True wellness encompasses treatment of current conditions as well as prevention and improved quality of life. But what happens when communities face overwhelming social determinants of health that interfere with their health care opportunities? Find out how a community health network in Chicago is overcoming these barriers to provide comprehensive care for its patients.
“There are a lot of barriers out there that prevent someone from having true wellness,” said Donna Thompson, chief executive officer of ACCESS Community Health Network in Illinois. “The need to access affordable, quality, comprehensive health care continues.”
Thompson has been leading ACCESS for more than a decade and also has been a nurse for more than 40 years. “My journey really started at the bedside … in central Illinois taking care of patients,” she said. “As I made my way to Chicago … I had a curiosity about why there are people who enter the health care arena and get better while others, in a very episodic way, still continue to have challenges with their health [that] many times [are] generational.”
Her work with ACCESS began at a clinic on Chicago’s South Side near the Robert Taylor homes, known at one time to be the largest concentration of public housing in the nation. It was there that she saw the real effect of social determinants on the health of the community. People were struggling with housing, “and even if they did have housing, we’d see asthmatics because there were rodents or lead in the buildings,” she said.
Patients struggled to pay for their prescriptions, find adequate food or secure a place to sleep. Patients would come in without appointments and wait for hours to be seen. At that time, the health centers only had the ability to treat patients’ immediate needs without much long-term health planning.
Over one-half of patients who come to community health centers live below the poverty level and are enrolled in some type of Medicaid. But now ACCESS is equipped to address both the health needs of their patients as well as the social determinants that affect their outcomes.
“Within the health center you have teams … working in a coordinated way to manage the health care needs of many,” Thompson said. “But when you get [some] patients in the exam room, they quietly tell their provider, ‘I’m hungry; I don’t know about my housing; my son is incarcerated again; I can’t take my medication because it says ‘take with food,’ and I don’t have food.’”
“I often say that many of our patients [feel] invisible,” she said. “The best way we can give [them] a voice is to really make sure that we are consistently questioning and pushing the needle around quality.”
For all the reasons above, ACCESS asked themselves these questions: How can health care be more than just an episodic intervention? How do you really create true partnerships?
“Two years ago, we put a stake in the ground on how we’re going to make those efficiencies possible,” Thompson said. A few of the changes they wanted to make were reduced waiting time for patients, same-day access to services, more consistent care over longer periods of time, extended hours for patients who work during the day and extended reach into the community through social agencies.
“The great thing about community health centers is that they’ve never been a medical-only model,” she said. “You might have people in the lobby helping patients register to vote … people who work on the outside of the health center infused in the community who ... work to partner with other social service agencies to get people to understand why it’s important to manage their diabetes or how to prevent heart disease.”
“As physicians are getting patients to engage in trust,” she said, “they can’t dismiss the social issues that it comes with in these areas.”
Four of the many ways that ACCESS has addressed patient and community needs include:
- Extended hours. ACCESS implemented extended hours at its health centers and is planning to open one health center on Sundays. “A lot of our patients are working every day,” Thompson said. Now they can come in as early as 7 a.m. to access care before work.
- Scheduling freedom. Patients now can go through a portal that allows them to schedule appointments on their own all day every day. ACCESS has seen no-shows drop from about 40 percent to about 10 percent since beginning use of the patient portal.
- Smaller waiting rooms. Waiting rooms were reduced in size as a result of decreased wait times and no-shows, which opened up that extra real estate for other resources and services.
- Partnerships with other organizations. Through community relationships, such as with the Greater Food Depository, the health care teams at ACCESS learn more about the socioeconomic needs of their patient population to understand how they can provide more comprehensive care in these communities. For example, ACCESS found that in Chicago Heights, “there are plenty of grocery stores,” Thompson said, “but not everyone can afford to shop at those grocery stores.”
“There’s not a one size fits all,” she said. “Every community is unique, and part of what we do is go into the community, look at the assets and really figure out as a collaborative member of a team of individuals who care about health, how to best deliver a service.”
Watch AMA Wire® for more details from Chief Medical Officer Jairo Mieja, MD, on how ACCESS coordinates care.