It’s 3 o’clock in the afternoon on Wednesday at Westside Family Healthcare when Dr. Katie McCarthy strides to an examination room.
Her patient is a little girl who has a slight tummy ache.
As she examines the girl’s abdomen and listens to her heart, the doctor asks questions. How are you doing in school? Do you drink milk? How much?
McCarthy also talks with the girl’s mother, speaking in Spanish. A bilingual nurse in the room helps to fill in any gaps.
The doctor looks into the girl’s throat and notes that it is a bit red. She orders a throat culture.
“Sometimes, strep throat gives us a stomachache,” she says.
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So many patients,
so few doctors.
This is the essence of primary care, identifying a potential problem before it becomes a full-blown illness. Patients suffer less. Treatment costs less.
A federally qualified health center (FQHC), Westside’s mission is to provide primary care to patients who live in urban or rural areas that don’t have ready access to care. Almost all are struggling financially.
The health center on West Fourth Street in Wilmington is the largest of Westside’s five locations. Outside, crushed beer cans litter the sidewalk, dropped by patrons of the liquor store across the street.
Inside, Westside is bright, cheerful and clean, a safe haven from want, neglect and poverty.
It is a medical home, a place where patients can rely on care regardless of their ability to pay. The model takes a team approach to providing the basics, including pediatrics, OB/GYN, behavioral health care, dentistry and screenings for cancer, hypertension and other illnesses.
“Having a medical home, the primary care, is very important,” says Lolita Lopez, CEO. “We tell our patients to come to us when they are well, not only when they are sick.”
Westside was launched in 1988, with two examination rooms and a staff of three, including Lopez, in the Adams Four Shopping Center in Wilmington.
In the past five years, Westside has doubled in size. In addition to its centers, the group operates a mobile health unit. There are more than 200 people on the payroll.
In 2011, the organization served 23,365 individual patients, who made more than 86,000 patient visits. This fall, the group will open a new center in Middletown.
So what is Westside doing right? Observers in the health care community point to the group’s proactive approach to going after grants and other resources. Less than one-third of funding comes from the federal government.
“Lolita Lopez and the people at Westside are social entrepreneurs,” says Dan Hawkins, senior vice president of public policy and research for the National Association of Community Health Centers (NACHC), based in Washington, D.C. “They are always looking for more ways to serve more people in the community.”
Westside also is known as a team player. The group has a strong relationship with Christiana Care Health System, providing a training ground for family medicine residents. One in ten babies delivered at Christiana Hospital is born to a mother who received her prenatal care at Westside. The organization also has been working with Bayhealth since it expanded into Kent County last year.
“When hospitals and health centers work together, it reduces the drain on the emergency department and admissions,” Hawkins says. “It’s a winner, all the way around.”
Currently, U.S. health centers provide care for 14 percent of Medicaid patients, with only 1 percent of Medicaid dollars, according to the NACHC. In Delaware, health centers serve 7 percent of Medicaid patients, with 0.5 percent of the budget.
Expect that trend to continue. A recent ruling by the U.S. Supreme Court upholding the Affordable Care Act (ACA) solidifies the role of FQHCs in providing preventative and primary care for patients who are poor or don’t have insurance. The initiative will funnel an estimated $42 million to 500 FQHCs to coordinate care for 195,000 Medicare patients over three years.
“When the ruling was announced, we all did a little dance,” Stephens recalls.
The Bear and Middletown sites both received the governor’s special designation as medically underserved populations, determined by assessing a community’s poverty rate and the number of primary care physicians.
Both are located in shopping centers. That makes it easier for patients who depend on public transportation to get to their PCP, Lopez notes.
“Buses usually stop at shopping centers where there is a supermarket,” she says.
The new Middletown site, located in a defunct real estate agency, will feature an open layout in keeping with the model of a medical team—doctors, nurses, social workers and other providers—collaborating to provide comprehensive care.
Stephens says Westside’s culture was built by people who are excited by primary care.
“We have made a conscious effort with our recruiting over the years to hire people who are passionate about the work we do,” he says.
Stephens has been focused on family medicine since his days as a young doctor in western North Carolina.
“I loved that it was general primary care, all different ages and the family members all together,” he says. “I loved seeing my patients in the grocery store.”
At Westside, PCPs see patients with many of the same conditions that are prevalent in private family practices. High blood pressure. Diabetes. Depression.
There is a higher prevalence of sexually transmitted diseases and HIV. Farm workers are more likely to test positive for tuberculosis or suffer from exposure to pesticides.
Nationwide, clinics are also reporting more patients with chronic illnesses that require more resources to monitor and control, such as diabetes and hypertension, according to a survey by Direct Relief International, a nonprofit medical organization.
Stephens says that’s why it is essential for PCPs to talk with patients about lifestyle and behavior. They discuss nutrition and exercise, too.
Back at the clinic, McCarthy heads into the next examination room. She wears black patent leather pumps with peep toes. They might as well be roller skates. In a typical day, she will see 25-30 patients.
Her next patient is Stephine Hernandez, who just turned one. Westside’s staff started caring for Stephine before she was born. Her mother, 24-year-old Blanca Llamas, received prenatal services at the center.
Llamas, who moved to Wilmington from Mexico, has been a Westside patient for five years.
In Delaware, the typical FQHC patient is a Latina age 20-34, according to a report by the Mid-Atlantic Association of Community Health Centers. Engaging that population is especially important because Hispanics are 30 percent more likely to go without health care, the report says.
“I don’t have to worry about me or my family getting good care,” Llamas says. “I know I can get that here.”
Westside is by far the largest non-profit community health center in Delaware. But two other groups also serve significant patient populations.
In Sussex County, La Red Health Center provides care for 6,500 patients, who make about 15,000 visits a year. In April, La Red opened a 23,000-square-foot clinic in Georgetown, more than quadrupling in size.
Henrietta Johnson Medical Center, originally known as the Southbridge Medical Activities Center, was founded in 1969 and operates two centers in Wilmington that serve about 7,000 patients.
The faith-based Delmarva Rural Ministries' Kent Community Health Center closed in June 2011 due to financial problems. That was due, in part, to a dwindling patient base.
“Delmarva was focused on providing care for farm workers and that population has gotten smaller because of advances in agricultural machinery,” Hawkins notes.
To fill the void, Westside pushed up its planned entry into Kent County. In July, the group rolled out its new mobile unit, funded by Highmark Blue Cross Blue Shield Delaware, to serve migrant laborers in Kent and Western Sussex Counties.
In May, Westside received a $1 million grant under the ACA that will fund a dental office in Dover. That service hasn’t been available to underserved patients since Delmarva shut down. The office is expected to grow rapidly and serve more than 2,000 patients.
“There’s a need—and our goal is to provide the best care possible,” Lopez says.
