Wouldn't it be great if every American man, woman and child had a health care home where the doctors and other medical professionals knew them and worked to keep them healthy, where their caregivers consistently provided sound advice about preventing illness, where they would be charged only what they could afford to pay?

Models for this ideal of health care reform are just down the street in thousands of U.S. cities: community health centers.

In 2007, more than 1,200 health centers were operating in nearly 7,200 sites, caring for more than 16 million patients, according to the Kaiser Commission on Medicaid and the Uninsured. Seventy percent of the patients (10.2 million people) served by health centers nationwide in 2007 had incomes below the federal poverty level, and only 9 percent were above 200 percent of poverty, according to a Kaiser report released earlier this year.

"The community health centers are developed around the needs of the community, the hours, services, initiatives," said Lil Anderson, RiverStone Health chief executive in Billings. "Community health centers have been medical homes since their inception. It's a buzzword now, but we've been doing it for 40 years. It really is broader than 'medical' home. We're a health care home where people are connected to many more health services." Those services include dental, mental health and transportation.

"We have a very high success rate of keeping them once we get them in the system," Anderson said. "They like the care they get here."

Patient-majority board

Anyone can get care at a community health center. What they are charged is based on their ability to pay, with federal funding subsidizing low-income patients.

A unique requirement for community health centers is that patients make up the majority of governing board members. Sondra Daly is part of that majority on the RiverStone Clinic board. Daly has been a RiverStone dental clinic patient for years because she's sold on the high quality of care provided by Dr. Michael Downing and other staff members. Since her job is downtown, she appreciates the convenience of the downtown clinic. Unlike most RiverStone patients, Daly can afford to pay her bills in full.

She recommends the dental and primary-care clinics to family and acquaintances, especially those who don't have insurance, and she even distributes RiverStone brochures to customers in her shop.

"I think it's outstanding," Daly said of the quality of care she has received. "This whole RiverStone Health is one of the most phenomenal things I've seen."

Health center patients are much more likely than patients at private practices to have serious and chronic health problems and to be low income. Nevertheless, health centers have been successful in caring for this needy population. The Kaiser researchers reported that health centers:

n Have been shown to exceed national benchmarks on standards of diabetic care.

n Outperformed other practice settings on preventive care.

"Specifically, health center patients were more likely to receive preventive services such as counseling on diet, smoking cessation and alcohol consumption," the Kaiser report said.

The report identified access to specialty care, staff recruitment and investment in information technology as common struggles for health centers. RiverStone has surmounted those challenges. Most of the physicians on RiverStone's staff are the residents and faculty doctors of the Montana Family Medicine Residency. Additionally, RiverStone has nurse practitioners and physician assistants who provide primary care. Riverstone "went live" in January with electronic medical records in a system that connects it to both Billings Clinic and St. Vincent Healthcare. So if a RiverStone Clinic patient is treated at either hospital, her doctor there has access to her medical record. And Billings is "very fortunate" that the hospitals and private medical specialists here accept patients referred by RiverStone, Anderson said.

25 centers and satellites

Montana has 14 community health centers scattered across the state, from Libby to Miles City. Additionally, those centers operate 11 satellite centers that operate in smaller towns such as Bridger, Joliet, Worden and Harlem.

While President Barack Obama and members of Congress, notably Montana Sen. Max Baucus, try to figure out how to deliver health care reform, they ought to consider how community health centers are meeting these needs and aim to replicate or expand their successes for the benefit of more Americans.

As Anderson said: "There's no reason to reinvent the wheel.