Southeast Kansas center provides integrated health care for all regardless of income, insurance
- on May 9, 2011
Pittsburg — A Community Health Center in this small southeastern Kansas town of 20,000 is garnering national attention.
That’s because it provides care for anyone regardless of their income or insurance, and it is doing it successfully. Its growth is off the charts, and it has come during the worst economy in decades.
When it was founded in 2003, the center had 3,300 patients, 6,600 patient visits and a $1.3 million budget. Last year, it had 21,300 patients, 70,300 patient visits and a $9.3 million budget.
It went from 15 full-time employees to 135, the majority of which hold good-paying jobs like doctors, psychiatrists, dentists and nurse practitioners.
Mark Turnbull, director of economic development in Pittsburg, said the center has helped the economy. More importantly, it has provided critical medical services for a very low-income population, especially at a time when many residents have suffered pay cuts or layoffs. The average per capita income in Crawford County is $29,900, about $10,000 less than the state average.
“It has been a very big help to families,” Turnbull said.
The clinic also serves residents in nearby Oklahoma and Missouri as well as others who drive 150 miles for care when they have no place left to turn.
“It’s not like poverty or the need for care stops at the state line,” said Jason Wesco, chief operating officer. “We just don’t turn people away.”
The Community Health Center of Southeast Kansas, commonly called CHC/SEK, is unique in that it provides more than just medical care in its 15,000-square-foot building, which is located just a few blocks from the town’s main street.
It also offers dental and mental health services along with a lawyer, patient care navigator and pharmacy. Providers and patients enjoy the integrated system.
While sitting in the waiting room, Michelle Mitchell, of Arma, said her family has used the center for its medical, mental health and pharmacy services.
“We’ve done about everything here,” she said. “It’s convenient. It’s easy to use.”
Mitchell has private insurance and her 12-year-old son, Richard Brown, is on a Children’s Mercy Hospital health plan. But, Mitchell said she used the center when she was uninsured.
“It doesn’t matter whether you have insurance or whether you can pay at the time or not,” she said. “They send you a bill and you pay what you can, when you can, and they don’t harass you about it.”
There’s also no wait. Her son had an asthma attack in the morning and she was able to get an appointment with a pediatrician right away.
“This is great,” she said of the center.
‘Job is easier’
Cheryl Rajotte, family nurse practitioner, has worked in the Community Health Center since it provided only medical care and she was the only one providing it.
She had to call community doctors for help. Some were receptive, others weren’t.
Back then, she had no relationships with dentists or psychiatrists. If someone had a toothache, she couldn’t do anything but say, “Go to the dentist.”
That’s different now.
“My job is a lot easier because I have resources within my building,” Rajotte said. “I have patient consults with internal medicine doctors, pediatrics, dentists, pharmacists — all within a phone call or walk down the hallway.”
She remembers when the clinic got its start and the private health sector was concerned about the center stealing patients. She knew better.
Rajotte was the town hospital’s emergency room director before helping start the Community Health Center. She saw the patients who were coming into the ER. Many just couldn’t afford care.
“They were getting episodic, most-expensive type care,” she said. “Now, they have a medical home and we can coordinate their care.”
Beyond basic services
The clinic has an internal medicine doctor, two pediatricians and two family medicine doctors on its staff. Specialists in cardiology, orthopedics and podiatry, provide care at the center on a part-time basis.
The center has three chairs in its dental clinic and it offers everything from crowns and root canals to fillings and extractions.
Dr. Patrick Lancaster said he had a patient who was on seizure medicine that caused her gums to grow over her teeth. She switched medications and then they fixed her teeth.
“She’s smiling again and going for job interviews,” he said.
“That’s where we fill a huge gap — being able to provide the sliding fee scale, so if somebody wants to take care of their teeth and couldn’t afford it elsewhere, they could do it here,” Lancaster said.
The center also provides dental services, from fillings to varnishes, in 33 school districts. Last year, it provided dental screenings for 30,000 students.
