Innovation in Managing Chronic Disease Flourishes in North Carolina

Willie Riddick manages his health with the remote monitoring program.  Courtesy: Direct Relief

Willie Riddick manages his health with the remote monitoring program. Courtesy: Direct Relief

Innovation does not always have to come with a hefty price tag in healthcare.  That is what health centers prove every day in the communities they serve, sometimes in the unlikeliest of places.  Our yearlong celebration of the 50th Anniversary of the Community Health Center Movement brought us to rural Ahoskie, NC, where the Roanoke-Chowan Community Health Center (RCCHC) operates a remote monitoring system for patients with chronic conditions, like cardiovascular disease, diabetes and hypertension.

RCCHC serves 14,000 patients annually with four locations in northeastern North Carolina. There is no public transportation in the area and for some patients who need regular care that can pose a challenge.  There is also the cost factor: over half (53 percent) of patients struggling with incomes at or below 200 percent of the Federal Poverty Level. The remote monitoring program helps identifying patients with chronic conditions and providing them with monitoring equipment at no cost to them.  A nurse case manager sets up their equipment and connects it wirelessly to a server.  After a patient has done all the screenings (blood pressure, pulse, body weight and blood sugar), the readings and data are transmitted to the nurse care manager and primary care physician. The real value for providers is that there is hard data to work daily with in determining a patient’s health status, rather than trying to guess at what has happened in the intervening months between appointments. The results are also impressive: there has been a 75 percent reduction in hospital admissions and readmissions for patients in the program.

The program was entirely funded by grants, such as the BD Helping Build Healthy Communities Award, but it was Direct Relief, an organization that works in partnership with health centers and NACHC, that brought the program to our attention.  You can read their blog post about RCCHC by visiting this link.

Have We Mentioned Cost Savings?

Economic-badge[1]We have written extensively on this blog about the cost-savings that Community Health  Centers produce for U.S. healthcare system ($24 billion a year, by the way).  Now comes a new report from the Massachusetts League of Community Health Centers which shows that the Commonwealth’s 49 health centers generate annual savings of more than $1 billon for Massachusetts. The $1.1 billion in savings is tied directly with the impact health centers have in reducing emergency room visits, hospital stays and the need for higher-cost specialty care among patients.  Also, the more health centers expand to meet growing demand for their services (they have added more than 295,000 patients since 2006 thanks to federal and state health reform), the bigger their economic punch as employers and economic engines that produce tax revenue for the state.

“This report demonstrates that health centers provide significant value far beyond just the communities in which they are located,” said James W. Hunt, Jr., president and CEO of the Massachusetts League of Community Health Centers. “For the first time, we are able to quantify the critical role health centers play in the economic health of Massachusetts. At a time when state leaders are looking for savings and wise investments, Community Health Centers can demonstrate that they are powerful economic drivers.” The analysis was conducted by Capital Link.  A link to the report can be found here.

Numbers tell an important story about the value of health centers.  A case in point: $11 of total economic activity is generated for every $1 of federal funding invested in health centers, according to this new infographic by NACHC.  That health centers have also been trusted stewards of tax payers dollars and delivered returns on the federal investment is no small reason why lawmakers on both sides of the political aisle have called for continued funding of the program in the face of a looming funding cliff.

House lawmakers recently voted by an overwhelming bipartisan majority of 392-37 to pass H.R. 2, which stabilized funding for an additional two years for health centers, as well as for programs to train and recruit health center clinicians.  Unfortunately, the Senate left for their scheduled two week recess without voting on H.R. 2, leaving final passage of the bill into law in limbo. Stay tuned to this blog so we can keep you posted once the Senate returns from recess.

In The Land of Plenty, Few Options for Healthy Food

800px-Fresh_vegetablesThroughout their 50 year existence health centers have reached beyond the traditional walls of medicine to address the factors that may cause illness.  In an earlier blog post we wrote about TCA Health, Inc., a health center in the South Side of Chicago which started a thriving food pantry for residents who had little or no access to healthy, fresh groceries.  Areas  of “food deserts” are all too common in economically challenged neighborhoods where for profit grocery stores with fresh produce are unlikely to set up shop.  That is certainly the case in Franklinton, OH, where Lower Lights Christian Health Center hopes to set up a 15,000 square foot grocery store by early next year. According to an article published in Columbus Business First,  the plan calls for both fresh produce as well as regular groceries and prepared food.

“We’re in the early beginning stages (but) we’ve had a desire for the last several years,” said Dr. Dana Vallangeon, CEO,  in an interview with the newspaper.  “Access to affordable, healthy food is one of the main issues we see in the neighborhood, and patients we interact with are missing.”

The newspaper also notes that access to healthy food is not only a health issue but an economic one, as few are willing to live in a neighborhood where there is no grocery store.  That is why community groups and the Ohio Healthy Food Financing Task Force are urging policymakers to fix the problem and establish a statewide healthy food financing fund.

Further north, South Boston Community Health Center has also established a “farmacy” (so to speak).  For over ten years, the health center has hosted the South Boston Farmers Market for community members to shop for nutritious fruits and vegetables, flowers, herbs, fresh fish from Cape Cod Fish Share, locally produced honey and fresh breads.  The project started as part of the WIC program, and thus accepts WIC Farmers Market Coupons as well as SNAP/EBT cards.

Also,  East Boston Neighborhood Health Center has adopted several initiatives to increase access to healthy food, including the East Boston Farmers Market, EBNHC Community-Supported Agriculture (CSA) (which connects community members and farmers for a convenient weekly subscription to healthy, affordable produce in season) and a EBNHC Wellness Garden.

