Piecing Together Health Care’s Puzzle
On any given day, MedNorth and CommWell health centers could be saving area hospitals a significant amount of money. That’s because the two centers provide care to a population in Southeastern North Carolina that might otherwise turn to hospital emergency departments for primary care.
“The ER is such an inappropriate starting point” for health care, said MedNorth CEO Althea Johnson, adding that, by the time an uninsured individual decides to visit the emergency department, “some problems can become giant.”
The bill could be giant as well, especially if the uninsured person has postponed getting treatment until the condition becomes a crisis.
A 2013 National Institutes of Health study calculated the median cost of one visit to the ER at $1,233 – and costs have risen since then. Uninsured and underinsured people, who are the most likely to use the emergency department as their primary source of health care, often can’t pay for the cost of their visit. In many of those cases, the hospital must absorb the cost.
Enter the community health center.
In the jigsaw puzzle that is health care in the United States, community health centers provide primary care in underserved urban and rural communities. These pieces are essential to holding the puzzle together and in reducing health care costs.
Christopher Ray Vann, CommWell’s chief development officer, cites a study that found when a federally qualified health center, or FQHC, lands in a county, there is a 30% reduction in emergency room use.
MedNorth, located in Wilmington’s Northside community, served about 7,000 of New Hanover County’s low-income residents in 2018, 53% of whom were uninsured and another 36% were on Medicaid or Medicare.
CommWell Health, with 16 centers in Southeastern North Carolina, reaches into Brunswick County’s more rural areas with locations in Bolivia, Shallotte and Ocean Isle Beach that, combined, served 3,300 patients in 2018.
It also runs an FQHC in Pender County’s Willard community.
In Southport, Goshen Medical Center Inc. also operates as a federally qualified community and migrant health center organization. It offers pediatric as well as family medicine services.
Like puzzle pieces, each of these centers is distinctive, reflecting the community it serves.
Each FQHC gets a set amount of federal funding each year, but the clinics can also apply for other federal grants for specific projects.
Vann said that the federal monies make up about half of CommWell’s overall budget.
FQHCs charge their patients on a sliding scale based on their incomes. Those at the lowest income level are charged $30 per visit.
Both MedNorth’s Johnson and CommWell Health CEO Pam Tripp emphasize that the majority of their patients do have jobs, but these jobs often don’t pay much and do not provide health benefits.
“These are the people who wait on us in restaurants, wash our cars and till our fields,” Tripp said. “People are happy we’re here, and they are happy to pay.”
Both centers aim to be one-stop shops for health care, with physical, behavioral and dental care for children and adults. Because these centers practice integrative care, a person who comes through the door with one health issue can be assessed for – and treated for – other, often related, problems.
Both local FQHCs are Joint Commission accredited, meaning they have been assessed and certified by The Joint Commission, an independent, not-forprofit organization. Such certification recognizes an organization’s commitment to meeting specified performance standards.
“We hire professionals, and all of them are board certified with years of experience with the population we serve,” Johnson said. “We are offering a quality product, and would love for people to know that coming here is not a step down.”
FQHCs are required to serve patients in the language of the patient’s choice. MedNorth has a full-time Spanish interpreter and several Spanish-speaking staff members. But speakers of other languages visit the clinic as well.
“Nineteen percent of our patients want to be addressed in a language other than English,” Johnson said. “I’m always amazed at the languages we hear in here: Congolese, Karen, Swahili. We’ve even had calls for American Sign Language, Farsi, Cantonese, Mandarin. We do have people on staff who can speak some of these languages.”
MedNorth also uses a remote translation service when needed.
Spanish is the primary language of CommWell’s Brunswick patients who don’t speak English, according to Vann.
“Over half of our (staff) colleagues are bilingual, and we also contract with a company that provides realtime video interpretation services for hundreds of languages and American Sign Language,” he said.
In carrying out their demanding mission, FQHCs develop partnerships or informal relationships with other health care providers.
One of MedNorth collaborations is with Cape Fear Clinic, a charity care health care center in New Hanover County that also provides a range of services to the uninsured and underinsured but does not receive a federal subsidy.
CommWell Health has a similar collaborative relationship with New Hope Clinic, also a charity care center, in Brunswick County. Because these charity care clinics charge less for a patient visit, they serve the very poorest in their communities.
