NorthBay biz interviewed four of the larger community health centers in Marin, Napa and Sonoma counties to discover the special challenges they’re facing as demand for health care services continues to soar—and what they’re doing to meet the need.
It’s been a full year since President Obama signed into law the Patient Protection and Affordable Care Act (PPACA, aka health care reform), the provisions of which are scheduled to roll out in phases over the next three years.
Critical to the act’s successful implementation are the nation’s community health centers (CHCs), which, over the last 40 years, have become the essential primary care medical home for millions of Americans. In 2010, more than 20 million people were CHC patients, one-third of them children.
Because the North Bay is home to a large population of farm-workers—both permanent and migrant—community health centers have always played a major role in the delivery of health care in our community. NorthBay biz interviewed four of the larger CHCs in Marin, Napa and Sonoma counties to discover the special chal-lenges they’re facing as demand for health care services continues to soar—and what they’re doing to meet the need.
Marin Community Clinics
One myth that needs to be dispelled is the demographics commonly associated with those seeking CHC services. It’s true that rural residents, ethnic minorities, the uninsured and those living in poverty still dominate the mix, but an economy in freefall over the last three years has changed the look in many waiting rooms. Nowhere in the North Bay is that more evident than at Marin Community Clinics, now located in Greenbrae, Novato and San Rafael.
“The ethnic composition is changing from minorities and immigrants to more mainstream,” explains John Shen, CEO of Marin Community Clinics (MCC). “We’ve had a great influx of uninsured people—in particular, people who’ve lost their health benefits. One of our physicians told us that the most challenging cases are those people who lost their jobs and their insurance. They have an expectation of services [because of what they had in the past], but we don’t have the assets to order the types of specialty services the patient may have previously experienced. It’s very hard to find specialists who are willing to see uninsured or public program patients.”
MCC got its start 39 years ago as a free clinic operating in an Episcopal church basement in Mill Valley. In 1991, the clinic moved to the Greenbrae campus of Marin General Hospital. It formally became a Federally Qualified Health Center (FQHC, meaning it’s eligible for federal funding) in 2000. In 2001, it expanded into a second location, inside a physician’s office in Novato.
With demand for services on a constant upswing, the MCC board of directors launched a $9.8 million capital campaign in 2007 to build two additional clinics, one in San Rafael and another in Novato. The San Rafael clinic, which opened on Keener Boulevard in 2008, was the first to offer dental care. One year later, the Novato clinic was moved to a larger and more accessible site on Redwood Boulevard. Last October, a second dental clinic was opened in Novato, doubling the organization’s ability to offer pediatric and adult dental services.
MCC provides pediatric, adult medicine, family practice and family planning/gynecological services, as well as mental health and general dentistry. By the middle of this year, it will also offer obstetrical services in a new clinic next to the existing one in San Rafael.
With a full-time equivalent (FTE) staff of 140, MCC now serves 24,000 patients, up from 15,000 in 2007. According to Shen, patient visits have risen from 50,000 to 100,000 per year in the same three-year timeframe, during which the nation took a serious economic hit.
“The economic downturn had a horrible impact on our community,” Shen says. “Since the middle of 2009, we’ve noticed an increase in the number of uninsured patients, including individuals who lost their health benefits. We’ve also had a lot of people coming across county lines and bridges because all of the counties’ [health care] capacities are very challenged right now.”
Shen is blunt. While MCC is working hard to cover the increased demand, he says, “Health care reform is three years away, and our resources will be challenged if this economic trend and an increase in the number of uninsured continues. For us to take care of the uninsured on a sliding fee scale, we need additional federal, state or local resources to bring on new physicians to meet the needs.”
Shen says county and federal grants are “limited to about 15 percent of MCC’s $15 million budget,” and fund-raising is difficult in the current economic environment. At the same time, the state’s “budget gyrations” and occasional payment delays make it even more difficult to make ends meet. The state budget impasses (“now an annual summer event,” he calls it) forces MCC to borrow to meet its financial obligations. “It’s a very challenging time for MCC—and for many community health centers: How do we balance our books and meet the needs of the uninsured, who keep coming to us for help?”
And while health care reform will result in more people having insurance, the community health centers remain caught in a bit of a Catch-22,” in that its own employee health care costs will increase by double digits.
Nonetheless, MCC soldiers on, working in tandem with other local volunteer physician specialists, who donate their time, and with Marin General Hospital and Novato Community Hospital, which provide charity care such as radiology, imaging, lab work and in-patient care. “We can’t do our work without their continuing support and services for our patients,” he says.
