Category Archives: United States

Why 107 Hot Showers Matter

In one morning alone, 107 men living outside St. Mary’s Dining Room (a full health and social services agency near San Francisco) had come to take hot showers. And what do showers have to do with health? Everything.

I traveled to St. Mary’s Dining Room in Stockton, California recently to visit our free clinic partner as part of the regular visits to clinics that receive our donations of medicines or that are part of our clinic programming. At St. Mary’s, the need is immediately visible. Rows of tents and tarps line the street leading up to the facility. Living inside these tents are many of the patients who rely on a myriad of services provided by St. Mary’s. While the organization has its roots in a soup kitchen opened in 1955, it has evolved into a full service primary care clinic (the Virginia J. Gianellli Medical Clinic), dental office and operatory, social service organization, clothing distributer and shower provider. As Mary Anne Soria, Director of Medical Services explained, “We are more than just a meal.” That’s an understatement.

CA-clinic-with-shower-program-for-homeless-lores

What St. Mary’s offers is more than services: it provides dignity. The staff at St. Mary’s intimately understands the critical concept of social determinants of health: that health is profoundly affected by the conditions in which we live and goes well beyond clinic walls. Examples of social determinants include not only access to health care services, but also availability of educational and job opportunities, social support, transportation options and cultural offerings. Good health is achieved by more than a diagnosis and a prescription; it is obtained by treating the whole person, beginning with the means to manage the daily reality of their lives.

St. Mary’s addresses poverty by feeding the hungry, addressing health concerns, and as Ms. Soria explains, “Restoring human dignity” to over 700 individuals each day, one shower at a time.

Learn more about our partner, St. Mary’s Dining Room, and their history of “restoring human dignity since 1955.”

Providing Behavioral Health Care in a Primary Care Setting

Extensive barriers to accessing behavioral health care exist in the United States – affordability, access to a behavioral health provider, fear of stigma. Each of these barriers can be eliminated or reduced by folding behavioral health services into the primary care setting, or “integrating care.” A national survey published by the Mental Health Association found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician if mental health concerns arose while only 4% would seek care from a mental health specialist.

Flipping the coin over, a strong case can also be make for integrating primary care into the mental health treatment setting. 68% of those living with mental illness in the United States also suffer from a chronic physical condition such as diabetes, hypertension and/or heart disease. The life expectancy of adults living with mental illness is reduced by over ten years due to their chronic conditions – not their mental illnesses. Thus those who regularly consult a psychiatrist or other provider regularly for counseling or medication management for their mental illnesses stand to benefit from the opportunity to obtain affordable primary care during the same visit.

Tarzana Treatment Centers in Southern California, serves as an example of successful integration. Dr. Jose Salazar of Tarzana explains, “Patients typically report higher satisfaction rates with health services that are fully integrated as opposed to those that are not,” while benefits to the provider include improved patient adherence and increased follow up to care.  Additionally, “many fully integrated care programs see their patient emergency department utilization reduce by 20%-30% [or higher],” lending our general healthcare system additional benefits from full integration.

The transition to an integrated care system is not without its challenges, particularly relating to an organization’s limited financial and human resources. Dr. Salazar explains that full integration of behavioral and medical care adds a valuable care component that may not be fully or even partially covered by third party reimbursement, such as case management and care coordination. Having undergone this transition already, staff members at Tarzana recognize now that “it is also important to change the culture and mindset of providers via training and development to operate in this new model, which has its own set of principles, values, and communication approaches.”

The transition to integrated care is a seismic shift in the way health care is considered and delivered. Through holistic care approaches – primary care integrating behavioral health and vice versa – these innovative organizations are ensuring that no patient is defined by a single diagnosis, but rather is understood and respected as a sum of his or her parts.

When a 10-Minute Drive is an Ocean Away

Last week I paid a visit to the University of Miami’s Pediatric Mobile Clinic (UMPMC). The 40-foot bus was parked outside the Center for Haitian Studies in Miami’s Little Haiti neighborhood as usual – the big blue bus took over the parking lot, with staff, interns, residents and volunteers providing care both in the mobile unit and throughout the Community Center. The services provided to the children visiting the clinic are highly integrated and holistic, ranging from sports physicals and immunizations to specialty care in cardiology, dermatology, endocrinology, hematology and nutrition. How does one mobile clinic possibly provide this breadth and depth of care?

Telemedicine. And an innovative medical director committed to serving her young patients with the highest level of continuous care.

