Hub & Spoke

Community Clinics, Oh How We Need You!

The United States currently faces the toughest economic times since the Great Depression, with an unemployment rate of 9.1 percent in September. This is bad news for families in HMOs as studies show that for every one percent that unemployment rises, the number of adults receiving health coverage from employers drops by that same amount. Times like these highlight the vital importance of quality nonprofit community health centers, otherwise known as community clinics.

 

Often referred to as the “safety net” for low-income and medically underserved communities, community clinics play an essential role in providing affordable, quality healthcare to an ever-growing population of patients. Today’s clinics are modern operations that specialize in primary care and serve any patient who walks through the door, regardless of their ability to pay. They provide patients with a medical “home” where they can receive regular checkups for the whole family and can develop long-term relationships with a primary care doctor.  Many community clinics also provide behavioral health services, dental health services, assistance with enrollment into coverage programs, and referrals for specialty care.

 

Studies have shown that the quality of healthcare provided at community clinics is excellent, patient satisfaction surveys continue to show overwhelming satisfaction with care received. In addition to being high quality, clinic healthcare services are provided in a language that patients can understand and with an appreciation for how different cultures view the medical system. Research has shown that patients who receive care at community clinics have lower medical costs because providing quality primary care services can reduce the need for other ambulatory and hospital-based medical care, thereby lowering overall medical costs. This means that patients are served in a timely and affordable way before they wind up in the emergency room with a condition that could have been prevented. A policy research brief completed by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative found that community clinics save $24 billion annually in medical expenses.

 

The passage of the Patient Protection and Affordable Care Act, or Healthcare Reform, on March 23, 2010 set the stage to expand healthcare coverage for nearly all Americans and help curb health care costs. Community health centers are well positioned to help the nation achieve both these goals and have, in fact, been touted by policy makers and the President as models of effective, quality and economically savvy healthcare delivery.  President Obama stated in December 2009, “I especially want to recognize the leaders from health centers across the country for what all of you are doing in your communities every day –- working long hours to provide quality care at prices that people can afford, with the dignity and respect they deserve, and in a way that takes into account the challenges that they face in their lives.” As implementation of Healthcare Reform continues, community clinics will play an increasingly critical role in the redesign of the safety-net delivery system and ensure expanded access to care.

The America We Want

Here's a riddle: What steadily shrinks for the first 39 years of its life and grows blazingly fast for the next 30?

(Sorry, gents - the answer's unfortunately not, as a general rule, "my hairline.")

Give up? 

It's the income gap in America - the difference in the percentage of the nation's wealth held by the richest 1% of the population and that held by everyone else.  Without getting into too many details, the more-than-somewhat-alarming fact of life in the USA these days is that if you're at the very top, you're sitting prettier than ever, and if you're not up there, things are looking grimmer.  

PBS had a great segment on this yesterday, which got us thinking.  

It got us thinking about what kind of America we Americans are making with the public policies we're enacting into law.  

Because regardless of what's to blame for the widening gyre that's blasting through the middle class, it seems that at least part of the answer to social inequality has to be wise federal legislation designed to bring us all together on common ground.

Case in point: Federal Healthcare Reform. Which, incidentally, just passed its anniversary. 

Congressman George Miller was in Concord this week to celebrate what the law's already provided to the sick and otherwise hard-to-insure.  He introduced Dr. Walker of CCHS (to whom he referred as his mentor on health policy) and a panel of regular people - from all walks of life - who're now able to access medical care that just months ago would have been totally out of reach.  

And then Mr. Miller said something so spot-on we wrote it down verbatim:

“On the horizon, there’s an insane idea that they can repeal this and replace it with a voucher. A voucher is the most expensive way to do healthcare… I don’t think that’s America. I don’t think it’s our future… As people find out more and more about this plan, I hope they will understand this is a generally great American idea.”

Right and right. Half of Congress is up in arms about how un-American it is to spend tax dollars on greater healthcare access for everyone. But America is what we make it through conscious policy choices. And the America that we here at the Consortium want to see isn't one where 1% of Americans have dream lives and the other 99% just scrapes by. 

