Hub & Spoke

From Patient to Promotora: The Story of Nora Vigil

By Vivian Nguyen

Nearly two decades have elapsed since Nora Vigil first arrived in El Cerrito, California from her native Peru. For years, she struggled to assimilate into what she calls the “American way of life.” However, when she joined Mujer, Salud y Liderazgo, a women’s empowerment program sponsored by the Latina Center in Richmond, she began to feel like she truly belonged.

“For my first few years here, I tried to adapt to this new country,” Vigil said. “Becoming a part of Mujer, Salud y Liderazgo really helped me go back to my roots and recognize the issues in my Latino community.” Awareness of these problems compelled Vigil to become a facilitator for sub-programs on topics such as domestic violence, mental health, and unemployment. Currently, she serves as a board member for the program.

Although she did not know it at the time, Vigil’s experience as a Mujer would be a major influence on her decision to join the community health movement. When private insurance premiums became too much of a financial burden for Vigil and her husband, they were referred to LifeLong Brookside Community Health Center by a friend who was also a patient advocate for the clinic. Vigil and her husband were extremely satisfied with the high-quality, affordable care that they received at LifeLong. After three years as a patient, she decided that it was time to give back.

An opportunity to do just that presented itself when LifeLong partnered with Community Clinic Consortium to launch the pilot Health Promoter Program in the summer 2012. The 10-week leadership training program is designed to build the capacity of LifeLong patients to become educators and advocates for their community. Upon completion, trainees become certified volunteers and commit to a minimum of one year working as a LifeLong Health Promoter.

“Patients make good health promoters because they know what the community needs and the kinds of services they should receive,” said Vigil, who graduated with the first cohort of Health Promoters on August 22, 2012.

Her cohort identified diabetes as the highest priority health issue, followed by obesity. According to Vigil, LifeLong addresses these concerns by providing diabetes education classes for its staff members, along with Cooking Matters courses on healthy eating habits and culinary practices. Through programs such as these, health promoters are given the opportunity to work with the community, which Vigil says is the most rewarding aspect of being a promotora.

 “As a health promoter, I can be a resource for future generations,” Vigil said. “[When I first joined the program], I was thinking more about myself and my own health but now I realized how important it is to lead the community for the rest of the women and for the future generations.”

And planning for the future is just what Vigil aspires to do as the new Assistant Coordinator for the Health Promoter program, which is currently seeking members for its second cohort. In addition to her work as a promotora, Vigil is the LifeLong representative for the Healthy Richmond Hub Steering Committee, which works to improve the health and safety of all neighborhoods in Richmond, California. She also serves on the Greater Bay Area Committee within Vision y Compromiso, an organization that partners with community health workers to increase access and improve quality of bilingual and bicultural health care for Latinos. Through her journey from patient to promotora to community advocate, Vigil hopes that her passion for health equity and her dedication to her community will inspire others to follow suit.  

“If you really want to help the community, you have to put your heart into it,” Vigil said. “It’s very important to keep in mind that you don’t just represent the clinic that you work for—you represent the community.” 

 

Vivian Nguyen is the Community Affairs Intern at Community Clinic Consortium. She can be reached at [email protected]. 

Staff Spotlight: Margarita Mendoza

Margarita Mendoza (Image by: Vivian Nguyen)

By Vivian Nguyen

Since being certified as a LifeLong Health Promoter, Margarita Mendoza has played a valuable role in improving the health outcomes of her community as both a community health worker and a Cooking Matters instructor.

Through a 10-week leadership training program, LifeLong Medical Care builds the capacity of health center patients as educators and advocates for their community. Upon completion, trainees become certified volunteers and commit to a minimum of one year working as a LifeLong Health Promoter. Community Clinic Consortium, in partnership with LifeLong Medical Care, launched the pilot program with a generous grant from The California Endowment. Margarita and her husband, Luis, both graduated with the first cohort of Health Promoters on August 22, 2012.

In their health analysis, Margarita and her fellow Health Promoters prioritized obesity and diabetes as the greatest concern for their community. Because of this, Community Clinic Consortium contracted with 18 Reasons (formerly Three Squares), a Bay Area non-profit organization that provides nutrition education to low-income families through a program called Cooking Matters. With funding support from Kaiser East Bay Community Benefit, Margarita and other Health Promoters successfully completed an 8-week training program and became certified to teach the Cooking Matters program in the Richmond community.

