In 2011, area health care providers in and around Bemidji-Beltrami County, Minnesota set out to determine if the community should pursue the development of a Federally Qualified Health Center (FQHC) or some version of a community health center. This is an economically depressed area, with high poverty rates and alarming health disparities. Recent citing of Beltrami County as 84th out of 85 ranked counties in the state for health factors (Robert Wood Johnson Foundation) inspires us to find solutions to better serve low income, uninsured and marginalized people.
Federally Qualified Health Centers receive a number of attractive benefits and for more than a decade, the Minnesota Association of Community Health Centers has identified Bemidji and Beltrami County as having an unmet healthcare needs and no such community health center to meet that need.
In September 2011, a federal planning grant was received, with the goal of positioning the community for a FQHC New Access Point Grant submission, or to develop a unique community-based solution that would better address the community’s needs.
Exhaustive efforts were made in include all aspects of the community in the conversation. Two tracks of activities occurred in tandem—a comprehensive community health needs assessment (required by the grant) and a planning process to design an effective approach to address the needs identified in the assessment. Some envisioned construction of a new clinic; others were not so sure.
The health care needs assessment was completed and distributed in early April 2012, outlining health priorities and determinant factors for health care for the target population. The assessment results demonstrated that our community has a robust health care delivery infrastructure in place for primary and dental care, with some capacity issues for mental health services—none of which dictates a necessary solution of another building. Planning team members concede that the ultimate “dream” would be a new, all encompassing clinic—but recognize the reality that, not only is it not financially feasible or sustainable at this time, there is little evidence that it would address the core disparities and access issues raised by the assessment. Rather, the report points to the fragmentation of current systems and lack of continuity among providers. Additional barriers such as transportation, health literacy, mistrust of the system—challenge us to look at how we, as a community, deliver care, not necessarily how we increase the number of facilities that provide care.
The conversation took a different course when, in February of 2012, the landscape of the projected federal funding for Community Health Centers shifted dramatically, with the hope of new FQHC access point funding essentially gutted by Congress. Not to be deterred, in the final weeks of the planning, the Planning team focused on those things that could be accomplished with local resources and that could keep the community on the path toward the vision of a community health center in years to come.
The concept of phases to development emerged, as a way to pursue the larger goal in incremental steps that are manageable and sustainable. The completion of the community health assessment is our foundation for formulating those next steps and will boost efforts to secure additional grant funds for service expansions.
The work ahead will require service providers, who have an interest in the target population, to put their heads together to determine what CAN be done with existing resources, to address the needs outlined in the assessment.
The journey to create something this substantial is long and arduous, but will be highly rewarding when our community health outcomes improve.
Special thanks must be extended to all those individuals and organizations who invested time, energy, expertise and moral support to this process. We submit that this report does not constitute the end of the process, rather the beginning, a roadmap for reaching the vision of a community health center.
Report to the Community - Planning Phase - Year One