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

Key Takeaways

Group well being facilities are a countrywide community of safety-net number one care suppliers serving low-income and medically underserved communities, together with communities of colour and the ones in rural spaces. Well being facilities additionally played a major role in nationwide, state, and native responses to the coronavirus pandemic, in particular in hard-to-reach communities, and helped to fulfill rising call for for psychological well being and substance use dysfunction (SUD) products and services. Annual data reported via group well being facilities sheds mild on how those safety-net suppliers and their affected person populations were impacted via the pandemic. Key findings from knowledge reported for 2021 come with:

• After shedding in 2020, the collection of well being heart sufferers and visits rebounded in 2021. Well being facilities served greater than 30 million sufferers in 2021, which was once the biggest collection of sufferers ever recorded in a calendar yr. As sufferers returned to in-person care in 2021, the rise in visits was once supported via larger telehealth use in comparison to 2019—telehealth visits represented 21% of visits (26 million) in 2021 – in comparison to lower than 1% of general visits in 2019.
• Clinical, psychological well being, and SUD products and services exceeded pre-pandemic ranges in 2021, whilst different products and services that have been harder to supply nearly – reminiscent of dental and imaginative and prescient – have been nonetheless underneath pre-pandemic usage. Expansion was once in particular notable for psychological well being visits, which rose via 19% from 2019 to 2021. The rise in psychological well being and SUD products and services additionally adopted a nationwide build up in call for for those products and services.
• The collection of youngsters served via well being facilities remained underneath pre-pandemic ranges. From 2019 to 2021, the collection of kid sufferers lowered via 6% and the collection of sufferers served at school-based well being facilities declined via 13%. Other research has proven lowered usage amongst youngsters throughout the pandemic, maximum recurrently because of considerations about visiting a healthcare supplier, restricted appointment availability, and closed hospital places. General, alternatively, will increase in nonelderly grownup and senior well being heart sufferers greater than offset the decline in kid sufferers.
• Fewer well being heart sufferers have been uninsured in 2021 in comparison to ahead of the pandemic, reflecting nationwide traits. The collection of uninsured sufferers at well being facilities declined via 10% from 2019 to 2021.

Because the country appears past the pandemic, well being facilities and their sufferers face a number of uncertainties. Transient insurance policies installed position throughout pandemic that allowed higher telehealth get right of entry to and ensured steady enrollment in Medicaid in addition to pandemic-related investment to suppliers are set to run out. On the similar time, call for for well being heart products and services, in particular for psychological well being and SUD products and services, continues to extend. How well being facilities reply to those concurrent demanding situations will have an effect on the power of the country’s number one care security internet to fulfill the wishes of underserved communities.

Creation

Group well being facilities are a countrywide community of safety-net number one care suppliers serving low-income and medically underserved communities. Health centers served greater than 30 million sufferers in 2021, together with one-third of all folks dwelling in poverty within the U.S. and one in 5 rural citizens. Along with offering complete number one care products and services, well being facilities have performed a big function in nationwide, state, and native responses to the coronavirus pandemic via providing a spread of products and services designed to sluggish the unfold and reduce the severity of COVID-19, particularly in hard-to-reach, underserved communities. As an example, well being facilities have administered over 22 million COVID-19 vaccinations as of December 2022, with 69% going to folks of colour.

Annual knowledge reported via group well being facilities sheds mild on how those safety-net suppliers and their affected person populations were impacted via the pandemic. Like different outpatient providers, well being facilities noticed a dip within the collection of sufferers and visits from 2019 to 2020. For the reason that well being facilities predominantly serve inclined and underserved populations, their studies can give treasured insights on how the pandemic has impacted those populations and the way the country’s number one care security internet is adapting to these wishes.

This temporary analyzes the adjustments in well being heart sufferers and products and services from 2019 (pre-pandemic) thru 2021 the use of knowledge from the Uniform Data System (UDS), to which all well being facilities are required to document every year. We additionally draw from earlier nationwide surveys of well being facilities to spot attainable pitfalls for well being facilities as they start getting better from the pandemic and going ahead.

How have well being heart sufferers and products and services shifted throughout the pandemic?

In comparison to ahead of the pandemic, the collection of well being heart sufferers and visits dipped in 2020 and started rebounding in 2021, with the rise in visits supported via larger telehealth use. Well being facilities served greater than 30 million sufferers in 2021, which was once the biggest collection of sufferers ever recorded in a calendar yr and represented a 1.2% build up from 2019 (ahead of the pandemic). In a similar fashion, the collection of well being heart visits reached a report 124 million in 2021 (Determine 1). Whilst sufferers returned to in-person care, reliance on telehealth visits persevered in 2021. Telehealth visits represented 21% of visits (26 million) in 2021 in comparison to lower than 1% of general visits in 2019. Whilst in-person visits larger relative to 2020, they remained underneath their pre-pandemic ranges.

Clinical and psychological well being products and services exceeded pre-pandemic ranges in 2021, whilst different products and services that have been harder to supply nearly – reminiscent of dental and imaginative and prescient – have been nonetheless underneath pre-pandemic usage. Some products and services, together with clinical, psychological well being, substance use dysfunction (SUD), and social supportive products and services, effectively shifted to telehealth to various levels, which greater than offset the drops for in-person visits from 2019 to 2021 (Determine 2). Services and products that have been in large part equipped in user, specifically dental and imaginative and prescient, have been nonetheless underneath the pre-pandemic baseline for visits in 2021 via 20% and 9%, respectively.

