The Wallace Medical Concern: Serving in a "healthcare desert"
Friday, October 11, 2013
Posted by: Joy Ingram
by Roger Smith, contract writer, The Wallace Medical Concern
“Even in the middle of the city, we’re a health care desert,” says the Wallace Medical Concern’s executive director, Lisa Cline. She is referring to the Rockwood neighborhood of Gresham, Oregon, part of the greater Portland metropolitan area. After a pause, she adds. “It’s a food desert out here, too. There’s such huge need.”
The Wallace Medical Concern (WMC) intends to alleviate such problems, and to do so it is swiftly evolving. In 1984 Dr. James B. Reuler launched WMC with a $1,000 bequest to provide the poor and uninsured with urgent care. For 28 years, while growing steadily, it essentially did just that at various temporary Portland locations.
In 2011 WMC’s evolution to a comprehensive primary care provider began with the move to permanent headquarters in the Rockwood Building, which contains other service organizations and low-cost housing. “The opportunity to be co-located in this building with other providers has helped to facilitate amazing partnerships,” Cline points out. These partners include Human Solutions, Meals on Wheels People, Mt. Hood Community College Head Start, Metropolitan Family Services, and LifeWorks Northwest.
Even on its own, WMC has expanded services. In 2012 it was designated a Federally Qualified Health Center because it offers a spectrum of medical services to uninsured, underserved, and low-income insured patients. That September it opened its doors as a Patient-Centered Primary Care Home and began enrolling patients for long-term, routine care.
That type of service is badly needed. Patients who visit for the first time can be very sick because they have had no help managing chronic conditions or interpreting symptoms. Diabetes is a particular problem but far from the only life-threatening disease WMC providers have encountered. Of the first nineteen patients seen in a clinic for women, for instance, three were diagnosed with breast cancer. According to the National Cancer Institute, 411.2 women per 100,000 are diagnosed with cancer (all sites) yearly in the United States.
Although the women’s clinic sample was small, that the cancer incidence was more than 35 times higher than the national average is an indication of the number of at-risk patients WMC will see in the months ahead. Rockwood residents are underserved for the same three basic reasons that pose obstacles to health care nationwide: poverty, availability, and lack of affordable insurance.
Rockwood’s population is increasing as low-income people are displaced from other areas because of gentrification and immigration. At least 32 percent of households have incomes below the federal poverty level, and 56 percent are below double the poverty level. It is difficult to scrape together money for sustained primary care when a person’s income barely covers immediate demands, such as housing and food.
Even if people found the money, local health care providers are scarce. One measure of availability is the U.S. Department of Health and Human Services’ Health Professional Shortage Area (HPSA) score. The higher the numerical score the greater the shortage. Tellingly, for the Rockwood area that WMC’s clinic serves the HPSA score is 16 for primary health care, higher than nearly all other areas in Oregon, urban or rural.
Accordingly, over the past year WMC has hired three full-time primary care providers: Dr. Anna Jimenez, the staff physician and medical director, and two nurse practitioners, Maya Strom and Christie Rivelli. A physician assistant will soon join them. Together the four will provide the sort of continuity to health care that can prevent medical conditions as well as treat them. Additionally, WMC contracts with an around-the-clock nursing triage system to help or refer patients when its offices are closed.
In fiscal year 2012-2013, the medical staff and their assistants saw 3,563 patients in 9,366 visits. As the community grows more familiar with WMC, and the clinic’s capacity ramps up, those numbers will rise. Even when Oregon’s health care reforms and the Affordable Care Act are fully implemented, there will be uninsured patients for the clinic to aid, among them migrant workers, who now account for a significant number of the patient population.
In addition to the Rockwood primary care clinic, WMC maintains three external programs. First is a clinic in a “bus.” WMC sends out its Mobile Medical Clinic three days a week to handle both urgent care and primary care. Opening at regular hours, the mobile clinic parks near service agencies, schools, and low-income housing, as well as in agricultural settings. Its outreach program also sends it to neighborhoods where residents, falling ill, frequently resort to fire departments for transportation to emergency rooms, a wasteful, expensive recourse. Patients are offered blood pressure and glucose screening, flu shots, and referrals to the Rockwood clinic.
Second, in the Central City Concern’s Old Town Clinic, WMC holds clinics on Thursday evenings (or sees patients by appointment). Basic urgent care is offered each time, and dermatologic and podiatric care twice a month. The clinic welcomes children for routine check-ups and immunizations. WMC volunteer medical professionals also staff urgent care clinics two evenings each week at the Rockwood Clinic. All told, more than 300 volunteer physicians, residents, interns, nurses, chiropractors, interpreters and other clinic workers supply the medical examinations and other services at WMC’s urgent care sites.
