Family Health Centers of Baltimore: Narrowing the Disparity in Health Care

by HCE Exchange on January 14, 2014

Paula-McLellan-thumbFamily Health Centers of Baltimore is a Federally Qualified Health Center, providing affordable, quality care to uninsured and low-income individuals.

The center provides general pediatric and adult primary care, prenatal care, infant-mortality prevention, dental services, substance-abuse and mental-health services, as well as transportation, translation, case-management services, and patient education to help improve access to care.

Paula McLellan recently celebrated her 20th anniversary as chief executive officer of the facility, which is practically a lifetime for health-care leadership.

“With our mission and challenges of health-care access, especially for low-income and underserved communities, people like me tend to stay,” she said.

She has seen the many changes in health care over the years and is driven by the belief that health care should be viewed as a right rather than a privilege.

“There has been a point in our history where the quality of care was dependent upon an individual’s ability to pay for it,” she said. “If you had no money or no job, you had no access.”

Centers like hers help to lower that disparity, as does the newly instituted Affordable Care Act.

She looks forward to health-care reform providing more people with access not just to doctors, but also to labs, diagnostic services, and specialty referrals.

Reforming access to care

Family Health Centers of Baltimore began doing outreach before the Oct. 1, 2013, opening of online health-insurance exchange markets in order to identify people in the community and within their patient load who were uninsured and would need to be signed up for a health plan.

Maryland was ahead of many other states in preparing for reform with navigators ready to help educate people about the health plans and their options. With the roll-out, the Family Health Centers works with patients and members of the community to educate them about health-insurance options and eligibility guidelines.

“For people who are not citizens, they will remain uninsured, but reform is good for our patients,” McLellan said. “We will continue to serve patients regardless of coverage or citizenship, and we look forward to being able to help and educate people who are hesitant to sign up for a health plan.”

Unfortunately, problems with the Maryland Health Connection and the federal government’s ACA websites are inhibiting health-care enrollment at Family Health Centers. Between 20 and 25 people are seen each week who need help with enrollment, she said. These people are encouraged to complete paper applications because of website problems, and paper is hard to track.

Forming a more cohesive system

Another element of reform McLellan thinks will be a move in the right direction is the establishment of a true health-care system.

“What we have is not a system but a hodgepodge,” she said. “You have primary care over here, pharmacy over there, labs somewhere else. Reform is going to give us more of a system of care, and that’s what we’re really looking forward to.”

As the country moves toward a more cohesive system, McLellan said Family Health Centers is trying to provide more one-stop shopping facilities.

The main facility is adding a mental-health program to complement the substance-abuse services already available. And the group is renovating a warehouse in the Brooklyn neighborhood that will include physicians services, dental, and behavioral health under one roof.

Balancing costs with quality care

The Family Health Centers of Baltimore is accredited by the Joint Commission and strives to provide the highest quality care to patients. As a Federally Qualified Health Center, the facility receives government grants, reimbursement of Medicare and Medicaid, and other benefits.

Patients are charged according to a sliding scale based on income and family size. About 60 to 70 percent of patients seen at the center receive coverage from Medicaid.

One of the biggest challenges financially is recruiting and maintaining medical professionals, McLellan said. Nurses, medical assistants, and physicians are not always paid market-based salaries, and many are lured away to larger hospitals or health centers once trained.

She said a large focus of the group’s strategic plan is to find ways to offer more competitive salaries in order to retain physicians and staff.

“It is hard to find doctors who come out of medical school interested in working with underserved populations,” she said. “There are a few, and paying them a good salary is a challenge. But they are committed to the population, and we want to keep them.”

Another challenge is meeting what she calls “unfunded mandates,” such as electronic health records. Going paperless requires a large investment in software and consultants with little to no funds available for the start-up costs.

McLellan said the center is working to help patients receive the maximum benefits they are entitled to and to sign up for health insurance when eligible.

“Our care is not free, but it is affordable,” she emphasized. “We see our patient encounters as a starting point. We treat people, and as their means improve, we hope they will see the value we provide and continue to come here after they acquire health insurance.”

McLellan maintains her dedication to the center and the patients she serves, stressing the importance of public health and the work that her staff does.

“Health care has always been perceived as a commodity, but it should not be an exclusive club,” she said. “When you have an element of the community that is unhealthy, the rest of the community will be affected by it. We live together, we breathe the same air. Without access to treatment in the past, tuberculosis would have spread much worse, HIV would have spread much worse.”

-by Patricia Chaney

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