Every day, more than770 Oklahomans turn to Variety Care (VC) for medical, dental, behavioral health, and vision primary care and social service programs. Insured or uninsured, all are welcomed with compassion and respect. Access is the core of our mission; therefore, the growth of patients and services offered are our most important accomplishments and mean that we are reaching those who need us most. Many people come to VC because we treat them as a partner in their healthcare. Many of our providers and most front office staff speak Spanish so that patients best served in Spanish can effectively communicate. We also have on-site translation services to other languages as needed. In 2015, VC cared for 88,795 people through 287,785 encounters. We served 3,005 teens through 22,052 encounters in our Teen Clinic pregnancy prevention program and involved 327 foster grandparents in 50,540 tutoring interactions with at-risk youth.
Goals include continuing to work with hospitals to reduce readmissions for high-risk patients and working with other agencies to develop services for seniors so they are able to remain at home as long as possible. In addition, a significant goal is to expand services to additional high-risk populations, which will require additional funding sources. As important as treatment of chronic disease is VC’s effort to prevent it in the first place. Patient education, screening and other services that help keep people well have even greater potential for healthier outcomes, but these services are non-billable.
Our most current and ongoing need is for unrestricted funding for the uninsured and for unreimbursed services that our patients need. VC’s federal grant helps offset some of the cost for patients in poverty and allows us to slide fees to a nominal charge. In fact, VC provides $3 of care for every $1 in federal funding. Many times that is not enough - we have patients who cannot afford to pay even the nominal fee. Some funding to offset the minimum fee is received from United Way and through our Patient Care Fund, but many needs are not covered. Uninsured patients need help to pay for diagnostic testing such as lab and X-ray and visits to specialists. Most chronically ill patients need on-going routine testing beyond the diagnosis of the disease. This lab testing contributes to medication management. This is true for patients suffering from diabetes, hypertension, and other illnesses. Funding is needed for more clinical pharmacy staff to help patients understand their medications and how to take them. Education about medications is proven to make a difference, especially to those patients who take several medicines. Other staff needs are for intensive case management, nutrition and wellness, and staff to undertake and maintain quality improvement activities.
At Variety Care, we care about the whole patient. Our culture is one of teamwork with staff at all levels that believe in our mission and treat patients with respect no matter their income or insurance status. We believe in the concept of community-based medicine, that it is more patient-friendly for individuals to receive medical care in their “family doctor’s office,” than in a clinic model where people must wait in line for the next available provider. The importance of relationship is very real at VC; when patients become known to staff and are addressed by name, they are more likely to confide in and listen to their medical provider. Because we serve the insured and the uninsured, entire families, from newborns to grandparents, can come to VC for their health care needs. Each patient has their own medical provider that they will see each time they visit the health center. We believe there is no wrong door into Variety Care. Our system is integrated so patients are treated holistically. A medical provider may identify a behavioral health need, or a dental provider may identify a medical need. That team-based approach puts the patient at the center of every appointment.
VC employees at all levels receive Mental Health First Aid training, which helps them to be more comfortable in working with the public as staff learn to recognize the warning signs of someone who needs mental health assistance. With training, comes a deeper understanding of mental illness and the confidence to act that helps break down the barrier of fear of encountering someone with a mental health problem. This helps us provide more patient-centered medical care.
VC’s combined and integrated services have huge potential for cost savings to the system, the community and the patient, but the cost of these services must be supported by community donations to make them affordable for low-income families and the working poor. We have recently opened up clinics in collaboration with OSU/OKC and will soon open clinics at Emerson Mid-High School, and in northwest OKC. We will continue to develop and nurture partnerships that allow us to reach out to the elderly, the disenfranchised, the uninsured and those who have limited options for healthcare. At VC, we ARE changing the face of healthcare in Oklahoma.
Variety Care faces governance challenges typical of a fast-growing nonprofit organization. With 16 clinics and 434 staff, ensuring continued management and financial stability is one of the board’s most significant responsibilities. Fortunately, we have a dynamic and visionary CEO who works well with the board and a stable management team. Confidence in this team allows the board to focus on trends in healthcare and on expansion opportunities.
VC expands at a controlled pace to ensure programs are sustained. Because of VC’s excellent reputation, individuals and communities often approach us asking VC to expand to their community. One such example is a local pediatrician who wanted to serve all children, whether insured or uninsured. Within a typical medical practice, she could not afford to do so. She approached VC, who acquired the practice, providing affordable access to this well-known and much beloved pediatrician for all neighborhood children. Another example is the community of Thomas, Oklahoma, whose sole physician was in his 80’s; the community asked VC to establish a clinic in Thomas so they would continue to have medical care, and that care would be available to everyone.
