Key Takeaways
Group well being facilities are a nationwide community of over 1,300 safety-net major care suppliers, serving greater than 31 million sufferers in 2023. They’re positioned in medically underserved city and rural communities and serve all sufferers no matter their skill to pay, offering a variety of medical, behavioral, and supportive providers. This temporary reviews on well being middle sufferers, providers, experiences, and financing in 2023 and analyzes adjustments from 2019 (pre-pandemic) by way of 2023 utilizing knowledge from the Uniform Knowledge System (UDS), to which all well being facilities are required to report yearly, and the 2022 Well being Middle Affected person Survey. Key takeaways embrace the next:
The well being middle affected person inhabitants elevated to over 31 million sufferers in 2023, up barely from 30.5 million in 2022. Whereas the variety of kids served at well being facilities elevated to over 9.1 million in 2023, this stays barely decrease than the 9.2 million served pre-pandemic in 2019, presumably reflecting general diminished utilization of major and preventive providers amongst kids on Medicaid.
Well being facilities disproportionately served low-income individuals, individuals of shade, and rural residents. In 2023, 90% of sufferers had incomes that had been at or beneath 200% of the federal poverty stage (FPL), and 40% had been Hispanic sufferers, 17% had been Black sufferers, and 4% had been Asian sufferers. As well as, over three in ten (31%) sufferers had been rural residents.
From 2019 to 2023, the share of sufferers who had been uninsured dropped from 23% to 18%, whereas the share of sufferers coated by Medicaid elevated from 49% to 51%, seemingly as a result of Medicaid steady enrollment provision, which briefly halted Medicaid disenrollments from March 2020 by way of March 2023. The share of sufferers with non-public protection and Medicare additionally elevated modestly.
Medicaid was the most important income supply for well being facilities, accounting for 43% of the $46.7 billion in complete well being middle income in 2023, however income by payer supply varies by state. From 2019-2023, well being middle income elevated as a result of availability of COVID-19 funding and elevated funds from payers. Nonetheless, internet margins after prices fell from 4.5% in 2022 to 1.6% in 2023.
About 66% of visits had been for medical providers and 13% had been for psychological well being and substance use dysfunction (SUD) providers. Sufferers continued to return to in-person care; nevertheless, well being facilities performed 5 million visits (13%) by way of telehealth in 2023. Telehealth visits dropped by practically half from the height of 28.5 million visits (25%) in 2020 at first of the COVID-19 pandemic.
Most sufferers report optimistic experiences at well being facilities, with over 9 in ten sufferers reporting that they had been handled with respect. Nonetheless, Black and Hispanic sufferers had been much less seemingly than White sufferers to report that well being middle medical doctors or well being professionals defined issues in a means that was simple to know.
Since 2019, well being facilities have seen a gradual rise within the share of their sufferers who’ve well being protection and have skilled steady financing; nevertheless, potential adjustments to the Medicaid program might reverse these tendencies. Modifications that might impose new boundaries to Medicaid enrollment or alter how this system is financed that could be adopted by the incoming Trump administration or Congress in 2025 would seemingly result in a rise within the variety of uninsured sufferers and a lack of Medicaid funding for well being facilities that would in the end undermine entry to major care in medically underserved city and rural areas.
Well being Middle Sufferers
In 2023, 1,363 well being middle organizations served greater than 31 million sufferers at over 15,600 service supply websites (Determine 1). Roughly six in ten well being facilities served sufferers in medically underserved city areas, whereas 4 in ten served rural communities. Almost three-quarters (73%) of well being facilities supplied care to 25,000 or fewer sufferers whereas 3% of well being facilities served 100,000 or extra sufferers in 2023. Typically, smaller well being facilities are positioned in rural areas or focus providers on sure neighborhoods or populations, whereas bigger well being facilities are inclined to serve extra city areas and function a number of clinic places.
Well being facilities served over 9.1 million kids in 2023, a rise of three.4% from 2022, however nonetheless decrease than the variety of kids served previous to the pandemic (Determine 2). The variety of little one sufferers ages 0-17 dropped in 2020 seemingly because of non permanent website closures and social distancing steerage at first of the COVID-19 pandemic. Whereas the variety of grownup well being middle sufferers shortly rebounded after plateauing in 2020, the variety of kids served by well being facilities has been slower to recuperate. There’s proof indicating that utilization of major and preventive providers amongst kids on Medicaid stays beneath pre-pandemic ranges, which can partially clarify the drop in pediatric sufferers at well being facilities. Though nonetheless a small share of the overall affected person inhabitants, the variety of grownup sufferers ages 65+ grew by practically 30% or over 800,000 from 2019-2023.