Below, Margarita shares her personal transformation from patient to Promotora and offers insight into why cooking really does matter. 

Q: Why did you decide to become a Health Promoter (Promotora) and what kind of work do you do?

A: I really wanted to help my community and get the word out that there are places for people to go when they want to see a doctor. During health fairs, I try to give out telephone numbers and addresses [of our community clinics] to people in case they need to see a doctor. For example, at the Cinco de Mayo Fair in Richmond, I found out that some people go far away to clinics in Oakland even though there are nearby clinics in Richmond and San Pablo. There are health centers available and I want people to know that.

Q: In addition to being a Health Promoter, you’re also an instructor for Cooking Matters. Can you tell us a more about the program?

A: Cooking Matters offers free lessons to the community on healthy cooking and eating. Lessons take place once a week and are 2 hours long. There are 6 lessons total. During the first 5 lessons, [students and instructors] cook together. On the last lesson, only students make food but they have to use all the knowledge that they’ve learned so far. The lessons are led by a 3-person team of instructors—a teacher, a chef and a helper. The instructors switch off roles every lesson.

Q: Who takes these lessons?

A: Many students are mothers with children or people who live in apartments or people with different health problems, such as a chronic illness. Cooking Matters gives [the instructors] all the ingredients in a bag before each lesson but it’s important that those ingredients are also readily available in the home. Any unused ingredients are shared with the rest [of the class] after the lesson ends.

Q: What is the process for becoming a Cooking Matters instructor?

A: To become an instructor, you have to complete 8 lessons and each one is 3 hours long. You learn things like which foods to buy and the best seasons to get certain fruits and vegetables. There is a lesson on how to cook lean meats, grains and protein. There is also a lesson on how to cook with dairy, lactose, yogurt and cheese. A lot of what we learn is how to know which [ingredient] is better for you and how to make healthy substitutions, like using yogurt instead of cream. I completed the program last year and began teaching as an instructor.

Q: What motivated you to become involved with Cooking Matters?

A: On a personal level, I needed to make a change in my food choices to get healthy. I love hamburgers but having good health is more important. Before [the program], I would only want meat and no fruits. My husband is diabetic and so are my mother and brother. I realized I needed to make a change for me and for them.

Q: What types of healthy changes have you made and have you noticed any results?

A: In the morning for breakfast, [my husband and I] used to have tortillas, eggs and beans but now we eat oatmeal, cereal and fruit. For lunch, we’ll have a light meal with veggies or soup. And at night for dinner, nothing too heavy. We also snack every 2 hours to maintain a good metabolism. I noticed that with my husband, it is easier now for him to control his blood-sugar level but these good habits need to continue for him to stay healthy. And once I understood how important eating healthy was, I lost weight—that’s the best part!

Q: It seems like you and your husband have made a lot of positive changes! How do you inspire others to do the same?

A: What’s important is that if you think about your health first, everything else will come after. You don’t need to diet, just eat in moderation. Or just make healthy substitutions. For example, I’ll eat anything but in smaller portions or only during special occasions. So instead of [eating] 2 pieces of sweet bread, only eat 1 piece. And other people can make the same changes! I think you can talk to anyone and tell them how to be healthy but it’s important to make changes that are realistic and that people will believe in.

                                                                   _

For more information about the programs and organizations discussed in this post, please visit:

• Community Clinic Consortium www.clinicconsortium.org
• 18 reasons www.18reasons.org
• LifeLong Medical Care www.lifelongmedical.org
• The California Endowment www.calendow.org
• Kaiser Permanente East Bay http://mydoctor.kaiserpermanente.org/ncal/facilities/region/eastbay/area_master/home/

Vivian Nguyen is a Community Affairs Intern at Community Clinic Consortium of Contra Costa & Solano Counties. She can be reached at [email protected].

Thousands rally in Sacramento against Medi-Cal cuts

“We Care for California” Rally at the State Capitol in Sacramento (Image by: Vivian Nguyen)

By Vivian Nguyen

On June 4, 2013, over 8,000 healthcare workers and community supporters gathered on the steps of the State Capitol for the largest healthcare rally in California history.

The event was hosted by We Care for California, a coalition of physicians, dentists and health care workers who are working to protest Governor Brown’s reduction of Medi-Cal provider rates by 10% or roughly $1 billion per year. Among those present were doctors, nurses and hospital administrators from all corners of the state, many of whom boarded buses early that morning in order to make their voices heard.

