Community Health Centers are the backbone of America’s safety net, and provide essential care to underserved, low-income communities in urban and rural areas throughout the 50 states, the District of Columbia, and the U.S. territories. In 2017, more than 1,400 community health centers (CHCs) provided health care to nearly 28 million people. By mission and mandate, health centers focus on expanding access to care for marginalized communities and populations.
One such significant population served by health centers are America’s veterans. The Veterans Choice Program (VCP), authorized by Congress in 2014, permits veterans to access care through eligible providers and facilities that are not a part of the veteran’s health care system. Prior to Veterans Choice, veterans were only covered for healthcare by the United States Department of Veterans Affairs (VA) treatment facilities and a limited number of providers who had contracts with a VA facility. Community health centers were one of just a few provider types, along with Indian Health Service facilities, specifically named in the statute as eligible to care for qualified participating veterans, indicating that Congress intended that health centers would play a central role in assisting the VA to successfully implement the VCP. The National Association of Community Health Centers (NACHC) has been at the forefront of developing strategies and establishing relationships to help increase participation in the VCP, and allow veterans to access care in their own communities. About one third of veterans in the VA system now see outside doctors through the Veteran’s Choice Program. In 2017, CHCs served 355,648 veterans, an increase of 15 percent in the number served since 2015.
We reached out to Dick Bohrer, Network Relations Consultant at NACHC, and to a few of our CHC colleagues, to learn more about how they are serving veterans and why CHCs are an important and necessary resource for this population.
Mr. Bohrer explained that health centers are essential because they can provide resources that supplement those of the VA:
"We are not competing to serve people, we are working together to get people the services that they need." “We are not competing to serve people, we are working together to get people the services that they need.” While the VA has an expansive system, there are areas where the VA has limited service capacity and this is where health centers can fill the gaps. For example, more than a quarter of all veterans live in rural areas, some distance from VA services, and with 44% of all health center sites in rural locations, they are well positioned to meet the needs of veterans with limited access to VA resources. Bohrer emphasized that CHCs can also be important in addressing specific needs, such as behavioral health, saying, “The veteran providers hit it out of the park-- they have had so much experience dealing with PTSD, and they have some tremendous resources in that area; however, the demand and need for behavioral health exceeds beyond the capacity of the VA.”
Zufall Health (Dover, NJ)
Zufall Health serves a primarily urban population in Northern New Jersey. Zufall started as a once-a-week clinic in 1990 and today provides services at eight different locations and also operates two clinical vans. In 2017, Zufall served 36,603 patients from six different counties in New Jersey. Health center staff realized several years ago that there was almost no dental care available for the community’s veterans. This gap exists because most veterans only qualify for VA dental benefits if their dental condition is service-related. Zufall’s President and CEO, Eva Turbiner, explained that initially, Zufall set up a medical van that they took to the local VA Community-Based Outpatient Clinic (CBOC). Veterans could receive some limited dental treatment from the van, and go to the health center’s brick and mortar clinic if they needed additional care. As the need for services grew, the health center obtained a fully-equipped dental van that could provide more comprehensive services. Today, the Zufall dental van goes to many locations, including soup kitchens and shelters, Stand Down, and The American Legion, where they can reach low-income veterans.
Most recently, Zufall partnered with generous corporate sponsors to bring a weekend of free dental care to almost 200 veterans and their families. Dentists from all over New Jersey generously donated their time and labor. In addition to oral health services, Zufall also provided free breakfast and lunch as well as other medical services over the two days. Volunteers from across New Jersey assisted with providing services. Zufall currently has a permanent part-time veterans’ outreach position, to help reach veterans who don’t realize that they might qualify for services at Zufall. As Turbiner explained,
"This is not a one-time charity event. The next day we are still here and that is critical to the ongoing health and wellness of these veterans." “The difference with having a community health center being the sponsor is that if something goes wrong with the denture, if the cavity comes loose, if they develop a second cavity, they can come back to the health center. This is not a one-time charity event. The next day we are still here and that is critical to the ongoing health and wellness of these veterans.” Another benefit to providing outreach and care is that veterans are also able to bring their families to the health center.
Turbiner acknowledged that there have been challenges. For example, she explained, “Where we run into difficulty is that many of these folks come in not just for cleaning and cavities, but with a huge need for dentures. These are people who have not had dental care for a number of years and providing free dentures is difficult. We try to make them as affordable as possible.” Many veterans are also older, which increases the need for dentures. The health center has been successful in identifying some foundation support to help make these services accessible.
Commenting on future opportunities, Turbiner said: “We are aware that certain women’s health services are also lacking and there is a gap at the VA. We are examining where the gaps are in women’s health. We are currently focusing on oral health, but woman’s health is probably the next thing we're going to look at.” Overall, Turbiner says that, “One of the things that we have found is that there is tremendous community support for veterans.”
