Feeling Fine

Community health centers play an important role in the lives of North Bay individuals and families facing economic challenges.

 

 

There are more than 8,500 community health center (CHC) locations across the United States. Collectively, they serve more than 22 million people each year. Since the inception of the first CHC in 1965, these instrumental medical institutions have continued to play an important role in the lives of individuals and families facing economic challenges. CHCs are known for providing low-cost, quality health care—but the benefits of having a center located in your area reach well beyond the exam room.

 

Looking back

Almost 50 years ago, during a turbulent time in America’s social history, civil rights activists were joined by community health advocates in an effort to raise the 19 percent of Americans living in poverty out of their penurious conditions. From President Johnson’s “War on Poverty” grew the Office of Economic Opportunity (OEO), which launched many new programs including the early childhood learning program Head Start.

 

Early on, some Head Start teachers in Mississippi and Alabama told federal program managers that their students wouldn’t be able to learn until the children’s profound, untreated health care needs were met. Government leaders suggested teachers use some of the OEO grant funds to purchase health care from local physicians only to find that many white doctors refused to treat the black children at any price. Federal program leaders as well as activists knew a system of care had to be developed to specifically address the needs of the poor and disenfranchised.

 

Physician activist Dr. Jack Geiger had spent time in South Africa in the late 1950s and witnessed how that country delivered primary health care services through community-based clinical settings in rural and urban locations. In 1965, Geiger and his colleague, Dr. Count Gibson, with the support of the OEO, founded The Columbia Point Health Center in Boston to serve residents from the nearby housing projects. This was America’s first CHC, and it’s still in existence today.

 

Marin Community Clinics

Linda Tavaszi, Ph.D, is so passionate about the work that gets done at Marin Community Clinics (MCC) that she was lured out of retirement to join the organization as CEO in 2011. Tavaszi, a former New York City social worker who spent her career in the health care industry working with hospitals, including Marin General, Kentfield Rehabilitation & Specialty Hospital and UCSF Medical Center, says she’s always been as an advocate for CHCs. With MCC’s four full-service clinics, two administrative office sites and two teen centers offering clinic services, there’s no doubt her wide berth of experience is fully utilized.

 

Forty years ago, MCC was started in two church basements in Marin County. Years later, Marin General Hospital wanted to ensure patients were being seen at an appropriate level of care (rather than taxing the emergency room system), so a clinic was established in a previously unused structure on hospital grounds in 1990. It was also in the early 1990s that MCC became a Federally Qualified Health Care Center (FQHC). The new classification meant additional regulations, but it also brought much-needed funding to the center as it continued to grow to meet the increasing demands of the county. Today, one clinic is located in Novato, another in Greenbrae, and two are in San Rafael.

 

In 2009, MCC was able to start providing much needed dental care at its clinics in Novato and San Rafael. “It’s been shocking to discover how much unmet dental work exists in such an affluent community,” says Tavaszi. The funds to provide the two dental clinics, including treatment of adult patients who are uncovered by any insurance or aid program, were fueled by the philanthropic community that raised almost $12 million, largely from individuals, with additional support coming from Sutter (through the Marin Community Foundation) and the county of Marin.

 

In 2008, MCC saw about 14,000 people. Today, it’s serving 32,000 unduplicated patients annually. A client’s income must be less than 200 percent of the Federal poverty level guidelines to qualify for MCC’s sliding scale fees. If they earn more, they can still use the services, but they’d have to pay the full fee. In 2012, a family of four earning $47,100 annually would fall right at 200 percent of the poverty level. Which disputes the fact that there’s nothing but money in Marin. The majority of medically insured people have insurance as a result of being employed, and when the downturn in the economy happened, it significantly impacted the amount of people who needed MCC services, bringing many new people to the clinics. Even after becoming employed again, many patients who still qualify financially for CHC services have continued to choose MCC as their medical home. “There’s a federally mandated focus on providing a medical home for our patients as well as effective preventive care and quality outcomes,” says Tavaszi, who feels the emphasis is in the right place when it comes to serving patients.

 

One thing CHCs offer are a wider range of office hours than traditional providers. This helps them meet the needs of the working poor who often find it difficult to get off to go the doctor or dentist. MCC’s dental clinic is open seven days per week, from early morning to late evening. On Sundays, it only treats patients who don’t need nitrous oxide (many pregnant women are seen on Sundays, since it’s dangerous for them to be exposed to the fumes on regular dental clinic days).