In the mental health area, they offer counseling, testing and medication management. There are four psychiatrists and one clinical social worker and they see about 65 patients per day.
Dr. Darwin Anderson, psychologist, said he has about 1,500 clients. Illnesses range from depression and anxiety to schizophrenia and childhood disorders.
The center also has a part-time attorney who has 60 open cases. She helps patients with anything from divorce to housing issues.
And there is a patient navigator who meets with patients during their first visit to go over the services and answer questions.
The Community Health Center has four small clinics that offer one or two services:
• Downtown Pittsburg — dental.
• Baxter Springs — dental and medical.
• Iola — dental.
• Columbus — dental, medical and pharmaceutical.
Wesco said the center has applied for a grant to open a clinic in Coffeyville. He also believes there is a need for affordable care in Chanute, Parsons and Fort Scott.
“A lot of it will depend on the communities,” he said. “We never go anywhere that we are not invited. It’s hard enough to do the work; we don’t need to face opposition as well.”
Keys to success
The Community Health Center is governed by a 15-member board that includes patients and community representatives.
Its $9.3 million budget comes from grants, donations and patient services. The breakdown:
• 20 percent — federal grants.
• 6 percent — state grants.
• 6 percent — private foundation grants and contributions from individuals and businesses.
• 68 percent — patient services. This includes reimbursement for Medicaid, Medicare, private insurance and reduced fees for services. CHC/SEK is a Federally Qualified Health Center, which means it gets cost-based reimbursement for its Medicaid services. In return, it has to follow federal guidelines.
“Our goal is to provide good quality health care primarily to the people who don’t always have it,” Wesco said. “We try to make it affordable so people will use us. We don’t want to create a financial barrier.”
He said the center has been successful because there is a great need for its services. Not only is the area financially poor, but itss health is too. Crawford County ranks among the 10 least healthy counties in Kansas.
Wesco also credits the staff.
“We work very hard to run a tight ship and to be as efficient as possible,” he said.
Hope for Heartland
Jon Stewart, CEO of Heartland Community Health Center in Lawrence, toured the Southeast Kansas center in February.
“They’ve done some incredible things with that program and it certainly is an inspiration to us. I see an awful lot of potential through that program,” he said.
Heartland also provides care regardless of a person’s ability to pay or whether she/he has insurance. It offers counseling and a food pantry, and it has applied to become a FQHC center, which would bring in hundreds of thousands of dollars in federal funding.
With the funding, Heartland would provide dental services and more.
“The whole goal has been to provide these kinds of services and have it happen in a very integrated, coordinated way, and really try to meet needs,” Stewart said.
CHC/SEK has become the place of choice for its patients, instead of the place of last resort. That’s what impresses Stewart the most.
“Certainly, that is what we want to be viewed as,” he said. “The place that is doing business and doing health care really, really well.”
BY THE NUMBERS
Here’s a look at the Community Health Center of Southeast Kansas in Pittsburg and its four area clinics:
• $9.3 million budget
• 135 — full-time staff members
• 7 — doctors
• 5 — dentists
• 1 — psychiatrist
• 4 — psychologists
• 8 — dental hygienists
• 8 — nurse practitioners
• 1 — clinical social worker
• 25,000 — patients each year
• 70,300 — patient visits in 2010
• 360 — new patients each month
Here's a look at its patient demographics:
• 50 — percent are ages 19 and under.
• 46 — percent are between 20 and 65.
• 4 — percent are older than 65.
• 45 — percent are uninsured.
• 32 — percent are on Medicaid.
• 20 — percent have private insurance.
• 3 — percent are on Medicare.
• 80 — percent have an annual income that is 100 percent of the federal poverty level or below. That’s $10,890 for an individual or $22,350 for a family of four.
• 2 — percent earn above 200 percent of the federal poverty level. That’s $21,780 for an individual or $44,700 for a family of four.