Erie Family Health Center in the New York Times!

Proud of this article about Erie Family Health Center's Humboldt Park location which appeared in the New York Times 12/4/09.

Treating a Community's Health Needs That Reform May Not Fix

Chicago News Cooperative reporter James Warren hit the nail on the head. Thanks, Jim!

The Chicago News Cooperative is a new non-profit started with seed money from the John D. and Catherine T. MacArthur Foundation. It will feed 2 pages of Chicago news in locally printed editions of the New York Times on Fridays and Sundays and will supply high quality local news to other clients in print and over the airwaves.

Two Weeks in Business School: Top Ten Take Home Points

After 2 weeks at the UCLA Anderson School of Management Johnson and Johnson Health Care Executive Program what did I learn? This is a program for leaders of community-based health care organizations. You compete to get in and then you work hard with 41 colleagues from around the country for 2 weeks: classroom work for 8 hrs a day as well as additional time devoted to development of a Community Health Improvement Project (CHIP).

Here are my top 10 take-aways in a tongue and cheek format. (A la David Letterman's Top Ten, start from the bottom and read up.) Behind each point below is a story, a lecture, a problem to solve, a challenge to face.

1	During your time at UCLA -- you have visited your own future. Take time to visit your own future. Visit, inquire, investigate agencies and programs which are leaders and innovators.
2	A CHIP is a many faceted tool: It's a tool for your future. Use the tool over and over again to create SMART goals, goals which are Specific, Measurable, Achievable, Reproducible, and Time Bound.
3	The faculty director is a groovy guy. And not only him, the entire faculty at UCLA. Excellent teachers. Leaders in their fields.
4	In any process, find the bottleneck. Shift it to the economic bottleneck. The economic bottleneck may be what is generating your revenue (think: the physician face to face component of the total health center visit -- you can't get rid of that!). In terms of process management and work flows, if you spend time fixing other aspects before the bottleneck you're wasting your time.
5	Fly coach. If you won't fly coach, there's Amtrak and Greyhound. Appearance matters.
6	Dust off your Shakespeare. Practice your eeees and ahhhs. Community health leaders must have a public presence and prepare for it.
7	IF cost effectiveness analysis is "Doing the right thing, " and cost benefit analysisis is "Doing the thing right." Then what is doing the right thing right? Clearly that is cost effective benefit analysis. Try to understand both and if you can't, get someone who does to help you.
8	Regarding your EHR (electronic health record system): The initial goal is not "best practice." Instead focus on "no bad practices." The main message here -- get one and GET IT ON.
9	Being a leader is like a big juicy peach. I think this is somewhat related to a big hairy audacious idea, except with fuz. Have clarity as a leader.
10	Build a leadership molecule: Vision and culture, operations, systems. They must overlap. If your leadership team has members with talents in these three areas you have a better chance for success.

Below: The famous on-line CHIP tool.

And, thoughts from class.

Immediate Demand: Federal Dollars to Stimulate Community Health Care, Jobs

In a previous blog post, I wrote about how federal stimulus dollars will flow to community health centers.

Now, we have some more details. Through the American Recovery and Investment Act of 2009, the US Department of Health and Human Services will soon distribute $337.9M to 1,128 community health centers in 50 states, Puerto Rico and other territories.

Named, Immediate Demand for Services (IDS) funds, these dollars are meant to assist health centers in providing primary health care services to a large number of people who have lost jobs and therefore their health care coverage. Currently 8.5% of workers are unemployed in the US. (Read more...)


With these dollars, health centers propose to serve 2.1 million new patients over the next 2 years. Half of the new patients will lack health insurance, and the majority of the other half will likely be dependent of state and federal programs such as Medicaid, which insures the lowest income Americans, including most low income children.

Nationally, community health centers serve almost 18 million individuals regardless of the ability to pay. IDS funds will promote an 11% increase in community health center enrollment over 2 years according to estimates.

Health centers provide economical health care services. The per patient federal outlay through these stimulus dollars is only $159.62. Health centers will likely look to other sources to meet the needs of supporting services to these patients on a long term basis.

