Dr. Ron Yee is the chief medical officer and senior vice president of the Clinical Affairs Division of the National Association of Community Health Centers (NACHC). Before joining NACHC in 2013, Dr. Yee was the chief medical officer of United Health Centers in Parlier, California — an eight-site, community-migrant federally qualified health center (FQHC) — for 20 years. While there, he addressed the challenging balance of front-line patient care and administrative leadership.
Dr. Yee received his medical degree from Oral Roberts University School of Medicine and completed his family practice residency and chief resident position at the University of California — San Francisco’s Fresno Center for Medical Education and Research. He obtained his M.B.A. degree from Golden Gate University in San Francisco and achieved the distinguished Degree of Fellow of the American Academy of Family Physicians (AAFP) in October 2010.
Q. What is a community health center, and how did these kinds of neighborhood clinics come about?
Community health centers were launched as part of President Lyndon Johnson’s War on Poverty. The first health centers were established in rural Mississippi and at a housing project in Boston during the mid-1960s. The idea then, as it remains now, is to combine the resources of local communities with federal funds and provide access to affordable primary care for people in need; reduce the incidence of chronic disease among vulnerable populations; and lower health care costs. What really makes health centers unique, however, is that governing boards run them with a patient majority to ensure that resources are effectively targeted to meet local public health needs. It’s a formula that works. Health centers have demonstrated impressive results in reducing infant mortality, improving immunization rates, developing programs for early screening and treatment of cancer, and managing chronic conditions such as obesity and diabetes.
Today, health centers serve as the primary medical home for more than 27 million people and more than 10,400 rural and urban communities across the country. They play a crucial role in the nation’s health care system, providing high-quality care for 1 in 12 Americans — including low-income working families, the medically underserved, and high-risk and vulnerable populations. Community health centers are tasked not only with treating acute and chronic conditions, but also with identifying health risk factors early to help improve patient outcomes and keep system costs lower. As trusted community providers, health centers offer each patient access to a host of services under one roof, such as behavioral health; addiction and mental health counseling; treatment of hypertension, diabetes and other diseases that have gone untreated; and extensive social services support.
Q. How has the health center model evolved since it was established in 1965 as the Community Health Centers Program?
The model has not strayed from its original mission of preventing illness and addressing the environmental factors that may be the underlying cause, such as nutrition, homelessness, mental illness or substance use. Health centers have always looked beyond the medical chart for solutions to the complex problems patients confront that may affect their health and recovery.
Now, health centers have evolved into innovative problem solvers that collaborate with partners to address the complex public health problems of our modern age. How health centers are responding to the national opioid use epidemic is a good example. Many health centers are developing successful treatment models for substance use disorders that integrate behavioral health services into primary care. That way, the entire health needs of each patient are met, and care is coordinated. Behavioral health services may involve medication assisted treatment (MAT) to reduce cravings for substances, and a range of other services that may include mental health and substance use counseling, pain management, acupuncture, housing or job assistance. The approach really depends on the health center and the specific needs of the patient population.
Q. How do community health centers work with QIN-QIOs and other quality improvement organizations to spread the word about access to health care in underserved communities?
Health centers have a proud tradition of forming partnerships with stakeholders at the local, state and national levels to foster improved access to affordable health care and ensure the coordination of primary care services. Here at the NACHC, we support community health centers through training, technical assistance, and partnerships with state and regional Primary Care Associations (PCAs) and health center-controlled networks (HCCNs).
Q. Can you describe any specific nationwide programs provided by community health centers that have garnered significant results in reaching people with Medicare or patients in rural areas?
Community health centers serve 1 in 6 rural residents and are increasingly using innovative approaches, such as telehealth services, to improve access to care. Telehealth encompasses a variety of technologies used to deliver virtual medical, health and education services, and has proven results in better outcomes for patients, making it a crucial tool to deliver quality health care for all populations.
Health centers continue to work on key clinical issues affecting health center patients, including hypertension, prescription drug abuse and obesity. Through work with NACHC, health centers have become lead players in the Million Hearts® initiative, which is co-led by the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare & Medicaid Services (CMS), and works to prevent cardiovascular events such as heart attacks and strokes. NACHC is currently working with partners to help develop a strategy to spread and scale integration and “routinization” of self-measured blood pressure monitoring into nine community health centers that were recognized in 2017 as Million Hearts Hypertension Control Champions.
Another NACHC/CDC partnership, the Cancer Transformation Project, focuses on improving screening rates for cervical and colorectal cancer, as we know that early detection of colorectal cancer through screening leads to better patient outcomes.
Q. What does the future look like for community health centers? Are there any nationwide programs in the pipeline that readers should know about?
Health centers are increasingly being called on to do more. The national opioid epidemic, which has impacted millions of lives, is, again, a perfect example. Substance use disorders have undoubtedly fueled a rise in the demand for behavioral health services at health centers. Visits for mental health and substance use disorders have grown by 83 percent since 2010. Health centers are part of the national strategy to address this spiraling problem. Indeed, the U.S. Department of Health and Human Services recently announced the availability of $350 million in funding for health centers to continue their work on this front.
Q. Anything else you would like QIO News readers to know?
NACHC’s Quality Center supports the advancement of health center quality towards the Quadruple Aim goals of better patient and staff experience, improved health outcomes, and lower costs. For more information, you can visit NACHC’s Quality Center website at bit.ly/nachcqualitycenter. You can also sign up for the Quality Improvement Touchpoints Network, a network of health center individuals working on the front lines of health center quality improvement at email@example.com.