One hundred percent of us deserve some basic things equally. Including health care.

In a society wedged further and further apart, Healthcare Reform honors the American ideal that we all have the right to a fair start.  

So, Mr. Miller, count community clinics in for the fight to keep Reform on the books. And thank you, as always, for your leadership!

Explaining our healthcare system to alien invaders

Sometimes the healthcare situation in this state (and this country in general) really makes us want to cry. When things are this bad - as they are now - the only way we know to avoid breaking down into hysterics is to write short fictional pieces in which we imagine being visited by an alien species, unfamiliar to our (in)human(e) ways. 

Here's how a close encounter of the third kind would sound this week:

Alien Invader: Greetings, Earthlings! We have traveled across the Universe to search out new ways of delivering healthcare to our species.  Please teach us how you do this in "California."

Human:  We're happy to explain our healthcare system to you, friendly Alien Invader! But how much time do you have? Our system of medical services makes rocketing across the Universe seem simple by comparison. 

AI: Ah, I see.  Well, our brains are 7 times larger than yours, so go ahead and give it a try.

Human: Okay then, first thing we should say is that every person in California has a right to comprehensive, preventive medical care no matter their income or age.

AI: That's Excellent! Teach us how you do this!

Human: Right, okay, so…. see, you have to understand, the system's not perfect.

AI: No system is.  Except for the solar system.

Human: Yah, for example, every year on January 10, we have a ritual that we call the Governor's Proposed State Budget.  In this ritual, the government proposes stripping tens of thousands of people of their healthcare benefits.  

AI: I see. That does seem like a bit of an imperfection.

Human:  Right now, the state government is proposing the elimination of Adult Day Healthcare services, services that keep low-income elderly people out of nursing homes and hospitals and enrich their lives immeasurably.  

AI: Hmm. Are these cuts being made because there is simply no other choice?

Human: Well, we could modestly raise the cost of registering a car and extend existing taxes for another couple years. 

AI: That doesn't sound so bad.

Human: It does to almost half the Legislature in Sacramento, which refuses to bring the proposal to the public for a vote.

AI: Ah, those legislators must be Romulans.  We know them.

Human: Another ritual we have here on Earth is called, "Devastating common-sense healthcare programs for political gain."

AI: That sounds….fun.

Human: For example, right now our federal House of Representatives has voted to cut 1/3 of all federal funding to community clinics.  It also voted to roll back a set of improvements to the healthcare system that our President, Barack Obama, passed last year.  

AI: We are still waiting to hear how you ensure comprehensive, preventative healthcare to all.

Human: Huh? What? Oh, no no no.  You misunderstood.  

AI: We did?

Human: Right, so what I meant was that everyone has the RIGHT to comprehensive, preventative healthcare. But not everyone actually GETS comprehensive, preventative healthcare.

AI: This does not compute.

Human: Silly Alien Invader - so technologically sophisticated, so politically naive.  

AI: We are going to take off now.  We hear there is a land called "Canada" where people have the right to healthcare and actually get it, too.

Human: Yes, we have another ritual that involves packing our elderly onto busses and driving them north across the border to buy affordable prescription drugs from that land.

AI: You have a remarkable system, here, Human.  We will note it under our "Do Not Adopt" file.  Thank you for your assistance.

Human: Wait, I didn't get to tell you about local healthcare funding!

AI: If you attempt to do so, we will blast you with lasers.

Human: Okay, bye now!

 ---

Well, writing that kept us from crying. But now we're just angry! If you're similarly upset with what's going on with healthcare in this state and country, be sure to sign up to take action on our website (click here). Together, we can make a change. And there's a lot to change.  

 

Saving Medi-Cal will take more than optimism

Have you ever fallen a bit into the red ink with your personal finances? Sure, who hasn't.  Have you then, as a sort of family recovery plan, written a budget that puts you back in the black, but does so based in large part on the expectation that your boss will agree to raise your salary by $12 billion?  