A challenge unique to community health centers is a federal requirement that at least 51% of the board be users of the center. Finding qualified board members, especially in rural areas, can be difficult. VC’s 14-member board has an active nominations committee that seeks out quality individuals for potential service and a roster is presented for election once a year. Board members who rotate off are replaced by persons with similar qualifications; for example, a health center user in a rural community would be replaced by another rural member. This keeps the board balanced and within federal compliance. Health care is one of the most regulated of industries, and community health centers among the most regulated in the industry. Training is critical, and all board members, each serving no more than two 3-year terms, must maintain a high level of expertise. Board training specific to community health centers is available locally through the Oklahoma Primary Care Association. Also, board members travel to national training meetings as funds allow.
VC serves tens of thousands of people each year, people who without VC would not receive the medical and social service care they need. VC is about access, about caring and about finding solutions, and I support this mission and these efforts whole-heartedly. I strongly believe that you don’t get involved with an organization without being fully committed to furthering its mission. I am dedicated to Variety Care and its mission to improve the state of health care in our community. It’s a calling and I enjoy doing it.
VC primary care services include a broad range of programs and services for all ages. VC full-time facilities include eight health centers in Oklahoma City and two in Norman, as well as rural clinics in Ft. Cobb, Grandfield, and Thomas. In addition, Variety Care operates a part-time site at Oklahoma Educare, and two sites in collaboration with Community Mental Health Centers.
Depending on the location, services include preventive and primary medicine, pediatrics, OB/Gyn, prenatal care, geriatrics, clinical pharmacy, mental health, substance abuse services, immunizations, optometry, dental, on-site lab and X-ray, WIC, patient education, referrals to community resources, discounted medications, a patient assistance program for receiving free medications for those who qualify, case management, and patient advocacy. Two of VC’s urban health center sites have walking trails with strategically placed benches. The Mike Dover Park at the Lafayette campus includes a beautifully landscaped park and active play equipment to encourage movement. Patients and community members utilize these outdoor facilities to exercise and gather together.
At VC’s Inasmuch Foundation Pediatric and Wellness Center (Lafayette campus), a new model of patient-centered, holistic care can be found. The campus includes a pediatric wellness center with integrated medical, dental and behavioral health. Services are provided in a family-friendly environment and there is nearby access to vision care. A dietician provides coaching in nutrition focusing on healthy diet and exercise. A teaching kitchen hosts classes in collaboration with OU to teach parents how to prepare tasty nutritious foods, and a Jr. League project offers small group instruction in nutritious meal preparation. Daily successes are celebrated as patients learn healthy, life-changing skills. At Straka Terrace, A Chronic Disease Management Clinic helps patients with chronic illness manage their disease and improve their quality of life. Throughout VC’s system, behavioral health is being integrated with other services to ensure a holistic approach to life long health and wellness.
For VC, long-term success focuses on improved wellness and quality of life for our patients. A survey was conducted of 355 patients who received assistance through our Support Care Fund; 87.3% increased health knowledge, 99.7% understand the importance of routine checkups, 65.6% feel they are in good health, and 84.2% can now recognize the specific symptoms of their condition. In another survey involving 241 patients, 71.4% showed improvement in their health. Long-term change in condition over a year was measured for 30 diabetic patients; 67% showed a sustained improvement in their health. These dynamic long-term successes happen because of VC’s commitment to patient education and coaching; they are all the more dynamic consider the poverty of the patients. Straka Terrace, VC’s flagship location, has received certification as Patient Centered Medical Home.
Variety Care’s Teen Clinic is a teen pregnancy prevention program focusing on Oklahoma City Hispanic teens ages 13 – 19, conducted at U.S. Grant, Capitol Hill, Southeast, Emerson, and Putnam City West High Schools, Putnam City Academy, and the Advanced Science & Technology Education Charter School. An 8-lesson evidence-based curriculum Cuidate (”take care of yourself” in Spanish) is offered to freshmen, sophomores, and senior students and students newly enrolled. Cuidate is a culturally appropriate program to reduce HIV sexual risk behavior among Hispanic youth. Teen Clinic also offers Be Proud, Be Responsible, a Centers for Disease approved curriculum featuring eight one-hour modules encouraging responsibility and accountability. In addition to the program offered in schools, Teen Clinic at VC is a series of sexual education classes offered several times per month during which students have free access to a medical provider for questions and contraceptive services.
Short-term success for this program is an increased knowledge of HIV and pregnancy prevention, knowledge about possible career tracks, the benefits of staying in school, and learning to respect oneself. Each Cuidate lesson is considered an intervention. For Teen Clinic conducted in the public school, 2770 students participated in 15,589 hours of instruction. Teen Clinic at Variety Care offers a series of sexual education classes offered several times per month during after school hours and on weekends at a VC clinic; students have access a medical provider for questions and free contraceptives. Teen Clinic at VC served 793 students during the 2015-16 year.
