Part of what keeps me going, outside of the work that I do each day, is pushing the envelope and striving to be bigger, bolder, and better in that work. A large part of how I do that is being one step ahead, always seeing the bigger picture – the end game – rather than getting caught up in the weeds and letting them hold me back. Which is why I have so enjoyed the work we are doing at the California Primary Care Association (CPCA) around our next strategic plan. It’s affording us the ability to look forward, get out of our own way, and mold the future we want for our organization and its members.
Over my nearly 20 years of leading this amazing organization, I have seen tremendous strength and innovation from its members. They have never been afraid to take bold steps forward and blaze a trail for others to follow. Community health centers have grown to become a network of more than 1,150 sites across the state serving nearly six million patients each year. That’s one in every seven Californians. And community health center revenue has grown from $795 million in 1997 to over $3.7 billion in 2015.
This is amazing growth in a relatively short amount of time, and we were able to accomplish much of this by coming together and working toward the greater good for everyone. Since the passage of the Affordable Care Act (ACA), we have made great strides in defining our own destiny through the three bold steps in our last Strategic Plan. As called for in that plan, we are currently in the process of implementing our payment reform pilot, the largest in the nation, with the State and our health plan partners. This innovation will allow health centers to transform the way they deliver care in a post-ACA environment where outcomes are paramount. We have created a robust training and technical assistance program to get our members ready for our payment reform pilot, ensuring their readiness and overall success.
We have also created a statewide brand, CaliforniaHealth+ to educate patients about the benefits of California’s community health centers. The “plus” represents all the services and support community health centers offer that go beyond primary care to encompass a whole health approach. The brand’s message is simple – “Whoever you are, we speak your language, honor your traditions and value your experiences. We treat everyone with respect and courtesy. We are a trusted friend and partner in your care.” We’ve had so much positive feedback on that messaging that we have also utilized the CaliforniaHealth+ name for our newly formed 501(c)(4) organization – CaliforniaHealth+ Advocates – which will advance the mission of community health centers through both state and federal advocacy and will provide more flexibility and capacity to advocate above and beyond what CPCA, a 501(c)(3) organization, is allowed to do.
While we have achieved some important milestones over the past few years, we have seen our share of challenges. We are currently operating in a space in which we are measured on value but paid on volume. We are facing a growing primary care workforce shortage, coupled with an increase in patient demand. We have celebrated the great success of the implementation of the Affordable Care Act here in California and are now realizing, as we plan for our future, that we may be victims of that very success. The lack of workforce capacity is making it more difficult to provide needed services. The healthcare landscape is changing, both here in our state and nationally. Additional health care delivery innovation is needed to address a growing complex patient population; and increased competition over resources and patients has required us to shift the way we think about what we do. On top of all of this, the current political climate has made our future uncertain in many respects.
But, one thing I have learned by criss-crossing the state, meeting with our members in their communities during seven regional strategic planning meetings this summer and fall, is that our members are up to the task. Every region is different and has unique challenges, but they are all ready to confront those challenges. Quite frankly, sitting in those meeting rooms and listening to our state’s brightest leaders define their own destiny, I was in awe. They are ready. We are ready.
For example, workforce issues were identified as the top challenge throughout the state. Health centers are ready to innovate in order to deal with this difficult challenge. They are embracing new payment models which will better incentivize team-based care in order to expand the types of providers available to serve their patients. The need to address social determinants of health is another issue we heard repeatedly. Health centers have a long track-record of being community-minded healthcare providers who are committed to the whole patient. Their commitment to food and housing security and addressing the non-health needs of their patients are second to none. But, listening to our members, they realize we must take these efforts to another level – we must address impacts of gentrification, violence, education inequities, and more. It was truly inspiring.
Pushing the envelope and striving to be better in our work is not an easy task. But the fact of the matter is, our members are up for the challenge. As we wrap up our regional strategic planning meetings, where nearly half of our member organizations turned out to inform our process, I am excited for what the future will bring. I am so proud to see how far we have come and where the health center movement is going. We are charting our own path and creating our own destiny. Soon we will have a new strategic roadmap to guide our journey through new and unknown areas. I look forward to embracing the next set of bold steps the California Primary Care Association and our member health centers will embark upon as we continue to be a driving force behind health care delivery for diverse communities throughout California.