Holding On: Community Health Centers’ Critical Role During the Pandemic

Federally Qualified Health Centers (FQHCs) are a critical provider of health care, particularly for communities of color and Medicaid beneficiaries. It is vital that health centers are financially and operationally stable so they can continue to effectively provide patients with primary care, behavioral health, and dental services.In October of 2020, in partnership with the Community Clinic Association of Los Angeles County (CCALAC) and with support from the California Health Care Foundation (CHCF), Aurrera Health Group interviewed several community health center executives and other FQHC experts about the impact the COVID-19 pandemic has had on clinic operations, staffing, and finances and how they responded to mitigate the damage. We are proud that the resulting paper, Holding On: How California’s Health Centers Adapted Operations and Care for Patients During the Pandemic, was released by CHCF last month.At the start of the COVID-19 pandemic, California’s health centers were already facing financial challenges that had put them on uncertain ground, with significant reductions in operating margins between 2016 and 2019. Once the pandemic hit, face-to-face primary care visits and corresponding reimbursements dropped precipitously. California health centers employed a range of immediate loss-mitigation strategies, which varied in level of effort, but taken together, sustained health centers through 2020 as the pandemic continued. Strategies included:

• Embracing and investing in telehealth

• Reassigning and furloughing staff

• Spending down reserves

• Closing sites temporarily

• Generating quick cash

• Tapping into COVID-19-related federal support

• Leveraging partnerships

Looking to the Future

Health centers have been nimble and creative in the face of the pandemic, delivering care in new ways to meet patient needs during an extraordinary time.With the ongoing pressure the pandemic is placing on California’s health care delivery system and the corresponding financial challenges faced by FQHCs, health centers will need to continue to be creative. COVID-19 has presented an opportunity to further explore opportunities to strengthen operations and garner long-term support from multiple stakeholders to continue their vital community health care role.In addition, policy actions can speed health centers’ ability to recover from the financial shocks of the pandemic and ensure they continue to play their vital role in providing access to care. As the state considers how to prioritize health equity, California’s health centers have a unique and important perspective to offer. The experiences of health centers during 2020 point to policy solutions, such as extending and expanding reimbursement for telehealth beyond the pandemic and reforming the Prospective Payment System that governs FQHC reimbursement to allow health centers to provide more flexible care beyond in-person visits.

Next Steps

Although this paper focuses on California, Aurrera Health Group is proud to also be working with health centers in Minnesota and Maryland as they continue to evolve in their critical roles in the safety net. In addition to exploring short- and immediate-term responses to the pandemic and the corresponding reductions in revenue, the experts for this issue brief also shared thoughts about COVID-related implications for the future of care delivery and reimbursement, and ways that health centers should anticipate and plan for future recessions. A deeper exploration of these operational changes and policy considerations will be provided in a final report to be published in Spring 2021, which will help inform FQHC policy across the country.