For the 2015-16 school year, Teen Clinic served 2,770 students, an increase from 1,075 students in 2011-12. Variety Care’s mission of making quality and affordable health care accessible to all is furthered by providing services to youth at risk for teen pregnancy with education, medical care and guidance to help them plan families after they complete school. With support for this program from the Kirkpatrick Family Fund, we are investing in the future of Oklahoma City. Long-term success for the Teen Clinic program is the prevention of teen pregnancy among program participants during their high school years.
Teen Clinic is monitored through data collection and analysis. Program success is measures by an increase in knowledge about HIV, the importance of condom use, the benefits of abstinence and knowledge of refusal skills. Ages of students served included 18.1% students ages 12- 14, 47.1% of students ages 15-16, and 34.8% of students aged 17-19. Just over a third of the students, 33.0%, were in 9th grade, 33.4% were in l0th grade, 6.3% were in 11th grade, and 27.6% were in 12th grade. Of the total number of students who participated in the program, 41.8% were enrolled at U.S. Grant, 38.7% at Capitol Hill High School, 7.8% at Southeast High School, 5.1% at Putnam City West, 4.1% at Emerson, and 2.6% at Putnam City Academy. Results from the 2015-16 school year show students showed a 21.2% increase in knowledge of STD transmission, and a 31.5% increase in understanding of HIV transmission and AIDS.
The following anecdote illustrates why Teen Clinic is so successful: M is 18 and started coming to Teen Clinic when she was 16. Her 14-year-old sister was pregnant and M wanted to avoid the same path. With the knowledge and support she received through Teen Clinic, M has graduated from high school and postponed pregnancy. She is very grateful for the influence of teen clinic and remarked to the Teen Clinic Coordinator that without Teen Clinic, she probably would be pregnant.
VC works with NorthCare Community Mental Health Center to provide integrated preventive and primary care to Seriously Mentally Ill adults at NorthCare’s new Wellness Campus. There are ample statistics demonstrating that mentally ill individuals have a higher rate of illness and death than the general population. Compared to Oklahomans overall, persons with serious mental illness typically die more than 26.3 years earlier. Many people with serious mental illnesses do not access medical care through traditional avenues. These individuals have multiple barriers to receiving medical care, including stigma, lack of integrated mental and medical health care, poverty and lack of insurance or insufficient financial means to pay for care. By working together, VC and NorthCare change the path of these highly at-risk individuals, giving them hope for a healthy future. Variety Care also has embedded a medical provider at Central Oklahoma Community Mental Health Center and we are expecting similar results as have been achieved at NorthCare.
Because the mentally ill do not traditionally
receive coordinated care, long-term success for this program is measured by the
sustainability of the program and overall improved health outcomes for
patients. The VC / NorthCare
collaboration began as a grant funded program and is sustained as part of
Variety Care’s overall commitment to improve access to care. Many of the individuals served at this site
have shown significant improvement, consumer/patients diagnosed as obese have made
progress toward their ideal weight, patients
with diabetes report improved blood glucose levels equal to or less than 9%
(the national benchmark), and patients
with hypertension have achieved adequate control.
Regular reports demonstrate that the program is used by an increasing number of mental health consumers and that the program works. A patient, “M,” nearly lost her leg because of diabetes. Because she had immediate access to her primary care providers within her mental health center, as opposed to fragmented care usually received through a hospital ER, her leg was saved. Another patient, “K,” came to the medical clinic at NorthCare with chest pain and rapid heart rate. K did not have any insurance. The VC provider performed an EKG, and noticed symptoms of heart disease. K was immediately referred to the hospital ER. VC and NorthCare case management staff made arrangements for him to be admitted to Mercy through a charity program so that he could see a cardiologist. His condition has stabilized. Time and again, these types of stories are reported. The VC/NorthCare partnership is saving lives.
Through the VC / NorthCare collaboration, consumer/patients receive integrated care and have experienced improved health and quality of life. When the mental health provider and medical provider communicate and develop treatment plans together, the patient is treated holistically rather than as someone with isolated diseases and complaints. Because both VC and NorthCare are patient-centered, the consumer/patient is involved in making health goals and in developing a realistic plan to meet those goals. Certified Peer Recovery Support Specialists work daily in the clinic, collecting data, and offering hope and support. Two Peer Support Specialists have been trained as wellness coaches and offer one-on-one support to health clinic consumers. The collaboration has led to placement of NorthCare clinicians in VC facilities to provide behavioral health services to VC patients. This furthers the practice of integrated care.
Because VC provides care onsite at Educare, children are immunized on time and have regular well-child checkups. School staff refer children to the VC provider, or parents bring the child in. Because their medical provider is at their school, children miss less school, which leads to increased success.
