2005-2006 Common Ground Health Clinic - LA

On the weekend of Friday, October 13, Common Ground Health Clinic held our Fall 2006 Retreat. The retreat was attended by clinic staff, volunteers, patients, neighbors, partners, and a few members of our new Board of Directors.

Our history
We began the retreat by telling our stories, of how we ended up at the clinic, and what we remembered through the tumultuous year since the storm.

One person said, to sum it up, “We are soaking in what has been accomplished and where things started. A few of you said, ‘This happened like magic.’ Dr. King in the 60’s said that the movement was like a zeitgeist, a spirit of the times. This, what we are sharing, is some serious big-time American history.”

Some of our accomplishments

 * We became a free nonprofit health clinic certified by the Department of Health and Hospitals, with a variety of programs including labs, overseen by a medical director. Medical schools use us as a teaching facility.
 * We mobilized massive amounts of donated supplies in a short period of time, and tapped into national and international networks of volunteers and donations
 * By our size, visibility, and particular approach to health care, we challenged the way others provide health care across New Orleans and the country. Hundreds of medical students and other health workers have changed how they thought about health care after volunteering with us, and several small health clinics have sprung up using our model in the last year.
 * From our first day, we sought out personal relationships with people in historically oppressed communities. We exposed and stood up against the military occupation of the city, forced displacement, the illegal “Angola South” jail in the Greyhound station, medical neglect, lack of coordination between post-storm "safety net" agencies, and abuse of day laborers.
 * We created safe spaces: we disarmed dozens of soldiers and police before allowing them to enter the clinic, we transformed an abandoned grocery store where a man was shot into a community health clinic, and we developed a community garden.

Our dreams
FAST FORWARD to Oct 2011 and CGHC is being honored by President Hilary Clinton for excellence in healthcare and providing leadership to the nation about serving poor communities. What is that we will have accomplished to get that honor?
 * We will have promoted prevention through support groups and partnerships; provided healthy foods, nurseries, or a learning center (for computer literacy and crime prevention).
 * We will have shared our national recognition with organizations and individuals thereby increasing health care funding in the mid-South, honoring our clients’ resilience, and fighting negative stereotypes that justify the dispersal of people.
 * We will have respected each patient's intelligence, history and needs; provided easy access regardless of documentation, literacy, or language.
 * We will have received a large part of our funding from within Algiers, continued to do a lot with a little, and always prioritized our clients, partners, and neighborhood in funding decisions.
 * We will have supported young people of Algiers to use clinic as their own, taking leadership on their priorities from healthcare to community justice.

Our patient population data
Total Yearly Patient Visits (10/2005-10/2006) Approx. 22,000

Top three Zipcodes where our patients live: More than half of our patients live in these three adjacent West Bank areas.
 * 70114 – 34% (Algiers)
 * 70131 – 9.4% (East Algiers)
 * 70053 – 7.3% (Gretna)

Data source: front desk database.

Return Visits Return visits are about 50%. In May 2006 we saw 409 patients and over 300 were returns.

Data source: front desk database.

Top four health conditions we treat: Data source: Adi’s study (7/06: sampling of 50 patient charts picked at random from the A’s and the M’s)
 * Hypertension – 30%
 * Diabetes – 14.4%
 * Asthma – 3.5%
 * Pain – 11.1% (arthritis, trauma, and all kinds of pain management)

Almost 30% of our patients have high Cholesterol.

Data source: Anne self-reporting (10/06)

Incidence of common health conditions in Orleans Parish: Data source: (from noladashboard.org) Rapid Population Estimate (EOC) took sample of 188,000 people from 7/06 until 9/06.
 * Hypertension – 17.3% indicated yes - 17.6% didn’t indicate either way
 * Diabetes – 7% – 18%
 * Asthma - 5.4 – 18%
 * Pain – unavailable
 * Serious mental health condition – 15% indicated yes.

''Data sources: CGHC: Adi’s study (7/06: sampling of 50 patient charts picked at random from the A’s and the M’s). NOLA: (from noladashboard.org) Rapid Population Estimate (EOC) took sample of 188,000 people from 7/06 until 9/06.''

There is a lot more old folk in our neighborhood (Old Algiers) than the rest of the city because of the ways that property ownership and families are organized.

Data source: Jack self-reporting (10/06)

30% to 50% of our patients are over 65.

Data source: Anne self-reporting (10/06)

''Data sources: CGHC: Adi’s study (7/06: sampling of 50 patient charts picked at random from the A’s and the M’s). We do not ask our patients to report race. NOLA: (from noladashboard.org) Rapid Population Estimate (EOC) took sample of 188,000 people from 7/06 until 9/06.''

6.5% of our clients report they are from outside Orleans Parish.

Data source: front desk database.

''Data source: CGHC does not ask our clients to report health insurance coverage. NOLA: LPHI study (Carrie doesn’t think this is very reliable)''

Clinic Income and expenses
In our first year, we spent about $6,260 per month, or $115,940 total. Our biggest single expenses were food, renovations, and rent. In the same time, we raised $244,360. That leaves about $128, 420 in our bank account. We also received about $368,000 worth of supplies, equipment, and other “in kind” donations in our first year.