To ensure that it is reaching patients who may not wish to visit the clinic itself, MedNorth partners with First Fruit Ministries, a Wilmington organization that provides food, shelter and related services to the homeless.
“It’s amazing how many vets are in the homeless population,” Johnson said, pointing out that veterans suffering from PTSD may be uncomfortable in institutional settings or in situations where they are around groups of people.
“First Fruit Ministries goes out and brings people in (to its facility) and gives them a shower, clothing, a hot meal. We provide health care. They don’t necessarily want to come to MedNorth. We meet the community where services are needed,” Johnson said.
In the next six months, she added, MedNorth plans to launch van service, providing transport to the clinic from First Fruit and various public housing developments.
In Brunswick County, CommWell has forged ties with several faith communities, schools and other organizations to build a supportive health care safety net. Its first mobile clinic came about thanks to New Beginnings Community Church. CommWell also has the use of Novant Health Brunswick Medical Center’s mammography equipment.
Each FQHC is required to have an advisory board. These boards must be consumer-led, meaning at least 51% of the members should be those who use the health center as their main source of care. The intention is to ensure the center is responsive to the needs of the communities it serves.
CommWell’s advisory board has been active in fundraising for CommWell Health in Brunswick County. One immediate goal is to purchase and set up a mobile dental unit. Another is to have a medical/ behavioral health mobile unit that can go to area schools.
“We have schools that are 100% free lunch,” Tripp said of the organization’s service area. She added that often students at these schools lack access to medical and dental treatment and, increasingly, behavioral health care.
“We get calls a lot from schools, saying ‘Can you help us with behavioral health?’ We are looking forward to doing that through a mobile unit,” Tripp said.
Despite the annual federal subsidy and potential availability of other grants, FQHCs must find other sources of funding to carry out their mission.
Vann says about half of CommWell’s budget for its entire 16-clinic operation is covered by an $11 million subsidy and another $1 million in other grant monies.
“We have to develop (other) revenues ourselves,” he said. “We’ve been building a foundation with our Wonderful 100 Campaign. In six months our board and colleagues have raised $170,000.”
CommWell and MedNorth, like other FQHCs in the state, are following the state legislature’s debate on whether to expand the state’s Medicaid program. Qualifying more of the state’s poor for Medicaid coverage would mean that FQHCs and other charity care clinics could get reimbursed at Medicaid rates for patients they are now treating for much less.
“That would be a beautiful thing,” said Johnson of the Medicaid expansion proposal. “We have to generate additional revenue. Staff want to be paid the market rate and will leave if they can find a better-paying job. We are always in recruitment mode, which has an impact on patient care.”
Expansion of the state’s Medicaid program would benefit whole communities, Vann said.
“We would see a significant increase to our revenues with Medicaid expansion,” Vann said. “We could expand more jobs, for the sake of our communities. Our leadership estimates a $3 million addition to our revenue. That $3 million would be considered an investment to the community because it translates to $5 million in terms of economic benefit. Right now, there is a restaurant being built down the street from our north Sampson County center; it’s opening because we are right here, and we pull in a lot of people.”
Link to story in WILMA Magazine
MedNorth Health Center is one of the proud recipients of the Women’s Impact Network’s Grants for 2019. During WIN Board of Directors, Kristine Moore began the invent by saying,“This is a celebration of our working together through philanthropy and making a difference in our community,” … “Over eight years we have awarded more than $315,000 to 18 New Hanover County not-for-profits.”
“MedNorth, which serves primarily New Hanover County’s uninsured and underinsured population with primary care, dental services and behavioral health care, plans to use its grant to enhance its services through purchases in four areas:
- · Blood pressure monitors for patients who will use them to manage and report their blood pressure.
- · Car seats for newborns whose families cannot afford them. Althea Johnson, MedNorth CEO, believes that having a car seat will encourage more new mothers to bring their newborns to the clinic within the first five days of birth for well-baby checks, and to visit the clinic themselves for post-natal checkups.
- · Wire loops used in a treatment known as Loop Electrosurgical Excision Procedure (LEEP) to remove abnormal cells from women’s cervixes, therefore reducing the incidence of cervical cancer.
- · A new autoclave to sterilize instruments.
