Model Proposals - HealthReach Clinic

Many clinics serving the disenfranchised one day reach the point where they must review their practices to improve or guarantee quality care, expand if necessary to better meet the needs of their patients, and employ the staff to undertake these processes. HealthReach, after 10 years of operating as a grass roots free clinic, is at such a point -- and its proposal presented below provides a strong example of the clinical restructuring and organizational capacity-building needed to grow into the future. Additionally, the proposal offers a wonderful example of resource sharing via the partnership between HealthReach and La Puerta Abierto (The Open Door Clinic), allowing VNA grant dollars to reach beyond the walls of one clinic to assist another.

Watching a small free clinic that was built on good will and volunteerism grow in sophistication and capacity is a satisfying experience for funders, and we were pleased to recommend and approve this proposal submitted by HealthReach Inc. for funding at the August 4, 2005 VNA Board of Directors meeting.

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PROPOSAL NARRATIVE

Background:

1. Organization's mission, history, overall goals and/or objectives.

The mission of HeathReach Clinic is to increase access to health care for medically underserved individuals in Lake County, Illinois, by filling the gap in the local health care safety net using the "Free Clinic" model of care.

Founded in 1992, to help address the needs of the of medically uninsured poor in Lake County, HealthReach provides high quality healthcare for residents who live below 120% of the federal poverty line and without the benefit of health insurance. We have provided over 40,000 episodes of care since 1992 and currently conduct over 6,800 patient visits annually serving over 1,500 individuals.

It is our overall goal to strive for increased levels of performance and contribution to the continually rising population we serve, while continuing to meet the growing demands of their needs. It is not our intent to duplicate the services of other agencies such as the Lake County Health Department.

2. Description of current programs and activities and major achievements over the last two years.

HealthReach is effective in meeting the needs of the population we serve because of an intensive community effort which enables us to provide free care by utilizing 17 local physicians; 4 registered nurses; one nurse practitioner; one physician's assistant; and clerical personnel who volunteer their services to staff the clinic. HealthReach currently employs 8 full-time, paid staff (including 1 registered nurse) and 4 part-time paid staff. HealthReach is divided into five separate but integrated efforts as follows:

• Medical Program - The main focus of HealthReach offers a broad range of medical services including primary and preventative healthcare, women's health services, pediatric healthcare, onsite cardiology and orthopedic specialties; and mental healthcare.
• Pharmacy Program - Prescription medications are a critical element of primary healthcare delivery and control of chronic disease. The HealthReach Pharmacy provides free or low cost medications (as prescribed by our physicians) to our patients via our onsite pharmacy. This highly effective program also provides substantial cost versus benefit leverage to our community. For each dollar spent HealthReach dispenses over $10 worth of pharmaceuticals.
• MedAssist Program - A prescription drug assistance program that helps low income individuals, who are not patients at HealthReach, obtain free medications through pharmaceutical company indigent medicine programs. MedAssist operates from the HealthReach pharmacy and is run by the clinic's pharmacy staff. Over 300 individuals have taken advantage of the program.
• HABLA (Healthcare Access By Language Advocacy) Program - The only medical interpreter training and service program in Lake County) provides bilingual medical interpretation to our patients free of charge. It was recently recognized in "Providing Language Interpretation Services in Health Care Settings" by the National Health Law Project for the Commonwealth Fund.
• Administrative Program - The managerial and general administrative arm of all aspects of the clinic.
3. Description of formal and informal relationships with other organizations

HealthReach implements collaborative partnerships with many healthcare providing agencies to ensure our clients get the care they need. In addition to our in-clinic care of patients we have agreements with 3 local hospitals and several specialty physicians that allow us to get needed testing and follow-up treatment should abnormalities be found. For example; laboratory, imaging and hospitalization services are provided by Vista Health (Victory and St. Therese Hospitals). Cardiology procedures and services are provided by Highland Park Hospital and specialty services including OB-GYN, general surgery, gastroenterology, urology and orthopedics are provided to our clients free of charge by several private professional practices. In CY-2004, HealthReach clients received the benefit of 1,172 separate referrals.

Also, HealthReach Clinic collaborates with Finch University of Health Sciences, Physician Assistant Training Program to administer an evening immunization clinic for children. Lastly, it is becoming clearer to us that a central part of patient care to the poor and indigent population we serve revolves around mental health and behavior modification. Nearly 10%, over 120, of our clients are diagnosed with mental health or neurological disorders. To this matter, HealthReach implements a cooperative partnership with Rosalind Franklin University who conducts a weekly mental health and behavior modification clinic at Health Reach. This community service is designed to provide counseling of HealthReach clients in the areas of depression, medication compliance, diet, smoking cessation and chronic disease management.

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Purpose of Funding Request

Briefly state how this grant will be used.
HealthReach respectfully requests the VNA Foundation grant monies in the amount of $40,000 to support the salary cost of a Clinic Coordinator (RN) and Clinical Medical Assistant (MA) as we utilize a team of registered nurses in a variety of new roles to reorganize clinic operations and implement the "Clinic Operations Upgrade" project for the benefit of our patient population. The overall goal of this project is to improve the quality of clinical operations while accepting a significant increase in client load and offering a wider range of health services.

