Clinical & Quality
Health Care to Improve the Lives of Pennsylvanians
Community Health Centers offer a comprehensive range of services to help patients maintain a high quality of life.
Pennsylvania’s Community Health Centers provide high-quality, comprehensive, affordable, culturally competent and community responsive medical, dental, and behavioral health care. Community health centers offer a wide range of integrated services to provide whole person care.
PACHC provides clinical support to Pennsylvania health centers through technical assistance, face-to-face trainings, webinars, dissemination of resources and peer-to-peer connections.
Areas of support and assistance include:
- Patient-Centered Medical Home (PCMH)
- Other accreditations such as the Joint Commission
- Quality, risk management and patient safety
- Physical health
- Oral health and oral-health integration
- Behavioral health, behavioral-health integration and substance use disorder
- Federal Tort Claims Act (FTCA)
- Special populations including:
- HRSA-funded migrant, homeless, and public housing
- Populations such as gender and sexual minorities, as well as LGBTQ
- Other special populations: elderly, veterans, persons living with HIV/AIDS, and school-based populations
The Quality Health Care Everyone Deserves
Quality improvement is systematic and continuous action that leads to measurable improvement in healthcare services and the health status of targeted patient populations. It looks at the health of an entire population and finds ways to help every patient within a community.
Pennsylvania health centers engage in quality improvement (QI) activities that are critical to achieving the quadruple aim of care:
- Enhancing the patient experience
- Improving population health
- Reducing costs
- Improving the provider/staff experience
Quality improvement involves everyone, from front desk staff to providers, and the health center’s patients to the board of directors.
The Health Resources and Services Administration (HRSA) continues to make quality improvement and risk management a high priority. HRSA defines quality health care as “the provision of appropriate services to individuals and populations that are consistent with current professional knowledge, in a technically competent manner with good communication, shared decision-making, and cultural sensitivity. Good quality health care is evidence-based, increases the likelihood of desired health outcomes, and addresses the six aims – safe, effective, patient-centered, timely, efficient and equitable – using a systems approach to continuously improve clinical and operational domains.”
Population health, social determinants of health, health literacy and cultural competence impacts quality outcomes. As reimbursement moves toward a value-based payment model, it is critical to measure, report, monitor, and demonstrate improvement of financial, operational, and clinical measures. Also, transparency of data is a critical component of quality outcomes.
PACHC provides training and technical assistance to ensure that as new models evolve, health centers will continue to be able to demonstrate their value for the care provided to their patients.
Providing the Highest Quality Primary Care
Community health centers provide wellness, prevention, and chronic disease care for their patients.
Physical health is the foundation on which all primary care is built, impacting overall quality of life. It encompasses preventive, chronic, and general wellness in a patient-centered care model. It is the most visible of the various elements of health; to include social, intellectual, emotional, spiritual, and environmental health.
Pennsylvania’s health centers provide integrated care for the patients in their communities. PACHC provides training and technical assistance to help keep health centers informed of new and developing models of care. Additionally, PACHC provides continuous surveillance of the clinical, quality improvement and health care environment, stays abreast of clinical trends, researches relevant topics, and disseminates pertinent information to health centers.
PACHC also maintains close collaborations with the Pennsylvania Department of Health, Department of Human Services, and other external organizations by participating on several stakeholder committees. PACHC serves as resource to connect health centers with various quality and health initiatives being implemented throughout the state.
Physical Health Resources
Physical Health Resources for Providers and Clinicians
- The Agency for Healthcare Research & Quality (AHRQ)
- American Cancer Society – for patients
- American Diabetes Association
- American Lung Association
- American Heart Association
- American Public Health Association
- Centers for Disease Control and Prevention Services (CDC)
- Colorectal Cancer – National Colorectal Cancer Roundtable
- The Community Guide
- Maternal and Child Health Bureau – HRSA
- Million Hearts
- National Guideline Clearinghouse
- One Stop Flu Facts
- PA Asthma Partnership
- PA Department of Health
- PA State Immunization Registry
- Target Blood Pressure
Providing Our Communities with Oral Health Care
Health centers invest in oral health and oral health integration to help patients achieve good overall physical health.