Steve McCrossan, CEO of Nourish NC, said his organization will use its grant funds for two programs that have shown great promise during recent pilot periods:
- · A partnership with Nunnelee Specialty Pediatric Clinics, which serve chronically ill children, that will provide – in the doctors’ offices – boxes containing 25 meals’ worth of food and a voucher for fresh produce and meats, to patients identified as suffering from food insecurity.
- · Toddler Tummy, a program that will send the same box and voucher with personnel from Smart Start and Coastal Horizons who make home visits to clients with young children.
For more information on the awards and the Women’s Impact Network, please visit the following links. https://www.winofnhc.org/ and https://www.winofnhc.org/2019-Luncheon
Althea Johnson returns to Wilmington to run New Hanover County’s only FQHC
BY CHERYL L. SERRA PHOTO BY TERAH WILSON
Althea Johnson has come ‘home’ in order to help run an organization aimed at providing people of all ages access to a comprehensive variety of health care services they wouldn’t normally have, something she thinks is a right.
Johnson is CEO of New Hanover Community Health Center, Inc., doing business as MedNorth Health Center, the only federally qualified health center (FQHC) in the county, located on North Fourth Street.
A FQHC qualifies for federal funding and enhanced reimbursement from Medicare and Medicaid because it serves an underserved area or population, offers a sliding fee schedule, provides comprehensive services, and has an ongoing quality assurance program and a governing board of directors. Its safety net services are often provided in an outpatient facility.
Johnson had a circuitous health-related career before returning to Wilmington in 2004. Originally from the city, she left to go to Shaw University and then moved to New Jersey where she worked for 20 years for Plainfield Neighborhood Health Services Corporation, an FQHC in New Jersey, eventually serving as COO. She also earned a master’s degree in management from New Jersey Institute of Technology.
She then went to Atlanta hoping to do something a bit different in the healthcare field and earned another bachelor’s degree from DeVry University in information technology, thinking she would work in health-related informatics, which would help her run her own reports. She uses the skills she learned there today.
Returning to Wilmington because her father was ill, Johnson worked for the New Hanover County Health Department as a health planner. In 2007, Johnson started her position as MedNorth’s deputy director, a position for which her 20 years in an FQHC and her other experience “uniquely qualified” her, she said. Her title was later changed to COO and now she’s CEO.
She sees her job as eliminating barriers to health care, pure and sometimes not so simple. Primary care is – or should be – the appropriate entry point for health care, she says. From there, patients at MedNorth can access a range of health care services available to people of all ages: adult and family medicine, dental care, women’s health, pediatric services, on-site pharmacy, and prenatal care. MedNorth recently added podiatry to this menu of services and Johnson notes there is a large diabetic population in the area and many of them suffer from foot issues.
“Having everything here in the same building helps to accommodate what they need,” Johnson says, referring to the onsite facilities for lab work, dental and behavioral health services, to name a few. “I think if you had to go to many different places that might present a problem.”
In addition, for those who are seeking behavioral health help and are weary of the stigma attached to it, having the words “behavioral health” or something similar on the door might be off-putting. Under MedNorth’s model, a person who comes to visit a clinical provider can learn about behavioral health services and be introduced to providers; it’s an integrated, interdisciplinary team approach to providing healthcare.
Johnson points to the statistic showing that 27 percent of MedNorth patients have Medicaid, which many physicians don’t accept, as a way to illustrate what MedNorth does for the community. Nationwide, she says, many states expanded Medicaid eligibility; North Carolina did not. An individual or family can qualify for an FQHC discount if the household income is 200 percent of federal poverty level, currently at $20,780, or less.
There are many people in the Wilmington area who fall into that category, according to Johnson.
She talks about the Wilmington area having many service industry jobs at which folks make minimum wage or slightly above it. There are also many self-employed people, including those in the building industry and the arts. Many of them are responsible for their own health care costs.
“They’re not making enough money,” to pay for insurance, she says. “Gone are the days when your employer is paying 100 percent of your insurance cost; all of that cost has shifted to the employee.”
Johnson believes universal health care is the answer, ensuring access to health care to all, although she acknowledges this is a politicized debate.
Asked if she’s disheartened by the position so many people are in related to their health care, Johnson says there are a lot of aspects that health care providers can’t control, such as patients’ health care literacy and proximity to supermarkets that offer healthy food at affordable prices. So she focuses on what they can control, at least to a degree.
