15 minute read
ONE FOR ALL
Community health centers typically provide outpatient care, including check-ups, vaccinations, and treating common injuries and illnesses. [Photo courtesy of Santa Rosa Community Health]
MORE THAN MEETS THE EYE
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Community health centers have far-reaching bene ts for us all.
BY JULIE FADDA
COMMUNITY HEALTH CLINICS ARE ONLY FOR POOR PEOPLE.
That’s the perception, anyway. And it is, in large part, true: Clinics are a literal lifeline for people with no social safety net. But clinics also serve those who are between insurance coverage due to a move or job change; teens and young adults, including full-time students, with no employer or familial insurance plan; children and spouses of working people whose employer premiums, deductibles and co-pays make family coverage prohibitive; and those who need help beyond what many companies or retirement packages provide (also known as the underinsured). What’s more, clinics provide education and career opportunities, as well as access to services beyond health care, such as transportation, housing assistance and disaster preparedness — something all Sonoma County residents are, sadly, familiar with.
COMMUNITY PARTNERSHIP In the past, when someone needed medical care but had no (or limited) insurance coverage, they often ended up in county emergency rooms, which was — and is — a costly and ine cient way to provide service for conditions that aren’t true emergencies. The last decade has seen an explosion of walk-in and urgent care clinics, which are meant to siphon less critical cases away from Rs by offering same-day, after hours and weekend availability for less-serious maladies. Of course, upon arriving at one of these types of facilities, you’re still asked to provide insurance information.
When someone without health insurance seeks medical aid at a county emergency room or urgent care center, their visit triggers a well-delineated series of interventions. Regardless of income level or immigration status, sick or injured persons will be treated (or referred to an appropriate provider if the matter can wait) and interviewed to determine eligibility for state and federal aid.
Thanks to federal passage of the Patient Protection and ffordable are ct ( ) in 201 , most people who need assistance with medical expenses can receive it; an expansion of state-funded Medi-Cal and the open exchange marketplace Covered California dramatically changed the state’s health care landscape. (For more about these options, see Definitions, page )
In Sonoma County, a network of nine community health care organizations (some that reach beyond our borders) provide thousands of residents with quality medical care and preventive, dental, vision and mental health services. In addition to five large clinic groups, there are at least four smaller or standalone care clinics run by various religious, social or community groups. All together, there are more than different sites throughout the county where one can find care. ach health center organization is independently owned and operated, but they all work within the system to provide — and be reimbursed for — the care they give.
ACA CHANGED THINGS Partnership HealthPlan of California (PHC) is a nonprofit, community-based health care organization that contracts with the state to ensure those covered by Medi-Cal have access to high-quality, comprehensive, cost-effective care. Serving 14 Northern California counties, including Sonoma, PHC’s mission
— DR. NURIT LICHT,
PETALUMA, ROHNERT PARK, AND
COASTAL HEALTH CENTERS
is to help its members, and the communities it serves, be healthy. In 2011, Dr. Marshall Kubota joined as a regional medical director. “I chose this position because the organization endeavors to use public funds in the best way possible — to keep people and communities healthy,” he says.
Originally from Fresno, Calif., Dr. Kubota attended UCLA then St. Louis University School of Medicine. After residency, he began medical practice at Russian River Health enter in Guerneville. When the ACA passed, community health centers saw an in ux of new patients. t PH , we were overjoyed,” says Kubota, “because we knew there was a large population of uninsured people not getting active and preventive care.” In just a short time, he says, “Our patient population quickly rose by one-third.”
With expanded eligibility came an in ux of patients, agrees Dr. Nurit Licht, chief medical o cer at Petaluma, Rohnert Park, and Coastal Health Centers (in Point Reyes and Bolinas). When the passed, the number of clinic patients skyrocketed, she says. So many people had avoided even routine health care due to fear of costs. The ACA took that fear away. It was incredible to intake the new patients and watch their health improve. Community health improved as a result.”
While health centers may have varying levels of specialty care capacity and coordinate a broad range of health care services for their patient population, they typically provide outpatient care, including check-ups, vaccinations and treating common injuries and illnesses (colds and u, digestive issues and the like). General patient care is largely determined by location and accessibility.
But when someone comes into a health center with a serious medical condition — for example, cancer or organ failure — the center will contract with PHC, which holds separate contracts with specialists and hospitals.