Community needs or problems that this effort will address, including population served.
Although one of the most affluent counties in the state, it is estimated there are approximately 100,000 uninsured in Lake County, IL. Since 1992 the trend toward more working uninsured coupled with the high costs of healthcare has gone unabated. More and more employers are raising employee costs of medical coverage to the point of being unaffordable or eliminating healthcare benefits all together. Without the services provided by HealthReach, patients would opt for high cost hospital emergency room services or in many cases would forego health care altogether. For those patients who have acute or chronic diseases such as diabetes or hypertension, the consequences of loss of access to healthcare could be severe or even fatal.

Of the over 1,500 patients treated in 2004, demographically, 75% come from Waukegan with the remaining 25% coming from collar townships close to our core service region. From a race/ethnicity perspective, 78 % are Latino or Hispanic, 11% are Caucasian, 10% are Black or African-American, and 1% represent Asian or other cultures. With regard to age and gender 48.4 % are 41 - 65 years, 34.4 % 17-40 years, 11% are 1-16 years and 6.1% are 65 or older; 62% of our patients are women or girls and 38% are men or boys.

Describe how the project addresses these identified needs.
HealthReach is highly effective in meeting the needs of the population we target for many reasons. However, as the number of uninsured poor in Lake County grows, the demands placed on the clinic and needs of these individuals grow as well. The Clinic Operations Upgrade Project will allow us to streamline our business practices and procedures making our clinic more efficient and allowing our nursing staff to better serve our patients.

Strategies employed to implement project: Goals and objectives, timetable for accomplishing stated goals and objectives, program methodology, staffing and collaboration with other agencies.

We rely on the dedication and expertise of the nurses at HealthReach. By putting into action the following objective strategies this program will enable us to better utilize this important resource while allowing us to better serve the growing number of uninsured in Lake County.

• Develop and implement new business processes and procedures related to 1) Patient triage; 2) Medical chart management and quality assurance; 3) Examination room operations; 4) Preventive healthcare delivery and records; and 5) Medical equipment and supply procurement and inventory management.
• Transfer this technology through a formal (existing) contract collaborative arrangement to the Open Door/La Puerta Abierta clinic in Mundelein, Illinois thereby significantly increasing the overall community leverage of this project. This clinic serves an additional 2,000 clients.
• Facilitate and support implementation of new clinical specialties in the areas of Chronic Pain Management and Obstetrics and Gynecology where a significant deficit in access exists for HealthReach clients.
• Identify all new chronic disease patients with Diabetes, Hypertension or Hyperlipidemia and establish control for each their disease states.
• Enhance formal patient education programs by providing programmatic group and/or individual counseling for all non-therapy compliant patients with Diabetes, Hypertension or Hyperlipidemia such that overall compliance and control significantly improves in this group.
• Increase number of client visits conducted at the clinic by 10%, without impact to the quality of service provided.
• All patients will be offered appropriate preventive healthcare.

HealthReach proposes to use registered nurses in the following key staff positions for this project: Clinic Coordinator; Chronic Disease Management Educator; Quality Assurance and Procurement Coordinator; Board of Directors Program Oversight Committee Chairperson; Infectious Disease Consultant and Clinical Medical Assistant. These staff will achieve the following outcome measures by the end of the grant period:

• The development of upgrades to clinical procedures regarding patient triage; medical chart management and quality assurance; examination room upgrades; preventive healthcare guidelines and the procurement inventory management of medical equipment and supplies will be completed by 11/01/2005.
• Overall value to community will be increased by the transfer of newly established business practices and procedures to La Puerta Abierta clinic.
• New chronic pain management practices including the upgrade of facilities for minor invasive procedures and procurement of specialty pharmaceuticals and delivery systems will be implemented.
• A new Women's Primary Care practice including the procurement of all specified exam room, laboratory and nurse station equipment, supplies and appropriate education materials will be implemented.
• Within six months of their first visit, all new chronic disease patients with Diabetes, Hypertension and Hyperlipidemia will be identified and controls established for of each of their disease states through effective drug, behavior modification and counseling therapies. The following American Diabetes Association control parameters will be used: 1) Glycemic control: HbA1C < 7.0%; 2) Blood Pressure: < 130/80 mmHg; 3) Lipids: a) LDL <100mg/dl, b) Triglycerides <150 mg/dl, c) HDL >40mg/dl. Note: this outcome is for therapy compliant clients only.
• Within 12-months of their first visit all non-therapy compliant patients with Diabetes, Hypertension and Hyperlipidemia will be identified and provided with programmatic group and/or individual counseling such that 25% of non-therapy compliant patients are compliant.
• The number of client visits conducted at the clinic in will be increased by 10%, from 6,800 in CY2004 to 7,480.
• All patients from children to adults are offered and receive (where accepted) a newly established wellness protocol based on the age, gender and where appropriate, race as documented in the medical chart checklist for each client.