Family Health Center of Marshfield, Inc. (Marshfield, Wisconsin)
Family Health Center (FHC) of Marshfield, Inc. is located in rural Wisconsin and first opened its doors on March 1, 1974. It was the product of a unique partnership with Marshfield Clinic, a multispecialty group practice, and the Greater Marshfield Community Health Plan, an HMO. FHC serves patients at 32 clinic sites in 13 northwestern Wisconsin counties. In 2017, FHC served 89,686 patients; about 60% of the services that year were for dental care. Family Health Center opened its first dental clinic in 2002, after realizing that rural Wisconsin had a significant need for oral healthcare. In 2005, as they were opening their second dental center, FHC learned from the County Veterans Service Officers (CVSOs) that access to oral health care was one of the most challenging health issues that veterans, particularly those of low income, faced. Today, FHC operates 10 dental centers throughout northwestern Wisconsin and works with the community to provide both dental and medical care to veterans.
"They served our country and we want to take care of them, and we also want to take care of our community." Nicole Larson, Family Health Center’s director of Business Development said: “They served our country and we want to take care of them, and we also want to take care of our community.” At the invitation of the CVSOs, health center staff attended the county veterans’ office annual conference in 2017, and were invited back in 2018. According to Larson, attending the yearly conference opened up many doors. Staff were able to meet directly with veterans' officers, who in turn relayed comprehensive information to the veteran community. She explained that “oftentimes when we speak specifically to veterans there is not a full understanding of what benefits are available to them, or a misunderstanding of what's available to them. Through the partnership with the CVSOs and other agencies, we are able to break down that barrier a bit. We want to see what we can do to meet their needs.” FHC has also collaborated directly with the VA to assist veterans, take referrals and fill gaps in care.
Today, Family Health Center is primarily focused on growing relationships within the community. Larson attributes the success of their program to the “deep roots in the community that we serve. We don’t build locations just to build; we build based on the needs of the community.”
Yakima Neighborhood Health Services (Yakima, Washington)
Yakima Neighborhood Health Services’ (YNHS) first clinic opened in downtown Yakima in May 1975 and today, YNHS has medical and dental clinics in Yakima, Sunnyside, and Granger, serving both urban and rural communities. In 2017, YNHS served 22,784 patients. Rhonda Hauff is the health center’s Chief Operating Officer; she explained how the health center has engaged with veterans over many years. YNHS participates in Stand Down, a national grassroots community-based intervention program designed to help the nation’s homeless veterans by offering a variety of free and low-cost resources. While Yakima provides a wide variety of general medical services, Hauff noted that they try to highlight their behavioral health services to veterans, “In our CHC setting, our number-one behavioral issue is PTSD and that hurts veterans and other clients alike. Services for PTSD are so well integrated into our primary care program that patients don't have to worry about being stereotyped.” Hauff mentioned that it's essential that health center staff are familiar with what's available in the community so that they can both refer veterans for care, and identify gaps and needs.
"Services for PTSD are so well integrated into our primary care program that patients don't have to worry about being stereotyped." YNHS has worked with the Yakima Housing Authority (YHA) for many years, and has recently embarked on an exciting new venture that it hopes will provide outreach and more services to veterans. The YHA has acquired armory property specifically to provide 41 units of supportive housing for homeless veterans and their families. An additional 12,000 square feet will be dedicated for social services that target homeless veterans. Through this partnership, YNHS will be able to provide medical, dental, and behavioral services onsite at the armory, providing care for both veterans that live there, as well as other veterans in the community who need medical services.
Zufall Health, Family Health Center of Marshfield and Yakima Neighborhood Health Services each serve a diverse and local population, and they share a commitment to serving those who have served. All have found unique ways to engage with and provide the resources that the veterans in their area need.
The new VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or “VA Mission Act” signed into law on June 6, 2018, is intended to expand on the Veteran’s Choice program, and establishes the Veteran’s Community Care Program to provide community-based services. What exactly that will look like in practice remains uncertain – especially because of the possibility of funding shortfalls - but Bohrer commented that, “Given the Mission Act and the direction that the VA is headed in, health centers are going to need to be in direct communication with the veteran treatment facility that is closest to them. At a minimum, people need to find out where that office is in that VA facility and who the people are, and what they need to begin that journey.” Health centers that want to get more involved in serving veterans can reach out to the VA, dedicated service organizations in their area, and access the resources that are available online including resources from the VA and those available through NACHC. An informal Veterans Health interest group convened by NACHC meets periodically; for more information contact Dick Bohrer at dbohrer@NACHC.COM.