For decades, federally qualified health centers (FQHCs) — facilities that are federally funded to provide primary care services to individuals regardless of ability to pay — have played a central role in increasing access to health care for medically underserved areas, historically marginalized populations, and people with low incomes. A recent report and series of case studies from The Pew Charitable Trusts and the Center for Health Care Strategies (CHCS) highlights ways that these health centers can work to expand access to medications to treat opioid use disorder (MOUD).
In recent years, FQHCs have increasingly worked to address the overdose crisis and treat opioid use disorder (OUD) because the patients they treat are disproportionately affected. In fact, nearly one in five adults with OUD are uninsured and six in 10 are considered low-income, illustrating the strong overlap between those with OUD and the populations FQHCs serve.
The federal government has added significant funding in recent years to help FQHCs treat substance use disorders (SUDs), including providing MOUD — considered the most effective treatment for the condition. This has increased the portion of centers offering these therapies, but more progress is needed; as of 2019, 34 percent of centers did not offer MOUD.
Pew partnered with CHCS to better understand barriers limiting FQHCs from providing MOUD, as well as ways to help centers expand access to these lifesaving therapies. The findings illustrate a range of clinical, operational, and financial approaches that health centers can use — which some centers are already implementing — to provide comprehensive care to patients with OUD. The resulting report and series of case studies highlights ways that health centers, states, and federal agencies can work to help expand access to treatment.
There are many issues directly linked to successfully treating patients with MOUD, including those at the provider level and organizational factors such as management practices, climate, and culture. To help prepare staff to work more effectively with people who use drugs, to offer MOUD, and to create a culture that facilitates access to and engagement in care as well as related services and supports, FQHCs need financial support. The centers also need educational and training opportunities to help reduce stigma around OUD.
In addition, FQHCs should consider adopting evidence-based harm reduction approaches designed to lessen the negative effects of drug use, such as offering naloxone, the opioid overdose reversal drug. Health centers could also work to address housing instability; for example, by strengthening partnerships with local housing and homeless services organizations or applying for a specialty designation to become a Health Care for the Homeless grantee. In addition, FQHCs could partner with certified community behavioral health clinics, as such previous partnerships have yielded an array of benefits in supporting patients with OUD.
States can use a variety of policy and program tactics to support FQHCs in providing OUD treatment, which fall into three categories: (1) funding and reimbursement strategies; (2) workforce development and partnership support; and (3) reviewing and amending regulations and policies that may impede access to MOUD. In particular, states can use opioid settlement funds to support MOUD, leverage grants to support clinician training and capacity building to provide OUD services, and use grants to fund partnerships between FQHCs and other community entities such as opioid treatment programs (OTPs), the only health care facilities where patients can receive the medication methadone for OUD.
As the primary funder for FQHCs, the federal government plays an important role in increasing access to MOUD in these settings. Federal policymakers can create supplemental funding opportunities for health centers, support the use of OUD-specific quality measures to understand how well efforts to connect patients to care in FQHCs work, and maintain telehealth policies that connect more people to treatment who may struggle to access in-person care. The federal government can also clarify guidance on SUD data sharing.
FQHCs are ideal locations to offer MOUD, and numerous opportunities exist to increase access to MOUD and connect patients to care in these settings. The findings from Pew and CHCS’ recent work outline opportunities that these health centers and state and federal policymakers can take advantage of to help improve the lives of people with OUD.
*Leslie Paulson and Jane Koppelman are senior officers working on Pew’s substance use prevention and treatment initiative. Meryl Schulman leads projects at CHCS related to integrating substance use disorder treatment into primary care. This blog post was originally published by Pew Charitable Trusts.