How to Start and Maintain a Free Health Care Clinic

1. How to Start and Maintain a Free Health Care Clinic Presented by: Haakon Carlson, M.D.

2. How to Start and Maintain a Free Health Care Clinic • A Need was Identified and Researched

3. 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?

4. 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

5. Need Identified and Researched • 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 Getting Facts and Figures with Research 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

6. How are Free Clinics Started? Need Identified and Researched Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South Street Kalamazoo, MI 49007 Phone: (616) 344-3751 Fax: (616) 353-4186 Email: fpchc@iserv.net Web: www.fcglr.org National Free Clinic Foundation of America 1240 Third Street, S.W. Roanoke, VA 24016 Phone: (540) 344-8242 Email: Foundation@freeclinic.net Web: www.freeclinic.net Volunteers in Health Care (VIH) Memorial Hospital of Rhode Island 111 Brewster Street Pawtucket, RI 02860 Toll Free: (877) 844-8442 Email: info@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: (920) 424-1242 Fax: (920) 424-0123 Email: collierj@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

7. How to Start and Maintain a Free Health Care Clinic • A Need was Identified and Researched • An Informed Community was Marshaled

8. An Informed Community was Marshaled • A Public Forum was announced through the local newspapers and by Spreading the Word • Individual Invitations for the presentation of plans for a free health care clinic • A Noon Meeting was hosted by St. John’s Church in the fellowship hall and Lunch was Catered by the Hospital • A Slide Presentation was given and Volunteer Forms were available

9. An Informed Community was Marshaled An Essential Ingredient The concept of a free health clinic has the unanimous support of the Sauk Prairie Memorial Hospital Medical Staff

10. An Informed Community was Marshaled Need Assessment for a Free Clinic: The “Economically Poor”Federal Poverty Guidelines (FPG), April 1998 Source: Wisconsin Primary Health Care Association

11. An Informed Community was Marshaled Percent of County Population Below FPG - 1995 Estimates Source: Wisconsin Primary Health Care Association

12. An Informed Community was Marshaled Percent of County Population Uninsured - 1994 Source: The Urban Institute, Washington, D.C.

13. An Informed Community was Marshaled Percent of Wisconsin Non-Metropolitan Population Underinsured - 1996 • 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

14. An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector. Access A clinic would serve people who are trying to improve their lives but do not have medical insurance or the ability to pay for medical care. It would be an evening, walk-in health facility where working people can seek medical care without having to take time off from work during the day without pay. Confidentiality and Quality An Informed Community was Marshaled What is a Free Clinic?

15. A private, non-profit, autonomous facility governed by a board of directors. Governance A relatively cost efficient facility relying on private contributions for the majority of the operating expenses and professional volunteers to deliver medical care. A small, dedicated staff is necessary to coordinate the daily operations of the facility. Operations A well organized facility which must have the support of the medical community as well as the community-at-large. Community Support An Informed Community was Marshaled What is a Free Clinic?

16. An Informed Community was Marshaled Who Does a Free Clinic Serve? • Patients referred from physicians, hospitals, schools, social workers, home health RN’s, 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

17. An Informed Community was Marshaled Who are the Providers in a Free Clinic? • Volunteer health care workers • Management and office staff • “People” people • Other professionals

18. An Informed Community was Marshaled What are the Services Offered? • 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

19. An Informed Community was Marshaled What providers of a free clinic DO NOT do: • Admit to the hospital • Obstetrics • Encourage emergency care • Surgery • Provide second opinions • Duplicate services • Other

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

21. An Informed Community was Marshaled How Will the Free Clinic be Financed? • 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

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

23. 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

24. An Organization was Formed That became, in large part the Board of Directors, was formed from the returned volunteer forms A Steering Committee • 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. John’s Church)

25. An Organization was Formed • The Name: The Goodneighbor Clinic of Sauk Prairie, Inc. (Incorporation of a tax exempt, not-for-profit, 501 (c) (3) corporation The Clinic Became a Reality • The Site: The Educational Unit of St. John’s Lutheran Church • Hours of Operation: One Day per Week (Monday) 1:00 - 7:00 pm • Equipment: Donated by the hospital, St. Vincent de Paul and Prairie Clinic • Staffing: All volunteer professional (MD’s, RN’s, 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

26. An Organization was Formed • Publicity: An Ongoing Effort The Clinic Became a Reality • 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

27. 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 it’s a beginning. Oscar Romero

28. www.goodneighborclinic.org

29. 3A Determining Cost Savings to Hospitals James Walton, DO & Adam Chabira, MHA

30. Charity Clinic Outcomes:Determining Impact on Hospitals Jim Walton, DO Adam Chabira, MHA Baylor Health Care System – Dallas, TX

31. 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

32. 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

33. Metrics Quantitative Answer the Questions: How many? How much? Examples: # of visits # of unduplicated pts. # of Rx’s 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 Data Collection:Metrics vs. Impact/Outcomes

34. 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 you’re impacting lives • How you’re impacting the community

35. 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

36. 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

37. 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

38. Project Access Dallas

39. Before & After Analysis

40. Before & After Analysis (cont.) ∆ = -22% ∆ = +50% ∆ = -74%

41. Before & After Analysis (cont.)

42. Before & After Analysis (cont.) ∆ = -58% ∆ = -63% ∆ = -2%

43. Central Dallas MinistriesCommunity Health Services

44. Two Population Comparison 48%

45. Two Population Comparison (cont.) 29%

46. Two Population Comparison (cont.) 20%

47. 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

48. Data Collection Tips • Ask for summary data without patient identifying information • Be prepared to produce patient consent to share health-related information

49. 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

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