Patients First

PCMH snapshotTo mark the 50th anniversary of the Community Health Center Program we are using the month of May to spotlight the various ways health centers operate as Patient Centered Medical Homes (PCMH). We found a good example in Colorado, where Peak Vista Community Health Centers has been spotlighted in the journal Health Elevations, published by the Colorado Health Foundation.

The article, authored by Kelly Dwyer, describes how each morning “small teams of primary care doctors, nurses, medical aides, behavioral therapists, and care managers” gather to discuss which patients are coming in and review their reports and check off which lab or diagnostic tests need to happen. “This is integrated care at work,”  writes Dwyer. “Peak Vista is defying perceptions of beleaguered clinics scrambling to merely keep up with demand and is instead leading the integration revolution through better design.”

We admit we’ve written about Peak Vista before on this blog when they received PCMH recognition. We are writing about them again because their work demonstrates how patients experience the “patients first” approach of PCMH. For instance, Dwyer writes:

A fair share of Peak Vista’s patients and their families miss work without pay to get to the doctor’s office. Some ride the bus to get there, which makes it convenient to schedule back-to-back visits with the dentist and pediatrician, for example.  A team-based approach to care allows primary care providers to intervene the moment they recognize a behavioral or dental issue. “When you get emotional outpouring from a patient, you have a way to say, ‘I can help with that,’” said pediatrician Barbara Divish, MD, who makes frequent “warm handoffs” to a pediatric psychologist on-site. Peak Vista’s behavioral care providers typically spend 10 to 15 minutes with patients on those handoff visits, then schedule longer follow-up visits if needed. Patients are more likely to see a dentist or therapist on the spot than they are to follow through on a referral at a different office and possibly weeks later.

The health center has also invested in areas that improve efficiency, as well as the patient experience, such a electronic health records and care coordination, strategic changes that has reduced wait systems and enrolled people into insurance coverage.   Staffing investments also paved the way for care teams that help patients and providers “connect what is disconnected.” For instance, the staff at Peak Vista also recognized that parents with multiple children may have difficulties accessing care, especially when they can’t find a baby-sitter.  Solution?  Open a drop-in child care room for healthy siblings, a move which cut the health center’s no-show rate.

Every day health centers prove in communities that a system of care exists where innovation is shaped around the patient experience and geared toward better outcomes.  Tell us how your health center is making patients first  and we’ll write about it on this blog.


Stage 4, How Did We End Up Here?

This blog was originally published in the Huffington Post as part of a series of posts raising awareness of National Women’s Health Week. 

womenshealth (3)My mother, the certified nursing assistant (CNA), has stage four breast cancer. She has tumors in her breast, on her hip and on her skull. The tumor on her hip is what bothers her the most because it’s painful to do just about anything. My siblings and I are working to get her the care she needs and if her treatment works and she changes her lifestyle a bit she could live long enough to see her grandkids graduate from high school. But she will never be completely healthy again.

How did we even end up here? We have no history of breast cancer in our family. My mother is a healthcare provider, I work in the healthcare industry, and my sister — with whom she lives — is very aware of the importance of staying healthy with regular care. How does someone like my mother — who often worked with terminal cancer patients — slip through the cracks, with no diagnoses until stage four? Simple — she ignored what was happening to her body. She ignored it until she could not ignore it anymore. She did not have health insurance and she was afraid. That’s the reality. My mother has — until this point — lived every day taking care of others as an occupation and caring for her family but not herself, often rationalizing that she didn’t want to be a bother to her grown children. Instead she pretended nothing was wrong until she could bear the pain in her hip no longer and tumor in her chest was visible to the naked eye.

After an official diagnosis my mother’s survival rate now stands at 22 percent. And so begins our journey of navigating the health system to confront a host of problems that include terminal cancer, coupled with arthritis and high blood pressure. At first I was angry, not just at her for not taking care of herself but also at a system that made it difficult for her to do so because she was uninsured. Then sadness slowly crept in. Here’s a woman who came to the United States from Honduras by herself in her early 20s, who raised three productive members of society, who received her CNA license in her 50s and now must fight for her life because she didn’t make time for a simple, routine exam and skipped out on a mammogram for over five years. She may not be around for my daughter’s first birthday or my nephew’s first day of school. There may not be visits to abuela’s house for Mother’s Day and Christmas. When my daughter is older I may only have stories and photos of her in my mother’s arms as an infant to share. All of those milestones and memories she could make in the future are now more uncertain than ever.

Women are strong, but not superhuman. We need to take time to care for ourselves and go to our healthcare provider for regular check-ups. We can’t be there for our loved ones if we can’t even be there for ourselves, mentally and physically. This year take the National Women’s Health Week Pledge, and learn the steps you can take at any age to be your healthiest you.