 

CHCs also work closely with their communities including local businesses. MCC is a member of the San Rafael Chamber of Commerce and regularly invites businesses to participate in MCC outreach programs. “Reach Out and Read” is a program where every child who comes to one of the clinics goes home with a book. It’s only possible with financial and volunteer support that’s received from various local businesses. MCC reciprocates by shopping locally for maintenance supplies, using local contractors for building repair and having special events catered by area restaurants and food vendors.

 

MCC has been creative when it comes to finding a way to meet the needs of its patients. “We offer optometry and an in-house pharmacy, and we’ve found ways to get things done that aren’t all about spending money,” says Tavaszi whose organization welcomes residents from the School of Optometry at UC Berkeley to provide patients with eye care. It’s a joint venture between UC Berkeley, County of Marin Department of Health and Human Services and MCC.

 

Tavaszi says that every morning, she stops at a local gas station and always talks to the same woman who works at the counter. On a recent day, Tavaszi had on her name tag and the woman told her what a great job the clinic does taking care of her and her 3-year-old daughter. The woman told Tavaszi she works at the gas station during the day at McDonald’s at night. The CEO was touched by the woman’s story and often thinks about her plight. “Marin has a huge service population and, just to live in the area, many people work two or more jobs and still can’t afford health insurance on top of rent, food and basic living expenses. It’s a privilege to be able to help people like that.”

 

Clinic Ole

Tanir Ami has been working in community health centers and the medical field for more than 20 years. When she first graduated college, she worked as a medical assistant and just kept moving forward, earning an MBA from UC Berkeley and a health services management certificate. She’s a good match for Clinic Ole, an organization that started 41 years ago in a Rutherford storefront and has since expanded to eight locations, including St. Helena, Calistoga and several in the city of Napa, serving more than 25,000 people each year.

 

Ami finds working for a CHC in this day and age exciting but also challenging, since plenty of substantive changes will be taking place in the near future. There’s probably no other provider group that will be as impacted by the provisions of the federal Affordable Care Act (ACA, aka Obamacare) as the Federally Qualified Health Centers (FQHCs), which include all CHCs. The new law looks to reform the insurance market and provides expanded coverage to millions of Americans, many of whom are uninsured today and being served by CHCs. The ACA has a number of new ideas to improve affordability, health status and patient experience. These initiatives include quality incentive programs, payment reform and the promotion of medical homes as well as the earlier federal efforts to facilitate market reform, such as incentives to develop interoperable electronic health records.

 

Health care coverage expansion is slated to begin in 2014, and CHCs should be in a good position to transition their uninsured patient population to Medicaid and state insurance exchanges. They’ll need new tools to clinically and financially manage their patient population, since provider networks will be held accountable for improving value, as measured by cost, quality and patient experience. Ami says that staffing for the coming changes will need to include employees who can work with sophisticated IT and data structures and professionals with quality improvement (QI) experience who can form the core of QI teams.

 

Though it may be daunting to find technical personnel, CHCs tend to attract top-notch medical providers. Clinic Ole is the eighth-largest nonprofit in the Greater Bay Region, employing close to 200 people, and the reasons that exceptional clinical staff are drawn to CHCs in general seems to be universal: “Our providers appreciate the dynamic environment, and community health centers are a little smaller than other health care institutions. They’re also mission driven, not profit driven. They can really focus on patient care versus administration like they’d have to do in private practice,” says Ami. She also stresses that Clinic Ole’s medical team enjoys providing care for members of their community and that most providers live within the community they serve.

 

FQHCs are required by law to have a board of directors that has a 51 percent membership comprised of patients. The board must also be matched by an ethnic composition that reflects the clinic’s population making for a diverse board that’s well-versed in the needs of the people it’s serving.

 

Though Clinic Ole is similar to other CHCs in dealing with a population that’s battling diabetes, obesity and heart disease, in other ways, it’s very unique. “Many counties have multiple FQHCs but, in Napa, we’re the only one,” says Ami. “All the energy is focused on just one organization, so we have a lot of direct support, especially from the vintner community.”

 

Clinic Ole was originally founded to provide care to farm workers and their families, a vital component of the wine industry, but these days, one in every six people in the community is a patient at the clinic. “In spite of the growth, there’s still a very strong commitment to the farm worker community,” says Ami. She says the recent unveiling of “Live Happy Napa County,” a needs assessment that’s conducted every three years, demonstrates there are positive indicators that Clinic Ole is doing its job well. Immunization rates are high, birth weight for babies is higher than the state average, and there’s a lower-than-average teen pregnancy rate—all good signs of a healthy community.

