BREAK

THROUGH
How Expanding Health Centers and Improved
Health Insurance Coverage ARE Improving
Outcomes for Detroit and Wayne County Residents

July 2016

This report was compiled by Rachel Easley for Covenant Community Care,
an FQHC based in Detroit, Michigan.
Data used in this report represents the most accurate
and recent data available as of July 2016.

Breakthrough
Affordable, quality health care has come to Detroit and Wayne
County. Too long considered the privilege of the wealthy and middle
class, services like annual physicals, dental check-ups, and behavioral
health care are being offered to poor and low-income residents of
Wayne Countyand are being utilized at unprecedented rates.
In seven years (from 2007 to 2014), the number of Federally
Qualified Health Centers (FQHCs) in Detroit and Wayne County has
increased by nearly 50%, and the number of patients served by these
FQHCs has surpassed 100,000 and is still on the rise.
A 2009 report created by the Michigan Primary Care Association
delved into the unmet health care needs of Detroit and surrounding
areas, and called specific attention to gaps in coverage by FQHCs.
With updated statistics and additional information, our report now
seeks to offer a data-rich celebration of how far FQHCs in Detroit and
Wayne County have come in just a handful of years.

KEY TERMS USED IN THIS REPORT:

FEDERALLY QUALIFIED HEALTH CENTER (FQHC): FQHCs receive federal
grant money under Section 330 of the Public Health Service Act, and also
receive alternative payment from Medicaid and Medicare. In order to
qualify, FQHCs must meet a series of stringent federal guidelines.
LOW-INCOME: The term low-income describes individuals and/or
families whose income is less than 200% of the federal poverty
threshold, calculated based on household income and number of
dependents. For example: in 2016, a 4-person family in the contiguous
United States with a household income of less than $24,300 would be
in poverty, and the same family with a household income of less than
$48,600 would be considered low-income. Low-income includes
individuals and families under the poverty threshold.

Demographic Shift
The demographic makeup of
Detroit and the surrounding
areas has shifted significantly
even in the short time period
of the last decade. According
to US Census data, from 2005
to 2014 the total population of
the city of Detroit dropped by
nearly 20%, while the lowincome population of the same
area decreased by less than 4%
over the same time perioda
sign that higher-income families and individuals are continuing to leave the city.
Data Source: U.S. Census Bureau, American Community
Survey 1-Year Estimates (2006, 2008, 2010, 2012, 2014)

Meanwhile, the number of lowincome residents of the surrounding area (Wayne County
excluding the city of Detroit) has
increased by more than 27%, revealing that the suburbs share
of Wayne Countys low-income
population is steadily rising.

Data Source: U.S. Census Bureau, American Community

Survey 1-Year Estimates (2005 and 2014)

Health Care Access

As the low-income population of Wayne County has shifted, the
areas FQHCs have moved to address their needsexpanding not
only in terms of capacity, but in terms of geographic coverage. Since
2007, the net number of FQHC clinic sites has increased by nine (9)
sites and expanded to eleven (11) previously unserved zip codes.
(Location shifts in existing clinic sites account for zip code expansion
being higher than net clinic site increase.)

Geographic Distribution of Clinic Sites in Wayne County

2007

2014
Maps created with UDS Mapper

LEGEND:

Clinic Site

Clinic Site, new since 2007

City of Detroit

Number of Clinic Sites Offering

On-Site Services, 2014

The scope of services offered has

also risen since 2007, when the
on-site focus was on primary
care. At that time, additional
services such as dentistry and
mental/behavioral health
services were available mostly by
referral. Today, many clinics
offer primary care, OB/GYN care,
dentistry, pediatrics, behavioral/
mental health services,
pharmacies, and laboratories
(for medical testing)all on-site.
5