If you answered yes to these questions, you may qualify for a job at the California Department of Finance, or perhaps in the governor's office itself, where the zeitgeist is a certain rose-tinted optimism about the generosity of the California public.  

Specifically, an optimism that in a June special election California voters will agree to extend about $12 billion in what were originally meant to be temporary tax increases.  Absent these tax extensions, the service cuts that Sacramento will have to make in order to balance the state budget will make drastically severe a quaint understatement.  

(As the comic to the right says, if you think the $1.7 billion in Medi-Cal cuts that Gov. Brown proposed in January are bad, consider what they'll be if he's got to find a dozen or so billion more dollars to squeeze out of state programs.)  

Actually, given that taxes do need to be raised somehow, the plan to bring tax extensions to the voters is a politically savvy one, given that it's harder for opponents in the Legislature to block something that's going to The People for approval.  Also, if a recent PPIC poll is any indication, it has at least a chance of succeeding.

To our mind, however, the PPIC poll demonstrates the possibility, but not the probability, of success.  If we - you, us, and all of the People Who Care about Our Community - want to save Medi-Cal and health centers from the chopping block, we've got to get out and vote in June.  

To that end, we at the Consortium are launching a major voter registration push, starting now.  More detail will follow - suffice to say that this will be our top advocacy priority in Spring 2011.  (BTW - if you're reading this and aren't registered - or have moved recently and need to re-register - follow this link to get the quick-and-easy process started.)  

But! We can't do it alone, and so we're writing to say: Join us! If you're an individual who can help out on the campaign to sign up voters, drop us a line and we'll put you to work! If you're an organization that's also doing voter reg. work this spring, let's figure out how we can work together to canvass the whole region.  

Future registered voters of Contra Costa and Solano Counties, we're coming for you! 

New Action Alert Live & Ready for....Action

This week, just a short note to point our faithful readers to Round 2 of our website's new policy advocacy action system, or PAAS. 

Just kidding, there's no way we're calling it PAAS.

But our advocacy action page is live and ready for you to use.  What is it, exactly?  It's an automated system that allows you to send an email to your elected officials regarding important issues on healthcare.  

We've already written the email for you, so all you have to do is plug in some basic info about your address (so the system can find which elected officials are yours) and press Send.  Of course, if you'd like to modify the email text in any way, you can do that, too, and we'll try not to take offense.

This week's issue is the upcoming budget hearings in the Legislature - where cuts to Medi-Cal and Adult Day Health Care are once again on the table.  It's vital that our Senators and Assemblymembers know they can't plan to balance the budget on the backs of our communities!  

Follow this link to the advocacy action center!

And for more background info on the cuts, check out the California Primary Care Network's bullet points here.  

Finally, if you have a better suggestion for what we should be calling this advocacy action system, please let us know.  

Curling toward the House

We don't know about anyone else, but we here at the Community Clinic Consortium are great fans of curling.  

Often referred to (in Canada, anyway) as "chess on ice," curling is the time-honored and strategy-intensive duel between two teams of competitors battling to see who can get their polished granite stones across the skating rink and closest to the target, which is called the house.  

We particularly like the part of the game when one team arcs its polished granite stone into the other team's polished granite stone, knocking it out of the way and erasing the other team's gains. 

What we don't like is how well our beloved game of curling stands as a metaphor for the US Congress.  

Next week, leadership in the House of Reps will schedule debate over repealing last year's hard-won healthcare reform law, whose passage was a major coup for advocates of a better, more equitable, and more affordable American health system.  

In other words, Republican leadership will be sliding the political equivalent of a large polished granite stone down the ice in an attempt to knock the existing polished stone of healthcare reform away from the house.  (Get it? House?)

Well, we cry foul.  The last thing that low-income and working-class Californians need is the federal government to pull the rug out from under their feet and strip away vital funding for community clinics and basic protections for insurance customers.  