Shen also notes local pharmacies, in particular Walgreen’s and Target, work with patients for “the cheapest deal they can get” on prescription medicines, which is critical. “People will come, see a physician and get a prescription, but won’t fill it because they can’t afford to. It’s just another challenge of clinical effectiveness,” he explains.
Community Health Clinic Ole
Like other CHCs in the North Bay and across the nation, Napa Valley’s Community Health Clinic Ole sees both opportunities and challenges with the enactment of PPACA.
“We know that health care reform will result in many previously uninsured individuals having health insurance, as well as more individuals eligible for MediCal. They’ll need a place to go for care along with those who’ll continue to be uninsured,” says Maria Stel, Clinic Ole’s development director.
“We expect to see a significant increase in the number of people coming to Clinic Ole. As a federally qualified health center, we’ve been able to take advantage of federal grants from the American Recovery and Reinvestment Act that has let us add six new exam rooms at our Napa site [the project is due to be completed this spring].”
At a 1972 meeting of a group called the Organization for Economic Latino Liberation (OLLE), a farmworker asked why Napa County didn’t have a health clinic like the one in Healdsburg for low-income, uninsured, Spanish speaking workers. That question mobilized the group to form a committee to establish a clinic in Napa. Thanks to volunteers from Queen of the Valley Medical Center and St. Helena Hospital, a small clinic was opened later that year above La Luna Market in Rutherford.
Over time, Clinic Olle’s acronym evolved into Ole (without the accent mark). Because of the name, “We still have people who think they have to be Hispanic to use our services,” says Stel, but the annual report to the community shows that 30 percent of Clinic Ole’s patients aren’t Latino.
Today, Clinic Ole serves nearly 19,000 patients per year at its main site at the Napa Valley Vintners Community Health Center on Pear Tree Lane in Napa, plus two other clinics in St. Helena and Calistoga as well as weekly clinics at Napa’s two homeless shelters and a student health services clinic on the campus of Napa Valley College. In the first quarter of 2011, it will add a part-time clinic at the Napa County Health and Human Services offices and, in December 2010, it took over a local obstetrician’s practice on Trancas Road in Napa, offering obstetric services for the first time.
In addition to providing comprehensive primary and preventive care and behavioral health services for children and adults, Clinic Ole operates the Sister Ann Dental Clinics in Napa and Calistoga. It also runs a Healthy Moms and Babies prenatal program at locations in Napa, St. Helena and Calistoga, serving more than 750 low-income women each year—representing roughly half the births in Napa County.
Clinic Ole also goes into migrant farm worker housing camps from spring to early fall, conducting health fairs and providing education on pertinent topics, such as lifting techniques, allergies and depression, as well as offering basic health screenings.
Like other CHCs, Clinic Ole is experiencing a major influx of patients. In the last recorded fiscal year (ended June 30, 2010), some 3,000 first-time patients sought medical services. And the economy continued to impact its demographics. Uninsured patients increased to 72 percent from the previous year’s 55 percent and the percentage of patients enrolled in government programs such as Medi-Cal dropped to 25 percent from the previous year’s 40 percent. Only 3 percent of Clinic Ole’s patients have private medical insurance.
“Obviously, our biggest challenge is the fact that the need for our services has grown so much over the past two years due to the faltering economy,” Stel says. “People are losing jobs and their health insurance, so we’re seeing so many more patients. But the need is greater today for all nonprofits, whether they’re providing food, clothing or medical care. At the same time, foundations and individual donors have less money to give.”
Clinic Ole gets half its funds from patient fees (charged on a sliding scale), health insurance and government health programs. The rest it must obtain through grants and fund-raising. Since 1984, Clinic Ole has been a beneficiary of Auction Napa Valley, “which is huge for us,” Stel says. Other major donors include the Peter A. & Vernice H. Gasser Foundation, Napa County Health and Human Services, Queen of the Valley Medical Center, Kaiser Permanente, Blue Shield Foundation of California, Boston Scientific, Tides Foundation, St. Helena Hospital and the California Wellness Foundation, plus the “hundreds and hundreds of individual donors who give us anywhere from $2 or $3 up to $10,000 and more.”
Major change is in the air for Clinic Ole, not only related to PPACA but also in management. Beatrice Bostick, who was the executive director of Clinic Ole for 13 years, retired in January and was replaced by Tanir Ami. According to Stel, strategic planning will be on an equal par with patient care as health care reform measures take effect. “We really need to prepare for the onslaught of even more new patients,” she says.