While the numbers of patients served at Educare is modest, the individuals who receive care at this clinic would likely not have received care elsewhere. Because care is provided onsite and on a sliding fee scale based on income, barriers due to poverty and transportation are removed. Variety Care at Educare has been in operation since 2010. Since that time, the number of patients utilizing the service has grown and that growth is expected to continue. VC will continue to reach out to individuals in the community served by Educare who prefer to have a medical home where they can see the same medical provider and in a comprehensive health system. VC will have long-term success at this site when all patients who need medical services are able to access them through the VC partnership.
Program success at Educare is measured by how effectively services have been integrated; Variety Care at Educare is a seamless parts of the organization’s model. Unfortunately, often services offered by nonprofit organizations to persons living in poverty start and stop depending on funding - individuals are naturally reluctant to trust yet another nonprofit who means well but may not have staying power. At VC, we do not open a new clinic unless we are certain it is sustainable. Due to our continued presence at Educare, we expect the utilization of services to continue to grow, as the community comes to trust that Variety Care is in their community for the long term.
Foster Grandparents receive an orientation and training before they are matched with a student. Program success is measured by improvement in three areas: academic performance, social behavior and attitude. Children are evaluated by their Foster Grandparent and their teacher to determine if the program has been successful in helping them to reach their goals. For the seniors involved in the program, success is more difficult to quantify and involves maintaining a sense of independence and fulfillment in sharing a lifetime of experience with a child who needs them. Numerous studies have shown that one of the keys to quality of life for seniors is a sense of community and the need to contribute, to make a difference. Through this program, seniors give back to their community, gain a sense of importance and purpose and see the difference their involvement makes in the lives of children.
VC collaborations include the Oklahoma State Department of Health and county health departments, Community Health Centers Inc., NorthCare for integrated primary care and Healthy Homes, Espra Mas, Educare, Reaching Our City, OK Dental Foundation for rural health access, the Commission to Transform the Safety Net (including Integris, Mercy, Deaconess, Ok Medical Society, the Health Alliance for the Uninsured, the University of Oklahoma, the Ok Commissioner of Health and Commissioner of Mental Health and the Delta Dental Foundation), Integris SW Medical Center and OU Medical Center for care transitions, OU College of Medicine Departments of Obstetrics and Pediatrics, OU College of Pharmacy, OU School of Public Health, the University of Oklahoma, the Oklahoma City Community Foundation, OSU OKC for their EAP program, Infant Crisis Services, Ok Rural Health Association, Ok Primary Care Association, Reach out and Read, a collaboration with NorthCare and the City of OKC for proposed operation of a new center for senior wellness, the Senior Center and Methodist Church in Tipton for a weekly music night, CMS and HRSA Patient Centered Medical Home initiatives, HRSA Diabetic and Patient Safety Collaboratives, SAMHSA integrated care program, Nat’l Association of Community Health Centers.
Opportunities abound for reaching out to those who are medically underserved, and are addressed through strategic relationships and outreach. Collaborations such as those between Variety Care and NorthCare, Central Oklahoma Community Mental Health Center, and Educare demonstrate VC’s philosophy to deliver care in a way that is truly accessible. It is a challenge to manage multiple sites, some of which are rural. We address this challenge by having clinic managers for all sites participate in leadership team meetings, regular visits to all clinic sites by senior management, participation by all staff in quarterly meetings, involvement of all staff in satisfaction surveys, and regular updates from the Board, CEO, and marketing department.
Variety Care was one of the first non-profits to complete the “standards of excellence” through the Oklahoma Center for Non Profits and our board members participate in training and development offerings from the Oklahoma Primary Care Association, the National Association of Community Health Centers, and Board Source. The Governance Committee of the board has organized a schedule of in-service so that board development is on the agenda every month. We have always been committed to our own assessments and making sure that we are also looking for ways to improve our performance as an agency, as a staff, and as a board. Annual Board surveys provide feedback to the incoming chair and officers to work on areas the board feels important to strengthen board performance. Maintaining rural representation and the federal consumer board requirement that keeps the patient’s voice at the table are challenges for the board of directors. Planning for the future in the midst of health reform is both a challenge and an opportunity. Variety Care’s board understands the concept of holistic care provided through a medical home setting. The board provides the governance framework through which innovative programming serves some of the area’s most high-risk patients. These innovations include agency-wide implementation of electronic medical records, which allows patients with chronic illness to be managed effectively and moves VC toward the patient centered medical home model. Another innovation is the patient portal, which allows patients to communicate with their providers outside of the medical visit, and emails reminders and educational messages to patients. Keeping up with important innovations in health care delivery is something to which the VC board is dedicated. The largest programmatic challenge for the board is obtaining the funding to serve the many and varied needs of the communities served by the health center, both urban and rural. VC has accomplished much, managed well, planned strategically, and implemented carefully - however, there is so much more to do and so many more people to help.
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