The Pediatric Mobile Clinic provides live interactive videoconferencing consultations in which young patients and/or their care givers interact directly with a specialist off site. As Dr. Lisa Gwynn, clinic director explained, “There are major barriers to the 10-minute drive to the closest hospital, from transportation costs and cultural barriers to fear of a bill and inability to pay.” Telemedicine removes those barriers by bringing a specialist right into the clinic with a portable videoconferencing tool that allows patients to interact directly with a provider in the comfort and convenience of their medical home. Gwynn notes she saw the clinic’s patient compliance rate sky-rocket with the integration of this technology in 2013, with 35% of her patients following through and meeting with their specialists to now over 90% of her patients meeting with their specialists.

The neighborhood of Little Haiti is home to one of the largest populations of Haitian immigrants in the country, with the majority of its residents of Haitian origin or descent. It is also an area of high levels of poverty and a lack of primary care providers. 45% of the residents of Little Haiti earn less than $12,000 a year and 40% of its residents have no insurance, compared to 16% of all Floridian residents that live below the poverty line and 20% across the state that have insured.  These demographics and a shortage of providers make it the ideal neighborhood for the Pediatric Mobile Clinic, which rolls out of its parking spot at the University of Miami 5 days a week to park in different high need neighborhoods throughout the city.

On my visit last week, I watched as Gwynn photographed the back of an infant’s head on her cellphone. She then uploaded the photo to an app on her phone which pushed the photo to a pediatric dermatologist for her diagnosis. This store-and-forward technology is yet another telemedicine tool used by the clinic to ensure continuity of comprehensive care. “Telemedicine is absolutely critical for compliance,” Gwynn explains. “My main concern is quality care for patients and their safety.”

a telemedicine machine

 

Established in 1992 by the Children’s Health Fund as a response to hurricane Andrew, the UMPMC has provided medical care to uninsured children in need for nearly two decades. Services provided include well-visits, sports physicals, immunizations, management of chronic conditions, urgent care, mental health, and social work. To learn more the Pediatric Mobile Clinic, click here.

Meeting the Growing Need for Affordable Dental Care

Sal-Migliaccio-blogger
By Sal Migliaccio, Associate, U.S. Programs

Although the Affordable Care Act (ACA) has helped approximately 22.8 previously uninsured people gain medical coverage, hundreds of thousands in the United States still lack access to critical care. Uninsured and underinsured people are faced with astronomically high medical bills, and the ACA has worked to address this broader issue directly. One specific area of human health which goes largely unnoticed, however, is the lack of affordable high quality dental care for those people who do not have the financial means for insurance coverage and/or access to services.

The expansion of Medicaid in 31 states and D.C. is primarily responsible for the large number of previously uninsured people who have gained coverage since the ACA became law in 2014. Medicaid, however, generally does not cover preventative care meaning that dental care is only covered when it intersects with a patient’s larger medical need. According to the National Association of Dental Plans, 126.7 million people in the U.S. lack dental coverage, and of that number only an estimated 17.7 million could gain coverage through some state’s expansion of Medicaid. Only 4.5 million adults are expected to gain extensive dental benefits through Medicaid and only 800,000 adults will gain dental benefits through the health exchanges.

Despite a direct and documented knowledge of the high need for affordable dental care, most free clinics and safety net providers cannot offer these services due to their tight operating budgets. One free clinic in West Virginia, however, has made it a priority to bring dental care to an affordable setting for the uninsured, underinsured, and low-income members of their community.

Wheeling Health Right in Wheeling, West Virginia, has been working on a year-long project to add dental health to the list of high-quality services they provide at no cost to uninsured and underinsured patients. The project, according to Executive Director Kathie Brown, was driven by need. Until recently, uninsured adults in Wheeling could receive free dental care at one of the city’s public school-based health centers. However, with school security and children’s safety in mind, the city decided that public schools were no longer appropriate venues for adults to receive dental care. This, of course, created a gap in the health services available to Wheeling’s most vulnerable populations. For a time, many dentists in the Wheeling area agreed to see uninsured people at no cost to the patient, although, as Brown describes, this did not allow for the continuity of care her free clinic patients needed.

With the help of public and private grant money, Wheeling Health Right has identified space and begun construction for the dental clinic within their existing free clinic facility. They have engaged local dentists who may be interested in volunteering some of their time to provide free dental care with seven already officially committed. In addition, the clinic has been working with manufacturers of dental products to secure lower prices for their charitable program. They plan to offer dental services to their existing pool of uninsured patients with the hope of eventually expanding it to insured patients who simply lack dental insurance.