The purpose of the rally was to demonstrate support for two bills –Senate Bill (SB) 640 and Assembly Bill (AB) 900—that were designed to reverse the 10 percent Medi-Cal provider cuts. Although SB 640 became stranded on the Senate Appropriations suspense file and AB 900 was amended to only reverse provider cuts for skilled nursing facilities, supporters continue to push for rescinding Medi-Cal cuts through negotiations in “trailer bills” that will accompany the budget bill for floor votes this Friday.

Still, hundreds of advocacy and professional organizations were present at the rally last week, including the California Primary Care Association, Services Employees International Union-United Healthcare Workers West, and Kaiser Permanente. One organization that brought in more than one hundred volunteers from all over the state was Planned Parenthood.

Workers at the Planned Parenthood booth (Image by: Vivian Nguyen)

According to Susannah McDevitt, Public Affairs Director for Planned Parenthood Shasta Pacific, these cuts would be extremely detrimental to Planned Parenthood branches all over the state.

“Medi-Cal cuts really affect reproductive healthcare access for our clients.  The cuts make it impossible for Planned Parenthood to cover our cost of providing health services, and consequently harder to see the patients who need them,” McDevitt said. “Our doors are opened for everyone and these cuts would hurt those who don’t have anywhere else to go.”

Susannah McDevitt, Public Affairs Director at Planned Parenthood Shasta Pacific Action Fund (Image by: Vivian Nguyen)

The consequences of these cuts would not only adversely affect existing Medi-Cal patients but also the approximate 1.5 million new beneficiaries who would be added under the Affordable Care Act (ACA) in 2014. According to McDevitt, because California already has one of the lowest Medicaid reimbursement rates in the nation, it is crucial that the $1 billion in funding be restored. 

“Given the timing of the Affordable Care Act, it will make it difficult to expand our services if Medi-Cal is being cut,” McDevitt said. “We’re hoping that our legislators take leadership on this issue because it will be a crisis if the cuts go forward.”

More photos from the event:

Hundreds demonstrated their support for the rally through photos and notes (Image by: Vivian Nguyen)

LifeLong Medical Care Health Promoters, Nora Vigil (left) and Margarita Mendoza (right), along with Community Clinic Consortium Director of Community Affairs & Finance, Sarah Ross (center) show their support (Image by: Vivian Nguyen)

Thousands gather to hear legislator Dr. Richard Pan speak (Image by: Vivian Nguyen)

Vivian Nguyen is a Community Affairs Intern at Community Clinic Consortium of Contra Costa & Solano Counties. She can be reached at [email protected].

LifeLong Medical Care Receives grant award that will save approximately $1 million

Yesterday LifeLong Medical Care (LifeLong) was awarded $1,109,231 as one of the Department of Health and Human Services’ first 26 Health Care Innovation Awardees. Made possible by the Affordable Care Act, the awards support 26 innovative projects nationwide that will save money, deliver high quality medical care and enhance the health care workforce.

Innovative is the appropriate word for LifeLong’s project, titled “Health Care Innovation Challenge: LifeLong complex care initiative to achieve the Triple Aim”. This award will allow the center to further integrate care and encourage healthy behavior, among 3250 seniors and other adults with disabilities who are Medicaid and dual Medicare/Medicaid-eligible beneficiaries. The goal is to reduce avoidable emergency room and hospital visits. The intervention will train adults with disabilities to support adoption of healthy behaviors among their peers and to encourage self-management, with the support of a team of nurse care managers. Improved care and better health for these high risk patients will lower costs with estimated savings of approximately $1 million.

Over the three-year period, LifeLong Medical Care’s program will train an estimated 60 health care workers, while creating an estimated 60 new jobs. These workers will include peer health coaches and nurse care managers who will facilitate integrated care for seniors and for low-income adults with disabilities. LifeLong will partner with Berkeley’s Center for Independent Living and the Alameda Alliance for Health to achieve program goals.

Congratulations LifeLong!!

