In 2018, Kaiser Permanente NW, Legacy Health, PeaceHealth and Providence Health & Services created the Health Systems Access to Care Fund for community-supported clinics in Oregon and Southwest Washington.
The goal of this funding opportunity, administered through the Oregon Community Foundation (OCF), is to “strengthen the capacity and infrastructure for clinics that are expanding and/or adapting their current models to respond to the changing needs of patient populations due to ongoing healthcare reform, Medicaid transformation and the increasing pressure on the safety net for access to care,” according to OCF.
The $1.2 million multi-year fund includes both funding and technical assistance, and an unprecedented opportunity for the beneficiary clinics to convene regularly for training and information sharing.
In January, the Free Clinic of Southwest Washington received $50,000 for year one of the fund to support the clinic’s volunteer program. In addition, seven other clinics, including Battle Ground Health Care, have been granted $100,000 for use over a two-year period.
The fund is out of the box when it comes to community health care financial support. It is uniquely focused on the operations and sustainability of area free clinics, rather than programming, which is what free clinics tend to be granted money for. In fact, the fund’s request for proposals reads like a venture capitalist’s might.
“The goal of this funding opportunity is to strengthen these areas of infrastructure for clinics that are expanding and adapting their current models to respond to the changing needs of patient populations due to ongoing healthcare reform, Medicaid transformation and the increasing pressure on the safety net for access to care. In our long experience of working with partners like you, we have identified four areas of organizational infrastructure that strongly influence the sustainability of safety net clinics. Therefore, this funding opportunity focuses on the following four project areas: a) Value proposition, market position and key partnerships; b) Business model and funding strategy; c) Engaged and aligned leadership; and d) Fiscal tracking, reporting, analysis and management.”
Free Clinic of Southwest Washington Executive Director Ann Wheelock said: “I think it’s really good. I came from work in the private sector and worked at for-profit companies for most of my career. I had been on the board here in the past. There are so many health care changes going on, and free clinics like other nonprofits have to figure out their niche. They have to figure out their niche and how to be sustainable — where do they need to focus their resources.”
Free Clinic will improve its volunteer program and expand its volunteer base, increase awareness to broaden its funding base and implement a needs assessment of focus populations in Clark County.
Wheelock added, “I think the way the proposal was written made us think in different ways.”
Collaboration is key
Meghan McCarthy is PeaceHealth System director of Community Health and PeaceHealth liaison to the Health Systems Access to Care Fund. She said in the past, free clinics applied independent of each other to each major health system every year. There was little communication between the health systems and less between the free clinics about sharing resources and collaborating to avoid duplicating services and reinventing the wheel.
“When we (Kaiser, Legacy, PeaceHealth and Providence) met regularly to create the process, we worked on strategizing what is going to be the most impactful to lift up all of these clinics, not just the traditional approach of writing checks,” she said. “The big shift that I think is so powerful is in reinforcing the message that we are all in this together.”
Wheelock agreed. One of the aspects of this granting process that she is most excited about is collaborating with the other community supported clinics in the region. The first “convening” of all 12 of the grantees and grantors will take place in early June.
“They are bringing us all together in the metro area, and we’ll be learning from each other,” said Wheelock, listing examples of shared information that would benefit the Free Clinic, such as learning about “a cheaper source for insulin, or maybe someone’s found a better way to schedule patients, or maybe an app.”
Through collaboration with the larger health systems, said McCarthy, the free clinics can “have access to the full playbook” of market and investment trends, data analysis, sophisticated tracking and more.
Because of the Affordable Care Act and Washington Apple Health for Kids, the priorities for local community supported clinics are shifting from urgent care with a heavy emphasis on pediatrics, to chronic care for adults and people who have fallen through the cracks of the Medicaid system — people who are working but can’t afford insurance, and people who are undocumented and don’t have access to benefits.
“Honestly, free clinics are at an inflection point,” said Wheelock, who previously worked in administration at The Vancouver Clinic. “We need to redefine ourselves and do that business case analysis, and find out what a sustainable funding model looks like.”
Returning a significant investment
Each health system made an initial $300,000 investment in the fund, bringing the first round of granting dollars to $1.2 million. A significant investment, but what’s the return on that investment?
“We only can react to what walks through our doors,” McCarthy said. “Health in America is shifting more toward chronic disease, but location-wise and access-wise, these free clinics can provide a crucial link in (the care of chronic health conditions such as diabetes). That’s where we need more strength, clinics operating at the peak of their skillset. They can have dynamic interaction with the patient and the patient’s whole family.”
McCarthy pointed to the work Battle Ground Health Care is doing in pain management. “They do amazing work in pain relief, they have built a program that is really unique. We would love to see their program continue to collect data and grow.”
With their funding, Battle Ground Health Care will develop a sustainable business plan that allows for increased access to health care for uninsured and underinsured people in Clark and Cowlitz counties.
Wheelock perceives the return on investment for the health systems is two-fold.
“They have two returns that they are going to see,” she said. “Like all nonprofits, they were founded with a mission to help their communities. This fund fits their mission. It also really ultimately controls inappropriate emergency room use — it reduces that burden for them.”
McCarthy agreed that a benefit will be to have patients ending up in the right place at the right time and pointed back to building the confidence, reputation and sustainability of free and community supported clinics.
“We want to reinforce the huge asset free clinics provide in valuing high quality care for all human beings — nonjudgmental care. (Free clinics are) safe and trusted resources for health care, and we also want them to have some street cred. We want them to be well and high functioning businesses,” she said, adding, “We are very invested and committed and proud of this work.”