This project has been put into motion by a local organization that identified a need in their community and sought a way to change things. AmeriCares is proud to support safety net health care organizations like Wheeling Health Right that are making issues of public health personal.

The dental clinic at Wheeling Health Right is scheduled to open in early 2016.

As the nation’s largest provider of donated medical aid to the U.S. health care safety net, AmeriCares works with over 800 free clinics and health centers in all 50 states. Supported by the GE Foundation, our U.S. Programs help partner clinics to increase capacity, provide comprehensive care, improve health outcomes and reduce costs for patients. Our vision is for every person in this country to have access to affordable and high quality health care regardless of their ability to pay. Wheeling Health Right in Wheeling, West Virginia is one of our safety net partners.

“Do you have any questions for me?”

By Lindsay O’Brien, Associate Director, U.S. Programs 

We all know that it’s a good idea to have a list of critical questions ready for our short visits with the doctor in order to maximize those precious few minutes with an expert. (With doctors’ appointments averaging about 18 minutes1,  it makes sense to come prepared). And yet how many of us have given a quick “no” at the end of an appointment when asked, “Do you have any questions for me?” Whether it’s because we’re unprepared or embarrassed, the appointment is ended on an incomplete note, and we may have missed an opportunity to give our care providers an important piece of the puzzle.

The Greater Killeen Free Clinic in Killeen, TX is working to solve this problem.

healthblog3On a visit to the clinic in the spring, I was struck by the impressive health outcomes of the Killeen’s Chronic Care Clinics. These “clinics” are actually year-long education series and wellness visits for individuals suffering from a chronic disease – diabetes, hypertension, heart diseases, asthma or COPD and/or thyroid disorders. (The national statistics on these preventable health problems are staggering: about ½ of all adults in this country have a chronic health condition, and these chronic conditions are the leading cause of death and disability in the U.S.2 These conditions are also notoriously difficult to treat.3) Patients enrolled in the Chronic Care Clinics at Killeen are provided with education on subjects including proper nutrition, exercise regimens and disease and prescription management. They learn effective ways to manage their disease.

Before acceptance into a Chronic Care Clinic at Killeen, patients sign a contract promising to attend mandatory appointments and education sessions. The contract explicitly states the dates and times of quarterly appointments as well as the ramifications of missed appointments. An addendum to Killeen’s Patient Contract is the Pledge of Care. Both patients and Killeen staff pledge to adhere to 14 different standards of care, including mutual “respect, honesty and compassion” and always telling the truth.

healthblog2One pledge really caught my attention: Killeen promises their patients that they will “listen to and answer your questions.” On the flip side, the patient pledges to ask questions when he/she does not understand “until I do understand.” There is an expectation at Killeen that patients will learn everything that they can about their conditions, and they will come to appointments prepared and leave informed. Just as importantly, Killeen staff are committed to ensuring that their patients are empowered with the information to make informed decisions about their care.

Explained by Executive Director Marlene DeLillo, “Patients in the program are wholly committed to improving their health. The Patient Contract clearly explains the program expectations and our commitment to serving as their medical home. And the Pledge ensures that patients know how much we care about them while also demanding participation and honesty. The contract and pledge have definitely enabled the success of the Care Clinics.”

The results of this comprehensive, patient-centered care at Killeen are impressive. Of the 188 diabetic patients participating in Killeen’s clinics, 153 showed an average of 3% point decline in A1C levels over the course of 24 weeks. “One patient’s A1C level dropped from 11.4 to 6.2 in 12 months. We were thrilled,” said Sheila Brooks, clinical supervisor.

When Brooks asks her chronic care patients, “Do you have any questions for me?,” you can bet she doesn’t take no for an answer.

As the nation’s largest provider of donated medical aid to the U.S. health care safety net, AmeriCares works with over 800 free clinics and health centers in all 50 states. Supported by the GE Foundation, the U.S. Programs help partner clinics to increase capacity, provide comprehensive care, improve health outcomes and reduce costs for patients. Our vision is for every person in this country to have access to affordable and high quality health care regardless of their ability to pay. The Greater Killeen Free Clinic in Killeen, TX is one of our safety net partners.

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1 http://www.washington.edu/news/2008/07/14/rx-for-time-crunched-physicians-communication-skills-that-increase-physician-efficiency-and-patient-satisfaction/
2 http://www.cdc.gov/chronicdisease/overview/
3 http://ecp.acponline.org/augsep98/cdm.htm#Note1