If this is a collaboration, briefly describe partners. The collaborative aspect of this project will be transferring the newly developed and implemented business practices and procedures to the La Puerta Abierta clinic Mundelein, Illinois. HealthReach manages a formal (contractual) collaborative alliance with the Mundelein Area Self Help Association to improve and expand their clinic operations. La Puerta Abierta serves a community similar to HealthReach demographically and is trying to solve many of the same issues regarding healthcare delivery to the underinsured poor of Lake County. By sharing the results of our VNA funded program, HealthReach will directly increase the community value leverage achieved by these monies.

If this request is for a specific program, explain how it will be supported after termination of the grant.
This project is a formal and necessary upgrade to our core business Medical Program which has received annual funding for over thirteen continuous years from various agencies, institutions and individuals. In addition to our ongoing search for funding, this year we are renewing our United Way grant. This is a three-year grant in which we will integrate the expense of salary support for this program into our long term funding strategy. The United Way has offered steady support in the past and we anticipate (although cannot guarantee) continued future support. We have had consistent success in obtaining monies from Community Block Development Grants from Waukegan and Lake County from which we anticipate aggregate amounts of $35,000 - $40,000. HealthReach will be receiving an additional $25,000 per year from increased rent revenue from building's tenant and, just recently received increased funding from the Presbyterian Women of Lake Forest. Finally, we have been assured by the CEO of Vista Health (including Victory and St. Therese Hospitals) that the significant and diverse in-kind services provided to HealthReach Incorporated will be continued for the foreseeable future.
These monies, along with other funding which we will continue to seek, will be allocated toward continued support of the clinic coordinator and medical assistant positions. These paid staff positions, in addition to the other volunteer nurses who staff our clinic, are of critical importance to HealthReach and its success. The need to fund these positions will remain a priority to HealthReach management.

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Project Evaluation

1. How will you measure the effectiveness of activities

HealthReach will proactively monitor, measure and report progress toward the objectives of the Clinic Operations Upgrade project on a continuous basis. All of the objectives and outcomes of the Clinic Upgrade Program are directly measurable by simple numerical means or by directly observing and evaluating the existence (or lack thereof) of a certain business function or element. Participants in the evaluation process will include HealthReach management and the HealthReach Board of Directors. In addition, a statistical sampling of patients who receive care will be surveyed to assess qualitatively if the intended impacts on outcomes have or have not been met.

2. Describe criteria for success

The success of this project will be measured by the on-time completion of the following high level list of activities and deadlines designed for implementation of the Clinic Operations Upgrade project:

Item Description

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Reorganize clinic staff using Nurse Upgrade Model
Develop/upgrade clinical process flow diagrams
Develop/upgrade clinical process procedures


• Patient triage procedures
• Medical chart management and Quality Assurance
• Examination room operations
• Preventive healthcare protocols
• Clinic laboratory practice protocols
• Medical equipment and supply procurement

Redesign medical record forms to improve physician access to information, continuity of care, compliance with IDPH requirements


Implement Women's primary care practice

Procure OB-GYN equipment (using Salton Anti-Trust Grant monies of $6,900 + other grant funding)

Establish formal dietary and exercise guidelines for chronic disease patients

Procure visual aids system TV/VCR/cart to facilitate patient education regarding chronic disease management and video training

Upgrade computer based tracking system for patient data entry and analysis

Complete population of patient database with first and last readings for HbA1c, Blood Pressure, and Lipids

Populate patient database with preventive health activity history

Conduct formal Quality Assurance chart management reviews and report clinic as is condition (approximately 1500 charts)

Develop clinic performance upgrade plan based on clinic accepted standards of care

Implement comprehensive clinic performance upgrade plan

Finish date


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9/1/2005
10/1/2005

10/1/2005
10/1/2005
11/01/2005
11/01/2005
11/01/2005
11/01/2005


12/01/2005



12/01/2005


12/01/2005



9/01/2005



9/01/2005



10/01/2005



12/01/2005



3/01/2006



6/01/2006


7/1/2006



8/31/2006



3. Describe results you expect to be achieved by the end of the funding period.

By the end of the funding period HealthReach will be positioned to safely and effectively increase the number of clients served thereby increasing the value of HealthReach to the community while keeping pace with the growing population of uninsured poor in Lake County, Illinois. Furthermore, geographically speaking, by sharing / transferring the deliverable elements of this project with the La Puerta Abierta Clinic in Mundelein, Illinois, HealthReach will also be effectively improving access to quality care and services to an additional 2,000 clients with the monies provided by this proposed grant.

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Program Budget

Clinic Operations Upgrade Project - Proposed Salary Budget

VNA Facts

VNA awards grants quarterly.

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20 N. Wacker Dr., Suite 3118
Chicago, IL 60606
Phone: 312/214-1521
Fax: 312/214-1529