Changes in Community Health Center Patients and Services During the COVID-19 Pandemic

Key Takeaways

Neighborhood well being facilities are a nationwide community of safety-net main care suppliers serving low-income and medically underserved communities, together with communities of shade and people in rural areas. Well being facilities additionally performed a significant position in nationwide, state, and native responses to the coronavirus pandemic, notably in hard-to-reach communities, and helped to fulfill rising demand for psychological well being and substance use dysfunction (SUD) companies. Annual information reported by group well being facilities sheds gentle on how these safety-net suppliers and their affected person populations have been impacted by the pandemic. Key findings from information reported for 2021 embrace:

• After dropping in 2020, the variety of well being middle sufferers and visits rebounded in 2021. Well being facilities served greater than 30 million sufferers in 2021, which was the most important variety of sufferers ever recorded in a calendar yr. As sufferers returned to in-person care in 2021, the rise in visits was supported by elevated telehealth use in comparison with 2019—telehealth visits represented 21% of visits (26 million) in 2021 – in comparison with lower than 1% of complete visits in 2019.
• Medical, psychological well being, and SUD companies exceeded pre-pandemic ranges in 2021, whereas different companies that had been tougher to supply nearly – comparable to dental and imaginative and prescient – had been nonetheless beneath pre-pandemic utilization. Development was notably notable for psychological well being visits, which rose by 19% from 2019 to 2021. The rise in psychological well being and SUD companies additionally adopted a nationwide enhance in demand for these companies.
• The variety of youngsters served by well being facilities remained beneath pre-pandemic ranges. From 2019 to 2021, the variety of baby sufferers decreased by 6% and the variety of sufferers served at school-based well being facilities declined by 13%. Different analysis has proven decreased utilization amongst youngsters in the course of the pandemic, mostly because of issues about visiting a healthcare supplier, restricted appointment availability, and closed clinic places. Total, nevertheless, will increase in nonelderly grownup and senior well being middle sufferers greater than offset the decline in baby sufferers.
• Fewer well being middle sufferers had been uninsured in 2021 in comparison with earlier than the pandemic, reflecting nationwide tendencies. The variety of uninsured sufferers at well being facilities declined by 10% from 2019 to 2021.

Because the nation seems to be past the pandemic, well being facilities and their sufferers face a number of uncertainties. Momentary insurance policies put in place throughout pandemic that allowed better telehealth entry and ensured steady enrollment in Medicaid in addition to pandemic-related funding to suppliers are set to run out. On the similar time, demand for well being middle companies, notably for psychological well being and SUD companies, continues to extend. How well being facilities reply to those concurrent challenges will have an effect on the flexibility of the nation’s main care security internet to fulfill the wants of underserved communities.

Introduction

Neighborhood well being facilities are a nationwide community of safety-net main care suppliers serving low-income and medically underserved communities. Well being facilities served greater than 30 million sufferers in 2021, together with one-third of all individuals dwelling in poverty within the U.S. and one in 5 rural residents. Along with offering complete main care companies, well being facilities have performed a significant position in nationwide, state, and native responses to the coronavirus pandemic by providing a spread of companies designed to sluggish the unfold and reduce the severity of COVID-19, particularly in hard-to-reach, underserved communities. For instance, well being facilities have administered over 22 million COVID-19 vaccinations as of December 2022, with 69% going to individuals of shade.

Annual information reported by group well being facilities sheds gentle on how these safety-net suppliers and their affected person populations have been impacted by the pandemic. Like different outpatient suppliers, well being facilities noticed a dip within the variety of sufferers and visits from 2019 to 2020. On condition that well being facilities predominantly serve weak and underserved populations, their experiences can present beneficial insights on how the pandemic has impacted these populations and the way the nation’s main care security internet is adapting to these wants.

This temporary analyzes the adjustments in well being middle sufferers and companies from 2019 (pre-pandemic) by 2021 utilizing information from the Uniform Information System (UDS), to which all well being facilities are required to report yearly. We additionally draw from earlier nationwide surveys of well being facilities to determine potential pitfalls for well being facilities as they start recovering from the pandemic and going ahead.

How have well being middle sufferers and companies shifted in the course of the pandemic?

In comparison with earlier than the pandemic, the variety of well being middle sufferers and visits dipped in 2020 and commenced rebounding in 2021, with the rise in visits supported by elevated telehealth use. Well being facilities served greater than 30 million sufferers in 2021, which was the most important variety of sufferers ever recorded in a calendar yr and represented a 1.2% enhance from 2019 (earlier than the pandemic). Equally, the variety of well being middle visits reached a report 124 million in 2021 (Determine 1). At the same time as sufferers returned to in-person care, reliance on telehealth visits continued in 2021. Telehealth visits represented 21% of visits (26 million) in 2021 in comparison with lower than 1% of complete visits in 2019. Whereas in-person visits elevated relative to 2020, they remained beneath their pre-pandemic ranges.

Medical and psychological well being companies exceeded pre-pandemic ranges in 2021, whereas different companies that had been tougher to supply nearly – comparable to dental and imaginative and prescient – had been nonetheless beneath pre-pandemic utilization. Some companies, together with medical, psychological well being, substance use dysfunction (SUD), and social supportive companies, efficiently shifted to telehealth to various levels, which greater than offset the drops for in-person visits from 2019 to 2021 (Determine 2). Companies that had been largely supplied in individual, specifically dental and imaginative and prescient, had been nonetheless beneath the pre-pandemic baseline for visits in 2021 by 20% and 9%, respectively.

