Virginia Garcia Unites Care Teams in Managing Population Health

by HCE Exchange on February 1, 2016

Gil-Munoz-thumb3Gil Muñoz, MPA, Chief Executive Officer, Virginia Garcia Memorial Health Center

by Patricia Chaney

Historically, Federally Qualified Health Centers (FQHCs) have always had to provide cost-effective, high-quality care for patients who are most in need. Perhaps this is why many of these centers have been quietly ahead of much of the healthcare industry in focusing on population health and developing new models of care.

In Washington and Yamhill counties, located west of Portland, Ore., Virginia Garcia Memorial Health Center is a network of five primary-care clinics and pharmacies, five dental offices, and five school-based health centers.

For the last seven years, Virginia Garcia has been exploring an integrated, multidisciplinary, wellness-focused model of care and is now a Patient-Centered Medical Home. Care teams and treatment plans incorporate primary care, pharmacy, nursing, social work, behavioral health, and other health-education services within a culturally sensitive environment.

Providing team-based, culturally sensitive care

The Center’s original mission was to provide care to seasonal and migrant workers, who now make up approximately 21 percent of the Center’s patients.

In 1975, Virginia Garcia, the daughter of a migrant worker died from an infection that developed in a cut on her foot. Because of language, economic, and cultural barriers, she was unable to receive appropriate care fast enough.

The Center was named in her honor, and it is the memory of her story that drives its initiatives.

“Our Center has developed a model of care that is patient-centered and uses a team approach to incorporate wraparound services that support the needs of each individual patient,” Gil Muñoz, MPA, chief executive officer, said.

Muñoz said the development of this approach started in conjunction with five other health systems.

“We saw that this model of care held great promise to approach the needs of our patient population and organize care in a way that made more sense to support providers and patients,” he said.

In addition to comprehensive care, providing culturally sensitive care that meets the needs of the Center’s patient population has been an equally high priority. The Center sees about 38,000 patients per year, 62 percent of whom are Hispanic and 89 percent of whom come from low-income households.

One recent initiative has been the development of group visits. Muñoz said a cohort of families can go through a care series together and learn from each other, receive group well-child visits, and form a support group. This initiative has proven effective within the Hispanic population.

Wellness facility addresses chronic conditions

During the past two years, Virginia Garcia has established its wellness facility, Cornelius Wellness Center, to support the organization’s integrated model of care and assist in managing chronic conditions. The wellness facility supplements Virginia Garcia’s emphasis on primary care through promoting healthy lifestyle activities such as Zumba, Tai Chi, yoga, and other exercise programs. Cornelius Wellness Center also offers a teaching kitchen for classes on how to prepare foods on a budget.

“The Center offers services that support people in making behavioral and lifestyle changes that will promote their health and manage or avoid chronic conditions,” Muñoz said.

Many of Virginia Garcia’s patients have diabetes, hypertension, obesity, and other chronic conditions, along with mental health issues. The Cornelius Wellness Center allows care teams to be co-located so that providers, nurses, medical assistants, and behavioral-health specialists can coordinate care for patients.

Muñoz said the development of the wellness facility has greatly improved the organization’s ability to meet the needs of its patients by further enhancing its comprehensive approach to care delivery.

Getting results through primary care

Recently, Virginia Garcia has been working with local hospital Providence St. Vincentto connect people who were seen in the emergency department or admitted to the hospital with a primary-care provider. The hospital provides referrals to the clinic and a specialized team, called a Community Coordinated Care Team, helps manage the high-needs patients.

Muñoz said the results have been dramatic for patients who are engaged in the program.

Among those patients, emergency-department visits dropped by 76 percent, inpatient visits dropped 82 percent, and associated charges dropped by 74 percent. Patients in the program have multiple health conditions and often behavioral-health issues as well.

The care team is comprised of a nurse practitioner, mental health therapist, and community health worker who closely manages the patients.

“We had heard that focusing on so-called ‘hot spotters’ was important, and we have seen that it does work,” Muñoz said. “Before enrollment in the program, patients had more than $4 million in total charges that included emergency services, inpatient services, and ambulatory surgery. After enrollment, those charges drop to $1.5 million.”

Working collaboratively across disciplines and bringing together providers in one location is a shift in traditional healthcare delivery and one that many organizations are starting to make. Muñoz said engaging providers and staff in developing standard work was the biggest key to success.

“Just bringing together the teams isn’t enough,” he said. “We had to look at what the standard work was for each member and focus on those key clinical areas.”

For example, screening for depression was typically conducted by nurses. By making that a target and incorporating it into the team’s standard work, the Center saw a dramatic improvement in how the screening was happening.

Having these clinical standards also enables tracking outcomes and results to be easier, thereby motivating the team to continue improving the model.

“Merely treating health conditions in a 15- to 20-minute office visit is no longer sufficient to address most patients’ overall health and reduce costs,” Muñoz said. “Developing teams, focusing on primary care, and understanding how to motivate patients is where we need to place our emphasis.”

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