Post Card from California

Redwood Coast Medical Services health center in Gualala, CA

Redwood Coast Medical Services health center in Gualala, CA

Too often when we talk about the health center funding cliff people ask what is at stake.  To answer that question for ourselves we went in search of stories and connected with Pat Owings, Communications Coordinator with Redwood Coast Medical Services (RCMS). The health center is located in Gualala, a small community overlooking the Pacific Ocean and sitting right on the edge of the rugged coast of Northern California.  Pat told us, “Gualala is about 120 miles north of San Francisco, and roads to and from the small unincorporated community are mountainous and narrow. Weather conditions, especially in winter, can cause difficult and dangerous driving conditions.”

That is why the services RCMS provides are so critical.  The health center is the sole provider of medical care to a community of approximately 8,500 residents.  Because of the remote location, and the nearest urban area, hospital or emergency room is about a two hour drive away, RCMS provides two unique services that make living in this wild but beautiful area a little easier for both residents and visitors:

* Urgent Care Medical Services after hours.

* Visiting Nurse Services with home visits made by a Skilled Nursing Team.

These services are not normally included in the scope of service for the Community Health Center model of care, but they are desperately needed.  They are also very costly.  Thanks to the vision and commitment of RCMS leadership and its board (health centers are directed by patient majority governing boards), fundraising and the financial support of the community have helped make this service possible.  In an unusual step, the community voted by special ballot to allow property taxes to be used to help support expanding  RCMS’ Urgent Care to on-call coverage on weekends and holidays from 8 a.m. to  6 p.m.   Expanded Services funds from the Health Resources and Services Administration also helped.

The RCMS Urgent Care Medical Team is headed up by Physician Assistants who  are able to treat a wide range of urgent medical issues, ranging from severe colds, flu, and lacerations, to more serious medical concerns relating to cardiac problems, stroke and severe injuries.  Having Urgent Care service available means patients are treated effectively at the health center and costly visits (not to mention long drives) to emergency rooms are avoided.

And speaking of long drives,  the nearest home health services are almost 60 miles away.  That is why RCMS operates one of very few Visiting Nurses program in the nation.  RCMS nurses make in-home visits Mondays through Fridays to patients who are homebound either due to a long- or short-term illness or injury. This service allows seniors avoid long drives to hospitals and specialists out of the area and is credited with eliminating or shortening hospital stays and/or reducing the time spent in rehabilitation facilities.

What makes the health center funding cliff so worrisome for RCMS, is the health center stands to lose up to $910,000 in funding if Congress does not fix the funding cliff.  That means patients who rely on RCMS as their sole provider could lose access to care or have some of the vital services cut.  No matter how you do the math, the funding cliff will affect people who need care in Gualala, CA.

For more information about the funding cliff visit this link.





A Colorado Health Center Shines in the Spotlight

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The staff at Peak Vista in Colorado Springs, CO

Every now and then we like to call out an individual health center for carrying out the mission in an extraordinary way.  Peak Vista Community Health Centers in Colorado Springs has received PCMH recognition for using evidence-based, patient-centered processes that focus on highly coordinated care and long‐term, participative relationships.  What does that mean exactly? It means that Peak Vista has represented the model of primary care that combines the essential ingredients of teamwork and information technology not only to improve how patients experience care, but to reduce costs.  This can’t be an easy task for a health center that serves more than 80,000 patients annually. But Peak Vista makes it look easy.

Too often in healthcare, the approach to patients can be episodic and fragmented; clinicians aren’t communicating with each other and the treatment is not coordinated. PCMH aims the bar much higher, and for good reason.  Research shows that medical homes can lead to higher quality and lower costs, and can improve patient and provider reported experiences of care.

“NCQA Patient-Centered Medical Home Recognition raises the bar in defining high-quality care by emphasizing access, health information technology and coordinated care focused on patients,” said NCQA President Margaret E. O’Kane in a press release.  “Recognition shows that Peak Vista has the tools, systems and resources to provide its patients with the right care, at the right time.”

To earn recognition, which is valid for three years, Peak Vista demonstrated the ability to meet the program’s key elements, embodying characteristics of the medical home. NCQA standards aligned with the joint principles of PCMH established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association. To find clinicians and their practices with NCQA PCMH Recognition, visit

Health Center Staffing Patterns a Model?