We hope you'll agree now's not the time to re-break the healthcare system.  And we encourage you not only to agree but to make your views known to your Congressmembers.  So we've set up a easy-to-use online tool that allows you to send your representatives a pithy plea for reason.  Check it out at this link, which will get you to our website's Advocacy Action page.  

Happy advocating, Team Community Clinic!  

A Fond Farewell to Julie Freestone of CCHS

We healthcare wonks spend a lot of time talking about the importance of “systems of care.”  It’s a phrase that – a lot like “quality improvement” – is jarringly meaningless to the general public and should be banned from all of our talking points and press interviews.  

But the idea behind the jargon – that healthcare delivery should be coordinated, continuous, and easily navigable for all patients – is hugely important.  It’s they key to making the most of scarce healthcare resources and providing patients (particularly low-income patients who move between County and nonprofit providers) excellent care.  

Perhaps no one has done more to promote cooperation and integration of the healthcare delivery systems in Contra Costa than Julie Freestone at CCHS.  Working behind the scenes as the right-hand woman to Health Services Director Dr. Bill Walker, she has consistently bridged the gap between community clinics and the County’s health centers and helped keep everyone's eye on the ball: providing excellent care for vulnerable populations.

She has been a particular champion of healthcare systems in West County - serving on the board of directors of RYSE, and helping lead stakeholders in planning for implementation of the Healthy Richmond project.  

So we were pretty bummed, on behalf of community clinics and on behalf of ourselves, at the news of Julie's retirement from CCHS (her last day was Friday).  We'll miss working with such a committed advocate for the community.  

We do wish her the best of retirements, though if we had to guess, we'd guess she's not going far from the world of healthcare.  She is, after all, one of us: a wonk to the core.  

Cheers and congratulations from all of us at the Consortium, Julie! 

Olé! (Tanir's New Gig)

Exciting and sad news this week, dear readers: Tanir Ami, ED of the Clinic Consortium and quite possibly the best boss ever in the history of the world, has been named the new CEO of Clinic Ole in Napa.  

Which is extremely exciting because What a Great Gig, right?!?  

But which is a bittersweet pill for us to swallow here at the Consortium as Tanir has been, as we mentioned, and will continue to mention ad infinitum, the best boss since the invention of bosses. 

Clinic Ole is Napa’s only community clinic, and sees over 18,000 patients a year.  It’s a vital part of the healthcare delivery system in that region.  Soon, it’ll have an all-new location at the Napa County Health and Human Services campus on Old Sonoma Road.  Vital, thriving, and growing – that sounds like the kind of place for Tanir, for sure. 

So while December 31, Tanir’s departure date, looms on the horizon like a giant black cloud of tears and sadness, we’re also, when we step back and think about all the great work that she will do for the good folks of Napa, stoked for Tanir and stoked on her next professional adventure.  

But that’s many weeks away, so let’s not get too weepy just yet.  The Consortium continues its operations apace, working with our partners throughout Contra Costa and Solano counties to integrate and strengthen the healthcare system for those in most need of high-quality, low-cost services.  

That’s the mission that Tanir has put front and center at the Consortium and that remains our guiding light moving forward.  Tanir’s lasting legacy will be a Consortium strong and sophisticated enough to continue this mission without her.  

But did we mention how much she'll be missed?

Waving Hi to a New Medi-Cal Plan

Guided by the time-tested adage that "week-and-a-half-old news is still news worth blogging about," we're interested in sparking a conversation here at Hub & Spoke about the recently-finalized 1115 Medicaid Waiver.  

As most of our readers will know, 1115 Medicaid Waivers are agreements between the state and federal governments that determine how California structures major parts of its Medi-Cal program.  It's a "waiver" because the agreement on Medi-Cal structure, while approved by the feds, deviates from the plain-vanilla federal template that the Medicaid program would otherwise default to.  

Here's how the LA Times framed the story:

The Obama administration on Tuesday approved a $10-billion plan to help California modernize and expand its Medicaid health insurance program for the poor, pushing the state to the forefront of the national effort to implement the new healthcare law.