Health centers also propose to create or retain 6,400 jobs in primary health care over the next 2 years: health care practitioners and support staff.

More about Illinois:  36 community health centers in Illinois will share $15M in Increased Demand for Services funds over 2 years.  An estimated 66,000 patients will be added in Illinois, a 6.6% growth rate over 2 years,  and 50% will be uninsured.  Approximately 270 jobs will be added or retained. Illinois community health centers currently serve 1 million statewide. 

The challenge for community health centers will be to sustain these new patients after the stimulus funds end in 2 years. (END OF POST.  Thank you for reading.)

If you see something, say something.

On a recent trip to Washington, DC, I could have caused an emergency response to a strange, unclaimed suitcase. With the national terrorism threat level elevated at YELLOW and the airport threat set even higher at ORANGE,  I'm sure the average citizen and security personnel alike are on the lookout for strange packages and unattended luggage.

While boarding the Metro at the National Airport stop last week, I inadvertently left my knapsack on the train platform, boarded he train with my suitcase, and headed into town.  By the next stop, ironically, the Pentagon stop, I noticed my error.  

Envisioning SWAT teams and bomb sniffing dogs surrounding my rucksack, heart in throat, I boarded the next train back to the airport.  For sure, the airport would be locked down, I'd be arrested and shipped off to Guantanamo Bay.  

Back on the platform, I spotted my laptop containing backpack; not a siren or black booted officer in sight.  I nonchalantly claimed my property.  National crisis averted.

If you see something, say something.

Of Hospitals and Safety-Nets

Crain’s Chicago Business recently pointed out in “Wealthy hospitals owe their heath to ‘safety nets’.” (Crain’s Feb 9) out that Chicago area hospitals cannot operate in isolation when it comes to serving the health care “safety net” population.

Hospitals and policy-makers cannot ignore the fact that the safety net health care system involves much more than acute care academic and community hospitals. The network of federally qualified health centers (FQHCs) and other clinics such as the Cook County system and free clinics should be important partners. FQHCs provide comprehensive primary care to over 500,000 individuals in the Chicago metro area and to almost one million in Illinois regardless of the ability to pay. They keep ill patients out of the hospital emergency room and help to reduce costs in health care system. They manage a high burden of complex chronic maladies such as diabetes, asthma and high blood pressure.

Perhaps existing expanding hospitals should partner more with FQHCs and others so that emergency rooms are not the first point of care for so many safety net heath care patients.

Such is the case with several hospitals already, including Northwestern Memorial Hospital, which was mentioned in the Our View editorial. Northwestern works with two FQHCs on the North and North West Sides of Chicago to enhance diabetes care, improve mammogram screening rates, and to increase access to hospital-based diagnostic testing and inpatient admissions. Efforts have focused on attacking specific diseases and measuring the outcomes in a results-oriented approach.

There is no question that hospitals and government need to do more in partnership to address challenges of the heath care safety net. Strengthening partnerships with community-based health care providers is part of the solution.(End of post. Thank you for reading.)

Retail Store Clinics Fill Nice Niche Above Your Waist -- But Stop Short

Word last week that CVS will cut some of its in-store MinuteClinics, opening some of them only in flu season got me thinking about the pros and cons of these types of clinics. In addition to CVS, Walmart and Walgreens also have clinics in their stores for a total of about 1,100 locations nation-wide.

These clinics are good for a spur of the moment need but do they really help address the need of the uninsured and those who are really diagnosed with something long term? The answer is more no than yes.

First, the advantages.

In-store clinics offer the basics such as basic physicals, checks for diabetes, cholesterol, and high blood pressure. Some offer help you to quit smoking (you’ll be buying your anti-craving pills and nicotine gum in their pharmacy, of course). They also provide shots for flu and pneumonia prevention and the basic childhood vaccinations. Their web sites provide the full lists of services offered.

Additionally, the clinics probably help keep people who have simple problems such as strep throat, ear aches, bladder infections, rashes, ear wax, the flu, a cold, pink eye, sprains and other acute minor problems from clogging up busy emergency rooms. Think you may be pregnant? Come on in for a test.

