As the U.S. struggles to revamp the nation’s health care system, many politicians and citizens are asking if public health care works as part of the equation.For many residents of Fairfax County and the City of Falls Church, the answer came 20 years ago: yes, it can.
As the U.S. struggles to revamp the nation’s health care system, many politicians and citizens are asking if public health care works as part of the equation.
For many residents of Fairfax County and the City of Falls Church, the answer came 20 years ago: yes, it can.
Since opening its first clinic in May 1990, Fairfax County’s Community Health Care Network (CHCN) has functioned on a public-private health care model to assist the area’s uninsured.
The CHCN serves the City of Falls Church, through cooperation with the jurisdictions’ joint Community Services Board.
The services are extensive – primary care, diagnostic, blood works, X-rays, vaccinations – and the costs to the patients are kept to a bare minimum, subsidized according to their ability to pay.
For Falls Church residents with no other means to access affordable health coverage, the CHCN operates a center just around the corner from the bustling Eden Center.
The small facade of the Bailey’s Health Clinic – operating since June of 1990 – is tucked inside the Willston Shopping Center on Route 50. Its name harkens to the center’s initial location several miles down Route 7 in Bailey’s Crossroads.
In 2000, the medical center replaced an old restaurant and pool hall in the Seven Corners area to serve eastern Fairfax County’s uninsured population.
Today, more than 20,000 area residents call on Bailey’s and the CHCN clinic for primary care.
Including the CHCN’s other facilities in Reston and Alexandria, the clinics serve 50,000 patients a year, and the numbers are growing, especially recently with the economic downturn.
The CHCN operation meshes public and private elements, using Fairfax County’s tax base and administrative capacity to power the large-scale operation.
“We believe it’s the best health care system out there,” Christina Stevens, the CHCN program director, told the News-Press during an exclusive tour of what is one of the D.C. area’s largest public health systems.
Stevens has worked with the CHCN for 12 years and over that time, she said, the program has continued to flourish.
“Fairfax County has been on the forefront of the health care debate for years now,” she said.
Chuckling, she added, “Of course, in 1990, we all thought national health care reform was coming soon.”
As Fairfax County faces a recession-generated budget crunch which has, to date, cut deep into the county’s public services, Stevens said CHCN operations remain intact.
“We work every day to be excellent stewards of Fairfax County taxpayers,” she said.
The county provides the CHCN with an annual budget of $9 million, which Stevens said the CHCN uses to leverage for even more value in medication and specialist care.
“By leveraging the county money, we bring in about $4.5 million of free medication from the pharmaceutical companies and $2 million in donated time from specialists,” she said.
“We maximize what we have, and we try to live with what we have been allocated.”
When citizens of Falls Church use the service, the CHCN bills the city.
Stevens is also one of the service’s few county government employees, who act only in administrative roles.
The majority of work – the day-to-day needs of the clinics like Bailey’s – remains the task of the county’s private vendor, Molina, which has been with the county since July 2008.
“We build on the best of both models,” Stevens said.
Molina Healthcare, based in California, staffs the CHCN clinics with 76 professionals: doctors, nurse practitioners, pharmacists, receptionists and the rest of the ground operation.
About 25 Molina employees run the Bailey’s Clinic, including a public health nurse specialist, doctors, medical assistants and social workers.
County employees include five who work on the Department of Family Services’ Health Access Assistance Team (HAAT), which helps qualifying citizens enroll and to utilize other available resources.
Beyond the center’s medical and administrative staff, the CHCN employs the voluntary aid of more than 290 specialists from every medical field – urologists, obstetricians and nephrologists among them.
The coordinated effort of public officials and private practitioners has garnered a 95 percent satisfaction rate from its patients last year, according to a survey released by Fairfax County. Satisfaction rates have consistently shot past 90 percent in recent years.
In the past year or two, the centers have also been serving a wider portion of the county’s population, with new immigration to the county and as the nation’s economy continues to lose jobs for millions of U.S workers. The county’s unemployment rate stood at 4.7 percent in September.
In this economy, “people in the Fairfax County area have a new appreciation for what we do,” said Stevens.
