1. Proser, Michelle MPP

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THIS year marks the 45th anniversary of what has now become the largest network of primary care providers in the nation-the Community, Migrant, Homeless, and Public Housing Health Center Program, also known as the Federally Qualified Health Center Program. Forty-five years ago, just 2 health centers set out to craft a model of primary care that looked beyond a single patient encounter to address the social, environmental, and economic root causes of ill health. The program's founders, Drs Jack Geiger and Count Gibson, applied a holistic, community-oriented, and mission-driven model of care that explicitly targeted communities with the most egregious health disparities.


Today, health centers reach more than 20 million patients in every state and territory. Their patients come from the most marginalized rural and urban communities, making up 1 in 5 low-income, uninsured individuals, 1 in 8 Medicaid beneficiaries, and 1 in 4 minority individuals in poverty. And their reach will continue to expand under new investments, including most recently those made through the 2009 American Recovery and Reinvestment Act and expected outlays built into healthcare reform. Importantly, many new patients are turning to health centers after being personally affected by the recent downward economy. As of the summer of 2009, health center uninsured visits were up by 21% compared with the same time last year (National Association of Community Health Centers, NACHC, 2009b). Under their ACCESS for All America Plan, America's health centers will reach 30 million patients by their 50th anniversary-and likely sooner.


Five years ago, a panel of authors composed a special addition of the Journal of Ambulatory Care Management, commemorating the 40th anniversary of the program. That issue described the health centers' unique history and critical partnerships, documented their niche in meeting the needs of at-risk and even forgotten communities, reviewed the literature on efficiency and effectiveness, and discussed future challenges for growth. Since then, new literature has demonstrated their ability to improve access to care, minimize health disparities, and improve outcomes-and to do so efficiently.* In fact, one recent study found that health centers save the healthcare system as much as $24 billion a year (Ku et al., 2009).


Over the course of this year, in celebration of the 45th anniversary, the Journal of Ambulatory Care Management will release a series of new articles that contribute to the growing body of literature on community health centers. These articles will document important program achievements, describe how to address persistent challenges to expanding capacity and reaching even higher levels of quality improvement, and even highlight the experiences of health centers engaged in translational and community-based research. These articles will demonstrate the extent to which health centers have adapted to embrace new challenges while remaining true to their original mission.


The US healthcare system is rapidly evolving into one more focused on performance and accountability. Healthcare reform will unveil new opportunities and challenges for expanding access to high-quality primary care. With or without system reform, demand for safety net primary care services, such as those provided by health centers, will only increase. Sixty million US residents are currently without access to a regular source of primary care due to local shortages of such physicians. Many of these so-called medically disenfranchised actually have insurance, as healthcare reform in Massachusetts proved (NACHC, 2009a). And yet this represents just one of many compounding barriers to care. Millions more still require comprehensive, continuous, coordinated, as well as patient- and community-centered, primary care.


The NACHC thanks the Journal for its commitment to disseminating effective models of primary care and community-based research and for serving as a forum for deliberating over how to effectively combat gaps in access and quality. We hope the articles that follow this year spark a productive dialogue on how best to address these issues, thus helping to transform the promise of improved coverage into a reality of improved access to quality, effective healthcare for all.




Ku, L., Richard, P., Dor, A., Tan, E., Shin, P., & Rosenbaum, S. (2009). Using primary care to bend the curve: Estimating the impact of a health center expansion on health care costs (Policy Research Brief No. 14). New York: Geiger Gibson/RHCN Community Health Foundation Research Collaborative. Retrieved December 31, 2009, from[Context Link]


National Association of Community Health Centers. (2009a). Primary care access: An essential building block of health reform. Retrieved December 31, 2009, from[Context Link]


National Association of Community Health Centers. (2009b). Recession brings more patients to community health centers: Fact sheet. Retrieved December 31, 2009, from[Context Link]


*See NACHC's summaries of health center literature,[Context Link]