A study published in Health Affairs reveals how non-physician staff can contribute to productivity.  Researchers examined medical staffing patterns at Community Health Centers across the United States. They identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, they found that in terms of productivity per staff everyone was at the same level. Productivity can affect a lot at a health care organization in terms of personnel costs and patient visits, and overall efficiency. But researchers concluded that while physicians make the greatest contributions to productivity, advanced-practice staff, nurses, and other medical staff also contribute. Interestingly, the study underscores the value of team based care.  They write:

“Traditionally, productivity is measured based on the number of visits in which a physician (or advanced-practice staff member) sees a patient. This ignores the roles of other staff, however. A single clinician is not usually the sole provider of patient’s care. A medical assistant may take vital signs; a physician may conduct the evaluation and make a diagnosis; and a nurse may draw blood, administer an injection, or educate the patient. According to a team-based care perspective, the visit should be viewed in terms of the joint productivity of the overall team.”

Health center staffing patterns vary from place to place, and the fact that health centers are located in medically underserved areas consistently pose provider recruitment challenges.  Other factors that apply are nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. The healthcare blog Fierce HealthCare also noted in a recent post that the study’s findings suggest that other group medical practices could employ the same staffing patterns without disrupting productivity and at the same time protect their bottom line.

Thinking Outside the Box in Workforce

On opposite sides of the U.S., two health centers are on the cutting edge of innovation when it comes to fostering a workforce that is trained and responsive in meeting the needs of the diverse communities they serve. These Community Health Centers’ efforts are highlighted in two new briefs on how health centers are pioneering new ways to redesign their workforce to produce effective results as Patient Centered Medical Homes (PCMH).

First, on the east coast, Community Clinic, Inc. (CCI) in Silver Spring, MD (a suburb of Washington, DC) provides primary medical care services, oral health services, family planning and behavioral health to more than 50,000 people.  There is a lot of diversity–more than 73 percent of the patient population are ethnic minorities.  Yet, most of CCI’s staff, which has grown from 84 in 2008 to over 250 people, are bilingual speaking (90 percent), with 22 languages. Read the CCI Issue Brief.

Seattle Indian Health Board (SIHB) in Washington state offers a range of services that include dental and traditional Indian medicine, but they are also known for being home to the Urban Indian Health Institutethe nation’s only urban Indian epidemiology center focusing on research, advocacy and education regarding the health disparities of the American Indian / Alaska Native (AI/AN) population. That is why it was critical for the center to have a pipeline of willing and able staff familiar with American Indian and Alaskan native populations. The center also looked at fostering important soft skills for entry level staff, such as customer service, communication, and cultural humility, all of which affect not only how patients experience care, but whether they utilize it regularly. Read the SHIB Issue Brief.

These two issue briefs, developed with support from the Hitachi Foundation, are worth a read because they underscore how health centers are improving patients’ healthcare experience by focusing on entry level care support; that is to say, what happens before and during a patient’s visit.  If you have any additional questions about these briefs, please contact Jason Patnosh, Associate Vice President, Partnership and Resource Development at NACHC (

2015 Off to a Good Start

We’re just a few days into the New Year and there are encouraging signs that health centers are getting some well deserved attention as they celebrate their 50th anniversary.  First, in Michigan, the work that U.S. Senator Debbie Stabenow has done on behalf of expanding affordable care garnered attention in the local The News Herald.  Stabenow toured a health center, where the Michigan Primary Care Association presented her with the NACHC Distinguished Champion Award.  “Many Michigan families rely on Community Health Centers to receive basic medical services, and thanks to the great work these groups do, more patients are getting the critical health care they need,” Stabenow told the News Herald.

 Jackson Citizen Patriot, another Michigan newspaper, used the accomplishments of health centers to make the case for continued funding and fixing the health center funding cliff, noting in its editorial,  that “while we support Congress’ efforts to be fiscally judicious, we believe dollars spent on Community Health Centers [sic] are dollars well-spent.”

We also note that the year 2014 also closed out with health center leaders taking pen in hand to make the case for fixing the funding cliff.  Minnesota is a case in point.  “Everyone has heard the term ‘too big to fail,’ ” writes Jonathan Watson, Public Policy Director of the Minnesota Association of Community Health Centers in an editorial published by the  MinnPost.  “Community Health Centers are, in contrast, ‘too effective to fail.’ Fixing the primary care cliff during the lame duck session would prove the pundits right (for once): Congress can indeed work together and avert a health-care crisis of primary care in our state.”

Stay tuned for updates as we track the local and national headlines featuring health centers.