It’s 4 p.m. on a Tuesday and the Bailey’s center waiting room is teeming with activity.
It’s Women’s Clinic tonight, and like every Tuesday, the center offers these women affordable access to health care and information about family planning.
Dozens of young women and mothers watching their children are sitting or checking in. The pace of patients flowing in the door to the center never slows.
The bustling scene reveals the diverse community Bailey’s serves: patients and receptionists converse in English and Spanish while whole Asian families wait together.
Any of the services the women will need won’t cost them more than $10 that night.
The regular Women’s Clinic attracts around 50 extra patients a week, explained Dr. Jean Glossa, one of the Molina health care doctors at Bailey’s.
Glossa works alongside a daily staff of four providers – two doctors and two nurse practitioners – and a dozen others who assist in patient care and manage the special services offered by the center. In addition, a triage nurse is on call for emergency cases.
“Each of the providers sees 20 patients per day,” Glossa said. “And for every no-show, there are multiple walk-ins, about two or three times as many.”
Glossa said she noticed “a definite rise in the number of appointments” in recent months.
“Because of the economic downturn, I have never seen as many unemployed patients as we get now,” she said.
Dr. Ann Maradiegue, a professor at George Mason University who coordinates the student-internship program at Bailey’s, agreed.
“The recently unemployed are very ashamed at first to be here because they lost their insurance and they feel a stigma,” Maradiegue said.
“But once they are here for a while, they love it.”
Glossa noted that one of the center’s unemployed patients who had been left without insurance recently found a new job.
“He asked us if he could continue to come by the clinic for care,” she recalled.
“Of course, he couldn’t, but it goes to show you how simple our system is,” Glossa said. “With their private doctors they have to pay each of the separate bills and spend a lot of time figuring out what referrals they need, and where they get the treatment.
“I think our country’s health care system is very complicated,” she continued. “Some of our patients have had private health care, but they weren’t fully able to navigate the complicated services.
“Our hope is that they are able to get better acquainted with what’s available to them.”
To qualify, patients must meet three criteria, one being a Fairfax County or City of Falls Church resident.
The patient must also live 200 percent below the official federal poverty line – a maximum of $21,660 for a family of one. Patients must also be unable to acquire insurance independently or through an employer.
“We screen potential patients very carefully to ensure that they meet the qualifications for enrollment,” said Glossa. “Patients have to re-apply every year so that we can verify whether they still qualify.”
If they qualify, patients are charged a co-pay depending on their income. “There are four levels of payment, A, B, C and D, and generally, they pay between $5 to 10 for care.
“When they pay for a primary care visit, the co-pay covers everything from the visit to any of the tests they may need to run in the labs or in radiology,” Glossa said.
In addition to the lab works and radiology, the center also keeps a mental health specialist on staff regularly, and receives once-weekly visits from a physical therapist from the Inova Hospital, a Falls Church-based private health care provider.
“It’s phenomenal cooperation that we get this voluntary help from Inova,” Glossa said. “In return, we refer our patients to Inova for MRIs and other scans they might need.”
She added that some of the CHCN’s volunteer specialists swing by the center on a regular basis.
“We have a retired cardiologist and an urologist who comes regularly,” she said. “It’s such a great help having these specialists on site.”
While the CHCN does not provide dental or eye care, it refers patients to the Northern Virginia Dental Clinic or Inova.
“We help piece together the services so the patients know where they need to go,” Glossa said.
Another key feature to the center, she said, is the on-site pharmacy, where patients receive virtually any needed medication.
“We are a big donation center for pharmaceuticals,” Glossa said.
“The companies send large volumes of medications like Lipitor or Nexium,” she explained, picking up one of the dozens of purple bottles of Nexium, a popular treatment for acid reflux disease. “For them, it can be a great tax write-off and for us, it’s an immense savings for the patient.
“Lipitor, which is about to go generic, might have cost them $90 a month. Here, they’ll pay no more than $10.”
The small pharmacy room’s walls are lined with fully-stocked shelves of all sorts of generics and brand-names.