Well being facilities skilled elevated demand for psychological well being and SUD companies in the course of the pandemic, mirroring nationwide tendencies. Total, the variety of visits for psychological well being points rose by 19% and visits for SUD companies rose by 1% from 2019 to 2021. There was a very notable enhance within the variety of sufferers experiencing nervousness problems; in 2021, three million sufferers, or 10% of all well being middle sufferers, had an nervousness dysfunction prognosis, a rise of 17% from 2019.  The variety of sufferers receiving medication-assisted remedy (MAT) for opioid use dysfunction additionally elevated considerably; in 2021, over 180,000 sufferers obtained MAT representing a rise 29% from pre-pandemic ranges. Along with rising demand in the course of the pandemic, these will increase additionally mirror progress in well being facilities’ capability to supply psychological well being and SUD companies. For instance, a survey of well being facilities in late 2021 discovered that roughly two-thirds (64%) of well being facilities added a brand new psychological well being or SUD service, together with companies that well being facilities newly supplied by way of telehealth.

On the similar time, the variety of youngsters served by well being facilities remained beneath pre-pandemic ranges. From 2019 to 2021, the variety of baby sufferers decreased by 6% (Determine 4) and the variety of sufferers served at school-based well being facilities declined by 13%. This pattern is in keeping with current analysis exhibiting decreased well being care utilization amongst youngsters, mostly because of issues about visiting a healthcare supplier, restricted appointment availability, and closed clinic places in the course of the pandemic. Associated to the drop in baby sufferers, youngsters accessed fewer preventive companies at well being facilities in 2021 in comparison with 2019: the variety of sufferers receiving chosen immunizations dropped by 19%, the quantity receiving childhood lead screenings declined by 13%, and the quantity receiving a properly baby go to fell 5%. These findings are in keeping with nationwide information exhibiting declines in lead screenings, baby screenings, and vaccinations for Medicaid and Kids’s Well being Insurance coverage Program (CHIP) enrollees in the course of the pandemic. Whereas the variety of youngsters served by well being facilities declined, the variety of sufferers ages 65 and older elevated by 425,000 or 15% and the variety of non-elderly adults grew by 501,000 or 3% from 2019 to 2021.

Reflecting nationwide tendencies, fewer well being middle sufferers had been uninsured in 2021 in comparison with earlier than the pandemic. The variety of uninsured sufferers at well being facilities declined by 10% from 2019 to 2021 (Determine 5), in keeping with nationwide patterns. The drop within the nationwide uninsured fee is essentially attributable to momentary insurance policies in place in the course of the COVID-19 public well being emergency to make sure steady enrollment in Medicaid in the course of the pandemic. Because of the continual enrollment coverage, the variety of Medicaid sufferers served by heath facilities elevated by 2% from 2019 to 2021, and Medicaid/CHIP remained the most important supply of protection for Well being middle sufferers. In 2021, practically half (49%) of sufferers had been lined by Medicaid/CHIP and 20% had been uninsured.

Pandemic-related funding made up 7% of all well being facilities’ income in 2021, though Medicaid was the most important income (41%). In complete, well being facilities obtained $2.8 billion in pandemic-related funding in 2021. This funding enabled well being facilities to reply to shifting affected person wants, such because the rising want for telehealth and psychological well being companies, and to proceed constructing out pandemic-related companies, comparable to vaccination drives and COVID-19 testing and coverings; nevertheless, these funding sources had been momentary and have all since expired or will quickly expire. For instance, HRSA has distributed practically all the $7.6 billion supplied to well being facilities within the American Rescue Plan Act (ARPA) in 2021 – the most important supply of pandemic-related funding for well being facilities – with the remaining funds obtainable to well being facilities by March 2023. Whereas the momentary funding has been vital to well being facilities in the course of the pandemic, Medicaid, together with federal Part 330 grant funding, stays their main supply of funding.

What to Watch

Adjustments in who sought care at well being facilities, how they accessed care, and the companies that they obtained in 2021 may symbolize longer-term shifts with implications for well being middle funds and operations. The variety of youngsters served by well being facilities declined and, whereas the variety of nonelderly grownup and senior sufferers elevated to fill within the hole, the well being care wants of those affected person populations differ. On the similar time, demand for well being middle companies, notably for psychological well being and SUD companies, continued to extend. Moreover, adjustments that accelerated using telehealth in the course of the pandemic may additionally mirror a extra everlasting shift in how well being middle sufferers entry companies. Though telehealth has develop into an vital mechanism for delivering sure well being middle companies, it’s unclear whether or not the reliance on telehealth will proceed within the absence of pandemic-era flexibilities that made it simpler for well being facilities and different suppliers to supply telehealth companies. Given that almost half of well being middle sufferers are lined by Medicaid, state Medicaid companies’ choices about whether or not or find out how to section out these insurance policies may have an particularly massive affect on well being facilities and their sufferers.

The tip of the Medicaid steady enrollment requirement and pandemic-related funding for suppliers may even have main implications for well being facilities and their sufferers. Within the months following the top of the continual enrollment requirement, thousands and thousands of individuals may lose Medicaid protection. These Medicaid protection losses may reverse the current decline within the variety of uninsured well being middle sufferers. Furthermore, as a result of Medicaid accounts for 41% of complete well being middle income, any important lack of Medicaid protection amongst well being middle sufferers may considerably scale back total well being middle income. These adjustments will coincide with the top of pandemic funding streams and will pose challenges for well being facilities, particularly these missing sturdy monetary footing. How well being facilities reply to those concurrent challenges will have an effect on the flexibility of the nation’s main care security internet to proceed to fulfill the wants of underserved communities.