Federal government makes a push for community health centers to provide virtual health services beyond the pandemic

The Biden administration is making another push for telehealth and other digital disease-monitoring tools to become sustainable beyond the pandemic.

The US Department of Health and Human Services announced Monday that it’s giving nearly $55 million to improve access to community health centers that have played a vital role in patient care as the country faced Covid-19.

The new funding is meant to help 29 federally qualified health centers provide better access to telehealth, expand digital disease monitoring and enhance health information technology to make these centers more accessible.

“We’ve learned, especially with Covid, that our health care system has holes in it and unfortunately, people are falling through those holes. And no one wants to be left behind,” HHS Secretary Xavier Becerra told CNN on Monday.

He called federally qualified community health centers a “game-changing” solution to fill those gaps.

“We’re going to help them zero in on virtual care, which we’ve learned through the pandemic is also a lifesaving way of getting to people who often are missed,” he said.

Barriers for virtual care were temporarily removed while Covid-19 is a public health emergency, but some centers are concerned the innovation could disappear.

“We share the angst because we’re going to need authority from Congress in order to be able to continue some of these telehealth opportunities that are available right now … but disappear once we no longer declare this to be a public health emergency,” Becerra said.

There are bills under consideration at the federal level that would remove some of the barriers to telehealth. At the state level, there have been at least 37 states that permanently incorporated telehealth flexibility into state law, according to the National Conference of State Legislatures.

The value of virtual care

This isn’t the federal government’s first move to advance digital health. In August, HHS announced 36 awards of $19 million to expand telehealth nationwide, calling it a “vital tool to improve health equity.” In January, the federal government asked for public input about how digital technology is used and could transform ways people get health care.

“The nonprofits have a tough time getting into some of the new technologies if they don’t have the kind of money it takes to make those kinds of investments. So this money is going to help them move quicker and stay longer and more durably in … virtual care,” Becerra said Monday.

The money can’t come soon enough for clinics such as the South Central Family Health Center in Los Angeles, which is among the groups receiving the $55 million announced on Monday.

South Central, like many centers around the country, couldn’t offer virtual care prior to the pandemic since health centers weren’t reimbursed for those appointments.

When that changed during the pandemic, it made a difference for patients who might otherwise have to forgo care, according to David Roman, the center’s director of development. He described one patient who found herself struggling with depression and anxiety during the pandemic. She wanted to get help, and even scheduled time with the center’s behavioral health team, but kept missing appointments. When the team reached out to find out why, she confessed that while she needed the help, she couldn’t afford to take a day off work for the appointment.

“One day off of work could mean not being able to feed your family that week,” Roman said. Since the center was able to schedule her for virtual appointments for her lunch hour, she hasn’t missed one yet.

Roman said his health center will use the new funding to determine how to provide the best virtual care.

“It will also help us learn how to apply different types of technology to help our patients,” Roman said. For example, he said the clinic cares for almost 4,200 patients with diabetes. After transportation and medicine adherence, the next biggest challenge is communication with their providers. This money will help the center provide remote monitoring devices to some of these patients so that the providers can help keep their diabetes in check.

“This is a technology that has been available to the general public that has insurance that will cover it, but a large number of our patients are not insured,” Roman said — about 40% of the center’s patients. “This is something that will significantly improve the kind of care we can provide.”

Pandemic safety nets

The United States’ 1,400 federally supported community health centers serve as a safety net for around 29 million underinsured or uninsured patients who live in rural and urban areas with high concentrations of poverty. Many patients at these centers have multiple underlying health conditions and the centers act are their only access to primary care. The centers also provide pharmacy services, mental health care, substance use programs and dentistry.

They’ve provided 19.2 million Covid-19 vaccines and two out of three of them have gone to hard-to-reach members in communities of color, according to the National Association of Community Health Centers. The centers have also been a significant source of Covid-19 tests, according to the Kaiser Family Foundation.

Their efforts during the pandemic paid off. In areas where there is an active community health center, there have been fewer Covid-19 deaths and infections, according to an analysis done by the Morehouse School of Medicine and the National Association of Community Health Centers.

The American Rescue Plan gave these health centers an additional $7.3 billion to provide pandemic care, HHS said. The centers, though, have been chronically underfunded and hit even harder this past year with the sharp rise in inflation. Federal government payment models are based on a fixed amount per patient, and they don’t account for inflation.

When there is funding, community health centers can do more. When virtual visits were reimbursed, the number of community centers that offered them increased 132%. Before the pandemic 592 centers offered virtual care, in 2022 it was 1,362, according to Health and Human Services. Virtual visits were up 6,000% during the pandemic, according to HHS.

Another recipient of the new funding, Middletown, Connecticut-based Community Health Center, which has centers throughout the state, will use the money to better understand how to use virtual appointments with patients with behavioral health and medical appointments, said Mark Masselli, the center’s founder and CEO.

“The community we serve is cost conscious. You work at the 7/11 and the thought of catching two busses to go and wait a half hour to be seen for 15 minutes is daunting,” Masselli said. “What if they could just do the appointment from their car at lunch instead. I think out of the pandemic we’re trying to figure out what this new delivery system will look like.”It also want to figure out what self-monitoring tools would work best with patients at home between patient visits.

“Sometimes people feel lost and abandoned between appointments and we think this could be a good tool,” Masselli said.

The center hopes to expand the model of school-based health center virtual care as well. “You simply can’t get a child psychiatrist to every school,” said Masselli. “They have to figure out ways that will be the force multiplier to do this.”

The center will also use the money to train the next generation of providers on how to integrate telehealth into their practice.