For patients with private insurance, health centers use the specialty network contracted with each insurance to direct referrals for patients. For patients without insurance, “It’s a challenge and a scramble,” admits Alvaro Fuentes, interim CEO at Redwood Community Health Coalition (RCHC, headquartered in Petaluma and serving patients in Sonoma, Napa, Marin and Yolo counties). “Health centers use internal specialists when they can, telehealth specialists if available, and e-consults if they’re available, to leverage their relationships and contracts with specialists to refer patients for in-person specialty care.” A HOLISTIC APPROACH
The idea behind holistic health care is that each patient receives everything he or she might need to be healthy, which often goes beyond medical services. We have counselors onsite who help people get insurance, and we help patients obtain food through CalFresh,” says Licht, a Dartmouth graduate who came to Petaluma in 200 expressly to work in a federally qualified health care center (FQHC) setting to embrace collaboration and advocate for systemic change in health care. We focus on understanding social determinants of health, and we provide full-spectrum family medicine, she continues. We provide behavioral health, dental, vision and nutrition care. We have established schoolbased health centers and a medical clinic in the homeless shelter. We also see patients in the hospital and at skilled nursing facilities. It’s a broad range of what people need.”
Says Naomi Fuchs, CEO of Santa Rosa Community Health Centers (SRCHC), “A holistic approach centers around any given patient’s personal health goals. SR H began with one location in 1996. When uchs came on board in 2000, there were employees. Today, there are eight locations and more than 00 employees serving upward of 0,000 patients annually.
SRCHC began with one location in 1996. Today, there are eight locations and more than 500 employees serving upward of 40,000 patients annually.
With a background in anthropology, I find the interface between culture and healing very important. My desire is to transform health care so everyone can access it,” adds uchs. We provide comprehensive care medical, dental, mental health and specialty services including case management.
“It’s about social justice and health equity,” she adds. We do a lot of advocacy and outreach to make health care more accessible to people who’ve been historically left out — regardless of education, income or language barriers.”
RCHC’s Fuentes has been working within the nonprofit sector since he was in his early 20s. I sought to make a difference first by wanting to become a police o cer, he says. “I later met a mentor, who told me I could make much more of an impact working with nonprofits.
“I got a job at AltaMed Health Services Corporation in Los Angeles as a grant writer, where I learned about community health centers. I came to the Community Clinic Consortium of Contra Costa and Solano ounties in 200 . I blinked, and it’s been 1 years. Yet it always feels fresh,” he adds.
Fuentes was brought in as interim O at R H in une 2021 to guide the organization during its transition between CEOs. The two organizations have since discussed a merger plan to create a consortium that would cover six Bay Area counties, including Sonoma County. There’s been a positive reaction within
— NAOMI FUCHS (ABOVE), SANTA ROSA COMMUNITY HEALTH CENTERS
the organizations, with lots of excitement surrounding the possibilities. “Even though we’d be a larger organization, there’s 100 percent commitment to deepening local relationships,” he says.
COVID-19 AND NATURAL DISASTERS
Most everyone’s least-favorite subject these days is O ID-19. We’re all tired of hearing about it, dealing with ever-changing mandates, and not being able to visit our loved ones, especially if they’re in a highrisk category. Community health centers are there to help.
“COVID brought a lot of people to us for testing. We worked with the county and other partners to fill gaps and develop a safety net. It was very heartening to see,” says Licht. “Then we focused on vaccinations and new challenges with the Delta variant. There will be a lot of twists down the pandemic road, but a lot of new patients have turned to us over the past year.”
“COVID has been the major disruptor of health care in my lifetime,” says Kubota. It caused tremendous upheaval. O ces were closed, hospitalization rates increased. Nursing homes and long-term care facilities were stressed.”
“Every year, we have to retool how we do things because of fires, evacuations, oods and now the pandemic,” adds Fuchs. “After the 201 fires, we launched a communitywide collaborative, called Sonoma County Resilience, and trained more than 200 people to be facilitators in mind/body medicine, with wonderful results. It’s an eight-day intensive training course, then the students go into the community to address and create awareness and understanding of how trauma affects people.
“Nobody was prepared for COVID,” says Fuentes, who also partners with statewide organizations and other health consortiums throughout California. “Now, almost two years into it, people are able to admit that. We realized right away that we’d play a key role in mitigating pandemic challenges. We leveraged local relationships with public health departments to provide personal protective equipment PP and accurate information. We had to protect front-line workers, first with PP and then with vaccination distribution.
“At the end of the day, it should be clear to everyone that community health centers are playing a vital role in ensuring the vaccine gets to patients and communities served.”
NEW IDEAS AND GOALS
One positive that’s come out of the pandemic is greater access to telemedicine. While remote diagnosis and treatment has long been important to outlying communities, it hasn’t always been the case for those closer to in-person help. Prior to the pandemic, insurance companies resisted telehealth visits, requiring in-house appointments instead. But that all changed last year. When COVID hit, we shifted to 0 percent telehealth visits in 10 days, says uchs. Now it’s about 0 percent.
“The pandemic opened the door for telemedicine, agrees Licht. We’ve had real success with it regarding chronic disease management, prenatal education and behavioral health. Patients like being able to stay home.”