Well being facilities skilled larger call for for psychological well being and SUD products and services throughout the pandemic, mirroring national trends. General, the collection of visits for psychological well being problems rose via 19% and visits for SUD products and services rose via 1% from 2019 to 2021. There was once a in particular notable build up within the collection of sufferers experiencing nervousness problems; in 2021, 3 million sufferers, or 10% of all well being heart sufferers, had an nervousness dysfunction prognosis, an build up of 17% from 2019.  The collection of sufferers receiving medication-assisted remedy (MAT) for opioid use dysfunction additionally larger considerably; in 2021, over 180,000 sufferers won MAT representing an build up 29% from pre-pandemic ranges. Along with rising call for throughout the pandemic, those will increase additionally mirror expansion in well being facilities’ capability to supply psychological well being and SUD products and services. As an example, a survey of health centers in past due 2021 discovered that kind of two-thirds (64%) of well being facilities added a brand new psychological well being or SUD provider, together with products and services that well being facilities newly equipped by the use of telehealth.

On the similar time, the collection of youngsters served via well being facilities remained underneath pre-pandemic ranges. From 2019 to 2021, the collection of kid sufferers lowered via 6% (Determine 4) and the collection of sufferers served at school-based well being facilities declined via 13%. This pattern is in keeping with recent analysis appearing lowered well being care usage amongst youngsters, maximum recurrently because of considerations about visiting a healthcare supplier, restricted appointment availability, and closed hospital places throughout the pandemic. Associated with the drop in kid sufferers, youngsters accessed fewer preventive products and services at well being facilities in 2021 in comparison to 2019: the collection of sufferers receiving decided on immunizations dropped via 19%, the quantity receiving formative years lead screenings declined via 13%, and the quantity receiving a smartly kid talk over with fell 5%. Those findings are in keeping with national data appearing declines in lead screenings, kid screenings, and vaccinations for Medicaid and Youngsters’s Well being Insurance coverage Program (CHIP) enrollees throughout the pandemic. Whilst the collection of youngsters served via well being facilities declined, the collection of sufferers ages 65 and older larger via 425,000 or 15% and the collection of non-elderly adults grew via 501,000 or 3% from 2019 to 2021.

Reflecting nationwide traits, fewer well being heart sufferers have been uninsured in 2021 in comparison to ahead of the pandemic. The collection of uninsured sufferers at well being facilities declined via 10% from 2019 to 2021 (Determine 5), in keeping with national patterns. The drop within the nationwide uninsured charge is in large part as a consequence of temporary policies in position throughout the COVID-19 public well being emergency to verify continuous enrollment in Medicaid throughout the pandemic. On account of the continual enrollment coverage, the collection of Medicaid sufferers served via heath facilities larger via 2% from 2019 to 2021, and Medicaid/CHIP remained the biggest supply of protection for Well being heart sufferers. In 2021, just about part (49%) of sufferers have been lined via Medicaid/CHIP and 20% have been uninsured.

Pandemic-related investment made up 7% of all well being facilities’ earnings in 2021, even if Medicaid was once the biggest income (41%). In general, well being facilities won $2.8 billion in pandemic-related investment in 2021. This investment enabled well being facilities to reply to moving affected person wishes, such because the rising want for telehealth and psychological well being products and services, and to proceed development out pandemic-related products and services, reminiscent of vaccination drives and COVID-19 checking out and coverings; alternatively, those investment assets have been brief and feature all since expired or will quickly expire. As an example, HRSA has dispensed just about the entire $7.6 billion equipped to well being facilities within the American Rescue Plan Act (ARPA) in 2021 – the biggest supply of pandemic-related investment for well being facilities – with the rest budget to be had to well being facilities thru March 2023. Whilst the brief investment has been essential to well being facilities throughout the pandemic, Medicaid, in conjunction with federal Phase 330 grant investment, stays their number one supply of investment.

What to Watch

Adjustments in who sought care at well being facilities, how they accessed care, and the products and services that they won in 2021 may constitute longer-term shifts with implications for well being heart funds and operations. The collection of youngsters served via well being facilities declined and, whilst the collection of nonelderly grownup and senior sufferers larger to fill within the hole, the well being care wishes of those affected person populations fluctuate. On the similar time, call for for well being heart products and services, in particular for psychological well being and SUD products and services, persevered to extend. Moreover, adjustments that speeded up using telehealth throughout the pandemic may additionally mirror a extra everlasting shift in how well being heart sufferers get right of entry to products and services. Even supposing telehealth has grow to be crucial mechanism for handing over positive well being heart products and services, it’s unclear whether or not the reliance on telehealth will proceed within the absence of pandemic-era flexibilities that made it more straightforward for well being facilities and different suppliers to supply telehealth products and services. For the reason that just about part of well being heart sufferers are lined via Medicaid, state Medicaid businesses’ choices about whether or not or tips on how to section out those insurance policies could have an extremely massive affect on well being facilities and their sufferers.

The tip of the Medicaid steady enrollment requirement and pandemic-related investment for suppliers may even have main implications for well being facilities and their sufferers. Within the months following the tip of the continual enrollment requirement, millions of folks may lose Medicaid protection. Those Medicaid protection losses may opposite the hot decline within the collection of uninsured well being heart sufferers. Additionally, as a result of Medicaid accounts for 41% of total health center revenue, any important lack of Medicaid protection amongst well being heart sufferers may considerably cut back general well being heart earnings. Those adjustments will coincide with the tip of pandemic investment streams and may pose demanding situations for well being facilities, particularly the ones missing robust monetary footing. How well being facilities reply to those concurrent demanding situations will have an effect on the power of the country’s number one care security internet to proceed to fulfill the wishes of underserved communities.