06/06/2014 01:09 pm ET Updated Aug 06, 2014

Challenges to Clinics Serving the Poor

By Robert Whitcomb

Last fall, when I was writing about my Cambridge Management Group (CMG) colleagues' work in helping to turn around a previously financially troubled Federally Qualified Health Center (FQHC) called Community Health Connections, based in Fitchburg, Mass., I learned more about the role that these centers play in addressing changing American health-care demographics in general and illness -- especially chronic illness -- in low-income populations in particular.

Such centers will continue to face reimbursement and other issues as the restructuring of the health sector accelerates. The Affordable Care Act, in increasing the emphasis on primary care while more closely integrating it with acute care, will almost certainly increase the importance of FQHC's and other nonhospital treatment centers.

With all the publicity about trying to get everyone signed up for insurance to use at physicians' offices and hospitals, we should keep in mind the need for facilities that are neither hospitals nor physician-group offices in treating under-served populations in such places as the old mill towns of north-central Massachusetts. These places have a high incidence of poor behavioral health and such related chronic diseases as diabetes and obesity, and sluggish economies. Obviously, high unemployment tends to be correlated with serious population-health problems.

Such institutions will have their hands full overcoming the clinical, financial and administrative challenges of meeting new federal and state health-care reform mandates while refocusing the payment structure on fee for value and away from fee for service in a new, far more accountable and evidence-based, health-care sector. And improving behavioral health will be at the center of these efforts.

Who knows what it will all look like in five years?

Robert Whitcomb, a former Providence Journal editorial-page editor, a former finance editor of the International Herald Tribune and former managing editor of several Manisses Communications Group behavioral-health newsletters, is a Fellow of the Pell Center for International Relations and Public Policy.