers from the beginning of the enrollment period. At first they focused mostly on outreach to make sure the communities knew about the opportunities, but the enrollment effort has become very fierce and up to the last day it’s going to be. It’s a continuous process, and they’re still having a great demand coming in, of people wanting to sign up.
NPH: How are you involved, now and in the past, in issues for patients coming in beyond just their health care?
Yee: The social determinants of health, the socioeconomic factors that really influence our patients’ outcomes are critical parts of the work we do at the clinic. You might thing a patient is non-compliant, but they often have so many other issues, such as transportation. They may be jobless, homeless. They may have major stress in their lives, a poor diet because of the economy. They may have a low educational level. So health centers have always gone beyond the walls of traditional medicine to consider these issues.
Our health center in Fresno, for example, purchased four vans. That because in the rural areas I had obstetric patients who would walk two or three miles in 100-degree weather to get to their OB appointments. So we partnered with local insurance agencies and they helped us purchase minivans to go and pick our patients up and take them home. Other health centers have offered housing assistance. Some have sponsored farmer’s markets, which we did during Health Center Week that happens in August every year where we expose the community to healthy choices for foods, and then hopefully that is an ongoing process. We would sponsor farmer’s markets, expose them to that, and have our nutritionists and dieticians out there handing out education material, which they also did at our health fairs to try to shift our patients to access more fresh produce. We’ve also done cooking classes for our diabetics where we show them healthy ways to cook their food, and that the preparation style affects their caloric intake and the amount of food and sugar they take in. We’ve also held exercise classes. I think at ours we even did Zumba classes, which was a lot of fun for the community, so they had fun, but they also learned how to exercise and enjoy that in a group setting.
NPH: In what way are the health centers involved in the new community benefit requirements—such as community assessments—of nonprofit hospitals?
Yee: Health centers actually are required to do community health assessments, so some health centers actually team up with a hospital so they have just one assessment. Others have gotten together after the assessment has been done individually and matched up their findings to say, OK, where can we collaborate and work together to help improve the health of the community? And, of course, there’s other situations where there’s no relationship and they do them separately and they act on them separately, but there are some good examples of health centers and community hospitals teaming up to do this together and/or working on action points afterwards.
NPH: How have community health centers modeled the medical homes that are emerging across the country in an effort to improve patient care?
Yee: Health centers have been doing this for years. That term came out in the late ‘60s, and it’s been publicized more in the last few years, but the patient-centered medical home has been our focus from day one.
I think the real value in health centers is understanding the comprehensive approach we need to take to patient care, which includes health needs but also all the barriers people face including social, cultural and language barriers. Those have always been part of what we do and which makes our mission very strong. I think the other thing is trying to make it a one-stop shopping for our patients. At our eight sites in California we had all services under one roof, so we had medical, dental, behavioral health. We had a psychiatrist. We had lab, x-ray and pharmacy all within the same building, and so when our patients came through the transportation vans we provided, they could get all of their needs taken care of at one time.
The combination of being very comprehensive, being centered on the patient with our consumer boards, and then also offering all the services under one roof in a comprehensive way I think really makes the health center stand out. And so, I think when you combine a very strong sense of mission, a great model of caring for people in a comprehensive way, and then bring in some good customer things and business practices, I think you have an unbeatable combination.