MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. San Diego is hosting a community health center conference with leaders from healthcare clinics across the country. Community clinics have served four years as some of the most accessible healthcare providers were underinsured populations. Now that the Affordable Care Act has opened up healthcare for more people, how are clinics managing the influx of patients while maintaining quality healthcare? Joining me to discuss the changes in community health care is Gary Rotto, public policy director for the council of community clinics of San Diego and Imperial Counties. How are community health centers different from other health centers? GARY ROTTO: Our network is the private nonprofit health centers. Sixteen members, 111 sites of care in three counties, about eighty-five here in San Diego county. Like I said, it's nonprofit. We are there, and it was constructed based on a need in the community developed by local groups about thirty years ago, and so they still have the mission driven sense of community health and medicine. MAUREEN CAVANAUGH: What kind of services do they provide, as far as hospitals, what they can do, how can you treat patients had community clinics? GARY ROTTO: Community clinics are found around the principle of primary care, so you go to family care and medicine, get ahead of the curve, anything that you would see a family doctor for, these are things where you can go to primary care. It's medical, many of them have mental and behavioral health programs as well as dental programs. MAUREEN CAVANAUGH: Kaiser did a survey a while ago about community health centers, and found many people cared for had no health insurance. Was that true for most for the Affordable Care Act? GARY ROTTO: The community health centers, because they were founded in areas that were medically underserved, there were significant numbers of people that were underinsured, no question about it, before the formal care act was passed and implemented. We have made great strides, and there are always many people on Medi-Cal, private insurance, but a large number were uninsured. MAUREEN CAVANAUGH: What other communities to health clinics serve? We talked about underserved community, are we talking about low income communities? GARY ROTTO: Traditionally there have been, but much like the old phrase about Oldsmobile, it's no longer your grandparent's Oldsmobile, community clinics are no longer your grandparents health Centers. They still have the mission driven sense and over half of the board have to be patient and users of the health centers. Now we are trying to transform along with the rest of the community and be available, because of the high quality work that we're doing for everybody in the community, especially with the size of the network that we have, there is probably health center near wherever you live or work. MAUREEN CAVANAUGH: Gary, we're only in the first year of Obama care, the Affordable Care Act, what changes are you seeing and hearing at community clinics because of that? GARY ROTTO: The number of uninsured has gone down because you have had people who have not been eligible for Medi-Cal for now are, you people that had not been eligible for Medi-Cal but could not afford insurance that are now subscribing to Covered California. The number has been brought down dramatically, even greater than what UCLA had predicted to be the best case scenario. MAUREEN CAVANAUGH: So the number of underinsured people is way down? GARY ROTTO: Correct, it's still significant, when I talk to different clinics it depends on where the clinic is, but somewhere between twenty and 50% is what it is down to. Some had been at 80%, some had been 40%, it's very, it has gone down, but there still significant amount of people in the community who need these services. MAUREEN CAVANAUGH: Joining me now on the phone is Thomas Tighe, he's going to be the keynote speaker at the community health center conference in San Diego. Thank you for joining us. As I said, this conference is bringing leaders from community health care clinics from across the nation, will be the major topics on the agenda? THOMAS TIGHE: They are looking at this dynamically changed environment, and trying to project what the Affordable Care Act means for the health centers around the country, and the Association itself is kind of the principle represented in Washington where a lot of the decisions are made. As Gary pointed out, the rubber hits the road with the health centers in nine dozen different places around the United States, where one in fifteen people in this country actually go to access health care. It's an extraordinarily broad network that serves millions of people. I think trying to get everyone together to see what the trends are and then see how they could be more of a forceful voice to do the great work there been doing for decades. MAUREEN CAVANAUGH: Not all states have signed on to the Medicare expansion, is that a problem for community health care clinics in those states? THOMAS TIGHE: As Gary mentioned, one of the interesting things that is key to remember, giving someone insurance status is not necessarily give them access to healthcare, it gives them insurance. If the insurance is not good enough for a doctor to take, they have no more access than they did before. Community healthcare centers were taking care of people before the formal care act for decades, it has never really been a flush system, they have been dynamic and innovative in trying to extend care. In those places that Medicaid has not expended, they will continue to do their best to take care of people, but there is not a new payer behind it. I think they will have additional challenges that will be lessened a bit in California, where the same patient who the San Diego health Center saw last year with no Medi-Cal, this year the same patient has Medi-Cal, which is great, but I think in other states, the dynamic is the same person, no payer, how can we make it work and ring cost down and continue to provide excellent care and access for people who otherwise will not have it? MAUREEN CAVANAUGH: Are the funds that go along with the Affordable Care Act, are they allowing some community healthcare centers to do more across the nation? THOMAS TIGHE: I think that is a good question, the policy folks, we are privately funded that Direct Relief, and we are mobilizing private charitable support in the form of medication and financial resources for the benefit of patients at health centers, but I think the health centers have talked about this nationally, that there has been a spike in funding this year to accommodate for anticipated growth that will drop off in the following year. They are anticipating a surge of money for expansion and a fiscal cliff they need to figure out in the following year. A lot of this remains to be seen, but again, the health centers, have if nothing else, proven that they are dynamic and committed and they didn't get into it for business reasons, they got into it for other reasons. They