“There will always be patients without insurance who need places to get care, but with health care reform, there will be more who have insurance. We need to make sure we’re prepared to serve the newly insured as well as the uninsured.”
One big help will be the clinic’s newly installed electronic health record (EHR) system, which will make it much easier to track data and follow up on patients and, ultimately, improve health outcomes. “It cost a lot of money to get it installed and then a lot of time to get personnel trained on the system, which initially slowed us down. But we’re getting back to our normal productivity level, and things will move much more smoothly as a result,” Stel says.
Santa Rosa Community Health Centers
As CHCs go, Santa Rosa Community Health Centers (SRCHC) is relatively new to the scene, having been founded in 1996 by a group of local physicians who had a vision of providing medical services for those living in Southwest Santa Rosa with limited access to health care. They partnered with Sister Michaela Rock of Saint Joseph Health System-Sonoma County, who provided seed money to open a clinic on Lombardi Court in the city’s Roseland district.
“We had one location with seven exam rooms when it opened,” explains Naomi Fuchs, CEO of Santa Rosa Community Health Centers. “Today, we have eight locations—about 94 exam rooms in all—and serve 34,000 people with more than 110,000 annual visits.” There are three school-based clinics, one at Elsie Allen High School, a second at Roseland Elementary School and a third on the campus of Santa Rosa Junior College; the “A-Street” Clinic, which serves the homeless and is co-located with Catholic Charities; the Turning Point Satellite Clinic, which assists those in a residential treatment center operated by the Drug Abuse Alternative Center; and the Southwest Adult Day Services, co-located with Friends House in Rincon Valley. But the pride of SRCHC is the brand new Vista Family Health Center on Round Barn Circle in northeast Santa Rosa, which opened in November 2010 in direct response to the overwhelming and increased demand for CHC services.
“Everyone is struggling for access to health care,” explains Fuchs, who’s been at the helm of SRCHC for 10 years. “Even people who are employed have issues. Many can’t afford their share of the cost of employer-provided health care, or the deductible is too high. And then there are those who’ve lost their jobs.”
Over the past eight years, SRCHC has experienced a 20 to 30 percent increase in patients each year, accelerated by the recent economic downturn. “We’ve always known that need was much greater than our capacity,” Fuchs says, “so we’ve been building capacity over the past five years. The new Vista Family Health Center will let us serve an additional 15,000 people who we anticipate will need our services over the next few years.”
Fuchs says the new center was designed “to support new models of care that are patient-centered and provide a continuous relationship between the patient and physician. There’s a myth that this is a drop-in center, but that’s not true. Everyone seen at Vista has their own personal physician, nurse case manager, medical assistant and front office team. The building is 42,000 square feet with four wings, each of which is a different color so people will remember where their medical team and clinic is. We also have an electronic health records system to keep track of everything related to the patient—mammograms, annual visits, you name it.”
SRCHC purchased the building and completely renovated it—to the tune of $15 million, financed through loans, tax-exempt bonds, grants and individual donations.
Throughout its system, SRCHC offers a wide variety of services, ranging from family practice to mental health and obstetrics. “Our physicians deliver more than 1,000 babies each year,” Fuchs says. It also has a partnership with Sutter Medical Center to train physicians in a family medicine practice residency program. While SRCHC currently doesn’t offer dental services, Fuchs says it’s a priority for the future.
SRCHC currently serves 34,000 people and last year had 110,000 patient visits. It works closely with the medical community in Santa Rosa to provide needed care. “It’s the fundamental tenant of our philosophy,” Fuchs explains. “‘Community-based’ means we work with local hospitals, other community organizations and the Department of Health Services. We have a very close collaboration with all. That means we can better coordinate health care, provide better access to care, and we know where to turn for the right resources. Recent research by the Health Resources and Services Administration shows that community health centers can provide care for 40 percent less cost than private health providers, because our emphasis is on primary care and prevention, coupled with coordination of services.”
Fuchs says health care reform will result in even more demand for services, quoting a Department of Health Services estimate that 45,000 people in Sonoma County who are currently uninsured will gain health care coverage. “As that happens, they’ll want to seek out care,” she says. “They’ll want access to the medical care they need and deserve. Our biggest challenge over the next 10 years will be keeping up with demand.”
Right now, without full implementation of PPACA, Fuchs says SRCHC receives 300 calls per week from people wanting to become patients. “Our mission is to provide health care to all. Keeping up with demand is our biggest challenge,” she says.