 

West County Health Centers

When the Russian River Health Center opened in 1974, Guerneville was a summer vacation spot filled with tourists fleeing San Francisco for a respite along the river. Highway 116 was well paved, but once you veered off the main drag, it was easy to get lost on a mud road in the middle of a dense redwood forest. Permanent members of the isolated community wanted accessible health care and decided to do something about it by opening a local health center. Two years later, another clinic opened in this rural part of western Sonoma County, this time in Occidental. In 2000, both clinics merged their leadership and resources and West County Health Centers (WCHC) was born.

 

Mary Szecsey has seen many changes take place during the 18 years she’s served as executive director of the rural CHC. WCHC now has five locations, the original two sites plus one in Sebastopol offering primary care, as well as a Wellness Center and a Teen Center in Forestville (it also has a dental clinic in Guerneville). WCHC also works in collaboration with the Labor Center in Graton, through which it provides services for mostly farm workers and day laborers. WCHC works hard to be a leader in the industry and was recently identified by the Robert Wood Johnson Foundation’s LEAP Projects (Learning from Effective Ambulatory Practices) as one of 30 primary care practices that uses health professionals and other staff in ways that maximize access to their services, with workforce models that can be replicated and adopted more widely.

 

Last year, WCHC served about 15,000 clients. In the 1980s, there was a large panel of HIV-positive patients and WCHC was the only local medical center offering specialized care for that population. There’s still an active HIV practice, with many longtime patients (along with the rest of the clinic population) now also being treated for other chronic diseases such as diabetes, hypertension, hepatitis C, asthma and mental health issues such as depression. “Our vision is for every person in the West County to have a medical home, to have a relationship with a health care team that empowers them to take charge of their medical health. If we have healthier residents, we have a healthier community,” says Szecsey.

 

Budget cuts in 2009 could easily have closed down its dental clinic, but WCHC found ways to support this crucial service, the only one of it’s kind in the area, which serves low-income and uninsured residents on a sliding scale. WCHC’s commitment to health is apparent in its support of wellness strategies. “We work with other community organizations in a partnership that supports keeping people healthy,” says Szecsey. Some of the partners offer alternative wellness strategies such as the California School for Herbal Studies, the Ceres Community Project, the Northern California Center for Well-Being along with local practitioners of yoga, meditation and stress management.

 

CHCs are also engaged in economic development as major employers in the areas where they’re located and are known to pay an above-average living wage. Not only do they employ doctors and nurses, their ranks include front desk personnel, medical assistants, data processors and other professionals. WCHC employs a large staff that has many opportunities for advancement. “We have a career ladder within our organization,” says Szecsey. CHCs help the local economy in other ways too. By helping local residents stay well, individuals can perform their jobs. Keeping kids healthy means they can participate in their studies and activities more fully and, in turn, become more productive in their school, home and community life.

 

“This is the most exciting time for community health centers in a very long while because of coming health care reform. CHCs are being highlighted as a model of how to transform the health care system. We’re all doing a lot of work this year, helping to enroll people in coverage, working internally to develop a model of care delivery that supports patients in improving their own health and helping them obtain coverage to assist them in getting their needs met,” says Szecsey. She states one of the biggest challenges the health care industry is facing is a transition from “sick care” to real, wellness-focused care and that providers are unsure if the payment system will align with what they want to achieve.

 

Investment in the present and future

The ACA will provide new resources that will let CHCs serve up to an additional 20 million people over the next five years and will also provide funds for additional primary care providers to quell the shortage we’re facing today. A study funded by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative found that CHCstake a unique approach to meeting the needs of the people in their surrounding communities. Their local approach to health care, combined with an innovative emphasis on comprehensive preventive care, generates $24 billion in savings to the health care system annually. Their expansion to underserved communities is estimated to save an additional $122 billion in totalhealth care costs between 2010 and 2015. In addition to providing significant cost savings, CHCs contribute to economic growth and stability of communities through the jobs they supply, the businesses they support and the health of local residents. They may continue to reinvent themselves, but it looks like CHCs are here to stay.

 

 

Ways to Support Your Local CHC

 

 

Summer Solstice Celebration, Annually in June

 

 

Friday, August 9, 2013: Sebastopol Community Health Center Open House Celebrating National Health Centers Week from 5 p.m. to 7 p.m. at the Sebastopol Community Health Center, 6800 Palm Ave., Ste. C, Sebastopol, CA 95472.