Just north of downtown Woodland, the Peterson clinic runs out of what used to be a one-story county hospital, built after world war two. Low income and uninsured people come here for health care. But not for much longer. The county wants to demolish the building. And that's just fine for Communicare CEO Robin Affrime.
"It would be so expensive to make it work, the way that we would like to present a community health center," says Affrime.
"We've been growing a lot over the last number of years, and we also expect a surge of patients that are newly eligible for health coverage. So...we need to be ready."
Affrime says they expect a 25% increase in patients at their Woodland site starting next year under the Affordable Care Act. So she's been working on a grand plan for a facility to serve them.
Communicare recently broke ground on the construction of a brand new clinic. It's right across the street from Peterson.
"The first time I came on the site, the sound of the tractors was music to my ears," said Affrime, looking at tractors moving around dirt and debris on the construction site. "A year from now, this site's going to have a beautiful new, 21,000 square foot building."
More than half the money for the new clinic comes from a five million dollar federal grant made available through the federal health law.
The new clinic will not just be bigger - it will have a different model of care. Affrime says it will be like "one-stop shopping." Many services - dental, medical, substance abuse treatment - all in one building.
This idea - of a "patient-centered medical home"- is being advanced under the Obama administration.
Dylan Roby with the UCLA Center for Health Policy Research says it's part of a push to improve the quality and efficiency of care.
"Health information technology, developing these team based approaches to care... So there's a little more funding designed to enhance the health centers we already have."
"Investing one dollar in a federal qualified health center might end up saving you two or three dollars in Medicaid claims, and in-patient and ER visits because of the fact that they're enabling patients to avoid those high dollar, more significant acute care episodes," says Roby.
Community clinic advocates are thrilled by the federal investment. But there's a problem.
"California has a very significant workforce crisis," says Carmela Castellano-Garcia directs the California Primary Care Association. She says a limited supply of family physicians in the state already has community clinics struggling to get the doctors they need. Soon, the problem will get worse.
"Community health centers are really feeling this," explains Castellano-Garcia. "They are having challenges with recruiting physicians; they are having challenges with retaining physicians as there's increased competition now because everybody's trying to expand and gear up for healthcare reform. Not just the community health centers, but the entire healthcare industry is facing the impact of this crisis."
The Affordable Care Act does offer financial incentives to primary care doctors who work in underserved areas. Some may want the stability of a clinic setting as opposed to starting their own private practice. But either way, Castellano-Garcia does expect a bumpy start next year.
"In Massachusetts when the healthcare reform happened, quite frankly the community health centers were overwhelmed. There was a tremendous demand on them. I actually believe that the community health centers will be quite popular in 2014 as well, and that we will probably be struggling to keep up with the demand," says Castellano-Garcia.