West County Health Centers
Sonoma County’s West County Health Centers (WCHC) originally started as two separate nonprofit organizations, Russian River Health Center and Occidental Area Health Center, serving Guerneville and Occidental, according to Mary Szecsey, the organization’s executive director.
“It was back in the 1970s, when a group of local citizens in both towns wanted to make medical care available for rural residents. They started out as separate organizations,” she explains. “West County communities were a lot more isolated than they are now.” Both hired doctors from the National Health Service Corps, a federal program that provides financial assistance to physicians who agree to work in underserved areas.
After years of collaboration, the two organizations agreed to merge to form WCHC in 2000. Today its service area stretches from Fort Ross and Valley Ford to Sebastopol. There are four clinic locations: Guerneville, which offers dental and mental health services in addition to general medical care; Sebastopol (now its largest clinic, which opened in 2008 at the request of Palm Drive Hospital to take the pressure off demands of its emergency room); Forestville, which has a dedicated teen care clinic; and Occidental. It’s also involved in a small partnership with the Graton Labor Center to provide once-a-week health screenings for day laborers. Szecsey says upward of 15,000 people currently depend on WCHC for medical care, and like the other CHCs interviewed, that number is steadily increasing.
“The main impact of the economic downturn is, we’re seeing more patients without insurance. It’s the same phenomenon as everywhere else—people lose their jobs or their employer cuts back on insurance, and they don’t have other places to go for services. We’re definitely seeing a lot more people with higher incomes than we have in the past,” Szecsey says.
Because WCHC is the “sole provider of medical care” in the Russian River area, it’s “always had a mix of patients,” Szecsey explains. “It’s more of an access issue for people who don’t want to drive all the way to Santa Rosa to see a doctor,” she says. As a result, about 30 percent of the patients are on Medi-Cal, 10 percent have private insurance, 10 percent are on Medicare, 10 percent have a combination of coverage from Medi-Cal and Medicare, and 40 percent are uninsured.
The organization manages to get 70 percent of its budget from public and private insurances and patient fees. The remaining 30 percent comes from grants from the federal government, Kaiser Permanente, the Sutter Medical Foundation, Blue Shield Foundation, Redwood Community Health Coalition and other private sources. It also has a contract with the county of Sonoma to provide mental health services in the Russian River area.
“One of the things we’re good at is tak-ing care of the whole person,” Szecsey says. “We believe in a model of care where we offer a whole integrated program of services for each patient who comes in.”
WCHC currently offers orthopedic specialty clinics in Sebastopol, and hopes to provide additional specialty services such as dermatology and neurology in the near future. The organization is also reaching out to physicians to provide needed services via telemedicine and video conferencing. Also in the planning stages is a new site in Forestville that will be focused on wellness and prevention, not just primary care. “We’ll have different programs and services, and we want to use the site for more health education and prevention-focused activities,” Szecsey says.
The biggest challenge Szecsey sees facing WCHC is change management. “But it’s something we’re good at, because we’ve always had to do it,” she says. “As a nonprofit, we’re always looking for opportunities; money is always a barrier, so we’re constantly looking for funding. When the state budget tanked, we lost 10 percent of our total budget and more than 50 percent of the budget for our entire dental program. We’re running that program at a loss now, which is a conscious decision our board has made to keep these services available for our patients. So yes, growth is a challenge. But it’s exciting.”
It takes a village
As health care reform rolls out, it’s evident that community health centers will play an ever-increasing role in delivering top-quality health care to the North Bay. In addition to those organizations profiled here, we want to also mention four other CHCs that serve the underserved.
Petaluma Health Center serves more than 15,000 patients and will open a new 53,000-square-foot facility this year to more than double the clinic’s capacity, thanks in part to a $5.87 million investment from United Heath Group’s California Health Care Investment Program.
Coastal Health Alliance operates Point Reyes Medical Clinic, The Bolinas Family Practice and Stinson Beach Medical Center, serving those living in coastal Marin County.
Sonoma Valley Community Health Center is the largest primary care practice in the Sonoma Valley, operating from three buildings on West Napa Street in Sonoma. It also operates a mobile medical van that travels to outlying schools and the Boyes Hot Springs community.
Alliance Medical Center, with clinics in Windsor and Healdsburg, celebrates its 40th anniversary this year. Originally founded to provide medical services to migrant farm workers and their families, it now serves a diverse range of patients.
There’s an old African proverb that says “It takes a village to raise a child.” A slight alteration could be made: “It takes a village to provide good medical care.” And the community health centers in the North Bay are living proof.
