As the global pandemic continues to impact how healthcare is delivered throughout the industry, Federally Qualified Health Centers (FQHCs) have needed to quickly address barriers to care that more traditional health centers have not necessarily faced. For many FQHCs, the development of telehealth services has been crucial to being able to continue to provide care during this time.
Through their ongoing mission and structure, community health centers primarily exist to serve patients who have limited access to healthcare. Unlike many private primary care practices, FQHCs focus their work on delivering quality care to low-income individuals, the uninsured, and the underinsured. Nationwide, there are more than 1,400 FQHCs serving approximately 29 million patients.
According to Joe Brennan, Senior Advisor for the American Telemedicine Association, telehealth services have been the ideal complement to the trusted in-person care that is delivered locally in community health centers.
“When you look at patients that are primarily located in underserved communities, there are common challenges that are experienced when seeking access to care. Barriers such as access to adequate transportation, or the ability to take time off of work, are very real for a majority of FQHC patients. These barriers have been magnified throughout the past year,” said Brennan.
Telemedicine during the pandemic
During the COVID-19 pandemic, community health centers dramatically adopted and increased their use of telehealth. According to the National Association of Community Health Centers, as of September 2020, 95 percent of health centers are now providing some level of patient visits virtually.
“Telemedicine has quickly become a game changer in the desire to provide more equitable healthcare services within all communities. Nationally, this would not have been immediately possible if not for the various changes and federal waivers that were put in place within the last year,” said Brennan.
During the ongoing national public health emergency, the Agency for Healthcare Administration (AHCA) and the Centers for Medicare and Medicaid Services (CMS) adapted policies and waivers that allowed FQHCs to more broadly provide primary and preventive care virtually – enhancing access for patients that were quarantined or reducing possible exposure through traveling outside their home.
For example, CMS waived the geographic requirements for health centers serving as originating sites, which allowed patients to receive care directly from their homes and also allowed health centers to provide services as distant site providers in the Medicare and Medicaid programs.
The recent impact of telehealth programs within FQHCs has been substantial in several clinical areas, but one area of key growth has been seen within the behavioral health realm.
At central Florida-based Community Health Centers, Inc. (CHC), there has been an increase in these telehealth visits given the additional burden that the pandemic has placed on patients.
According to Debra Andree, MD, President & CEO, her organization has successfully implemented new telehealth programs that have allowed for the delivery of vital behavioral healthcare services.
“Our platforms to deliver emotional and behavioral healthcare has created much needed access for patients with transportation needs and other challenges, such as anxiety, that are frequently barriers to receiving in-person care,” said Andree.
“Patients have expressed that they are grateful for the options available to them for an array of services that we offer. They frequently voice their gratitude and are pleasantly surprised for the flexibility that is now offered to them,” she said.
Challenges with telehealth implementation
While telehealth services have provided a never before seen level of convenience for patients, these advances have not been without a few challenges along the way.
According to Ben Browning, VP, Florida Association of Community Health Centers (FACHC), one of the most significant challenges for smaller FQHCs to date has been the overall lack of experience with telehealth programs.
“The increased demand for telehealth services came on quite quickly for FQHCs and some centers needed to build up the in-house staffing to support this unprecedented demand,” said Browning.
While the initial level of resources may have created challenges, trade associations such as FACHC stand ready to assist its members.
“Fortunately, there is significant training and technical assistance available to FQHCs through their state associations. Whether it be through trusted partnerships, or data and information that is available from other FQHCS, there is help out there,” said Browning.
The trusted partnerships that Browning references includes those that can provide real world, boots-on-the-ground experiences from those that live these challenges on a daily basis.
“Connecting with others to have conversations about implementation and overcoming barriers, that is invaluable. These connections and conversations can help put pieces together and educate others on how to successfully make this all seamlessly work,” said Browning.
While the implementation of telehealth services for FQHCs has been significant to date, there are always going to be challenges to address as technology continues to adapt and evolve.
“When you eliminate one barrier, there is always potential for new barriers to arise. However, patient expectations have now been created and we can’t turn back now. Telemedicine is here to stay, and it truly has redefined how healthcare is delivered across our country,” said Brennan.
Browning agrees, saying, “I think in some way we all saw the focus on telehealth coming, but the pandemic has really expedited the push for electronic patient visits. While this doesn’t stop the need for centers from being open down the street, or in local neighborhoods, it has set a new precedent for care expectations.”