If lack of resources or coverage are keeping you from getting your check-up, visit your local Community Health Center. Community Health Centers provide quality preventative and primary healthcare regardless of ability to pay. The care is affordable and offered at a sliding scale fee. You can access a range of preventive healthcare services all under one roof — from cervical and breast cancer screenings to health education and assistance with signing up for health coverage. Best of all, a health center is a healthcare home, a place to return on a regular basis for continuous care.

Life can be tough enough without the added stress an illness can bring. We matter. We mean something to all the people we touch including our friends, and family so we shouldn’t ignore our health.

Fighting Illness and Hunger for 50 Years

H. Jack Geiger and Count Gibson

H. Jack Geiger and Count Gibson

We have been looking at the ways health centers set themselves apart from other providers by not just preventing illness but addressing the factors that cause it. Tackling the social determinants of health is not a new concept.  In fact, when the health center movement first took root in rural Mound Bayou, Mississippi, 50 years ago, the focus was not just on medical care but the environmental factors that were causing poor health, such as hunger and malnutrition. The book, Community Health Centers: A Movement and The People Who Made it Happen, by Bonnie Lefkowitz, describes how the health center founding physician,  H. Jack Geiger, MD, became “infamous” for prescribing not just baby formula, but groceries for patients, who often did not have access to food, or could not afford it.    “The last time I looked at a medical text, the specific remedy for malnutrition was food,”  Dr. Geiger said with a smile.  The first health center, which Geiger co-founded, also operated a farm co-op, not just because many residents in the rich agricultural county were hungry, but because they wanted jobs.  Nearly 6,000 people were recruited as worker/owners of the farm co-op, according to Lefkowitz. Fast forward five decades and Community Health Centers are still stretching the bounds of primary care by focusing on nutrition and diet. As we’ve written in a previous post, health centers are trying to address “food deserts,” meaning poor neighborhoods where fresh produce is not readily available. And where that happens, one often encounters high rates of obesity and diabetes. In fact, a recent study in the American Journal of Preventive Medicine documents that moving to an economically challenged neighborhood can expand one’s waistline. All though more research is needed to definitively establish a cause, the authors speculate that a more deprived neighborhood can encourage consumption of unhealthy foods or make it hard to stay fit. Meanwhile, many health centers continue the tradition of prescribing fresh food and making it available.  In Humboldt County, California, for instance, food insecurity is an issue for patients at Open Door Community Health Centers, which is why a nurse started a community and wellness garden that is maintained by staff and community volunteers. The garden is open to all and anyone is welcome to harvest food, though they are asked to contribute a little time for maintenance in exchange, such as weeding the beds of Swiss Chard, beets, lettuce and kale. Health centers also often operate food pantries, or host farmer’s markets to ensure their patient populations can access healthy foods.  Depending on the health center, one can also finding cooking classes to ensure better eating habits, particularly among diabetics, and nutrition education classes.

Celebrating Health Center Advances in PCMH

New-PCMH-infoMCAs we celebrate 50 years of the Community Health Center Movement we continue to highlight the ways in which health centers are innovators in the healthcare system. From the very beginning health centers have worked to address their patients’ unique needs through patient focused, coordinated, comprehensive care. Today the Patient Centered Medical Home (PCMH) model of care—also known as medical healthcare home—continues to build on these effective principles of quality patient care. The adoption of the model, which focuses on the patient as the center of team-based, coordinated, comprehensive care, has increased from just 1 percent in 2009 to 59 percent among health centers. And studies continue to show results—decreased costs of care, reduced cost from unnecessary ER visits and hospitalizations, as well improvements in disease management and patient satisfaction.

To learn more about how Community Health Centers are embracing PCMH visit the PCMH page on the NACHC website, and read this blog on how two different health centers produced effective results as PCMHs.

Health Centers as Keystones

Today the Department of Health and Human Services announced New Access Point grants that will expand care to nearly 650,000 people in 33 states and two U.S. Territories [see news release]. In making the announcement in North Carolina Secretary Burwell. said,“Health centers are keystones of the communities they serve. Today’s awards will enable more individuals and families to have access to the affordable, quality health care that health centers provide. That includes the preventive and primary care services that will keep them healthy.”

The Secretary made the announcement at the Charlotte Community Health Clinic, one of eight North Carolina health centers receiving a total of $6 million through the Affordable Care Act, according to a report in the Charlotte Observer.

The announcement comes as 62 million people still struggle with little or no access to a primary care provider– and many of them do have insurance, just no place to go for care.  The announcement by HHS also comes on the heels of new report from the American College of Emergency Physicians that ER doctors are busier than ever due to a lack of primary care providers and a surge in the newly insured. USA Today reports that a root cause is “the nation’s long-standing shortage of primary care doctors–projected by the federal government to exceed 20,000 doctors by 2020–[and that] some physicians won’t accept Medicaid because of its low reimbursement rates. That leaves many patients who can’t find a primary care doctor to turn to the ER.”

NACHC also underscored the need for more primary care services in a statement posted today, with Senior Vice President for Policy and Research Dan Hawkins mentioning the “roughly 500 additional applications pending from communities desperately in need of health care services.”