August 16, 2017

Health Care Lesson from the Community: Put Patients First

 

Gwenn-Rausch

 

Gwenn Rausch is the CEO of Heartland Health Centers, a community health center whose mission is to improve the well-being of communities by providing accessible, high-quality healthcare to those most in need, particularly low-income individuals, the uninsured, under-insured, immigrants, and refugees.

“I was at the lowest end of my life before, and now, I feel like I’m at one of the highest,” says Pat Parsons, 70. “I’m involved, I’m enjoying life… what more could you ask?”

 

Parsons came to Heartland Health Centers to get medication she needed but was unable to purchase after her company abruptly closed and canceled its insurance policy in 2009. A friend told her she could afford Heartland, which primarily serves the un- and under-insured and is required by law to offer sliding-scale fees. But the “whole patient” care she received — part of our commitment to put patients first — was what prompted Parsons to stay, get engaged, and ultimately to commit to serve on our all-volunteer board of directors.

Her story may be unique, but the solutions that her care and the experiences of other community health center patients represent offer lessons for the country as we move forward in solving the health-care crisis. In honor of National Health Center Week, here’s a perspective on community health centers from the CEO of Heartland Health Centers, Gwenn Rausch.

It may be surprising given the headlines about partisan battles on health insurance most of us have been reading, but officials from across the political spectrum mostly agree on providing primary care to people in need. Many will visit one of the 1,375 publicly-funded community health centers across the country that serve as the family doctor to more than 25 million Americans. That includes Heartland Health Centers and a dozen others in Chicago that staff nearly 100 clinics in schools and communities.

The program started more than 50 years ago as a small but bold demonstration project to provide health care in medically underserved areas. They reach beyond the walls of conventional medicine to address the factors that may cause sickness, such as lack of nutrition, mental illness, homelessness and opioid addiction. Their work has also been demonstrated to save money: on average Medicaid spends 24 percent less on treatment at community health centers compared to other types of medical providers, according to a 2016 study in the American Journal of Public Health.

The patient-centered approach to care builds on community health centers’ legacy of producing innovative solutions to the most pressing health care issues in communities. One promising practice emerging from our work that our healthcare systems should adopted widely — not just in care for the un- and under-insured is to connect mental and physical care in a more integrated way.

A 2006 study found severe mental illness shortened Americans’ life expectancy by 25 years. The National Association of State Mental Health Program Directors found that three out of every five persons with serious mental illnesses die due to a preventable health condition. Those afflicted with mental illness are 3.4 times more likely to die from heart disease, 3.4 times more likely to die from diabetes, 3.8 times more likely to die from an accident, 5 times more likely to die from respiratory ailments, and 6.6 times more likely to die from pneumonia and influenza.

While progress has been made, in 2015, JAMA Psychiatry reported that people with mental disorders lived on average 10 years less and attributed 8 million deaths worldwide per year to mental disorders.

Several years ago, Trilogy Behavioral Healthcare and Heartland Health Centers started providing primary-care clinics inside mental-health treatment centers, providing one-stop shopping for patients who need both kinds of care. Putting patients’ needs first helped us to see that this saved multiple trips for patients who might not have access to reliable transportation.

Co-locating physical- and mental-health care providers also made it easier to put them on the same team and let them share information about patients’ issues and treatment plans. Half of the Trilogy patients who got their primary care from the Heartland Health Centers integrated clinic showed significant weight loss, nearly 60 percent reduced cholesterol levels, and a third quit smoking.

Meanwhile, community health centers have also added more social workers and psychiatrists at community and school health clinics. Quite simply, there is a great need for behavioral health care among our un- and under-insured population. In Rogers Park, for example, mental health disorders cause by far the largest portion of hospitalization rates for mental disorders other than drugs or alcohol and occur 52 percent more frequently than the Chicago average.

But adding behavioral health care is also just good sense, allowing health centers to perfect what we call the “warm handoff,” where a general practitioner, in session, can offer a patient the option to see an LCSW before they leave the office that day. A typical recent case was a 12-year-old who came to a Heartland Health Centers clinic after being hit by a car. Her pediatrician suggested she speak to the social worker after the young woman said she had become too anxious to cross the street by herself.

The social worker and patient discussed deep breathing techniques for relaxation. The following week, the young woman came back saying it had worked well enough to let her cross the street by herself, and she was already using deep breathing to stay calm before taking tests at school.

These practices are helping to save money and provide excellent care in underserved communities. Community health centers come by our whole-patient orientation for a lot of reasons, not the least of which is, we are required by law to have half our board members come from the patients we serve. In the case of Heartland Health Centers, Parsons is not just a customer, she also helps govern the organization. Perhaps that is the most important lesson of all: when consumers have a strong voice in health-care delivery, good ideas result.

Hopefully we will see progress in improving the health care system in the coming year and that progress will enshrine tested practices from community health centers as it comes.