Total Clinic Sites

30

Primary Care

28

Dental

14

OB/GYN

16

Pediatrics

23

Mental/Behavioral Health

17

Pharmacy

13

Laboratory

19

Health Care Access Points

Services Offered *

Organization
Clinic Name, Site Address
Advantage Health Centers
Advantage Family Health Center
4669 E. Eight Mile Rd, Warren, MI 48901
Bell Community Health Center
882 Oakman Blvd, Detroit, MI 48238
Childrens Dental Center
79 W. Alexandrine, 3rd floor
Detroit, MI 48201
Thea Bowman Community Health Center
15400 W. McNichols St
Detroit, MI 48235
Waller Health Center
60 E. Warren, Detroit, MI 48201
American Indian Health & Family Services
American Indian Health & Family Services
of SE Michigan
4880 Lawndale St, Detroit, MI 48201

Community Health & Social Services Center (CHASS)

CHASS Southwest Center
5635 W. Fort St, Detroit, MI 48209
Covenant Community Care
Covenant Community Care at
Grace Community Church
20901 Moross Rd, Detroit, MI 48236
KEY:

Primary Care
Dental
OB/GYN
Mental/Behavioral Health
Pharmacy
6

Pediatrics
Laboratory

Health Care Access Points

Organization
Clinic Name, Site Address

Services Offered *

Covenant Community Care (continued)

Covenant Community Care at
Joy Southfield
18917 Joy Rd, Detroit, MI 48228
Covenant Community Care at
Michigan Avenue
5716 Michigan Ave, Detroit, MI 48210
Covenant Community Care Royal Oak
27776 Woodward Ave,
Royal Oak, MI 48067

Covenant Community Care Waterman

1700 Waterman, Detroit, MI 48209
The Newton Clinic at
Rutherford Winans Academy
16411 Curtis St, Detroit, MI 48235
Detroit Central City
Detroit Central City
3427 Woodward Ave, Detroit, MI 48201
Detroit Community Health Connection
Dr. Feleta Wilson Health Center
6550 W. Warren Ave, Detroit, MI 48210
Dr. Sophia Womack Health Center
7900 Kercheval, Detroit, MI 48214

East Riverside Health Center

13901 E. Jefferson Ave
Detroit, MI 48215
KEY:

Primary Care
Dental
OB/GYN
Mental/Behavioral Health
Pharmacy
7

Pediatrics
Laboratory

Health Care Access Points

Services Offered *

Organization
Clinic Name, Site Address

Detroit Community Health Connection (continued)

Nolan Family Health Center
111 W. 7 Mile Rd, Detroit, MI 48203
Oscar Pascal Health Center
12800 E. Warren Ave, Detroit, MI 48213
Woodward Corridor Family Medical
Center & Healthy Teen Community Care
Center
611 Martin Luther King Jr. Blvd
Detroit, MI 48201
Health Centers Detroit Medical Group
East Jefferson Health Center
7633 E. Jefferson, Suite 340
Detroit, MI 48214
Greenfield Health Center
23077 Greenfield Rd, Suite 400
Southfield, MI 48075
University Health Center
4201 Saint Antoine, UHC 7A
Detroit, MI 48201
The Wellness Plan (TWP) Medical Centers
TWP East Area Medical Center
4909 E. Outer Dr, Detroit, MI 48234
TWP Gateway Medical Center
2888 W. Grand Blvd, Detroit, MI 48202
KEY:

Primary Care
Dental
OB/GYN
Mental/Behavioral Health
Pharmacy
8

Pediatrics
Laboratory

Health Care Access Points

Services Offered *

Organization
Clinic Name, Site Address

The Wellness Plan (TWP) Medical Centers (continued)

TWP Northwest Medical Center
21040 Greenfield, Oak Park, MI 48237
Wayne County Healthy Communities Health Centers
Wayne County Healthy Communities
Hamtramck Health Center
9021 Joseph Campau
Hamtramck, MI 48212
Wayne Health Center
33030 Van Born Rd, Wayne, MI 48184
Western Wayne Family Health Centers
Western Wayne Family Health Center
Inkster
2700 Hamlin Ct, Inkster, MI 48141
Western Wayne Family Health Center
Taylor
26650 Eureka Rd, Suite C
Taylor, MI 48180
Western Wayne Family Health Center
Lincoln Park
25650 W. Outer Dr
Lincoln Park, MI 48146
KEY:

Primary Care
Dental
OB/GYN
Mental/Behavioral Health
Pharmacy

Pediatrics
Laboratory

* Services Offered refers to services available on-site at each clinic. Most

clinics also offer additional services by referral, but those services have not been
indicated on this chart.
Data Source: Michigan Primary Care Association, 2015-16 Directory: Michigan Health Centers and
MPCA Members

Usage of Health Centers

With the expansion of access
points, usage of Wayne County
FQHCs has steadily increased
since 2007, slowly but surely
increasing the reach of health
care in low-income
communities. The adjacent
graph shows total user numbers
for the past three years and in
the span between 2012 and
2014, FQHCs added nearly
10,000 new patientsa 10%
increase.

Data Source: Health Resources & Services

Administration (HRSA), Uniform Data System

The following pages break

down this usage by service
typemedical, dental, and
behavioral/mental health.

In 2014, Wayne County FQHCs provided care to over 38,000 children.

10

*data unavailable 2008-2011

2007 Data Source: Michigan Primary Care
Association, 2009 Guide to Michigan
Community Health Centers. 2012-2014 Data
Source: Health Resources & Services
Administration (HRSA), Uniform Data System.

Since 2007, the number of

patients using medical services
of FQHCs has increased by
20%, and continues to grow.
Over 80,000 patients are
served annually by these
services, which include primary
care, pediatrics, and ob/gyn.

11

2007 Data Source: Michigan Primary Care

Association, 2009 Guide to Michigan
Community Health Centers. 2014 Data
Source: Health Resources & Services
Administration (HRSA), Uniform Data System.

Dental service usage

has increased by a
whopping 535%
thats 24,000 more
Wayne County
residents who are
enjoying healthier,
more comfortable
mouths as a result of
FQHC efforts.

This is in large part due to the expansion of access to dental clinics.

In 2007, only a few clinic sites offered on-site dental care, and only
on a small scalein 2014, fourteen different clinic sites throughout
Wayne County provided affordable dental care to low-income
residents, averaging 2,000 dental patients per clinic.
12

2007 Data Source: Michigan Primary Care

Association, 2009 Guide to Michigan
Community Health Centers. 2014 Data Source:
Health Resources & Services Administration
(HRSA), Uniform Data System.

Prior to 2007, all mental and behavioral health services were offered
by referral only. When the 2007 data was collected, FQHCs were
beginning to develop on-site mental/behavioral health services but
hadnt yet generated significant data. 2014, however, tells a new
storysince 2007, behavioral health services have grown from brand
new beginnings to 4,000 patients.
Low-income individuals are at a disproportionate risk for mental and
behavioral health issues that can make self-care and medical followthrough difficult. For this reason, mental and behavioral health
services are key to producing significant positive health impact in
low-income communities.
FQHCs realize thisand in 2014, seventeen Wayne County clinic sites
offered on-site mental/behavioral health services, from behavioral
health specialists who assist in doctor-patient interactions to
counseling services for depression, anxiety, and more.

13

Health Insurance
Federal activity has heavily
influenced the insurance
statuses of low-income
residents since 2010. As
reflected in the adjacent
graph, the initial reforms of
the Affordable Care Act
contributed to a slight
decrease of uninsured
persons (both locally and
nationwide) from 2010
through 2013. When the
full power of the Affordable
Care Act kicked in at the
beginning of 2014, the
percentage of uninsured
Data Source: U.S. Census Bureau, SAHIE
persons dropped even more
significantly. In Wayne
County, the percentage of uninsured individuals dropped from
15.8% in 2013 to 12.2% in 2014. Though behind the State of
Michigan in uninsurance rates, Wayne County continues to beat the
national uninsurance average.

Where are the uninsured

going? To Medicaid, or to
Michigans state health care
option, the Healthy Michigan
Plan. Taking effect in April of
2014, Healthy Michigan
specifically targets uninsured
individuals under 133% of
the federal poverty level.

14

Data for the Healthy Michigan Plan picks up where national year-byyear data leaves off, offering further confirmation of an impressive
trendwith the expansion of insurance availability, previously
uninsured individuals are taking advantage of their new insurance
options.

