As published in Inside Business, February 24, 2014.
The Williamsburg nonprofit offers free care to indigent, chronically ill patients, who can visit the brick building at 7151 Richmond Road on Tuesdays and Thursdays. On the other days, staff members make and take patient calls.
The outgoing phone calls are part of a strategy the nonprofit implemented about six years ago that’s rooted in team-based care. With about eight paid staffers and 20 volunteers, the clinic gives every patient a pre-visit, a clinical visit, a post-visit and follow-up phone calls.
Executive Director Jeff Black said the new approach was prompted by increased grant funding and a challenge. “The challenge was: How can we redesign primary care to meet the complex needs of the chronically ill?” he said.
The clinic sees extreme levels of health conditions, including diabetes, hypertension and high cholesterol. Many patients have more than one condition. Black said the average patient has four chronic illnesses. One man in his 40s visited the clinic and had an A1c level of 14 percent, Black said. The hemoglobin A1c test measures blood sugar, and in most labs the normal range is 4 percent to 6 percent. Those who have more than one condition might have readings above 8 percent, Black said, but the goal is to get it as close to 7 percent as possible.
That patient suffered a heart attack during surgery and now has lower extremity complications. Black said he came too late.
But for every tragedy, there are multiple success stories. Health providers there see about 350 patients a year, and Black said, “After following this model, we were able to show that the average A1c hemoglobin for our patients went from about 8.6 percent to about 7.4 percent. It was remarkable.”
The pre-visit involves registered nurses and sometimes William and Mary student health coaches checking vital signs, doing in-house lab tests and performing preventative health screenings. In the clinical visit, a doctor or nurse practitioner does a diagnosis and develops a collaborative treatment plan.
In the post-visit, the patients have access to counselors specializing in diabetes, smoking cessation, nutrition and fitness. The idea here, officials say, is to advance self-management by reviewing the patient’s treatment plan with them and setting goals. The phone calls keep the conversation going.
Those steps are rooted in the Teamlet model, Black said, created by Dr. Thomas Bodenheimer. It’s been tweaked, Black said, but it’s served as the framework for their new approach after joining the Williamsburg Health Foundation’s Chronic Care Initiative.
Joining the initiative meant gaining more than $100,000 a year in funding for the clinic, which has an operating budget of just under $200,000.
The forerunner to the clinic was named the Norge Primary Care Clinic, which was started by Black’s mother Jeanne in 1997. It was the first clinic in Virginia to be owned and operated by a nurse practitioner. It started off as a business taking some Medicaid and Medicare patients before shifting to a nonprofit taking the uninsured.
Jeff Black said depending on finances, the clinic may open up a third day. For now, its focus is on fulfilling two things that traditional medical offices aren’t.
“It’s missing preventative medicine, such as health screenings,” he said, “and it’s also missing self-management disease support – teaching patients how to manage their disease.”
– Jared Council