“If a patient needs a particular brand where there is no generic available, we have someone on staff who is responsible for working directly with the pharmaceutical companies’ Patient Assistance Programs, which provide the medication at no cost,” Glossa said.
Charitable pharmaceutical companies make for diligent auditors, however, and companies like Merck and Glaxo-Smith will pore through Bailey’s records to ensure no medication was dispensed carelessly.
Glossa recalled once when a representative from pharmaceutical giant AstraZeneca paid a visit to the center for that precise reason. “The auditor told us, ‘It is my only job to find something wrong and I will find it. I always find something.'”
She grinned. “We passed with a 100 percent.”
For many of the center’s patients, the on-site pharmacy is more than financially freeing: with its diverse staff, it is often part of the center’s medical outreach to patients.
Several pharmacists mill about the room with different orders, but each individual acts as an educator for a patient population that largely doesn’t speak English.
“Many of our patients don’t speak the best English and so they don’t always understand what their doctor tells them,” said Katherine Trinh, a pharmacist.
Trinh, who speaks Vietnamese, said patients were more comfortable and inquisitive talking to someone fluent in their primary language.
“They ask if they can take this medication for another ailment, or whether they need to take it regularly,” Trinh said, chuckling. “Sometimes you have to be persistent.”
Doctors and nurses, however, are not without recourse for linguistic barriers. Glossa said each room is equipped with a phone which is wired to a language hotline.
“They can use a translator to act as an intermediary between the doctor and the patient,” she said.
Even so, there are problems from time to time. “A patient who spoke a particular dialect of Arabic had a difficult time finding the right translator,” she said.
“During the visit, the doctor noticed that the translator and the patient began to chat beyond any of his questions. It turns out that since it was such a rare dialect, they knew each other.”
Staff at the Bailey’s center have also noted the rise in enrollment applications since the economic recession hit two years ago.
“Over the past three and a half years, there has been a definite new pattern of increased enrollment,” said Dr. Seema Nair, a former doctor at the center. “I have seen more unemployed, white Americans.”
Dr. Messay Balcha, a 10-year resident physician at Bailey’s, noticed the trend, too.
“The number of recently unemployed here is very reflective of the times we are in,” said Balcha, an Ethiopian immigrant who took up residence at Bailey’s following his medical education in Eastern Europe.
“The unemployed are so apologetic for using the system,” he said, which contrasts with the immigrant population who are “mostly appreciative that they can come to this place and have access to this medicine.”
Not only does the center furnish accessible care, Balcha said, but the Bailey’s center also “keeps patients out of the emergency rooms.”
“If they are unaware of this center, and they do not have insurance, where do they go? They take up the vital resources at emergency rooms at places such as Inova.”
With the center’s special relationship with pharmaceutical companies making the medication mostly free, the cost-reduction is immense, he explained.
The center can provide another key medical service: health care prevention awareness.
Balcha said a common complaint among patients is the timeliness of visits to the center.
“Often, if I say, come back in three months for a check-up and reevaluation, they will say, three months? I want to come back next week!
“We have to explain that if you’re healthy and there is no chronic condition that needs attention, there’s no need to come in so quickly,” he said.
It might take “six to eight weeks to see a primary care provider,” according to Glossa, for a wellness visit at Bailey’s.
For emergencies, however, there is always the triage nurse.
“If you walk in the door and there is an immediate health concern, you will see a provider,” she said, noting that in private health care, “you see the same kind of wait for wellness visits and check-ups.”
“It might be a little slower than seeing a private doctor, but we believe it is the same quality care,” she said. “The patients who need the attention now, are seen now.”
The Bailey’s Health Clinic is more than a medical center: with its Health Access Assistant Team, the center acts as a point-person for its patients as well.
“We work with each patient to see if they qualify for Medicare or Medicaid, or if the children can enroll in SCHIP,” Glossa said.
SCHIP (State Children’s Health Insurance Program) is a federal program that provides matching funds for family health care to the states.
“Even with the higher enrollment these days, we don’t have a waiting list when it comes to signing up for our services,” Glossa added.
“At the very heart of it, we are a patient-centered clinic.”