Community Clinics Under Pressure to Keep Patients

File Photo/David McNew/Getty Images
File Photo/David McNew/Getty Images

The phones at LifeLong Medical Care in Berkeley started ringing off the hook and voicemail boxes started filling up in November. Office spaces shrank to make room for the desks of new staff hired to help patients navigate through the often-difficult process of signing up for insurance.

Linda Collins, Patient Services Director at LifeLong, says the calls for assistance grew more intense in the days before the March 31st deadline to secure coverage through Covered California. “The website naturally went down so people couldn’t get on,” Collins said. “People were panicking.”

LifeLong Medical Care, like many community clinics, has been through the spin cycle of the sign-up for the Affordable Care Act. And now, also like clinics across the state, they have to compete for those newly insured and paying patients they helped to enroll.

County clinics once were the one and only stop when low-income people without health care needed treatment and clinic staff expected to help their clients secure a card for Medi-Cal. The program, for the first time, was accepting low-income childless adults, a change that was part of the Affordable Care Act.

But like the sign-up process, the certification process was beleaguered by technical problems. LifeLong hired 38 enrollment and outreach specialists, but they needed to be certified by the state to navigate the sign-up process. By the end of February, one month from the end of the open enrollment period, only 22 of the 38 LifeLong enrollment specialists had the badge and delegation code needed to access back channels of the website.

Those who were certified helped to enroll more than 1,300 people. In the final days of open enrollment, Collins and her staff learned that as long as they got patients into the system with a username and password, they could complete the applications after the deadline as long as they were complete by April 15th.

They are still working on a few hundred applications and in the meantime improving patient services.

Holding on to Paying Patients

Mekelia, like many of those who are newly qualified for the program, was skeptical of enrolling in a state-run safety net program again. Mekelia worked as a home care aide until her health gave out, problems she had treated at Highland Hospital, a public hospital in Oakland, where she had two hernia surgeries, one in 2001 and one in 2004. But an information session at LifeLong helped her understand her options under the reforms and convinced her to sign up for Medi-Cal.

Four years ago, she found LifeLong’s Berkeley Primary Care Clinic. They helped her enroll in the Alameda County low-income health program, HealthPac, the only insurance available to her at the time.

“My friends are surprised, they say: ‘Mekelia you’re excited to be on Medi-Cal?’ But when you don’t have insurance you’re a non-entity.”

With Medi-Cal, she has a broader choice of doctors, but she wants to stay with Berkeley Primary Care, part of the LifeLong clinic consortium. She appreciates that staff take her seriously and treat her with respect.

Berkeley Primary Care recently gained recognition as a Level Three Patient-Centered Medical Home, the highest level possible. It was Crystal Eubanks’ job to bring the clinic up to the standards required for the designation.

“In health-care reform our patients will have opportunities to choose other places,” Eubanks said. “We want them to stay here and we want to attract more patients.”

LifeLong had to reduce their clinic visit-times and develop a way for patients to call in and reach a provider, both during clinic hours as well as after hours.

They also created an eight-person patient voice collaborative that meets on a monthly basis to guide the clinic personnel and prioritize reforms. Shorter visit-times were at the top of the priorities list.

They’ve tried to improve care team coordination and communication to decrease the time a patient spends at the clinic from check-in to check-out. The clinic recently put a electronic health records system in place, too, which initially were more time consuming for patients and staff. But soon, staff had reduced visit times by fifteen minutes so that the average patient spends less than an hour at the clinic. Their goal is a visit-time of no longer than 45 minutes.

“It was a little overwhelming at the start,” Eubanks said.

Eubanks looks closely at the no-show rate to understand how they’re doing. Community and public health clinics face a high number of people who don’t show up for their appointments. Berkeley Primary Care reduced their no-show rate by 9 percent in the 12 months they worked for Level Three Patient-Centered Medical Home designation.

“To me that is patient feedback,” Eubanks said.

But for Linda Collins patient feedback comes in the form of those who decide to come to LifeLong for care after they’ve helped them enroll in a health insurance program.

Many of the enrollees came to LifeLong to navigate their private insurance options like Kaiser and Blue Cross. The private insurers’ phone lines were so overloaded they often disconnected as soon as patients got though, but enrollment specialists were able to call contacts with the agencies and work around the system.

Collins estimates 75 percent of the new enrollees in Medi-Cal and Covered California plans have stayed with LifeLong for health care.

For Collins the most significant enrollment happened at barbershops, libraries and churches in the community where specialists brought laptops and enrolled people on the spot. “If you meet them where they are you get better results,” Collins said.

For all the challenges in the enrollment process, Collins said patients feel it’s worth it. “People are just so thrilled to have health insurance for the first time,” Collins said. “We get so many cheers and smiles, that just says it all.”

*Last name withheld to protect patient privacy.

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