How to Start and Maintain a Free Health Care Clinic

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How to Start and Maintain a Free Health Care
Clinic

• Presented by
• Haakon Carlson, M.D.

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How to Start and Maintain a Free Health Care
Clinic

• A Need was Identified and Researched

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Need Identified and Researched

• The need for free health care is almost a given .
  . . But where to start?
• Free health care in Haiti or Here at Home?

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Need Identified and Researched

• Reality Testing

• Sharing the Idea with Confidantes
• Spouse
• Professional colleague and friend
• Pastor
• Hospital Foundation Administrator
• Society of St. Vincent de Paul Administrator and
  two Board Members

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Need Identified and Researched

• Getting Facts and Figures with Research

• Prairie Clinic, S.C. - the local primary family
  practice group (and my former group practice)
• Sauk Prairie Memorial Hospital Clinics - the
  community hospital
• Society of St. Vincent de Paul - a very active
  social service force in the community
• County Public Health Nurses - Sauk, Dane
  (Northwest), Columbia and Iowa
• Statistical Publications

• Federal Poverty Guidelines
• Health Policy Center, The Urban Institute,
  Washington, DC
• Wisconsin Family Health Survey, Center for Health
  Statistics
• Division of Health, Dept. of Health and Family
  Services

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Need Identified and Researched
How are Free Clinics Started?

• National Free Clinic Foundation of America
• 1240 Third Street, S.W.
• Roanoke, VA 24016
• Phone [phone]
• Email Foundation_at_freeclinic.net
• Web www.freeclinic.net

Jane E. Zwiers, RN, Convenor Free Clinics of the
Great Lakes Region 321 West South
Street Kalamazoo, MI 49007 Phone (616)
344-3751 Fax [phone] Email
fpchc_at_iserv.net Web www.fcglr.org
Volunteers in Health Care (VIH) Memorial
Hospital of Rhode Island 111 Brewster
Street Pawtucket, RI 02860 Toll Free (877)
844-8442 Email info_at_volunteersinhealthcare.org
Web www.volunteersinheatlhcare.org
Jill Collier FNP, Wisconsin State Coordinator
(Wisconsin Free Clinics) Living Healthy
Communicty Clinic 800 Algoma Blvd Oshkosh, WI
54901 Phone [phone] Fax (920)
424-0123 Email collierj_at_vaxa.cis.uwosh.edu
John Vick, Administrator, Volunteer Health Care
Program Bureau of State Risk Management PO Box
77008 Madison, WI 53707-7008 Phone (608)
261-6638
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How to Start and Maintain a Free Health Care
Clinic

• A Need was Identified and Researched

• An Informed Community was Marshaled

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An Informed Community was Marshaled

• Spreading the Word

• A Public Forum was announced through the local
  newspapers and by

• Individual Invitations for the presentation of
  plans for a free health care clinic

• A Noon Meeting was hosted by St. Johns Church in
  the fellowship hall and Lunch was Catered by the
  Hospital

• A Slide Presentation was given and Volunteer
  Forms were available

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An Essential Ingredient
An Informed Community was Marshaled
The concept of a free health clinic has the
unanimous support of the Sauk Prairie Memorial
Hospital Medical Staff
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Need Assessment for a Free Clinic The
Economically PoorFederal Poverty Guidelines
(FPG), April 1998
An Informed Community was Marshaled
Source Wisconsin Primary Health Care Association
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Percent of County Population Below FPG - 1995
Estimates
An Informed Community was Marshaled
Source Wisconsin Primary Health Care Association
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Percent of County Population Uninsured - 1994
An Informed Community was Marshaled
Source The Urban Institute, Washington, D.C.
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Percent of Wisconsin Non-Metropolitan Population
Underinsured - 1996
An Informed Community was Marshaled

• No insurance for part of the year - 6
• No insurance for the entire year - 7
• In 1996, 7-13 of the non-metropolitan population
  in Wisconsin was without adequate insurance.

