United States

Downey Family Health Center Program Expansion Summary

September 14, 2010

Dr. Natalie Nevins and Dr. Martina Fuchs

Downey Family Health Care Center

September 1, 2010

1. Change in Scope Summary

Family Health Care Centers of Greater Los Angeles (FHCCGLA) is requesting a change in scope to add a site, Downey Family Health Care Center (DFHCC) located at 8530 Firestone Blvd., Downey, CA 90241. The new site replaces a site previously identified in Huntington Park that was added to FHCCGLA’s scope under CIP funding. This location is no longer viable. The new site is located within FHCCGLA’s defined service delivery area as presented in its original NAP application and will serve the same target population, uninsured and vulnerable community residents below 200% FPL. There are large numbers of residents living at or below the poverty level in census tracts surrounding the new service delivery location. FHCCGLA has/will enter into a 10-year lease for the new health center location. The addition of the DFHCC was approved by FHCCGLA’s board of directors in June 2010.

The new service delivery site will operate under the auspices of FHCCGLA in collaboration with Downey Regional Medical Center (DRMC). The DFHCC site blends two mutually beneficial objectives of providing access to health services for low-income and uninsured populations while serving as a training site for the next generation of health care practitioners, many of whom choose to continue to practice in underserved communities beyond their training.

Dr. Natalie Nevins will serve as the site director for DFHCC, while also serving as the Director of Medical Education at DRMC. Dr. Nevins has been the driving force in securing initial funding for the new health center. She has been able to rally the community to provide significant in-kind and tangible donations to the project. Dr. Nevins will additionally provide direct care as a part-time provider at the new site and implement linkages to the Family Medicine Residency Program and Neuromusculoskeletal Medicine Residency programs at DRMC.

DRMC will provide clinical internships and residency training serving as the primary practice location under the direction of Dr. Nevins. In addition to providing free rent for the clinic, DRMC will provide: one attending Physician two days/week; five second-year Residents two days/week; seven three-year Residents two days/week; and three fourth-year Residents 1.5 days/week. As part of their training, these physicians will maintain a provider relationship with patients at the DFHCC over the course of their three year training program. Patients will be transitioned to a new physician during the first year of training while working in conjunction with the senior resident assigned to the patient. The clinic will introduce new workforce capacity to the current system extending access to patients for primary and urgent care, while introducing future providers to the community.

DFHCC will operate part-time (less than 20 hours weekly) beginning December 1, 2010 until the required State of California Community Clinic license is approved. Once approved, the site will operate 40 hours weekly, and within the first year expand to after-hours and weekend availability. The 5,000 square foot site includes nine treatment rooms, radiology, laboratory, dispensary, patient waiting areas, conference room, nurse education rooms, staff lounge, and staff offices. The site will operate using FHCCGLA’s successful approach of community-oriented primary care that fits with its mission and strategic priorities.

Staffing for the new site includes 2 FTE providers (not including residents and students), 2 FTE medical assistants, and 4 additional FTEs (biller, front office, outreach, health educator). CFHCC will serve 7,566 unduplicated patients through the delivery of 15,132 patient visits at full operational capacity. FHCCGLA will provide essential health care services to all individuals regardless of their ability to pay and will target and focus on those groups and individuals without a regular source of health care.

2. Why we want to add the Service Site
FHCCGLA was founded in 1926 and currently operates from two sites, one in Bell Gardens and one in Hawaiian Gardens, delivering over 29,000 patient visits in 2009. A strategic priority identified for our organization is to expand our presence in the service area to facilitate greater access to care for low-income, medically uninsured, and marginalized community residents. The DFHCC meets this criteria and the collaboration with DRMC’s residency training program is a natural fit. The residency training program sought out FHCCGLA as their partner given they already had a strong community presence and had earned the trust and support of residents. DRMC, a 199-bed hospital located 1.5 city blocks from the new clinic, operates an extremely busy Emergency Room (ER) that has a significant number of uninsured patients increasingly seeking primary care services in this setting. Patients will appropriately be referred from the ER to the new health center site.

DRMC has a tremendous opportunity to decongest their ER from non-emergent visits that are more appropriately treated in a primary care setting. Concurrently, DRMC’s Residency Program needs practice locations and it makes good sense to accommodate patients already coming to DRMC’s overcrowded ER in a setting that can provide ongoing care in a patient-centered medical home. DRMC Residency Programs will benefit from the DFHCC practice location to train approximately 30 physicians (clinical internships and residency) in Family Practice each year (affiliated with Western University of Health Sciences/College of Osteopathic Medicine of the Pacific). FHCCGLA is the most appropriate partner to operate the new health center given its experience in serving the Downey community and commitment to expanding access to health services.

FHCCGLA will address the major health needs of the target population within the service area, which includes: prevention, diagnosis, and treatment for chronic diseases such as diabetes, hypertension, and heart disease; immunization, prevention and treatment for illnesses before they become life-threatening, such as pneumonia and influenza; and prevention and screening for cancer.

3. How adding this site will benefit our health center and the patients it will serve
DFHCC will provide access to primary care services and serve as a referral source for patients without a primary medical home, particularly those released from local hospitals such as Downey Regional. Some of the specific services will include immunizations, prenatal care, child wellness, diagnosis and management of chronic diseases such as diabetes, hypertension, heart disease, congestive heart failure, and lung diseases which are endemic among residents in that service area. The health center will also offer walk-in urgent care type services for the immediate care and treatment of minor illnesses.

FHCCGLA will extend its successful service delivery model in response to the changing health and social needs of the community through the addition of the DFHCC service delivery site to fill a void in access to health services evidenced by the overwhelming number of uninsured service area residents with incomes at or below 200% federal poverty level. We will additionally tailor services to meet the needs of the target population in order to motivate them to use the health center as their medical home. Because the majority of the target population is Latino/Hispanic, services will be provided in a linguistically and culturally appropriate manner. Many immigrants have little working knowledge of the complexities of the U.S. health care system.

In order to best serve the target population, we will provide health educators and providers that speak Spanish, understand Latino/Hispanic culture, and provide low literacy level literature or educational materials in Spanish for the large number of individuals in the target population that have not attained at least a ninth grade education. This ensures that the target population will understand service availability and preventive health care approaches so that they effectively utilize health services.

At all times, DFHCC will provide services in a culturally and linguistically competent manner. The new site will be integrated fully into FHCCGLA’s existing services, blending seamlessly into our Quality Management/Performance Improvement systems, which tracks specific disease outcomes, monitors patient satisfaction, and includes risk management activities. Clinical and Financial performance measures will be extended to the new site and monitored accordingly. Patients requiring referrals beyond the scope of services provided at the new site will be referred to established referral relationships for social services, specialty care, oral health, mental health, and substance abuse services.