2015

2014

2016

Data Source: Michigan Department of Health & Human Services, Healthy Michigan Plan Health Plan
Enrollment

Since its inauguration in April of 2014, the Healthy Michigan Plan has
recruited nearly 134,000 individuals to its rolls in Wayne County
alone. FQHCs have participated in this success by employing
enrollment teams to identify and assist eligible individuals in
health care plan enrollment.

15

Because of the direct overlap in target demographics, the impact of

Affordable Care Act reforms and introduction of the Healthy
Michigan Plan are readily apparent in data specific to individuals
utilizing FQHC services. Though again this data is only available
through 2014, in 2014 (the first year of implementation) the
uninsurance rates of FQHC users had already dropped to 25%.

2007 percentages calculated with data from the Michigan Primary Care Associations 2009 Guide to
Michigan Community Health Centers. 2014 percentages calculated with data from HRSAs Uniform
Data System, 2014 Health Center Profiles.

Three years of numerical data reinforces the trendwhile the total

number of patients at FQHCs continues to rise, the total number of
uninsured patients is falling, replaced by publically-insured patients.

Data Source: Health Resources & Services Administration (HRSA), Uniform Data System

16

Health Outcomes
With increased access options and expanded insurance opportunities,
FQHCs are leading the charge towards a healthier Detroit and Wayne
County. Even within a relatively short timespan, data reveals
important improvements in standard community health measures.

Low Birthweight
Globally, low birthweight statistics are used to identify health status
and trends in communities. Low birthweight offers not only an
indicator of maternal health (BMI, nutrition, risk behaviors), but is
also often used as a predictor of the infants future development and
health.
Low birthweight refers to an infant weighing less than 2,500 grams
(approximately equivalent to 5.5 pounds) at birth. In the chart below
(and the others that follow), statistics have been split into three
geographic categoriesthe state of Michigan, the city of Detroit, and
Wayne County excluding the city of Detroit. A stark contrast is visible
between the city of Detroit and everywhere elseeven as the lowincome population
increases in Wayne
County (see page 4),
the percentage of low
birthweight babies has
suffered only a slight
uptick.
As a statistic, the
percentage of low
birthweights in
Detroit and Wayne
County have
stagnated over the
past decade, despite
an increase in access
to health care for atrisk populations.

Data Source: Michigan Department of Health & Human

Services, Division for Vital Records & Health Statistics

17

Geographic Area Data Source: Michigan Department of Health & Human Services, Division for
Vital Records & Health Statistics
FQHC Data Source: Health Resources & Services Administration (HRSA), Uniform Data System

The low birthweight statistics for patients of Wayne County FQHCs

show a similar patternbut with significantly lower numbers. FQHC
low birthweight percentages have consistently fallen significantly
below those of Detroit, and below Wayne County and the state of
Michigan for two out of three available data years, proving that
indeed FQHC usage leads to healthier pregnancies and babiesand
as FQHC access continues to increase, we can expect the numbers
for Detroit and Wayne County to improve.

18

Infant Mortality
Infant mortality rates are another important indicator of community
health, and often reflect patterns of maternal risk behaviors and
proper prenatal care. Infant mortality refers to the death of a child
before reaching the age of onerates are calculated per 100,000 live
births.

Data Source: Michigan Department of Health & Human Services,

Division for Vital Records & Health Statistics

In Detroits case, infant mortality statistics have improved

significantly (nearly 4 points over the past decade) and are
continuing to dropand thats good news, reflecting an increase in
community health that was not as clearly reflected in the low
birthweight statistics.