If you know of a health center fighting food deserts with a farmacy — please let us know and we’ll highlight it on this blog!

Update on Outreach and Enrollment

Our guest blogger today is Ted Henson, Director of the Robert Wood Johnson Outreach and Enrollment Project, with a progress report on  health center patients and insurance.

NACHC recently conducted a poll of enrollment assisters and staff at Community Health Centers about the second open enrollment (OE2) under the Affordable Care Act (which turns five years old this week).

A vast majority of the 377 respondents — 84 percent— reported that the second enrollment period (OE2) met or exceeded expectations in terms of total enrollment assists and that there was a reduction in problems overall. Of the 111 respondents from states that participated in the federally facilitated exchange (Healthcare.gov), nearly 91 percent reported that OE2 met or exceeded their expectations.  On the other hand, the poll also revealed persistent challenges for new enrollees when it comes to accessing care. Nearly 84% of respondents said that the overall cost and affordability of coverage remains a major obstacle that prevents new enrollees from utilizing their benefits and accessing coverage.

Some key trends have also emerged. During the first open enrollment period, many consumers who were assisted by certified application counselors, navigators, and other staff at health centers were enrolled into the low-premium but high-deductible Bronze plans.  But the trend shifted during the second enrollment period.  Over 71 percent of assisters now say a majority of people enrolled into Silver-level plans or higher due to premium tax credit assistance and/or other factors. Eighty-one percent of respondents in states that did not expand Medicaid reported that a large majority of people enrolled into Silver-level plans or higher and fewer people enrolled into Bronze plans.

Despite the boost in the numbers of people choosing Silver plans, some assisters reported that the renewal process was problematic and, in some cases, resulted in many people losing coverage.  Also Silver plans were not available in some areas, and even if they were, they were still unaffordable despite the APTCs in some states.

While cost and affordability were the biggest obstacles for new enrollees in terms of  accessing their care, 56 percent of respondents reported that a lack of understanding of the general healthcare costs covered by insurance posed a significant challenge for new enrollees. Also over half (52.3 percent) reported that many people lack a thorough understanding of insurance terms and how to use insurance.  Other issues cited included password recovery and reset issues, significant technical glitches in several state-based exchanges, and a lack of access to in-network providers.

In terms of what’s next for enrollment, nearly all respondents (93.7 percent) reported that assisting consumers qualifying for a special enrollment is a priority or major priority going forward. The federal government announced a special enrollment period (SEP) for tax season from March 15 – April 30, 2015 in states that utilize Healthcare.gov. Health insurance literacy is also a major focal point of ongoing efforts: 53.6 percent reported that assisting consumers with understanding their coverage is a priority, and an additional 35 percent said it is a major priority.

For more information about this poll or NACHC’s ongoing efforts on O&E, contact Ted Henson: thenson@nachc.com

 

 

Chicago Health Center Launches Thriving Food Pantry

Volunteers distribute food to community members.

Volunteers distribute food to community members.

When Community Health Centers began 50 years ago, the mission was not only to prevent illness with affordable primary care, but also address the causes.  Confronting  the social determinants of health, meaning factors such as nutrition, homelessness and poverty, is a mission carried out by all health centers even today.  That is what brought us to the south side of Chicago, where TCA Health, Inc. saw a need in the community, and sought to fill it.

Since diet is so often the culprit of ailments such as obesity, diabetes, heart disease and cancer, TCA Health decided to take action by opening the Peter’s Rock Food Pantry just a few blocks from its main clinic site.

“In order to truly build healthy communities, it is critical we address disparities beyond traditional healthcare.  The south side of Chicago is a food desert where healthy choices are extremely limited and in most cases non-existent,” said Mariann Chisum-McGill, Director of Programs. “Regular check-ups and health screenings are excellent preventive measures, however, they are not enough if people are not eating well.  Not only do we educate our constituents on proper nutrition, we opened the food pantry in order to make healthy options more accessible and affordable.”

TCA Health serves 8,500 patients and offers a range of affordable primary care services, such as dental, pediatrics, OB-GYN, and even employment counseling.  But a growing need among patients stretches beyond the walls of the health center.  Stores that sell healthy food are scarce, and for many residents who do not have access to a car, it means trekking several miles to the nearest affordable grocery store for fresh fruits, vegetables and other healthy staples.  On the other hand, establishments that sell processed junk food are plentiful.

TCA Health responded to this barrier by forming the Health & Wellness Collaborative (HWC), an alliance of local community organizations, social service agencies, concerned residents, schools, churches and other stakeholders. The HWC partnered with Peter’s Rock Church of God in Christ to open the food panty on January 30, 2015.  Not just any food pantry, though.  The Peter’s Rock Food Pantry (located inside the church) offers comprehensive nutrition and cooking workshops along with free canned goods, fresh produce and meat.  The pantry serves up to 100 families every Friday from 10 to noon.

TCA Health’s successful efforts to venture beyond the reach of conventional medicine to target specific community needs is part of a legacy that has been in existence for five decades, thanks in part to public support.  Now that support is being imperiled because of the health center funding cliff, which could slash federal funding by up to 70 percent.  If Congress does not act, every health center will be affected.  For TCA Health it means over 1,000  patients could experience reduced access to care.

“The health center funding cliff would deliver a crushing blow to what we are accomplishing on the south side,” said Veronica E. Clarke, CEO.  “TCA Health’s mission is not only dedicated to quality healthcare, we are empowering individuals by improving their quality of life.  We are creating solutions locally, but we need federal investment to continue our work.”