“I’m not disheartened,” she says. “There are a lot of different organizations that are working together to improve the health of residents.”
To view more of photographer Terah Wilson’s work, visit www.terahwilson.com.
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Dr. Mayra Alicia Overstreet Galeano and her family fled war-torn Nicaragua in 1985.
In 1985, Dr. Mayra Alicia Overstreet Galeano fled war-torn Nicaragua with her family. She was only 9.
The Sandinistas had confiscated the family’s personal belongings. They left with just three suitcases and their parents’ advice: “The only thing that can’t be taken from you is your education.”
Galeano would make the most of her education in America, getting a scholarship to college and then going to medical school.
But it was difficult in the beginning. Galeano and her family settled in Tennessee with an aunt who helped get all the paperwork for them to come to the United States as refugees.
Going from a tiny island off the coast of Nicaragua to the mountains of Tennessee was a culture shock for Galeano. At the time, her family was one of only three Spanish-speaking families in the county. Her English was limited; she only had a few crash courses before beginning elementary school.
For Galeano, her elementary school experience was a great one. The school she attended was very accommodating to her family and they went above and beyond to welcome them. She remembers her principal giving her rides to after-school sports activities and even purchasing her a pair of running shoes.
Her family knew the struggles of being refugees and a low-income family. They had no insurance and it wasn’t until she was 15 that she had the chance to visit a dentist. With the encouragement of her parents, she and her siblings did very well academically and after graduating from high school she was awarded a scholarship to attend Duke University. At the time, she had not planned on becoming a doctor, but knew she wanted to serve families who struggled like hers.
Galeano graduated from Duke in 1999 with a degree in biology and had planned to do HIV research until an opportunity opened for her to work for the Children’s Environmental Health Initiative.
As a result of her scholarship to Duke, she met a faculty member that received funding from the CDC for a project to study lead exposure in children. There was a need for a Spanish-speaking person with a science background. As part of the job, they would be doing an analysis of data and also going into homes to collect samples of paint. A lot of the homes were lower-income, Spanish-speaking families. Galeano was perfect for the job.
During her time working with the Children’s Health Initiative, Galeano was studying the social determinants of health and trying to find ways to address them to change the outcomes for the underserved families she was working with.
According to the CDC, economic and social conditions influence the health of people and communities. These conditions are shaped by the amount of money, power, and resources people have, all of which are influenced by policy choices.
During the course of her work, Galeano noticed a need to address the immediate health care concerns of these underserved families and came to the conclusion that until these needs were met they would not be able to address the larger issues affecting their health.
The families she worked with were struggling with health concerns such as asthma due to mold in the home. The mold issue had to be addressed but asthma needed to be treated first. These pressing issues were stopping the families from addressing the cause of asthma.
“Being able to address the immediate health care concerns, I thought, would help me better advocate for addressing the social determinants of health,” Galeano said. At that moment, Galeano decided to go to medical school.
In 2011, Galeano graduated from the University of North Carolina Chapel Hill School of Medicine. She then began her family medicine residency at Oregon Health and Science University in Portland. She completed her residency in 2014 but stayed for one more year to do a faculty development fellowship. After completing her fellowship in 2015, she remained at OHSU and taught for a year until she moved to Wilmington in March 2016.
A few key factors led Galeano to Wilmington. “I grew up on an island so being close to the beach and seafood is really good,” Galeano said. “I get to, professionally, do the things that I want to do as well.”
Galeano wanted to be in a position where she could teach, do prenatal care and deliveries, and serve a population similar to the one she came from. She now teaches in the Family Medicine Residency Program at New Hanover Regional Medical Center and is a family physician at MedNorth.
“For me, I understood the importance of family health, understanding how my family was affected by the war and how the community affects your health as well,” Galeano said. “It’s been an important part of my career and my personal life. It’s incredibly rewarding.
“Health doesn’t come just from a pill. It really comes from your community and from a better understanding of how you fit in the world.”
Getting to know: Dr. Mayra Alicia Overstreet Galeano
Hobbies: Running, reading, cooking, Latin dancing, hiking
Bucket list: Traveling
Health care tip: “Taking care of yourself is one of the most important things you can do. Taking care of yourself, ideally, would include healthy eating, drinking water, staying active, and staying connected. Connected to your community but also to yourself, being aware of who you are, what’s important for your health, and what brings you joy.”