will do it as well as it can be done, but I think big issues remain to be worked out in the years ahead. MAUREEN CAVANAUGH: Felt like you will have a lot to talk about. I appreciate you joining us on the phone. Thanks a lot. Let me go back to Gary, let's bring the idea of community health expansion closer to home to San Diego. What has ACA funding enabled you to do? GARY ROTTO: One of the things, Thomas mentioned on the national level that one in fifteen go to a community health center. Talking with Thom at the San Diego medical society about primary care, we came to the conclusion looking at some data that at least one in seven if not one in six primary care visits are made up mainly clinics in our region. It's even more critical here as far as dependence on the population to go to a clinic. What has happened as part of the funding, we always talk about the Medi-Cal expansion and the exchange, but there was a pot of money put aside as part of the ACA called the health center trust fund. Several programs have been funded out of that, one of which is called new access points. New access point allow clinics across the country to prepare proposals to either become a fairly qualified health center, or add an additional site. Our clinics here have competed well for those funds, so that you have new clinics, like the King-Chavez Clinic in Lincoln Park, which is operated by San Ysidro Health Center, the new Vista Community Clinic. I can go on about the number of new sites. That is obvious to expand our footprint and the ability to be able to be further in the community and provide more appointment slots as well as also funding and hiring people. And also, practice transformation to maximize what we have as far as the ability to take on additional clients and patients, but to provide even better patient experiences. MAUREEN CAVANAUGH: If I understand correctly, one of the new things that you are adopting is a patient centered medical home model, what does that mean? GARY ROTTO: It means instead of just coming in to see a doctor when you're sick, we want to turn this. It's not just clinics, we're looking at healthcare and healthcare where it needs to go, not just sickness, but wellness. How do we engage people and be a partner in healthcare to keep them healthy and help them be healthier than they are, especially if they have chronic conditions, hypertension, diabetes, asthma, how do you prevent emergency room visits? Patient centered medical home as a team of professionals with the physician as the hub, a care coordinator, at health educator, a nurse, a number of different professionals are working together, so not only when you see your physician or provider, but even outside of that, you'll get a phone call and a reminder about filling your prescription, about how was the experience, setting up the next appointment, those kinds of proactive things to keep you well and on target. MAUREEN CAVANAUGH: Some patients I also hear will be going home with a blood pressure cuff? GARY ROTTO: That is a new program that funding coming down from the center for innovation in the federal government that is trying to work with you, and clinics and centers will be provided with it also, that says this person does not have to come into the doctor's office to get a blood pressure taken if you're monitoring it for hypertension. You can monitor it from home. So there's a pilot program that will provide wireless blood pressure cuffs that you can take it home, it will be transmitted platonically, your physician and their team will see it, and if for some reason it is higher than it should be, you'll get a call from someone on the team saying what is going on? How are you doing? Did you get your medication? Do we need to change your medication? Figuring out if this person is to come back in, if it's something they were prescribed to do and they hadn't. Are they keeping up exercise and diet? It's being able to do innovative things, and this is something that is right of our alley in San Diego. MAUREEN CAVANAUGH: Among the things you have mentioned here, these new models have an accent on the patient, but they also sent a little bit like they streamline patient to Doctor communication, and they seem to make it a little faster. The reason I mentioned that is because I know there were a lot of concerns when the Affordable Care Act is being debated, about whether or not there are enough doctors to see a host of newly insured patients. The you running into that, are some of these models a way for you to try to work with more patients with the same amount of doctors and get the same or better results? GARY ROTTO: Absolutely, and a portion will be able to do that, that won't necessarily streamline or limit patient access to the physician or the provider, it will maximize the time you can spend with the physician, because there are things that the physician does not necessarily need to do, that other members of the team can do, so when you sit down face-to-face with your provider, you can maximize that exchange and understanding, letting them utilize their medical knowledge and training to work with you as the patient and so your understanding each other, instead of just a quick visit in and out. MAUREEN CAVANAUGH: Using all sorts of technology to make that possible. GARY ROTTO: Absolutely. MAUREEN CAVANAUGH: I want to go back to something you said earlier, the number of underinsured patients that San Diego clinics are seeing is down, but it's not eradicated. We've seen that Covered California has been very successful in getting people sign up for healthcare, but there still seems to be a significant population that has not been reached, what can we do about that? GARY ROTTO: That is something that the California Wellness Foundation has provided a grant to us to do to take a look at. They said there has been great success with even the first year with the Covered California and Medi-Cal expansion, but there are still people that are uncovered, why, and who are these people? Do they live in certain places, are they certain sectors of the work force or certain members of the family? Can you do research for us and tell us within your counties who is out there, and come up with some ideas for how to cover folks, whether it be a partnership, something the private or public sector the need to do? We are in the midst of this eighteen month study that will come out in the spring with preliminary recommendations in the summer. MAUREEN CAVANAUGH: We will definitely see you then. GARY ROTTO: I would love to come back. MAUREEN CAVANAUGH: Thank you very much. GARY ROTTO: Always a pleasure, thank you.
San Diego will host a Community Health Center conference beginning Friday with leaders from healthcare clinics across the country.
Community clinics have served for years as one of the most accessible healthcare providers for underserved and underinsured populations.
Now that the Affordable Care Act has opened up healthcare for more people, how are clinics managing an influx of patients, while maintaining quality care?