With full implementation of the health care law on everyone's mind, from providers to insurers to employers, federally qualified health centers have long been viewed as a critical piece of expanding access, many of them anticipating an influx of new patients and thus an increase in services.

But while the Affordable Care Act will add significant funding for the nonprofit health sector, such health centers are rapidly evolving on their own, in part to address changes in health care but also in response to increasing demand, according to North Bay health center executives.

What that essentially means is that health centers are increasingly expanding to include more than just the primary care and safety-net offerings they've traditionally focused on and adding new, more nuanced and complementary services such as mental health, nutritional education and others.

[caption id="attachment_66403" align="alignright" width="108"] Kathie Powell[/caption]

"We've really added some complementary medicine," said Kathie Powell, chief executive officer of Petaluma Health Center.  "And basically the reason we're doing that is because we get so much better outcomes."

Yet health centers will also face some unique challenges of their own, particularly as more of the population obtains health insurance, either through a significant Medicaid expansion or through state-run health exchanges, where individuals will be able to shop for insurance with federal subsidies for those who quality.

Although it's unlikely that health centers will see their demand lessen significantly as a result, health centers should still be considering how they can attract new patients while maintaining their existing base, according to Mark Knight, a Santa Rosa-based health care consultant.

[caption id="attachment_66401" align="alignright" width="120"] Mark Knight[/caption]

"Clinics will have a lot more insured patients, so the question now is, how are the community clinics gearing up for that?" Mr. Knight said.

Mr. Knight said not all health centers will be as well prepared, and those that don't plan carefully could see their patients go elsewhere as options increase under the health bill.

"The wait-and-see approach is not a good one, and their volumes could go down," Mr. Knight said.

Several of the region's largest health centers are not waiting, taking proactive measures to expand their populations. But the focus remains on preventive, primary care and improved health outcomes.

"We are offering more services, branching out in what we think is primary care and what we think affects primary care," Ms. Powell said, specifically pointing to a strong shift toward meeting an unmet need of mental health care and other integrated medicine.

[caption id="attachment_66400" align="alignright" width="154"] Naomi Fuchs[/caption]

For the past decade or so, health centers have continually met an unmet need, often doing so by becoming innovative, medical homes for an under-served patient base, said Naomi Fuchs, executive director for Santa Rosa Community Health Centers.

"We've been preparing for this for years," Ms. Fuchs said. "We already offer so many services for all people."

For Santa Rosa Community Health Centers, a concerted effort is now focused on treating Medicare patients who traditionally have been privately insured and who used private physicians.

"Really in the last year, we've been trying to make sure everybody understands we offer Medicare, really making sure we have systems to deal with chronic illnesses," Ms. Fuchs said.

While it may seem that there could, in theory, be more competition from more traditional providers as more people become insured, health centers expect the demand to stay roughly the same, chiefly because of a lack of primary care physicians that will keep their services in high demand.

[caption id="attachment_66404" align="alignleft" width="108"] Mary Szecsey[/caption]

Mary Szecsey, executive director for West County Health Centers, said the situation for rural providers is a bit different.

"We think we're pretty well positioned," she said. "It's a little bit different for us."  

In rural West County, the group of health centers already takes care of about 14,000 people out of the 48,000 in the service area.

"The majority of the low income and Medi-Cal patients already see us. I don't see flocks of new Medi-Cal people in West County," she said, adding that there simply aren't as many options in the area.

But that hasn't stopped the health centers from incorporating new services.

"The other thing that I know is going to help is that we opened the Forestville Wellness Center. It's not something you would find in just any family practice setting," Ms. Szecsey said.

Other measures include tele-medicine with institutions like UC Davis or Stanford, which allow for some specialty services to be offered.

All three health centers said that outreach and marketing would need to increase, particularly related to debunking the antiquated notion that clinics are the last resort.  And each health center is eying continued expansion, whether through opening new locations or perhaps expanding weekend hours, particularly as demand steadily increases.

Ms. Powell, of the Petaluma Health Center, said health centers may want to consider partnering with hospital physicians in providing more acute-type care over the weekend, although it's still too soon to say if that would happen.