Today approximately 90 percent of Pennsylvania health centers offer oral health services in at least one of their sites. Implementing fully integrated and collaborative models of medical-dental care in community health centers increases access to oral health, significantly decreases the number of children and adults experiencing primary tooth decay, and facilitates early treatment, prevention, and education. Integration requires an understanding of the governance, financial modeling, policies, procedures, operations, and systems needed to achieve change.
PACHC participates in these oral health initiatives:
The PCA Oral Health Collaborative (POHC)
The PCA Oral Health Collaborative (POHC) is a collaborative oral health network of Primary Care Associations supporting Community Health Centers across the country facilitated by the National Network for Oral Health Access. The mission is to lead innovative change to optimize oral health within whole person care. It is a key partner in efforts to achieve the national goal of increasing access to quality oral health care. Uniquely positioned as a primary care association peer network, the opportunities to support and protect policies, as well as the ability to provide direct technical assistance to federally qualified health centers are unmatched. POHC is comprised of oral health representatives from PCAs from across the nation, representing more than 37 states including Pennsylvania.
The Family Oral Health Collective
The Pennsylvania Coalition on Oral Health (PCOH)
Oral Health Resources
Oral Health Resources for Providers and Clinicians
- American Dental Association
- Cavity Free Kids
- Children’s Dental Health Project
- CareQuest Institute
- HRSA Oral Health Website
- Healthy Teeth, Healthy Children
- Infection Prevention Checklist for Dental Settings
- National Maternal and Child Oral Health Resource Center (OHRC)
- National Network of Oral Health Access (NNOHA)
- Operations Manual for Health Center Oral Health Programs
- Oral Health Implementation Guide from Qualis Health
- Organization for Safety, Asepsis and Prevention (OSAP)
- Smiles for Life
- Summary of Infection Prevention Practices in Dental Settings
Behavioral Health Prevention and Treatment for the Well-Being of Health Center Patients
Integrating behavioral health services into primary care can result in increased access, improved quality outcomes and better cost effectiveness of a patient’s care. Integrated models also help to reduce the stigma associated with these conditions. Nearly 95 percent of Pennsylvania’s Community Health Centers offer access to this type of care through various models of integration.
As trusted healthcare providers rooted in the heart of their communities, health centers are becoming more actively involved in providing solutions to address the rampant opioid use epidemic. Approximately 40 health centers directly provide Medication Assisted Treatment or collaborate with other drug & alcohol services within their community.
Most community health centers are providing either behavioral health services or substance use disorder treatments – or BOTH! To find a health center near you that provides these services, please click here.
PACHC serves as resource for health center Behavioral Health and Substance Use Disorder staff by offering on going educational trainings at low or no cost, policy support and technical assistance for all types of issues health centers may encounter. We offer a variety of free webinars, training opportunities and professional development workshops on key issues in the field. We also host a bi-monthly Behavioral Health peer networking call (scheduled on Wednesdays at 12:00 pm) as an opportunity to host important guest speakers that may serve as a resource to you and your patients. This call also serves as a time for you to connect with peers across the State. Email Amy Williams to join the listserv for these calls and training opportunities.
OMHSAS – Mental Health in Pennsylvania
Mental Health in PA offers resources from the Office of Mental Health and Substance Abuse Services (OMHSAS) for mental health and substance use disorder. Get more information on OMHSAS, find Children/Adolescent Resources and Adult/Older Adults Resources on their website.
Substance Use Disorder (SUD)
PACHC Joins Forces with State and Community Partners to Fight Opioid Epidemic.
PACHC is working in collaboration with the Pennsylvania Departments of Health, Human Services and Drug & Alcohol Programs to combat the opioid crisis in response to the governor’s opioid epidemic disaster declaration.
