Community Health Centers: Not Just a “Safety Net”

What do you think when you hear the term “safety net provider?” It doesn’t make a very positive brand impression, does it? Trapeze artists are glad that there’s a safety net underneath them, but they sure as heck don’t want to fall into it. If they screwed up and landed there they wouldn’t go around telling all their friends how great it was. And there’s absolutely no chance they’d rather perform in the net than up above.

What do you think when you hear the term “safety net provider?” It doesn’t make a very positive brand impression, does it? Trapeze artists are glad that there’s a safety net underneath them, but they sure as heck don’t want to fall into it. If they screwed up and landed there they wouldn’t go around telling all their friends how great it was. And there’s absolutely no chance they’d rather perform in the net than up above.

I thought about this as I read Safety-Net Providers After Health Care Reform in the Archives of Internal Medicine. Here’s the bottom line: uninsured patients in Massachusetts who use community health centers tend to keep using them even after becoming insured. Why? Because the centers are convenient, affordable, and offer services beyond medical care. As the nation as a whole follows Massachusetts’ example and the number of uninsured falls dramatically, I suggest it’s time to stop thinking of and labeling these facilities as mere “safety nets” and start treating them as the prototypical patient centered medical homes that they are. Not only should we encourage newly insured patients to continue using community health centers, we should encourage traditional primary care practices to evolve toward the health center model.

My own primary care office in downtown Boston is a traditional one: cramped, unattractive, filled with paper records, limited in its hours, indifferent in its customer service and focused entirely on medical issues. The only ways you’d know it serves an upper middle class clientele is by its address and by viewing the people in the waiting room. Visit a typical community health center in Boston and you’ll see something much more dynamic, friendly, modern. and efficient. They have electronic medical records, friendlier administrative staff, and offer dental, vision and mental health care along with a variety of community oriented outreach services.

Community health centers have been “patient centered” since well that phrase became trendy. They attached themselves to the community and focus on serving the needs of the population. I spoke with a physician leader at a large health system that has both private practices and community health centers under its umbrella. She told me that there’s a major difference in how the physicians look at their work. When there’s a surplus within a private practice the physicians want to pay out bonuses. When a community health center has extra money, the staff look for opportunities to bolster the infrastructure and expand services. As a patient, which  attitude would you prefer?

I’m all for keeping a “safety net” in place, and community health centers should be proud to have that as part of their mission. But it’s time to shuck the “safety net” label and position health centers in the vanguard of primary care where they belong.