The Social Services Block Grant evaluated the value of our care in that time span by the hours we were open, exams we performed, services we offered, and other factors. They said our care (which cost us $115,940) was worth $2.3 Million per year.

We plan to spend about $299,800 in our second year. Due to decreased volunteerism and donations of equipment as we get further from the storm, our expenses are increasing.

The full budget is available from Bay.

Overview of the re-design plan
You can read the Louisiana Redesign Collaborative notes at http://dhh.Louisiana.gov


 * 1. Universal Insurance. (Not universal care)

Idea is to expand coverage of Medicaid to include all adults under 100 to 150% of the poverty line. And everyone from 150% to 300% will get discounted health insurance.


 * 2. Create a Medical Home

implement managed care (meaning more administrative controls on health services, and by putting more responsibility on primary care docs vs. specialists in hospitals)

Clinics are going to have to be certified as a medical home, defined as: This is still awaiting official approval, the idea will remain the same but some numbers might change. Senator Joe McPherson is a major decider in this whole process.
 * prevention primary care focus
 * patient centered
 * personal physician
 * formally tied with specialist and inpatient care
 * use evidence based care
 * 24 hour access
 * comprehensive,
 * evidence-based medicine and “best practices,”
 * culturally competent care


 * 3. Charity hospital will be replaced by an LSU University teaching hospital 

The new hospital will not bound to serve the poor or underinsured. Medical homes will serve the poor.


 * 4. Time frame 

it will take one year to 18 months to begin phasing this in.

''Q. Do you think it would be possible for this clinic to survive long term and not be certified as a medical home?

A. That’s a good question, this clinic seems to be the model for how the medical home should be, the question would be what changes to the clinic’s vision would be required.

Tony suggested folks from the clinic sit in on these meetings to address some of these issues.''

Clinic programs break-out group
This group listed priorities for the clinic's programs in the future. Most of the priorities are already provided by the clinic out of tradition. They would like to protect them within policy for the future. They placed the goals in the following categories.

Type of Program:
 * (1)= low hanging fruit: achieving it is easily within our reach
 * (2)= more bang for our buck: while it may take some work, each hour/dollar really pays off
 * (3)= next step down the line: where we are going

Purpose for Approach:
 * (x)= helps individual staff maintain roots in community
 * (y)= ensures that individual clients get good continuity of care
 * (z)= helps clinic as a whole relate well with neighborhood

Programs
Programs we already provide
 * 1) Integrative health care (strong communication between biomedical, herbal, acupuncture, and social work providers, to provide comprehensive care) (1,2)
 * 2) Free Medication Program (1, 3)
 * 3) Primary care medicine (1)
 * 4) Lab Work (1,2)
 * 5) Anti-racist advocacy (our work is based on relationships that challenge oppressive systems) (1)
 * 6) Volunteer-based staff (1)
 * 7) Community Garden (1, 3)
 * 8) Preventative care classes / groups (1, 2)
 * 9) Interpretation services (2)

Programs we do not provide but could easily offer
 * 1) Health and Safety education (1, 2)
 * 2) Women’s Health Services (Pap Smears) (1, 2)
 * 3) Vision Services referral network (1,2)
 * 4) Education for providers about patient literacy (2)

Next stops on the clinic train
 * 1) Child Care, Literacy, and Youth Leadership programs (3)
 * 2) Increased neighborhood food security (farmers markets, produce in corner 	markets) (3)
 * 3) Increased green space and parks (3)
 * 4) Integrated Pain Management Program (3)
 * 5) Home Health Services (3)
 * 6) Needle Exchange Program (3)
 * 7) Dental work referral network (3)

Approaches
Our community-based approach to deciding and providing.
 * 1) Our services are not based on patient income (all patients know they will get the same level of care) (1, 2, y, z)
 * 2) Patients are greeted by name (1, 2, x, y, z)
 * 3) Stipends for community volunteers (1, z)
 * 4) Direct Action Fund (pays for expenses that keep patients from getting needed further care) (1, x, y, z)
 * 5) Frequent block parties, B-B-Q’s, and open houses (1, x, z)
 * 6) Staff personal relationships with people in our neighborhood (living in the community we serve helps us maintain roots and neighborhood-based vision) (1, 3, x)

Approaches to deciding and providing we do not do now, but should do.
 * 1) General Assembly (provides community guidance to clinic development) (2, x, y, z)
 * 2) Serious follow up on referrals (2, y)
 * 3) Use clinic van to provide patient transport (appointments, grocery store, Angola) (2, y, z)

Actionable goals:
 * 1) Clinical WG will establish policy and procedures for patient eligibility (type/ # of forms/ literacy level/ appropriate languages) by the January, 2007 board meeting. The Clinical Management Team will propose the policy to the board.
 * 2) A group consisting of Noah, Lanetta, Jennifer, Gina, and Katya will establish policy and procedures regarding van use by December, 2006 board meeting. The Administrative Management Team will propose the policy to the board.

Next Steps Make SMART goals out of each category. Achieve goals.