Pennsylvania has a growing pool of resources to assist those struggling with substance use disorder and their providers.
If you need immediate assistance in finding a treatment provider or paying for addiction treatment, please call 1-800- 662-HELP (4357). This number is a confidential, no cost, 24-hour-a-day, 365-day-a-year information service for individuals and family members facing mental and/or substance use disorders. Communication is available in English or Spanish. This service provides referrals to local treatment facilities, support groups, and community-based organizations. You can also contact your local County Services Provider.
Medication Assisted Treatment (MAT)
MAT is the use of medications with counseling and behavioral therapies to treat substance use disorders and work to prevent opioid overdoses. MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. Here are important resources if you are interested in learning more about MAT:
Become a Buprenorphine Waivered Practitioner: Become a Buprenorphine Waivered Practitioner | SAMHSA
MAT Statutes, Regulations and Guidelines: Statutes, Regulations, and Guidelines | SAMHSA
Centers of Excellence
Currently, there are ten FQHC Centers of Excellence (COE) that strive to ensure people with opioid-related substance use disorders stay in treatment, maintain follow-up care, and are supported within their communities.
Berks Community Health Center – Reading, PA
Community Health and Dental Care – Pottstown, PA
Hamilton Health Center – Harrisburg, PA
Neighborhood Health Centers of the Lehigh Valley – Allentown, PA
NEPA Community Health Care – Montrose, PA
Philadelphia Health Management Corporation – Philadelphia, PA
Project HOME – Philadelphia, PA
Sadler Health Center – Carlisle, PA
Squirrel Hill Health Center – Pittsburgh, PA
The Wright Center for Community Health – Scranton, PA
Behavioral Health/SUD Resources
Pennsylvania Provider Information:
PA Provider Resources: Pennsylvania Provider Resources | PA Health & Wellness (pahealthwellness.com)
Office of Mental Health and Substance Abuse Services: OMHSAS Information (pa.gov)
Department of Drug and Alcohol Services: Department of Drug and Alcohol Programs
IRETA Institution for Research Education and Training in Addictions – based in PA
Provider Behavioral Health and SUD training resources
The Danya Institute: The Danya Institute Inc.
Providers Clinical Support System: Home – Providers Clinical Support System: Resources for PCPs (pcssnow.org)
Substance Abuse and Mental Health Services Administration: SAMHSA – Substance Abuse and Mental Health Services Administration
Anxiety and Depression Association of America Anxiety and Depression Association of America
National Council for Mental Wellbeing Homepage – National Council for Mental Wellbeing (thenationalcouncil.org)
Veteran’s Crisis Hotline – 1-800-273-8255, Press 1
Patient-Centered Medical Home (PCMH)/Health Home
The high-quality teams at health centers focus on providing comprehensive care specific to the needs of each patient.
The patient-centered medical home (PCMH) model or philosophy of primary care promotes patient-centered, comprehensive, team-based, coordinated, accessible care focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system. PCMH is defined by the Patient-Centered Primary Care Collaborative as “a model for achieving primary care excellence so that care is received in the right place, at the right time and in a way that best suits a patient’s needs.”
The medical home encompasses five functions and attributes:
- Comprehensive care
- Care coordination across health system
- Quality and safety focused
- Enhanced access to care
The HRSA Accreditation and Patient-Centered Medical Home Recognition Initiative
The HRSA Accreditation and Patient-Centered Medical Home Recognition Initiative supports recognition for health centers that meet national quality standards. HRSA contracts with three organizations to provide technical assistance and training for their respective recognition processes:
- The Joint Commission for ambulatory health care accreditation and PCMH recognition
- The Accreditation Association for Ambulatory Health Care (AAAHC) for ambulatory health care accreditation and PCMH recognition
- The National Committee for Quality Assurance (NCQA) for PCMH recognition
HRSA may support certain fees for participating health centers. The fees covered may be associated with initial accreditation and re-accreditation for ambulatory health care accreditation and PCMH recognition, initial, renewal, and add-on surveys.
