Community health centers at the crossroads

The provisions of the Affordable Care Act (ACA) are expected to increase demand for primary care services across the United States as millions of people gain health insurance through health insurance exchanges and expansion of Medicaid and children’s health insurance programs.1 Many of these newly insured patients will be medically complicated, and the millions of patients without insurance will still need a source of high-quality care. The national network of community, migrant, homeless, and public housing health centers (known as community health centers [CHCs] and federally qualifi ed health centers) is not immune to these growing demands on primary care, and will play an increasingly prominent role in meeting the needs of the newly insured and remaining uninsured alike. CHCs’ unique model of care delivery uses multiple primary healthcare team members with varied skills to increase capacity, reduce barriers to care, improve patient outcomes, and control the costs of care. CHCs save the healthcare system $24 billion annually, in part by reducing the use of EDs and inpatient care for preventable conditions.2 Their broad staffi ng model, which includes extensive use of physician assistants (PAs), nurse practitioners (NPs), and certifi ed nurse midwives (CNMs), plays a major and growing role in the centers’ ability to meet the demand for care and generate systemwide savings. The ACA also expands CHC capacity. CHCs have long recognized the value of PAs, NPs, and CNMs in expanding their capacity to serve more complex patients, and also recognize the link between multidisciplinary healthcare teams and improved patient outcomes, reduced disparities, and lower care costs.3-6 This article describes how CHCs’ growing use of PAs, NPs, and CNMs is grounded in their model of care, how they augment their capacity for primary and preventive care, and the special challenges that could inhibit their ability to apply a multidisciplinary staffi ng approach to meet the need for care as shaped by health reform.