They are relatively affordable. The average charges are around $60 - $80 for the common conditions listed above or for a check up such as a school physical, sports physical or health screening. Additional charges may apply. For example, the price of shots is added on to your visit charge in some cases and if you need a prescription filled, you still have to buy it (at the in-sore pharmacy, of course, and pick up some shampoo, deodorant and toothpaste while you’re at it).

Convenience is probably the major advantage, with hours 7 days a week and no appointment necessary. Evening hours are available which is good for working families and kids who are in school.

The clinics are staffed by advanced practice nurses (nurse practitioners) and physicians assistants. Both classes of  these professionals are uniquely qualified to provide the services the clinics offer.

This is all good. It’s hard to argue against making acute care, screening and prevention more conveniently available.

However, the clinics do fall short, especially in the area of comprehensiveness, the ability to diagnose and treat complicated chronic illness and the promotion of continuity of care rather than episodic care. Patients registering at an in-store clinic should lower expectations. (Read more.....)


These are basically “above the waist” clinics, unless you have athlete’s foot. They do treat that. Below the waist? Find another option.

In-store clinics are set up to skim off the easy diagnoses and treat them, leaving the complex medical issues to other health care providers. For example, babies younger than 18 months, women and men with possible or overtsexually transmitted diseases, HIV testing, women needing pap tests for cervical cancer breast exams with a connection to a mammogram are not served. If you have a gynecologic problem you may be out of luck. Colon cancer screening with a take home test? Not on the list. Family planning? Not advertised on the list. And if you actually have diabetes, high blood pressure, heart disease, asthma, arthritis, a pinched nerve, or any chronic condition, you will be referred to your primary care provider – if you have one. If you don’t and you have no insurance, to where will you be referred?

Although there are 1,100 in-store clinic locations around the country, a quick survey of the ones located in the Chicago area show that they generally avoid areas with the highest concentrations of poverty and the uninsured. By contrast, community health centers have over 7,000 locations nation-wide, located in the most highly impacted communities, and provide services regardless of ability to pay. Unfortunately, many community health centers struggle with rapid access as they are overwhelmed with uninsured and low-income patients trying to get in, and few probably offer Sunday hours, although most offer evening and Saturday hours and 24-hour answering services for telephone advice.

The fee at in-store clinics seems reasonable, but can be a barrier. At our health center, many low-income, uninsured patients struggle to pay their flat $30 fee per visit and, as a result, we collect an average of $21 per visit. We never decline services based on the ability to pay. In-store clinics will not slide your fee down based on your income and will not accept a payment less than the full charge.

I am a big fan of the talents and skills of advanced practice nurses and physicians assistants. In Illinois, these professionals may practice without a physician on-site. Our health center uses this model in some of our school-based health centers. Advanced practice nurses and physician’s assistants in Illinois must have a collaborating physician. At in-store clinics, the collaborating physician will never be on site and available to lay eyes and hands on, an advantage we have at our health center’s comprehensive care locations. It is more difficult to collaborate with a physician when the physician is off site.

Overall, I’m glad the in-store clinics are out there. They fill a specific niche. But a smart health care consumer should realize their limitations. Policy makers should pay attention to the growing need to manage chronic care and to provide quick access to complex medical problem solving for safety-net populations. Big box clinics are an “above the waist” entrepreneurial approach but not a solution to the care of the uninsured.

What do you think?
END OF POSTING – THANK YOU FOR READING

Federal Stimulus Dollars Flow to Community Health Centers

Federal stimulus dollars have been directed by Congress to community health centers. Health Centers are economic engines that provide hundreds of thousands of health care jobs nation wide as well as stimulus to the economy through purchasing of supplies and equipment.

The American Investment and Recovery Act of 2009 includes (read more):


$2 billion for community health centers. There are over 1,000 community health centers nation wide with over 7,000 service sites. For example, Erie Family Health Center is 1 community health center with 8 service locations.

Included in the $2 billion mentioned above:

$340 million has just been announced for health centers to immediately increase the number of uninsured patients served by hiring more health care workers, increasing hours of operation, and increasing existing health center services. Applications are due on March 16th to compete for these funds.