The administration's much-anticipated decision to grant a so-called Medicaid waiver could ultimately help cover hundreds of thousands more Californians over the next five years. State and federal officials hope that will bolster efforts to improve the quality and efficiency of care provided to the state's poorest residents.

So, that said, the question for this community is this: how will the new 1115 Medicaid Waiver impact Contra Costa and Solano Counties?  

More specifically:

1. In Contra Costa County, given that a Health Coverage Initiative already exists - a facet of the previous 1115 Waiver - what will change for low-income adults under the new Waiver?
2. In Solano County, what are the opportunities presented by the new Waiver that the County might have the resources to take advantage of?  

We don't pose these questions rhetorically - we really do want to know.

So if you, dear reader, have insight into any of these mini-mysteries, please comment below and share the wisdom for our online community!

De-Symbolizing Healthcare Reform

With a couple of breathing days since the election that swept a near-record number of majority-party congressmembers out of their seats, we thought we'd add our own voice to the din of analysts trying to figure out WHAT THIS MEANS FOR HEALTHCARE REFORM.  

Because, as we all know, the (former) majority party voted the reform law into existence.  Now that many of them are gone, we and others are left nervously wondering what the future holds.  

Couple of points here.  First of all, it's notoriously hard to judge the public's opinion on an issue based on the party it votes into power.  It's not like a vote for a Republican is an automatic vote against extending health insurance to those with pre-existing conditions.

And even direct polling, in which members of the public are explicitly asked whether healthcare reform should be repealed, is hard to decipher.  In October, the Kaiser Family Foundation published a round-up of polls on this point and basically concluded that even though about 1/2 of the country supports repeal, responses vary widely with the way "repeal" is defined and how the polling questions are asked, and that it's impossible to judge the intensity of the public's sentiments from the polling that's been done so far.  

Second, the political math of repeal is fuzzier than a new crew cut.  It's hard to see the Democrat-controlled Senate or the President acceding to any "repeal" that goes beyond some tweaks around the edges.  In the House of Reps itself, the big news is that San Francisco's Nancy Pelosi will seek election as the minority leader, and if she retains her leadership position you can be sure she'll work overtime to stop any rollback of one of her most significant policy victories.  

Also, let's not forget that the public basically doesn't know what's good about healthcare reform.  That's in large part because most of the awesome provisions of the law have yet to kick in.  The difficulty of repealing a law that becomes more and more popular as time goes on (and as benefits kick in for seniors and others) may be insurmountable.  A good discussion on the politics of taking away benefits from key constituencies played on PBS this week and is worth a gander.  

Our own take is that healthcare reform is - in the minds of many in this country - a symbol of what is perceived to be too much government control over the private sector.  

Maybe with this week's election the voting public has blown off some steam, feels more secure about its representation in DC, and no longer needs a symbol of government over-reach to rally around.  

But just in case that's not the case, it may be time that we supporters of the law start purposefully stripping it of any symbolic importance whatsoever.  That means filling in details where now there's only broad abstract ideas.  

And it means ceasing to talk about "the healthcare law" as a single Thing altogether.  Skeptics always assume that "the reform law" is an enormous, Godzilla-like creature bent on destroying mom and apple pie.  So let's start talking about one specific part of the bill at a time.  We're excited about how comprehensive it is, but that's because we're health policy nerds.  Normal people are somewhat less stoked on thousands of pages of statutory modification.  

So, no, it's not "healthcare reform."  It's "Help Paying for Prescription Drugs" when talking to seniors.  It's "No More Exclusions for Children" when talking to parents.

The more that we as supporters of reform can shine light on specific parts of the law, the less it serves as a symbol and the more it becomes an unrelated set of common-sense, average-Joe friendly rules of the road.  

Much easier to understand.  Much easier to embrace.  

So here's to the death of a symbol, and to the long, long life of a hundred really good ideas to fix healthcare in this country.