Again, Wayne County statistics are calculated excluding the city of

Detroit, and again we see an uptick across the decade (this time
slightly more significant than present in the birthweight statistics),
reflecting the increase in low-income individuals outside of the city of
Detroit. The overall trend, however, retains a downward slope.
19

Heart Disease and Hypertension

Data Source: Michigan Department of Health & Human

Services, Division for Vital Records & Health Statistics

As a risk factor for heart disease,

hypertension provides a portal
through which to inspect FQHCs
treatment of heart disease. From
2012 to 2014, the number of FQHC
patients diagnosed with hypertension jumped by almost 6,000
individualslikely reflecting the
overall increase in individuals
seeking health care. The number of
patients with controlled
hypertension has increased less
drastically, likely because
hypertension management requires
long-term lifestyle adjustments, and
results from the recent increase in
FQHC access will take a few more
years to become apparent.
20

Age-adjusted death rates

for particular diseases give
a snapshot of health on the
other end of the life cycle.
Early deaths from chronic
disease can often be
prevented by proper
screening and careand
therefore death rates
provide a glimpse into the
availability and usage of
quality health care services.
The drop in deaths from
heart disease indicates
success in prevention,
identification, and
maintenance of disease.

Data Source: Health Resources & Services

Administration (HRSA), Uniform Data System

Diabetes
Diabetes data (also ageadjusted) is more
sporadic, but none-theless promisingeach
category shows
improvement across the
decade, with the city of
Detroit boasting
improvement of 5.5
points. The drop in this
death rate indicates a
healthier population, as
well as better self-care
and access to diabetes
medication.
Data Source: Michigan Department of Health & Human
Services, Division for Vital Records & Health Statistics

FQHC-specific data again shows an

increase in diabetes patients, and
again likely indicates that more
individuals with existing diabetes
are seeking health care.
Like with hypertension, control of
diabetes requires long-term lifestyle
changes, and therefore a few more
years of data are needed to track
the trend in rates of controlled
diabetes versus diagnosed diabetes.
Data Source: Health Resources & Services
Administration (HRSA), Uniform Data System

21

Cancer
Cancer deaths have also
been on the decrease
indicating not necessarily a
decrease in the prevalence
of cancer, but rather an
increase in proper
screening for cancer and
better outcomes for
diagnosed patients seeking
treatment.

Data Source: Michigan Department of Health & Human

Services, Division for Vital Records & Health Statistics

22

Cancer screening is an
integral part of FQHC
health care, and physicians
work against social and
economic barriers to
ensure that patients
receive age and genderappropriate cancer
screenings.

Conclusions
Across the city and around the county,
medical and support staff are striving to
bring top-of-the-line health care to the
people of Detroit and Wayne County, and
the residents are responding. FQHCs in
Detroit and Wayne County are riding an
unprecedented wave of success and
building momentum for increased access
and better care.
Even as this report is being published, area FQHCs are planning new
clinic sites, expanding health service offerings, collaborating with
other social service groups to provide additional support to residents
in need, and implementing new visions for reaching those who need
their services the most.
Mobile teams are hitting the streets to bring
health care to the homeless of Detroit, and
Michigans new Health Homes initiative will
bring care management to individuals
suffering from depression or anxiety and
chronic disease.

As data becomes available for 2015 and the

years after Affordable Care Act/Healthy Michigan implementation,
the success of Detroit and Wayne County FQHCs will be further
documented. The early results are already very encouraging.
Barriers to health still exist for many Detroitarea residents, but we are overcoming those
barriers through the concerted efforts of
FQHCs, and the future promises hope and
further growth.
We have had a breakthrough.

23

FQHC Council of Southeastern Michigan

We would like to thank the following health centers
of the FQHC Council of Southeastern Michigan, who
accomplished this breakthrough together:
Advantage Health Centers
American Indian Health & Family Services
Community Health & Social Services Center (CHASS)
Covenant Community Care
Detroit Central City
Detroit Community Health Connection
Health Centers Detroit Medical Group
The Wellness Plan Medical Centers
Wayne County Healthy Communities Health Centers
Western Wayne Family Health Centers

SUCCESS IS A TEAM EFFORT

made possible by our partners:
Health Resources and Services Administration (HRSA)
Michigan Primary Care Association (MPCA)
Authority Health (formerly Detroit Wayne County Health Authority)
Voices of Detroit Initiative (VODI)
Greater Detroit Area Health Council (GDAHC)
Institute for Population Health
Detroit Health Department
Michigan Department of Health and Human Services
And Local Foundations Who Funded Our Expansion Efforts