Structuring a practice to truly make care available to all
What makes us different from a typical medical practice in some ways comes down to philosophy and approach rather than anything easily quantifiable.
At White Mountain Community Health Center, we sometimes have trouble explaining what we do. We have so many services and programs that it's hard to summarize quickly. And what makes us different from a typical medical practice in some ways comes down to philosophy and approach rather than anything easily quantifiable.
First, we ARE a normal primary care practice in many ways. We see people of all income levels, including people who have health insurance and are generally healthy and happy. We have nurse practitioners for adults and children and a consulting physician for complicated health issues. We also provide dental care for children from the first tooth through high school, and a complete prenatal care program. There's no big difference between the care you get in these programs and the care you'd get at any practice.
That said, we are especially focused on meeting the health needs of community members who face extra challenges, and on ensuring that everyone can get the care they need. We have a sliding fee scale for those who are not able to access affordable health insurance, such as Maine residents who would have qualified for expanded Medicaid, and we never turn anyone away because they are not able to pay. We also have many programs specifically geared towards facilitating access to care, such as our Health Insurance Navigators and Teen Clinic. Partners in Health supports families of children with chronic health conditions. Our food pantry, which is open to the community Mon-Fri 10-12 and 1:30-3:30, serves about 140 families a month.
But one of the biggest ways that we keep people from falling through the cracks is through a shared philosophy that to truly keep a patient healthy a provider must understand much more than just his or her vital signs. We choose to rely primarily on nurse practitioners and dental hygienists because they are able to take more time listening to and educating patients, and are trained to look for all issues, internal and external, that could affect a person's health.
For example, our pediatric nurse practitioner, Shawn Rogers, puts a high priority on getting to know families and building trust. She talked about a young patient who had gained a lot of weight since her last visit. "You really have to look at the emotional component when you talk about food and exercise. I eat when I'm stressed, and kids are the same way. I talk with kids and parents generally about limiting sugary drinks and getting exercise, but you have to be sensitive to each family's situation. For this child, her family had recently become homeless, and what she really needed was counseling to help her cope with the stress, so we worked with the family to set that up."
Some of our programs are designed to work in tandem with our primary care, dental and prenatal programs to support providers helping patients with issues that are not strictly medical but are affecting their health. Just in the last few weeks, our social workers and providers have worked with a number of patients with heroin addictions who asked one of our nurse practitioners for help finding treatment.
One person walked in recently at his wit's end, having gone everywhere else he could think of trying to get help. Everywhere else he tried either had waiting lists or wouldn't see him for financial reasons. The medical team and social workers worked together to find a treatment option that was right for him, helped him start the process of getting in, and made sure he was set up to complete all the steps. They even gave him a gas card through our transportation fund so he could get there. When it was done, he thanked everyone profusely and said if he hadn't walked in here he likely would have gone back to heroin or taken his own life.
Lisa MacAllister, our mental health counselor, also works closely with providers. Nurse practitioner Deborah Cross mentioned an uninsured patient who suffers from life-threatening depression, and who sees both Deborah and Lisa regularly. The two providers are able to discuss this woman's care so that they are always on the same page about treatment and medication plans.
For those who are insured, mental health care is now covered by all plans, but it often goes toward a high deductible. Our low fixed fee for mental health counseling make this service attainable for many who would otherwise go untreated. For those who cannot afford the fee, we have an in-house private fund that can assist. In fact, we have many patient care funds to fill gaps in care, which are primarily funded by local donors.
Our programs are structured to support a full, whole person definition of health, and to support providers who are listening to patients to understand what in their lives may be standing in the way of good health. This is good for all patients, but it is crucial for patients who are struggling financially and have complex issues, even when they are insured.