La Clínica de La Raza Celebrates an Expansion of Quality Health Services With New State-of-the-Art Facility in the Monument Corridor

Our country recently celebrated the second anniversary of the Patient Protection and Affordable Care Act, fondly referred to as Obamacare, which expands healthcare access for millions of individuals throughout the nation. There are plenty of positive changes in store for Californians due to the historic passing of this law. Among them are expansion opportunities for Community Health Centers, which provide quality primary health care services for all patients who are in need of care. A shining star in quality healthcare delivery is La Clínica de La Raza (La Clínica), which was founded in 1971 in response to the lack of health care services for residents of East Oakland.

La Clínica presently operates 29 medical, dental, and school-based clinic sites throughout Contra Costa, Solano, and Alameda counties. In 2011 La Clínica served 74,302 patients resulting in 361,261 medical, dental, podiatry, mental health, and health education visits.

As La Clínica continues to expand to meet the needs of a growing patient population, they maintain their vision to be a premier community health center, rooted in the concepts of wellness, prevention and patient-centered care.

La Clínica’s most recent expansion achievement is the opening of a new health center on 2000 Sierra Road, Concord, CA, which began serving patients in the beginning of March. They renovated and expanded a building purchased in 2009 in the Monument Corridor Community to create a 16,958 sq. ft., two-story, modern, state-of-the-art, health care facility.

All are welcome to join in a celebratory Open House for La Clínica’s new site on April 12, 2012 from 5:30-7:30. Location is 2000 Sierra Road, Concord, CA 94518.

Impact of expansion:

• Medical exam rooms increased from 6 to 12 with 2 new procedure rooms
• Dental operatories doubled from 6 to 12
• Expanded site from 5,000 to 16,958 sq. ft.
• Capacity expected to expand the number of patients served annually from 5,000 to close to 14,800 patients
• Ability to provide a “medical and dental home” for more Contra Costa residents (one-stop with comprehensive services under one roof)

Services Provided:

• Integrated Behavioral Health Services
• Case Management
• Chronic Disease Management
• Dental Care
• Family Medicine
• HIV Testing
• Health Education
• Immunizations
• Pediatrics
• Women's Health
• Community Programs
• Senior Services
• Optometry Services

Community Health Centers Launch Local Community Health Vote 2012

 

Community Health Centers in Contra Costa and Solano Counties are now offering patients the opportunity to register to vote and to receive information on the voting process as a service to the community.  As non-profit organizations, La Clínica de La Raza, Brookside Community Health Center, LifeLong Medical Care, and Planned Parenthood Shasta Pacific offer non-partisan voter registration and education as part of their commitment to help staff and clients become more engaged in their community. 

Why health centers are registering voters:

This effort is part of Community Health Vote 2012; a national initiative started in 2008 by the National Association of Community Health Centers (NACHC) to establish permissible, nonpartisan voter engagement activities -- voter registration, voter education, and get-out-the-vote (GOTV) in the low-income, medically underserved communities served by health centers across America.

Voter engagement is a natural extension of community health centers’ long time bi-partisan grassroots advocacy mission, and is consistent with the founding purpose of being leaders in improving the life and well-being of their communities.  By integrating voter registration into the daily activities and highlighting the importance of voting, health centers hope to help patients and communities be more informed and civically engaged.

How it works:

When patients check-in for their appointment, they have the opportunity to register to vote.  Completing a voter registration application takes just a few minutes, and the Health Center collects and submits completed forms to the Secretary of State’s office as a courtesy to patients and community members. 

The deadline to register to vote in the upcoming June Primary Election is May 21^st. To register, individuals must be a U.S. citizen, at least 18 years old by Election Day, and a resident of California.

The importance of community health centers:

Brookside, La Clínica, LifeLong, and Planned Parenthood provide comprehensive, high-quality primary and reproductive health care services to residents of Contra Costa and Solano Counties. They offer services at affordable prices for the uninsured and medically underserved. According to 2010 Office of Statewide Health Planning and Development (OSHPD) data, community health centers recorded approximately 280,000 patient encounters in Contra Costa and Solano Counties.

Why your vote matters!

1.  One vote can and often does matter in election outcomes
2. If you don’t vote, you give someone else the power to affect your life and the lives of your family.
3. If you don’t vote, you double the value of someone else’s vote.
4. When you vote, you send a signal to whoever gets elected to pay attention to you and the needs of your health center, especially when you are a health center patient or staff member.
5. Your vote is your voice in what happens in this country and the only person who can silence your voice is you.

Visit your local health center and register to vote!

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!

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! 

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! 

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!