Finally, WMC operates the Ventanilla de Salud (Health Access Window) at Portland’s Mexican Consulate. Its function is informational, promoting health and disease prevention and making health care and social services referrals for Mexican citizens and their families in Oregon. The Mexican government has thought highly enough of WMC’s Ventanilla de Salud to invest in it as one of five model sites for additional program development.
Additionally, WMC designs programs for specific groups and health problems. Many of its Rockwood clients are Latino. As a group, Latinos have a high rate of diabetes, which unmanaged leads to debilitating illnesses and costly interventions. With a three-year grant from Kaiser Permanente, WMC created PODER (Patients Overcoming the Diabetes Epidemic in Rockwood), a model program of education and assistance in managing or preventing the condition.
WMC’s Rockwood Clinic empowers individuals and families with the means to understand and improve their health themselves. As Lisa Cline puts it, “We’re looking for opportunities to help people introduce fitness into their lives. There are a lot of barriers to fitness and health. If there’s a barrier, we ask ourselves, ‘how do we help them overcome it?’”
WMC holds classes on nutrition and cooking, basic health literacy, children’s health, senior health, dental health, asthma management, and chronic disease management, as well as hosting support groups. There are exercise classes featuring yoga and dance to improve flexibility and overall conditioning. These classes are free, and instruction and all materials are in both English and Spanish. (WMC’s staff is bilingual.)
Rockwood residents also have an acute need for dental care. The service area has a dental HPSA score of 20, the highest in Multnomah County. With funding from United Way of the Columbia-Willamette, Wallace partners with Willamette Dental and Northwest Medical Teams to offer exams, fluoride prescriptions, cleaning, extractions or fillings at the Rockwood clinic and nearby community locations.
But education and disease treatments are, unfortunately, not enough to ensure the health of WMC’s patients. Among them food security is a constant worry, and many face hunger or poor nutrition from poor quality foods, both of which can worsen overall health and specific diseases. In October 2012 WMC began screening patients and their families to assess their access to food. Those in need are given a list of local food pantries and meal sites and help in enrolling in the Supplemental Nutrition Assistance Program (SNAP, or food stamps). WMC partners with other organizations to make food boxes available and to encourage participation in a garden plot program.
In addition to its various health care initiatives, WMC is a Public Housing Community Health Center, the only such grantee in Oregon. Working with other Rockwood Building organizations, such as Human Solutions, it helps patients locate affordable housing.
All this effort costs money, a lot of it. Some of the region’s leading charitable institutions and health systems extend support to WMC, including the Collins Foundation, Hoover Family Foundation, Jackson Foundation, Kaiser Permanente, Marie Lamfrom Charitable Trust, Legacy Health, Maybelle Clark Macdonald Fund, Meyer Memorial Trust, Northwest Health Foundation, Oregon Community Foundation, Oregon Health & Science University, PGE Foundation, Providence Health, St. Paul Foundation, Vera Smith Charitable Foundation, and Rose E. Tucker Charitable Trust. Faith communities such as St. Luke Lutheran Church assist too. During the last fiscal year, appeals for private donations brought in more than $130,000, testimony to strong community support.
In 2012 WMC began billing those patients who have insurance and is just starting to enroll the uninsured in the newly expanded Medicaid system. For all others the clinic asks a nominal contribution, $25.00, per visit. It is asked but not required. In accordance with a central WMC precept, staff and volunteers never deny anyone services for lack of payment.
As WMC grows, it works to become more diverse ethnically, in keeping with Rockwood and American society in general. Today its staff comprises 45 percent ethnic or social minorities. Among patient ethnic groups in 2012 the largest was white at 44.5 percent, followed by Latino (36.1 percent), African American (7.2 percent), Asian or Pacific Islander (4.8 percent), and Native American (0.7 percent), with 6.7 percent multi-racial or of unknown ethnicity.
To further enhance its responsiveness to the community, WMC has a Latino Patient Advisory Council and a Board of Directors with 51 percent of the members drawn from consumers.
Wallace relies on its extensive referral network and community partnerships to provide medical services and address economic and social barriers to health for those in need. Through the Coalition of Community Health Clinics, WMC coordinates with 13 other Community Health Centers and safety net clinics. Other key partners are the social service agencies with whom WMC shares the Rockwood Building, as well as Portland-area health systems and others addressing basic needs.
“What we’re doing is thinking as a group,” Cline says about networking with a wide variety of other organizations. The common goal is to set people on a path to self-management and independence. “Of course, we can’t impact poverty itself. But what are some steps along the way? Here’s one. If someone is healthy, then they’re more likely to keep their job or get a job.”
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