Clinics unite to better serve low-income patients

Photo: Alex E. Proimos/Flickr


It is 9 a.m. on a Tuesday and the St. John’s Well Child & Family Wellness Center in South Los Angeles is busy. More than 40 adults and children sit in the clinic’s large waiting area while the sounds of friendly conversations in Spanish and English, ringing cell phones and fussing youngsters fill the air.

In the middle of this, Olivia Mendez stands and begins to speak, first in Spanish, then in English, her voice rising above the buzz while her partner Evelia Castaneda hands out literature.

Mendez and Castaneda are Promotoras de Salud, or community health workers, employed by the Southside Coalition of Community Health Centers, a consortia of eight community health clinics based in the greater South Los Angeles area. The nonprofit Southside Coalition was established nine years ago as a way for a small number of clinics located in a limited geographic area with common traits to better coordinate services, improve access to both primary and specialty care, and present a united voice when it comes resource allocation, workforce development and communicating with their members in the community.

“The community health workers are a beautiful example of how we can collaborate,” said Dr. Felix Aguilar, CEO and President at UMMA Community Clinic and former Chief Medical Officer at the South Central Family Health Center, both coalition members.

Mendez and Castaneda’s task that Tuesday morning at St. John’s was to inform the community about health care reform, something they’ve done for the last two years and one of the coalition’s priorities. The duo visits one or two clinics a day, handing out information about health care reform while answering questions.

“We talk about everything,” Mendez said. “Our goal is to reach more people.”

East Los Angeles resident Jonatan De Leon approached Mendez with a question while waiting for a family member at St. John’s. De Leon, 24, said he’s been a legal resident for four years and wanted to know in what ways health care reform would benefit him. Mendez explained that while he will enjoy some benefits, additional benefits take effect following five years of legal residency. Mendez added that one of the more common questions she receives from the community is how will health care reform impact undocumented residents.

Edgard Augusto Jimeno, 33, didn’t know if he qualified for health insurance because he lacks income, so he took a brochure titled “Health Reform: Seven Things You Need to Know.” The Inglewood resident admits he might not pursue the matter further.

“I don’t know if I’m ever going to call the numbers and all that,” Jimeno said. “It seems like it’s a lot of work, but I might be wrong.”

While the Promotoras are a prime example of the Southside Coalition’s effectiveness in working as a unit, the collaboration is not limited to community outreach. The eight clinics have made concerted efforts establishing an internal referral system and sharing specialty care. St. John’s now employs a podiatrist that coalition members may refer patients to, and the To Help Everyone (T.H.E.) Clinic secured a retinal camera through the coalition’s efforts. Eisner Pediatric and Family Medical Center boasts a strong prenatal practice and does most of the deliveries for coalition patients at California Hospital Medical Center. Any of the clinics within the coalition can refer expectant mothers to Eisner.

The Southside Coalition has also made strides in care coordination. A pilot program at St. Francis Medical Center features a care coordinator on site. When a coalition patient enters the emergency department at St. Francis, the care coordinator makes sure that the patient seeks follow ups with his or her primary care provider. This improves continuity between hospital-based and primary care, and reduces emergency services utilization through education.

“I foresee that our coalition will continue to do more to bring us together, to enhance services for patients, to provide for greater collaboration, and also to connect the patients better with services,” Dr. Aguilar said.

The eight federally qualified health centers of the Southside Coalition are Central City Community Health Center, Eisner Pediatric & Family Medical Center, St. John’s Well Child & Family Center, South Bay Family Health Care, South Central Family Health Center, T.H.E. Clinic, UMMA Community Clinic and the Watts Healthcare Corporation. All coalition members are located in the County of Los Angeles Public Health Department’s Service Planning Area 6, the community of Lennox, or the city of Hawthorne; or receive at least 60 percent of their patients from those areas.

The Southside Coalition first formed in 2004, hired Nina Vaccaro as its executive director in 2006, and received 501(c)(3) status in 2007. Vaccaro reports to a Board of Director comprised of the CEOs of the eight participating clinics.

“Politically I think one unified voice is heard a lot louder than eight small voices,” Vaccaro said. “On the other end of that, it’s not just political. It’s looking at how do we actually improve care, and we really do a better job of that if we’re working together and sharing best practices, looking at programs and services that maybe one agency is doing really well.

“It was just kind of every man to himself, and (they) found they were competing for the same resources, competing for the same doctors and grants and patients,” Vaccaro added. “It didn’t make sense for them to compete with one another. It really made more sense for them to collaborate.”

Dr. Tracy Robinson, Chief Medical Officer at T.H.E., is quick to credit Vaccaro’s leadership as one of the reasons for the coalition’s success. “She’s very effective at communicating,” Dr. Robinson said.

The members of the Southside Coalition also belong to the Community Clinic Association of Los Angeles County. Fifty clinics spread out over the geographic expanse that is L.A. County make up the CCALAC, and Vaccaro stresses that the Southside is not in competition with CCLAC, but is instead a way for clinics with things in common to focus on their needs and challenges as a group.

According to Vaccaro, when the coalition was first established, the idea of referring and sharing patients made some in leadership nervous.

“Initially, we actually had a lot of conversations about what does it mean if I’m sending my patient over to your clinic,” Vaccaro said. “Do I trust that you’re going to send them back? We had some conversations initially with the administrators, and that was something they were really concerned about.”

According to Vaccaro, the medical providers assured administration that they had built relationships with patients, bonds not easily broken.

“We recognize that the benefits of collaboration outweigh the benefits of competition,” Dr. Aguilar said. “We emphasize through our community clinics a trust that they will send the patients back. Otherwise the system cannot work.”

Dr. Robinson of T.H.E. had a more pragmatic approach to the whole topic of referring patients.

“If a patient goes to another clinic because they have something there that we don’t have in our clinic, the patient is getting care,” Dr. Robinson said. That, she added, is a precious commodity for an underserved population.

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