Geriatric care is also on the radar. We’re working with UCSF and the Institute for Healthcare Improvement on a model of health care for elders, says Licht. We’re always looking for new ways to provide highquality services. Eliminating barriers is the key to success.” We’re about to launch our three-year strategic plan,” adds Fuchs. “Part of it addresses the needs of older adults, a growing population in the area. We’re also looking to expand mental health services, chronic disease management, team-based care, telehealth and more.”
At PHC, transportation services were added a few years ago for people without means to get to medical appointments. We provided more than 00,000 non-emergency transports in 2019, says ubota (the organization’s region extends to the Oregon border). PHC has also provided support in the form of grants for medical and other housing programs. “Hospital-style beds are important for the acutely ill,” he says. But for many who are recovering from illness or injury, 2 -hour medical surveillance isn’t necessary. “These programs allow more open beds in hospitals, while patients receive the rehabilitative care they need at a separate facility.”
FACING CHALLENGES
One of the biggest challenges faced by community health clinics is maintaining a strong workforce. While clinics cannot compete with large hospitals regarding salaries, they can attract employees by providing a positive, family-like work environment.
“During the last several years, we’ve been focusing on teaching and training people onsite, says Licht. We have nurse practitioner and physician assistant residency programs that are growing. We also have post doctorate programs and are starting a pediatric dental residency. We also train dental assistants as well as medical assistants and nursing externs. We find that, when they train with us, they want to stay.”
Providing job training and employment opportunities is just another way clinics support the larger community. We offer a positive work culture and excellent benefits, says uchs. We have lots of opportunities and a strong growth ladder for people who work here. For example, one person who started here in high school as a volunteer ended up becoming our associate director of nursing.” Congressional Representative Jard Hu man (dark jacket) visits a North Bay health center during the pandemic. [Photo courtesy RCHC]
here have been mass resignations in the healthcare sector] because people are burnt out,” says Fuentes. “Community health centers aren’t immune to that. There’s a tremendous amount of pressure on all healthcare workers, which COVID has increased. We have local training programs to build up the pipeline and ensure the workforce re ects the communities served.”
Another challenge is long-term sustainability. “Fiscal sustainability is a very important thing to factor into organization planning,” says Fuentes. “The federal government, over the last 18 months, has provided three rounds of COVID relief funding, which has been key to keeping health centers running and able to provide key health services during the pandemic.
“Added support from community foundations has likewise been essential during this challenging time,” he continues. “Community Health enters receive significant funding from the federal government, through reimbursement from Medi-Cal, which is administered by the State of California, some private insurance, as well as nonprofit community foundations and private donations from community members.”
OVERCOMING BARRIERS
Community health centers help our entire community, not just those patients directly served. They’re a trusted information, education, career, and (of course) health resource that extends into everyone’s lives. With luck, hard work and perseverance, this valuable resource will continue for generations to come.
Find a complete list of Sonoma County community health centers on page 78.
About the author: Julie Fadda is a freelance writer and former magazine editor based in Sonoma County.
DEFINITIONS
CALAIM is a state-funded program that provides safe discharge housing for patients to stay and finish home medical therapies. CALFRESH, federally known as the Supplemental Nutrition Assistance Program (SNAP), issues monthly electronic benefits that can be used to buy most foods at many markets and food stores. The CalFresh Program helps to improve the health and well-being of qualified households and individuals by providing them a means to meet their nutritional needs.
CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES (DHCS) is the backbone of California’s healthcare safety net, funding healthcare services for about 13 million Medi-Cal beneficiaries, including low-income families, children, pregnant women, seniors and persons with disabilities.
COVERED CALIFORNIA is the state’s health insurance marketplace, established under the federal Patient Protection and A ordable Care Act. The exchange lets eligible individuals and small businesses purchase private health insurance coverage at federally subsidized rates. FQHC is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. An FQHC provides care to underserved areas of population, provides a sliding fee scale, and comprehensive services (either onsite or with a thirdparty provider) including transportation services, hospital and specialty care. Each FQHC must have an ongoing quality assurance program and a governing board of directors.
CENTER FOR MEDICAID AND CHIP
SERVICES (CMCS), is one of six centers within the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). CMCS serves as the focal point for all the national program policies and operations for three important, state-based health coverage programs, which, together, provide an important foundation for maintaining the health of our nation: • MEDICAID provides health coverage to low-income people and is one of the largest payers for health care in the
United States. • The CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP) provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t a ord private coverage. • The BASIC HEALTH PROGRAM (BHP) gives states an option to provide a ordable coverage and better continuity of care for people whose income fluctuates above and below
Medicaid and CHIP eligibility levels. MEDI-CAL is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.
MEDICARE is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with EndStage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
