Fall 2006 Retreat Notes Grace Keller

On the weekend of Friday, October 13, Common Ground Health Clinic held our Fall 2006 Retreat. The retreat was attended by clinic staff, volunteers, patients, neighbors, partners, and a few members of our new Board of Directors.

Our history

We began the retreat by telling our stories, of how we ended up at the clinic, and what we remembered through the tumultuous year since the storm.

One person said, to sum it up, “We are soaking in what has been accomplished and where things started. A few of you said, ‘This happened like magic.’ Dr. King in the 60’s said that the movement was like a zeitgeist, a spirit of the times. This, what we are sharing, is some serious big-time American history.”

Some of our accomplishments

  • We became a free nonprofit health clinic certified by the Department of Health and Hospitals, with a variety of programs including labs, overseen by a medical director. Medical schools use us as a teaching facility.
  • We mobilized massive amounts of donated supplies in a short period of time, and tapped into national and international networks of volunteers and donations
  • By our size, visibility, and particular approach to health care, we challenged the way others provide health care across New Orleans and the country. Hundreds of medical students and other health workers have changed how they thought about health care after volunteering with us, and several small health clinics have sprung up using our model in the last year.
  • From our first day, we sought out personal relationships with people in historically oppressed communities. We exposed and stood up against the military occupation of the city, forced displacement, the illegal “Angola South” jail in the Greyhound station, medical neglect, lack of coordination between post-storm "safety net" agencies, and abuse of day laborers.
  • We created safe spaces: we disarmed dozens of soldiers and police before allowing them to enter the clinic, we transformed an abandoned grocery store where a man was shot into a community health clinic, and we developed a community garden.

Our dreams

Fast forward to Oct 2011 and CGHC is being honored by President Hilary Clinton for excellence in healthcare and providing leadership to the nation about serving poor communities. What is that we will have accomplished to get that honor?

  • We will have promoted prevention through support groups and partnerships; provided healthy foods, nurseries, or a learning center (for computer literacy and crime prevention).
  • We will have shared our national recognition with organizations and individuals thereby increasing health care funding in the mid-South, honoring our clients’ resilience, and fighting negative stereotypes that justify the dispersal of people.
  • We will have respected each patient's intelligence, history and needs; provided easy access regardless of documentation, literacy, or language.
  • We will have received a large part of our funding from within Algiers, continued to do a lot with a little, and always prioritized our clients, partners, and neighborhood in funding decisions.
  • We will have supported young people of Algiers to use clinic as their own, taking leadership on their priorities from healthcare to community justice.

Our patient population data

Total Yearly Patient Visits (10/2005-10/2006)

Approx. 22,000

Top three Zipcodes where our patients live

  • 70114 – 34% (Algiers)
  • 70131 – 9.4% (East Algiers)
  • 70053 – 7.3% (Gretna)

More than half of our patients live in these three adjacent West Bank areas.

Data source: front desk database.

Return Visits

Return visits are about 50%.

In May 2006 we saw 409 patients and over 300 were returns.

Data source: front desk database.

Why people come to CGHC

Top four health conditions we treat Incidence of common health conditions in Orleans Parish
* Hypertension — 30% * Hypertension — 17.3% indicated yes — 17.6% didn’t indicate either way
* Diabetes — 14.4% * Diabetes — 7% — 18%
* Asthma — 3.5% * Asthma — 5.4 — 18%
* Pain — 11.1% (arthritis, trauma, and all kinds of pain management) * Pain — unavailable
Data source: Adi’s study (7/06: sampling of 50 patient charts picked at random from the A’s and the M’s) * Serious mental health condition — 15% indicated yes.
* Almost 30% of our patients have high Cholesterol. Data source: (from noladashboard.org) Rapid Population Estimate (EOC) took sample of 188,000 people from 7/06 until 9/06.
Data source: Anne self-reporting (10/06)
Top health conditions seen by our Herbalists Top health conditions seen by our Social Workers Top health conditions seen at LHOP
* Upper and lower respiratory infections * Insomnia / symptoms associated with PTSD * Skin conditions
* Stress / post-traumatic stress * Need for community referrals * Gastric conditions
* Chronic pain / arthritis / menopausal discomfort Data source: Marie self-reporting (10/06) * Respiratory conditions
* Difficulty sleeping * Need for first aid
* Secondary management of diabetes and hypertension Data source: Djen self-reporting (10/06)
Data source: Katya self-reporting (9/06)

How old are our patients?

Age CGHC % NOLA %
<18 5.1 21.2
>18 90.5 78.2

Data sources: CGHC: Adi’s study (7/06: sampling of 50 patient charts picked at random from the A’s and the M’s). NOLA: (from noladashboard.org) Rapid Population Estimate (EOC) took sample of 188,000 people from 7/06 until 9/06.

There is a lot more old folk in our neighborhood (Old Algiers) than the rest of the city because of the ways that property ownership and families are organized.

Data source: Jack self-reporting (10/06)

30% to 50% of our patients are over 65.

Data source: Anne self-reporting (10/06)

Clinic Income and expenses

In our first year, we spent about $6,260 per month, or $115,940 total. Our biggest single expenses were food, renovations, and rent. In the same time, we raised $244,360. That leaves about $128, 420 in our bank account. We also received about $368,000 worth of supplies, equipment, and other “in kind” donations in our first year.

The Social Services Block Grant evaluated the value of our care in that time span by the hours we were open, exams we performed, services we offered, and other factors. They said our care (which cost us $115,940) was worth $2.3 Million per year.

We plan to spend about $299,800 in our second year. Due to decreased volunteerism and donations of equipment as we get further from the storm, our expenses are increasing.

The full budget is available from Bay.

The future of healthcare in New Orleans

Overview of the re-design plan

You can read the Louisiana Redesign Collaborative notes at http://dhh.Louisiana.gov

1. Universal Insurance. (Not universal care)

Idea is to expand coverage of Medicaid to include all adults under 100 to 150% of the poverty line. And everyone from 150% to 300% will get discounted health insurance.

2. Create a Medical Home

implement managed care (meaning more administrative controls on health services, and by putting more responsibility on primary care docs vs. specialists in hospitals)

Clinics are going to have to be certified as a medical home, defined as:

  • prevention primary care focus
  • patient centered
  • personal physician
  • formally tied with specialist and inpatient care
  • use evidence based care
  • 24 hour access
  • comprehensive,
  • evidence-based medicine and “best practices,”
  • culturally competent care

This is still awaiting official approval, the idea will remain the same but some numbers might change. Senator Joe McPherson is a major decider in this whole process.

3. Charity hospital will be replaced by an LSU University teaching hospital

The new hospital will not bound to serve the poor or underinsured. Medical homes will serve the poor.

4. Time frame

it will take one year to 18 months to begin phasing this in.

Discussion

Q. Do you think it would be possible for this clinic to survive long term and not be certified as a medical home?

A. That’s a good question, this clinic seems to be the model for how the medical home should be, the question would be what changes to the clinic’s vision would be required.

Tony suggested folks from the clinic sit in on these meetings to address some of these issues.

Clinic programs break-out group

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Fundraising break-out group

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Community collaboration break-out group

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Decision-making structure break-out group ==

this section still needs to be added

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