$155 million has been already awarded to community health centers who applied to launch new sites last year and were not funded. In Illinois, the following community health centers just received $1.3 million each to add a new service site: Lawndale Christian Health Center (Chicago), Lake County Health Department/Community Health Center, Community Health and Emergency Services (Carbondale), and Friend Family Health Center (Chicago, and affiliate of the University of Chicago).

$1.5 billion for construction, renovation, equipment and health information technology systems at the community health center level. We do not yet know how community health centers will be able to compete for these funds. Buildings such as Erie Family Health Center's, Humboldt Park location  (Chicago, pictured above) are in need of state of the art upgrades.

Community health centers are cost effective providers of primary health care. Health centers provide primary care for 17 million individuals in the US, over 1 million in Illinois and over 500,000 in the Chicago metro area. Currently at least 45.7 million Americans are uninsured. This does not count the underinsured and those who are not residents of the US but who are workers and their family members who need health care.

Farewell Governor Blagojevich

It was just announced that the Illinois Senate has removed Governor Rod Blagojevich from office. I guess I will see him jogging by my house more frequently than usual.

He and I probably share something in common (besides a passion for getting health care services to those in need). Chances are we both read a popular 1970s book, Culture of Narcissism, by Christopher Lasch. Elements of narcissism permeated our culture according to Lasch. Reading it as a college freshman I was, like, what? But now it makes more sense, especially if we look at our ex-Gov in light of a personality disorder which Lash thought was shared by American society.

Perhaps, our ex-Gov has Narcissistic Personality Disorder (diagnosis 301.81 in the DSM IV).

"A pervasive pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following:

• has a grandiose sense of self-importance...exaggerates achievements and talents
• is preoccupied with fantasies of unlimited success, power, brilliance...
• believes the he is special and unique
• requires excessive admiration
• has a sense of entitlement
• takes advantage of others to achieve his or her own ends...is interpersonally exploitative
• lacks empathy
• shows arrogant haughty behaviors or attitudes"

Well, either Mr. Blagojevich is a product of the Culture of Narcissism, or he suffers from the above diagnosis. Or both. You decide.

Paging Dr. Gupta for Surgeon General? Yes!

The buzz in the mainstream press is that Dr. Sanjay Gupta (left), CNN chief medical correspondent, is tops on the list to be the next Surgeon General. Although some of my colleagues in the trenches of community and public health are offended by the selection of someone outside of the public health field, I think it is a brilliant choice. Because of his international media stardom (he was named as one of People Magazines 50 sexiest men alive in 2003 and a pop culture icon by USA today in 2004) he has the opportunity to influence the public health more than any Surgeon General in memory, even more than white bearded Dr. C. Evertt Koop (right), the quintessential public health leader we remember from the Reagan administration.

The Surgeon General heads the U.S. Public Health Service with the job of being the "nation's chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury. " The most recent Surgeon General, Dr. Richard Carmona, resigned in 2007 and later testified to Congress about restrictions placed upon his message by the Bush administration. The current acting Surgeon General is Rear Admiral Steven K. Galson, M.D., M.P.H., a career commissioned officer of the U.S. Public Health Service.

Dr. Gupta is a brilliant choice for the next Surgeon General.

Imagine the chief public health officer reaching out to everyone younger than a baby boomer via social networks and electronic media such as Facebook, MySpace, Twitter, and via the blogosphere and YouTube (just to name a few).  And for those of all ages, think about the natural talent he has for communicating via television where previous Surgeons General have looked awkward and have delivered messages as if they were cardboard cutouts of a person frozen at a podium. Dr. Gupta has the opportunity to bring public health messaging to an entirely new level by leveraging his talent as a media specialist. And, as a practicing neurosurgeon already with many public health credentials, he has the panache to man the bully pulpit like no other.  If he is nominated and confirmed, leveraging the incredible assets of the U.S. Public Health Service via innovative media outlets should be his focus.

Also, don't you think he'll look super great in that uniform?

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