Ravenswood Family Health Center Finds Strong Partner in Community

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Luisa-Buada-thumbLuisa Buada, Chief Executive Officer

by Patricia Chaney

In the midst of the prosperous Silicon Valley is a smaller pocket of East Palo Alto where one community health center is making tremendous gains in providing care to patients most in need.

Since it opened in 2001, Ravenswood Family Health Center has grown from a start-up clinic to being the recipient of national recognition for its primary-care model, a model that integrates medical, behavioral-health, and dental services into a patient-centered medical home.

Ravenswood serves a population of African-Americans and Latino and Pacific-Islander immigrants. Nearly half the population of the center’s catchment area earns incomes under 200 percent of the poverty line.

Gaining community support for a health center

Chief Executive Officer Luisa Buada started as a consultant to Ravenswood when the center was just beginning and became the CEO at the start of the second year of its operations.

“A number of important institutions in the community understood the necessity of having a community health center here,” she said.

The federal government, however, only provides about 20 percent of funding for federally qualified health centers. The Peninsula Community Foundation, which later merged to become Silicon Valley Community Foundation, and other community healthcare partners helped raise money for Ravenswood.

“We created a blue-ribbon task force of county leaders, political leaders, community advocates, community healthcare institutions, and donors to raise money,” Buada said. “The city donated a piece of land in the industrial part of town for $1 per year, which we then cleaned up.”

The industrial area was projected to become the downtown for the city, and the clinic and complementary nonprofit services for low-income families were the first to establish themselves. Ravenswood put in about 13,000 square feet of modular units for the clinic and nonprofit organizations.

The Lucile Packard Children’s Hospital (LPCH) was a major partner in this endeavor. The hospital worked with the community center to help improve its management of asthma and reduce the burden on the emergency room of children coming in with asthma crises. LPCH, now Stanford Children’s Health, continues to provide funding and deliver the babies of Ravenswood’s prenatal patients.

Expanding services and building a permanent location

The modular units were intended to be used for five years until a permanent location could be built. Ravenswood has about 80,000 visits per year that include health education, referrals, medical, dental, and mental health and was in need of expansion.

The center recently poured the building foundation for a $32-million, 38,000 square-foot permanent clinic that will house radiology services, optometry services, and a pharmacy.

The center plans to expand its education and training programs. It already is a site for pediatric residents and will be adding family practice and internal medicine residents in the new facility.

The dental clinic moved into a newly constructed facility in 2010 that is in a separate building. It also trains dental residents, students, and hygienists.

Buada said Ravenswood has raised all but the last $1 million of the current building project.

“The new clinic will allow us to grow to 22,000 patients,” Buada said. “There are still a lot of people in the area who don’t have access to healthcare.”

Managing challenges with regulatory requirements

As with many community health centers, Ravenswood operates on a tight budget and seeks efficiency in all aspects of care delivery. Although an electronic medical record provides great benefits, in a resource-challenged, nonprofit environment with many other challenges, the EMR requirements can be a burden.

“The demand for regulatory requirements today in terms of meaningful use, patient-centered medical homes, team care, and other certifications add incredible costs in documentation for reporting,” Buada said. “We have had to add a staff-development department for ongoing training and a decision-support department to mine all the data being created by the EMR.”

Regardless, Ravenswood is managing these challenges with the implementation of an EMR and PCMH Level 2 certification, but sometimes, Buada said the electronic requirements take away from patient care.

“We need to be able to provide care in a meaningful, qualitative way with patients, but we are still paid on a volume basis, so we have to operate that way,” she said. “Many providers feel they are managing care technologically and not personally and intimately. Commitment to quality and a caring patient relationship for underserved populations is what drives providers to come to a clinic like Ravenswood.”

Buada believes the key to making the technology work with patient care is having coherence in the management team. Before adopting its EMR, Buada said the clinic reviewed all of its workflows and then adapted them for the electronic system.

This process required a great deal of training and preparation in advance of the launch and funding for extra staff to support the EMR launch. The clinic continues to grow and develop its EMR and expects to achieve PCMH Level 3 with the larger clinic.

“We have tremendous faith in the possibilities, and we operate from having a vision,” Buada said. “We will be able to fulfill our mission no matter what. We work to instill that value with everyone in the organization.”

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