Source Wisconsin Department of Health and Family
Services
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What is a Free Clinic?
An Informed Community was Marshaled
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What is a Free Clinic?
An Informed Community was Marshaled
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Who Does a Free Clinic Serve?
An Informed Community was Marshaled

• Patients referred from physicians, hospitals,
  schools, social workers, home health RNs, clergy
  and others.
• Those in financial need
• Minimum wage workers
• People between jobs
• Single parent families
• People who are trying to get on their feet
• Those who are working two or three jobs
• Senior citizens who cannot afford medications
• Those who do not have any third party coverage
• Those who cannot afford private care

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Who are the Providers in a Free Clinic?
An Informed Community was Marshaled

• Volunteer health care workers
• Management and office staff
• People people
• Other professionals

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What are the Services Offered?
An Informed Community was Marshaled

• Evaluation and treatment of acute/chronic health
  care problems
• Health maintenance and education
• Assistance for people requiring eligible health
  care from other providers
• Eye care
• Dental services
• Other services

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What providers of a free clinic DO NOT do
An Informed Community was Marshaled

• Admit to the hospital
• Obstetrics
• Encourage emergency care
• Surgery
• Provide second opinions
• Duplicate services
• Other

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Where is a Free Clinic Housed?What are the Hours?
An Informed Community was Marshaled

• Accessible site
• Hospital and professional clinics
• Churches
• Free standing buildings
• Service organizations (St. Vincent DePaul,
  Salvation Army)

Hours based on need - possibly starting with one
evening per week
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How Will the Free Clinic be Financed?
An Informed Community was Marshaled

• Local Support
• Hospitals professionals
• Churches
• Service organizations
• Private donations
• Local governments
• Token co-pays from those who can afford it
• Grants
• State and Federal aid

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Where Do We Go From Here?
An Informed Community was Marshaled

• Informal, temporary steering committee selects an
  acting board of directors
• Made up of a small number of qualified people
• Establish an executive committee with skills in
  organizational planning, budgeting, marketing,
  etc.
• Appoint a medical director, head nurse, office
  manager

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How to Start and Maintain a Free Health Care
Clinic

• A Need was Identified and Researched

• An Informed Community was Marshaled

• An Organization was Formed

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An Organization was Formed

• A Steering Committee

That became, in large part the Board of
Directors, was formed from the returned volunteer
forms

• President
• Vice-president
• Secretary/Publicist
• Treasurer
• Medical Director
• Clinic Director
• Board Member (Attorney)
• Board Member (Member of Society of St. Vincent de
  Paul Board)
• Board Member (Pastor Don Wendt, St. Johns Church)

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An Organization was Formed

• The Clinic Became a Reality

• The Name The Goodneighbor Clinic of Sauk
  Prairie, Inc. (Incorporation of a tax exempt,
  not-for-profit, 501 (c) (3) corporation

• The Site The Educational Unit of St. Johns
  Lutheran Church

• Hours of Operation One Day per Week (Monday)
  100 - 700 pm

• Equipment Donated by the hospital, St. Vincent
  de Paul and Prairie Clinic

• Staffing All volunteer professional (MDs, RNs,
  Pharmacists, Dentists, and Optometrists) and
  numerous non-medical personnel

• Support Services Diagnostic tests (lab and
  imaging) and various support needs are donated by
  the hospital and Prairie Clinic

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An Organization was Formed

• The Clinic Became a Reality

• Publicity An Ongoing Effort

• Financial Support Comes From the Community
• Individuals
• Service Clubs
• Churches
• Community Banks
• The community United Way
• School Children
• Grants

• Future Growth
• New Location - St. Vincent Service Center
• Open two days a week

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A Quote . . .
It helps, now and then, to step back and take the
long view . . We plant the seed that one day
will grow . . . We lay foundation that will need
further development . . . We cannot do
everything, and there is a sense of liberation in
realizing that. This enables us to do something,
and do it very well. It may be incomplete, but
its a beginning.
Oscar Romero
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• www.goodneighborclinic.org