A majority of well being middle sufferers stay in low-income households (Determine 3). Reflecting the mission of well being facilities to serve anybody no matter skill to pay, 9 in ten sufferers served at well being facilities had incomes that had been at or beneath 200% of the federal poverty stage (FPL) and two-thirds of sufferers (67%) had incomes at or beneath the poverty stage in 2023 (the poverty stage was $30,000 for a household of 4 in 2023). The share of low-income sufferers served at well being facilities is roughly 3 times that of the U.S. inhabitants, through which 28% of people lived in households incomes below 200% FPL in 2023.
Most well being middle sufferers (63%) are individuals of shade, however there are variations between city and rural well being facilities within the racial and ethnicity of sufferers (Determine 4). Throughout all well being facilities, Hispanic sufferers comprised the most important share of sufferers at 40%, adopted by White sufferers (37%), Black sufferers (17%), Asian sufferers (4%), and all different sufferers (3%). Nonetheless, the share of well being middle sufferers who’re sufferers of shade is larger at well being facilities in city areas in comparison with these in rural areas, reflecting variations within the traits of individuals with low-income throughout the 2 settings. Sufferers of shade comprise a majority (75%) of sufferers at city well being facilities whereas White sufferers symbolize the bulk (61%) of sufferers at rural well being facilities.
Well being facilities served hundreds of thousands of sufferers who had been a part of particular populations with distinct well being wants in 2023 (Determine 5). The Well being Assets and Providers Administration (HRSA), which administers the well being middle program, supplies focused funding for well being facilities that serve sure populations recognized as underserved by the federal authorities, together with migratory agricultural employees and folks experiencing homelessness. In 2023, well being facilities served 1.4 million sufferers experiencing homelessness (5% of all sufferers) and 1 million agricultural employees (3% of all sufferers). As well as, well being facilities are additionally required to report knowledge on different populations with identified challenges accessing major care. For instance, three in ten sufferers (31% or 9.7 million) had been rural residents, which is larger than the 20% of the U.S. inhabitants residing in rural areas, and roughly 1 / 4 of sufferers (27% or 8.4 million) had been finest served in a language aside from English.
Well being Middle Affected person Protection and Financing
Fewer than one in 5 well being middle sufferers had been uninsured in 2023, persevering with the decline within the share of uninsured sufferers for the reason that begin of the pandemic in 2020 (Determine 6). As safety-net suppliers, well being facilities serve many sufferers who’re uninsured, enrolled in Medicaid, or who in any other case have issue affording care. From 2019 to 2023, the share of uninsured sufferers dropped from 23% to 18%, whereas the share of Medicaid sufferers elevated from 49% to 51% and the share of each privately insured and Medicare sufferers elevated. The drop in uninsured sufferers is probably going attributable to the results of pandemic-era protection protections, together with the Medicaid steady enrollment provision, which briefly halted Medicaid disenrollments from March 2020 by way of March 2023, and enhanced subsidies for Market protection, enacted in 2021 and prolonged by way of 2025. After March 2023, states resumed disenrollments as a part of the unwinding of steady enrollment in Medicaid, and nationwide Medicaid/CHIP enrollment has since declined. As a result of the unwinding was nonetheless ongoing into 2024, the total impact on well being middle sufferers’ well being protection won’t be clear till knowledge for 2024 and 2025 can be found.
In 2023, complete well being middle income was $46.7 billion, with Medicaid comprising the most important supply of funding (Determine 7). Over two-thirds (68%) of well being middle income got here from funds from Medicaid, non-public insurance coverage, Medicare and self-pay sufferers, with Medicaid accounting for over 60% of affected person care income and 43% of complete income. Federal Part 330 grant funding, which helps well being facilities’ function as security internet suppliers, made up 11%. COVID-19 funding, which is about to run out after 2023, accounted for 4% of complete income. Analysis means that the impression of the expiration of those funds on well being middle financing could also be higher for well being facilities positioned in rural areas and within the South, and people with larger shares of sicker, uninsured, and unhoused sufferers as a result of they typically obtained larger COVID-19 funding on a per affected person foundation.
Well being middle income has elevated since 2019 partly due to the supply of COVID-19 funding and different supplemental funding in the course of the pandemic. Income from payers has additionally elevated in response to the expansion in sufferers. Though Medicaid stays the most important supply of funding, Medicaid income as a share of complete well being middle income decreased from 44% in 2019 to 43% in 2023 (Determine 7). On the similar time, funds from non-public insurance coverage and Medicare each elevated as a share of complete income. In distinction, Federal Part 330 grant funding remained comparatively flat, rising by solely $200,000 over the 4 years and dropping from 16% to 11% of complete income.
