Sandra Hare of Carroll Park and her grandkids Selena Hernandez,11,… (Lloyd Fox, Baltimore Sun )
The lobby of the new Highlandtown Healthy Living Center is busy these days, with many seats filled. But once national health care reform is fully under way, the waiting area at this community health center — and others like it around the nation — is likely to be standing room only.
Millions of the nation's newly insured are expected to land in such "safety net" centers when they seek out care, potentially doubling the number of patients in the next decade, experts say. On Fleet Street in Highlandtown and across Maryland, health officials are developing strategies to cope with the crush of patients.
"Our goal is to handle what the market gives to us. We're planning for growth," said Jay Wolvovsky, president of the Baltimore Medical System, the parent of the Highlandtown center and five others.
The Highlandtown center cares for 22,000 patients annually as one of 16 such nonprofit clinics in Maryland that serve the disadvantaged. The center moved from a block away and reopened in March after an $11 million remodeling that was funded partially with federal stimulus dollars.
It offers one-stop shopping for patients, providing primary care and other services, including mental health care, gynecology services and health education that officials say ultimately saves money by keeping people out of the emergency rooms and hospitals.
Nationwide, there are more than 1,200 such centers, known as federally qualified health centers because they are supported by the government and operate under its rules. They make up the largest national network of primary care providers, according to the National Association of Community Health Centers. Research indicates their annual patient load is likely to jump from about 20 million clients to 40 million during the next decade.
Highlandtown, like most centers, gets most of its money from Medicaid reimbursements, followed by federal, local government and private grants and Medicare. Some of the $35 million total Baltimore Medical System budget comes from private insurance and patients, who are charged on a sliding scale for services based on their ability to pay.
The federal government views such "safety net" centers as an efficient way to bring primary care to low-income groups that include minorities and immigrants in urban and rural communities, according to the Centers for Medicare and Medicaid Services, which oversees the public health programs.
The federal health care reform law provides $11 billion in new funding for such centers over five years, much of it to expand capacity. The centers have historically offered a high level of care efficiently by using physician's assistants and nurses to stretch staffs, focusing on prevention and providing many services under one roof, said Leighton Ku, a professor of health policy at George Washington University who has been studying the impact of health reform on the centers.
Ku said the centers could more than double their patients in the coming decade, as they've done in the past decade. If they absorb 20 million patients over that time, it would represent two-thirds of the 32 million people expected to gain health insurance nationally.
In the next decade, savings from medical expenditures could reach $180 billion, including $50 billion in Medicaid savings and $30 billion in state savings, he said.
It's not clear where the rest of the newly insured will get care — some will find private doctors or continue using the emergency room, free clinics or local health departments for all of the services that they can.
But the federal government is banking on community health clinics expanding their role, by adding clinicians and building new centers, Ku said. Medical students are being offered incentives to become primary care doctors and loan forgiveness if they practice in community health centers. The centers themselves are given government malpractice insurance, as private rates have spiked.
Community health centers are "already considered a real success story," he said. "They've really been trying to improve health over the past decades. And they do save money."
Still, Ku said not all services are available where they are needed and there is an opportunity now to help even out services. He said it will be up to the states to do that and plan for the influx of patients.
In Maryland, about a half-dozen of the 16 clinics are in Baltimore, leaving some areas without total coverage, said Frances Phillips, Maryland's deputy secretary of public health services and among the officials charged with coordinating health care reform in the state.
She said officials already know Western Maryland, the Eastern Shore and Prince George's County in the Washington suburbs need primary care doctors. The lack of care is translating into high rates of preventable and costly hospital admissions. In the far west, Garrett County needs obstetrician-gynecologists.