The Health Care Safety Net
Where do you turn when you get sick? I don’t hesitate to visit our clinic, make an appointment for diagnosis and treatment, knowing the bill is paid by an invisible system courtesy of our good health insurance plan. What if my family didn’t have this insurance, or if our clinic wouldn’t accept our plan? Fortunately, we could call one of Minnesota’s 16 community health clinics (CHC) and receive high quality, appropriate care. Last night I attended an event hosted by the Minnesota Association of Community Health Centers celebrating National Health Center Week and the importance of community health centers (CHC) in Minnesota. The 16 centers in the state served 190,000 patients last year and health center board members, staff and other supports gathered to celebrate their success. At least 51 percent of CHC board members must be patients at the clinic, assuring a strong voice for the community.
The work we do at Nonprofits Assistance Fund (NAF) is rich in variety since we work with Minnesota nonprofits in all fields – social services, housing, arts, education, and on and on. A few months ago I wrote about our experience working with charter schools and the expertise we have developed in that part of the nonprofit world. Through our Minnesota Primary Care loan fund, we have also developed expertise in working with community health centers.
While their budgets have grown, clinics are constantly under financial stress because of the complex and changing system of payment, reimbursement and grant funds on which they rely. CHCs serve people who may not otherwise have access to quality medical or dental services because they are uninsured or seriously underinsured. Many patients at CHCs are covered by public health care programs (including Medicaid and Minnesota Care) and can also receive grants from both federal and state agencies that support health and human service programs. The number of uninsured patients has been increasing by almost eight percent each year, and the costs of providing quality care are magnified by the severe or chronic conditions faced by patients who have not had consistent access to care. Additional costs are often needed as well, including translators and health care educators to serve very diverse patients.
Most of our work with clinics has been for lending to help with cash flow shortfalls caused by processing time and delays of reimbursements from a web of public programs and the high costs of facilities, equipment and medical supplies. When most nonprofits prepare cash flow projections – which we always encourage – they have a pretty good idea of when their grants and contract funds will be received. Some of the payments received by clinics have been delayed for more than a year while they work through reporting, documentation and reconciling overlapping programs and their requirements. That has made cash flow management more challenging then ever. Fortunately, recent changes in processing and payment in Minnesota has eased some of the difficulties – at least for the time being. As we learn in every field of nonprofit service, the needs in the community are growing, financial resources are limited and there is much work to be done.
Our lending and financial management assistance for clinics has been supported by capital funds and grants from the Robert Wood Johnson Foundation and has been in partnership with The Minnesota Department of Health’s Office of Rural Health and Primary Care . The ORHPC provides a variety of research, information and grant programs. Read their recent overview of these safety net clinics in the ORHPC Summer 2007 Newsletter. We recently issued a report about this work, Patient Capital: Minnesota Primary Care Loan Fund 10-Year Report