It was the late 1990s and Cynthia Sierra was working as a clinical neuropsychologist focused on trauma when she first stepped into a community health center (CHC). She felt the pull of the mission — the "joy and the opportunity," as she puts it — and never really left. Her clinical work eventually led to a succession of administrative and senior leadership roles and, two decades later, she is now wrapping up her fourth year as CEO of Manet Community Health Center.
Sierra has overseen a period of steady evolution at Manet, which serves an economically and ethnically diverse population at five sites in eastern Massachusetts. Alongside its core primary care and urgent care services, the health center has expanded integrated care for behavioral health and substance use disorders and offers a growing list of services including vision care and occupational health.
The patient population is growing, too. Manet's newest site, launched with grant funding tied to the Affordable Care Act (ACA) in the small city of Taunton, Mass., has seen its patient volume increase exponentially since opening its doors in 2014, highlighting the long-standing unmet need for primary care in an economically depressed region of the state.
Manet's story mirrors a national trend. Over the past 20 years, thanks in part to the ACA and the expansion of Medicaid, the number of federally funded health centers has nearly doubled, while the number of patients they serve has nearly tripled, to 29 million. (That's roughly 1 in 12 Americans.) And while the traditional focus on primary care remains, health centers find themselves playing a frontline role in addressing the opioid epidemic and providing access to behavioral health services.
Health centers would seem to be thriving and too big to fail. But this is also a fraught time for CHCs. In a repeat of years past, the reauthorization of federal funding — a critical source of revenue for health centers — has been held up by Congress, prompting some centers to consider cutting back on spending. A temporary spending agreement reached in December is set to expire in late May.
With this familiar uncertainty as a backdrop, Sierra sat down with HealthCity at Manet's headquarters in North Quincy, Mass., to discuss the role of health centers and the importance of telling their stories.
HealthCity: How would you describe the role that health centers like Manet play in our healthcare system?
Cynthia Sierra: Health centers are a tremendously important part of the infrastructure. We exist to make sure that the medically and socially most vulnerable have a place to turn. No patient is turned away or left behind. Health centers truly are intended as a care hub for all, regardless of your walk of life, background, country of origin, economic status, vocational status, or linguistic status.
We exist to make sure that the medically and socially most vulnerable have a place to turn.
We do everything we can to understand the influence of social factors in our patients' lives and respond to those needs when they're here with us. That really goes back to our workforce. Our greatest asset is our staff. The majority are from the communities we serve, and many of them have walked in the shoes of those they now serve. Those burdens — whether it's homelessness, a particular disease, addiction and recovery, the experience of being a new arrival — have once, perhaps, been theirs.
HC: Federally funded health centers are required by law to have a patient majority on their board of directors. How does that patient involvement influence the organization and your role as CEO?
CS: How extraordinary is it that we all need to maintain that standard? Health centers truly are created for, and managed by, the community. There isn't a day I enter the office that I don't reflect upon what a wonderful opportunity it is to be governed and led by our patients, because you cannot be more accountable than that.
The patient board members lead the way, and it's because of them and their contributions that we have the ability to offer the services that we do. They're influencing our future direction, and they also remind us of the rich history we have — not only why we exist, but also for whom we are working.
At Manet, we're tremendously proud of the fact that our board has a supermajority of patients and patient family members. Over the last few years in particular, the composition of the board has been well above 51% patients, and that continues to be an aspiration of the board of directors, to go above and beyond in terms of patient representation.
HC: Health centers have grown rapidly in recent years. How do you envision they'll continue to grow and evolve?
CS: We take quite seriously our own commitment to growth and innovation. Whether that means developing our workforce and creating the very best experience for them — making sure we're taking care of the caretakers as they're taking care of their patients. Or innovating our technology, moving into models like telehealth and telemedicine. Or continuing to grow the services that we offer.
Behavioral health is such an important program. Addiction medicine. Wellness programs. Occupational medicine. It's about continuing to grow and be nimble and meet the needs of your community, thinking about what's here and what's coming next.
I think health centers also understand our future is in strong and steady partnerships. For Manet, it's really being smart and thoughtful about our partnerships. It's not only about what our partners are going to provide for us and our patients, but also, how we can best assist and support our partners and our communities.
HC: Behavioral health has been a big focus in recent years, as it has been for many CHCs. What approach have you taken at Manet?
CS: For Manet, there's a great opportunity to move forward with the collaborative care model. Over the past two years we've created a comprehensive program that looks at the whole patient and continues to foster the growth and development of primary care providers and behavioral health providers.
We have a behavioral health director and a staff of LICSWs and interns across the five sites that deliver integrated behavioral health services, as well as warm handoffs and consultation to our primary care providers and behavioral health partners in the community. We're also growing urgent care for behavioral health. In the same way that you'd call and say, "Oh boy, I think I have strep throat," or, "I think I might have an earache," we want our patients to be able to call us to say, "Gosh, I'm really depressed today. Is this a panic attack? I think I'm on the verge of relapse. Can someone see me today?"
HC: You've mentioned addiction several times. How has the opioid crisis impacted Manet and the need for addiction-related care among your patients?
CS: Our health center plunged into this pond with both feet. We were one of the early participants in the Massachusetts Department of Public Health's Opioid Overdose Prevention and Reversal program — frontline, proactive outreach for the loved ones and friends and partners and colleagues of folks who were at risk for overdose. We had a team doing naloxone training in the communities that we serve, and they would say to us, "My goodness, there's not enough treatment options for the families we're working with."
That was back in 2010. Manet had one medication-assisted treatment provider, and she just didn't have any capacity, she was filled so quickly. We knew we needed to build some capacity to respond. The percentage of providers that now provide integrated primary care and addiction care continues to grow, and nearly two-thirds of our providers are now waivered to prescribe buprenorphine. We need to continue to fortify and develop the staff that offer this tremendously important, vital, and ever-growing program here at Manet.
HC: Federal funding for CHCs will be debated by Congress again this spring. What's necessary to ensure that the work of health centers is recognized and preserved?
CS: There are 29 million Americans receiving care at community health centers. That's a significant patient population, and without those base grants to health centers, the vulnerabilities are significant and real. The grants allow health centers to continue to do what they do, but also to grow in those areas such as behavioral health. And it's not just the base grant funding that's at risk. It's programs such as the National Health Service Corps, which is so important to our primary care workforce.
Advocacy is really important — engaging our boards, engaging our communities, engaging the leaders we work with to stand strong and advocate for our future. I feel really fortunate that our congressional representation across the districts that we serve, the mayors and the boards of selectmen and selectwomen that we work with, the committees that volunteer their time, the patients that provide testimonials, and our partners very much understand our value and our place.
As health centers, we have to continue working to improve our visibility and message, to organize our data. We have to continue sharing our stories and our impact. When you keep the patients in the center of it, the joy of serving them is going to radiate and you're just going to make sure your story is heard.