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3A Determining Cost Savings to Hospitals
James Walton, DO Adam Chabira, MHA
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Charity Clinic OutcomesDetermining Impact on
Hospitals

• Jim Walton, DO
• Adam Chabira, MHA
• Baylor Health Care System Dallas, TX

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Introductions

• Jim Walton, DO
• VP and Chief Health Equity Officer
• Baylor Health Care System Dallas, TX
• Adam Chabira, MHA
• Program Manager
• Office of Health Equity
• Baylor Health Care System

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Purpose of Presentation

• Discuss the importance of outcomes reporting
• Present analysis methodologies for hospital
  impact
• Key indicators/variables
• Present examples of hospital impact analyses
• Discuss strategies for collecting and analyzing
  hospital data

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Data CollectionMetrics vs. Impact/Outcomes

• Metrics
• Quantitative
• Answer the Questions
• How many?
• How much?
• Examples
• of visits
• of unduplicated pts.
• of Rxs dispensed

• Impact/Outcomes
• Qualitative or Quantitative
• Answer the Questions
• What difference are we making?
• How are we impacting our community?
• Examples
• Improved health of pts.
• Reduction in unnecessary hospital use

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The Importance of Impact/Outcomes

• Outcomes are important to
• Your Boss/Board of Directors
• Funders
• Potential Partners
• Policy Makers
• They tell the story of your work
• How youre impacting lives
• How youre impacting the community

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Charity Clinic Impact on Hospitals

• Fundamental Principles
• Providing primary and preventive care to patients
  will reduce dependence on hospitals for obtaining
  care
• When patients do require hospitalization the
  severity/complexity of their conditions will be
  lower because they are receiving primary care

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How do we Demonstrate Impact on Hospitals?

• Show a reduction in the following Key Indicators

• Utilization
• ED Visits
• Admissions
• Outpatient Visits
• Average Length of Stay (ALOS)

• Costs
• Total Costs
• Direct Costs
• Indirect Costs

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How do we Demonstrate Impact on Hospitals?

• Two methodologies
• Before After Analysis compares hospital
  utilization and costs before and after enrollment
  in an intervention
• Comparison of 2 populations compares the
  hospital utilization and costs between a
  population receiving an intervention and a
  similar population not receiving the intervention

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Project Access Dallas
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Before After Analysis
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Before After Analysis (cont.)
? -22
? 50
? -74
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Before After Analysis (cont.)
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Before After Analysis (cont.)
? -58
? -63
? -2
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Central Dallas MinistriesCommunity Health
Services
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Two Population Comparison
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Two Population Comparison (cont.)
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Two Population Comparison (cont.)
20
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Data Collection

• Provided hospital decision support staff with a
  roster of patients enrolled in an intervention.
  We provided enrollment dates for Before After
  analysis.
• Requested utilization and costs for these
  patients for a given timeframe
• Results were returned in summary format without
  patient identifying information

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Data Collection Tips

• Ask for summary data without patient identifying
  information
• Be prepared to produce patient consent to share
  health-related information

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Analytical Tips

• Provide data in tabular graphic formats
• Provide aggregate data and per patient data
  (total costs/ of patients)
• Use a static timeframe for Before After
  analyses (1 yr. before/1 yr. after)
• Calculate percent change
• (After Costs-Before Costs)/Before Costs

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Analytical Tips

• Comparison population should be as similar to
  your population as possible
• Uninsured
• Demographically
• Geographically
• Same time period

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Summary

• Impact on Hospitals can be measured by showing
  changes in utilization costs
• 2 primary methodologies
• Before After analysis
• Comparison of 2 populations
• Next steps documenting preventive health care
  services

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• Brent Hafele, MA
• Executive Director
• Chippewa Valley Free Clinic
• 421 Graham Avenue
• Eau Claire, WI 54702
• 715-839-8477
• Brent_at_cvfreeclinic.org