Community Health Centers’ Role in Delivering Care to the Nation’s Underserved Populations During the Coronavirus Pandemic

In the midst of the coronavirus pandemic, community health centers are serving as public health responders, especially for medically underserved populations. Health centers are a national network of safety net primary care providers who provided care to nearly 30 million patients in 2019, and disproportionately serve patients who are low-income, persons of color, uninsured, or publicly insured – groups that have been especially hard hit by the pandemic. Based on focus group interviews conducted in September and October 2020 with informants from 16 state and regional Primary Care Associations (PCAs) representing 750 health centers and a supplemental questionnaire completed by PCAs following focus group interviews, this brief examines how health centers have adapted their service delivery models during the pandemic response and the current challenges they face continuing to meet patients’ needs.

Key Findings

• Health centers are providing testing in underserved communities, but PCAs report there is still unmet need. In the week ending December 4^th alone, health centers provided over 335,000 tests. Respondents described a range of efforts by health centers to increase testing capacity, such as testing in parking lots, creating temporary testing sites, and deploying mobile testing units. Despite these efforts, some of the participating PCAs said that health centers in their state or region cannot provide tests to all patients who need them, identifying long wait times, shortages of PPE, and staff shortages as the most common barriers to adequate testing.
• Health centers are coordinating with state and local public health agencies on response efforts. Respondents reported that health centers in their states have been working with public officials to conduct testing and contact tracing, secure reimbursement for telehealth visits, and ensure access to services for vulnerable populations. These efforts have helped provide continued access to care and have been important to health centers’ financial stability.
• Rapidly pivoting to telehealth was key for health centers to continue seeing patients amid the pandemic and helped to keep health centers financially solvent. Despite the success in shifting to telehealth services, respondents noted both technological and cultural barriers for some patients. While respondents agreed telehealth would likely remain an important service delivery mode, they also described health center efforts to create safer environments for in-person care, such as upgrading HVAC systems and reconfiguring space for “sick” and “well” clinics.
• Many health centers are meeting patients “where they are” by taking medical care outside the clinic – while also addressing non-medical needs like food insecurity. Respondents reported health centers’ use of mobile vans and other strategies to reach agricultural workers where they work and live, American Indian reservations, and other underserved communities hard-hit by the pandemic. Depending on the need, health centers are providing COVID-19 testing, handwashing stations, and flu immunizations, among other services. Additionally, respondents described health centers partnering with local organizations to distribute food and assess needs for housing and other social supports.
• Health centers face ongoing shortages of testing supplies and PPE. Respondents reported that the competition among hospitals and large health systems for PPE often made acquiring the supplies more difficult. Many health centers have relied on consortia or PCAs for group buying power, though PCAs indicated that health centers continue facing difficulty getting adequate testing supplies and PPE.
• PCAs reported that staff layoffs due to the pandemic have been relatively limited, but the pandemic’s impact on staff morale is a concern for the workforce and health care accessibility. Most respondents reported that the length and uncertainty of the pandemic were impacting staff morale. They noted several other factors impacting morale, including the challenging pivot to telehealth for staff providing services that are difficult to perform virtually, balancing work with obligations at home as schools moved online, and the ramifications of staff becoming infected with the coronavirus.
• Health centers are facing financial uncertainty on several fronts following the drop in patient volume during the pandemic. PCAs expressed concerns about the expiration of temporary provisions and authorizations related to Medicaid coverage and telehealth reimbursement when the public health emergency ends. They noted these provisions have been key to making telehealth viable for health center finances during the pandemic. On the other hand, Congress recently voted to reauthorize federal funding for the Community Health Center Program ($5.7 billion in FY 2021) and, if signed into law, would add much needed stability for health centers during the pandemic, although financial challenges remain going forward.
• Questions remain about health centers’ role in administering a COVID-19 vaccine to medically underserved communities. Several PCA respondents reported that health centers are involved in vaccine distribution planning with states, but at the time of interviews, major questions remained about where vaccines would be shipped and stored, how frontline health center staff would be immunized, whether staff should be deployed to state-run vaccination sites, and how staff would track multiple doses of the vaccines. Most respondents also expressed the need for targeted messaging to encourage patients to get the COVID-19 vaccine, especially because populations served by health centers may be more reluctant to get a vaccine due to mistrust of the health care system.

Health centers have made major adaptations to their service delivery models to address health care needs in the most vulnerable communities during the pandemic, but they still face many challenges. Most immediate will be undertaking a massive vaccination campaign as the country continues to struggle with rising COVID-19 cases. Still, with the end of the pandemic potentially in sight, shifting focus from the immediate response to longer-term recovery will help ensure health centers remain able to care for historically underserved communities during the pandemic and after its resolution.