After rising in the course of the pandemic, the nationwide well being middle internet margin fell to 1.6% in 2023 (Determine 8). The rise in well being facilities’ internet margins, which account for each prices and income and are reported as a proportion of income, was pushed primarily by the rise in COVID-related and different supplemental funding in the course of the pandemic. The drop within the internet margin in 2023, which continues to be barely larger than the margin in 2019, mirrored larger prices because of inflation in addition to the expiration of COVID-19 funding.
Well being Middle Providers
Well being facilities supplied greater than 132 million visits in 2023 (Determine 9). Most visits (66%) had been for medical providers, although well being facilities additionally supplied a variety of different medical and supportive providers, together with psychological well being and substance use dysfunction (SUD) providers (13%), dental providers (12%), imaginative and prescient providers (1%), and different skilled providers (3%), which embrace providers equivalent to diet counseling, bodily remedy, and conventional therapeutic. Enabling or supportive providers, that are non-clinical providers like case administration, transportation, and well being schooling that facilitate entry to care, represented 6% of all visits. Well being facilities are required by federal legislation to offer major care and supportive providers, and so they might provide dental, imaginative and prescient, or different providers relying on affected person want and organizational capability.
Extra sufferers are returning to in-person care however reliance on telehealth continues. In 2023, well being facilities supplied 17.5 million telehealth visits, which represented 13% of all visits (Determine 10). The variety of telehealth visits peaked in 2020 at first of the coronavirus pandemic when 28.5 million visits (25%) had been performed by way of telehealth however has declined yearly since. Regardless of the lower, telehealth nonetheless represents an essential means for sufferers to entry well being middle providers in 2023, notably since some sufferers face geographic and transportation boundaries that may make it harder for them to attend in-person visits.
Roughly two-thirds (68%) of grownup sufferers have utilized supportive providers which might be designed to scale back socioeconomic boundaries to well being care. In accordance with a 2022 survey of well being middle sufferers, 65% of grownup sufferers reported ever receiving sure medical-related help providers and 22% reported ever receiving economic-related help by way of their well being middle (Determine 11). The medical-related help sufferers reported receiving included assist arranging medical appointments exterior of the well being facilities (46%), well being schooling providers (24%), free treatment (19%), transportation to medical appointments (11%), interpretation throughout medical visits (8%), and residential visits to debate well being wants (3%). Well being middle sufferers reported receiving economic-related help that included assist making use of for presidency profit packages like Medicaid or diet help (17%), acquiring meals (7%), discovering a spot to stay (4%), acquiring clothes or footwear (3%), and discovering employment (2%). Well being facilities present economic-related providers on-site or by way of referrals. Whereas the survey identifies among the most typical sorts of supportive providers, the listing will not be complete.
Well being Middle Affected person Expertise
Roughly eight in ten sufferers reported that they had been in a position to get appointments as quickly as they wanted at well being facilities in 2022 (Determine 12). Based mostly on self-reported responses, 60% of well being middle sufferers reported they had been “all the time” in a position to get a check-up or routine care as quickly as they wanted whereas 21% mentioned they might “normally” get care as shortly as wanted. For sufferers who wanted quick or pressing care prior to now 12 months, three-quarters reported they had been “all the time” (54%) or “normally” (21%) in a position to the care they wanted straight away.
Throughout racial and ethnic teams, most well being middle sufferers reported optimistic experiences interacting with well being middle medical doctors and different professionals, however Black and Hispanic sufferers had been much less seemingly than White sufferers to say medical doctors or well being professionals defined issues in a means that was simple to know (Determine 13). Greater than 9 in ten well being middle sufferers (95%) reported that they had been normally or all the time handled with respect by medical doctors or different professionals at well being facilities. There have been no variations within the share of White, Black, and Hispanic adults who mentioned they had been handled with respect. Equally, 93% of sufferers mentioned well being middle workers normally or all the time listened to them, with no variations between White, Black, and Hispanic sufferers. These findings for well being middle sufferers distinction with different KFF analysis that reveals Hispanic, Black, Asian, and American Indian or Alaska Native adults are extra seemingly than White adults to report unfair therapy by a well being care supplier because of their race and ethnicity, which might negatively impression their well being and well-being. Nonetheless, Black and Hispanic sufferers had been much less seemingly than White sufferers to report that well being middle medical doctors or well being professionals defined issues in a means that was simple to know.