- The Agency for Health Research and Quality (AHRQ) PCMH Resource Center
- NCQA Government Recognition Initiative Programs
- NCQA Patient-Centered Medical Home
- Overview of The Joint Commission’s Primary Care Medical Home (PCMH) Certification
- Patient-Centered Primary Care Collaborative
- Qualis Safety-Net Medical Home
PA Health Centers, Serving the Special Populations in their Communities
Providing quality affordable care to all Pennsylvanians.
Pennsylvania’s Community Health Centers provide care to all populations within their communities. Section 330 of the Public Health Service Act legislates health center program funding for migrant and seasonal agricultural workers, public housing residents and homeless populations. The Health Resources and Services Administration (HRSA) also provides technical assistance and support for “other” special populations such as gender and sexual minorities, the elderly, veterans, people living with HIV/AIDS and school-based health centers.
In 2016, Pennsylvania health centers served more than 6,429 migratory and seasonal workers. Currently two health centers are migrant health centers with one of these centers overseeing statewide the migratory and seasonal farmworker population. Signed into law on September 25, 1962, by President John F. Kennedy, the Migrant Health Act established the authorization for delivery of primary and supplemental health services to migrant farmworkers. The Migrant Health Program is currently funded under the Consolidated Health Care Act of 1996 and administered by the Office of Minority and Special Populations in HRSA’s Bureau of Primary Health Care.
In 2016, Pennsylvania health centers served 23,891 homeless patients. A person experiencing homelessness is defined as “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations, and an individual who is a resident in transitional housing.” Without permanent housing, individuals might be living on the streets, stay in a shelter, mission, single-room occupancy facility, abandoned building or vehicle, or in any other unstable or non-permanent situation. Those identified as “doubled up” are individuals unable to maintain their housing situation and forced to stay with a series of friends/extended family members, as well as those that are to be released from a prison or hospital without a stable housing situation to which they can return.
In 2016, close to 140,000 residents of public housing received care through Pennsylvania health centers. The Housing and Urban Development’s (HUD) defines public housing as housing that is established to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities. Public housing comes in all sizes and types, from scattered single-family houses to high-rise apartments.
School-Based Health Centers
Several Community Health Centers in Pennsylvania have school-based health centers that provide care to approximately 9,000 patients. School-based health centers are exactly what the name implies, primary care service delivery sites located in schools. Students and their families rely on school-based health centers to meet their needs for a full range of age-appropriate health care services.
In 2016, more than 13,000 veterans received their care at a health center in Pennsylvania. VA Community Care provides veterans access to health care within their communities when services are either not available at a VA facility or when distance or appointment wait times makes these services inaccessible. Patient-Centered Community Care (PC3) is a nationwide program that utilizes healthcare contracts to provide veterans access to medical care when local VA facilities cannot. The Community Care Program, which supplements the PC3 program, is a benefit that allows eligible veterans to receive health care from a community provider rather than waiting for a VA appointment or traveling to a VA facility. FQHCs may participate in the program by joining the PC3 Network or by signing a provider agreement with Health Net Federal Services, one of the VA administrative contractors managing the program based on geographic assignments.
As part of required screening services, all health centers offer HIV testing and counseling either directly or through a formal referral agreement. Some health centers also participate in the Ryan White HIV/AIDS Program, which provides a comprehensive system of care that includes primary medical care and essential support/social services including case management, prevention education, and medical benefits including counseling for people living with HIV who are uninsured or underinsured.
Gender & Sexual Minorities
According to HRSA, lesbian, gay, bisexual and transgender (LGBT) citizens and other gender and sexual minorities are “a diverse community that share a common need for culturally competent health care that recognizes and responds to specific medical risks.” Many of Pennsylvania’s Community Health Centers help gender and sexual minorities overcome health challenges posed by social and structural inequities, such as stigma and discrimination. One resource is the National LGBT Health Education Center, supported by HRSA through a cooperative agreement with The Fenway Institute.