A community’s health
Community Health Connection plans to expand its affordable medical and dental services.
Dr. Diana Hellman examines 3-year-old Fernanda Hernandez-Medina, a patient of Community Health Connection. The nonprofit provider offers primary health and dental services to Tulsans at its two locations.
William Snider worked for the same Tulsa company for more than three decades and was close to retiring with a full pension. Then came the Great Recession of 2008.
His company went under and took Snider’s job with it, leaving him with only a third of the income he expected. With the local economy in the dumps, Snider couldn’t find other work.
“There were no jobs at the time, especially for a man my age,” he says.
Snider and his wife now get by on Social Security and Medicare. However, there is one thing they don’t have — dental insurance. And they can’t afford it, either.
Fortunately, they were able to turn to a local nonprofit, Community Health Connection (CHC), for help. The organization provides a full range of health services for clients who lack insurance or are underinsured.
Snider, who turns 70 in December, received affordable dental care — in his case, fillings and caps — at CHC. His wife visits for teeth cleanings.
“I have to pay out of pocket, and their rates were much cheaper,” Snider says. “I probably saved $400 or $500. Plus, it’s convenient, and I think they give excellent service.”
CHC exists for people like Snider and thousands more in the Tulsa community and beyond, says CEO Jim McCarthy.
“What we are is a federally qualified health center (FQHC) whose mission is to provide primary health care to the uninsured and underinsured community,” he explains. “That means providing preventative medicine, dental care, and behavioral and mental health services.”
CHC, which started in 2003 as an outgrowth of Community HealthNET, operates on an annual budget of around $5 million, about one third of which comes from federal funding. Another 60 percent comes from Medicaid patients with the remainder from private insurance, fundraisers and philanthropic benefactors. CHC is the primary beneficiary of this year’s Tulsa Run.
The nonprofit is one of two FQHCs in Tulsa (the other is Morton Comprehensive Health Services), and 17 others are located statewide. As with all FQHCs, the Department of Health and Human Services requires CHC to collect data and to demonstrate that it is improving patient outcomes.
CHC operates two clinics: one at East 21st Street and South Mingo Road and one near Whittier Square on the northwest corner of East Third Street and South Lewis Avenue. The nonprofit draws patients primarily from the Tulsa area but also from as far away as southeastern Oklahoma and Kansas. According to the Community Service Council, 113,000 people in Tulsa County have no medical insurance; thus, their access to health care is limited or nonexistent.
“These people are the working poor,” says McCarthy, adding they are either unable to pay for insurance, do not receive it through their employer, or work multiple part-time jobs and do not qualify. “When you eat out at a restaurant, they are the ones who are prepping the food, washing the dishes, taking your order. They are also the ones who are doing your landscaping, roofing and construction work. These are our patients.”
Approximately 58 percent of CHC’s patients are uninsured, and 60 percent live at or below the federal poverty line. Ninety-nine percent of all patients are at or below 200 percent of the poverty line.
Although people of many ethnicities use CHC’s medical and dental services, its primary patient population is Hispanic.
“According to the U.S. Census, the Hispanic population is where Tulsa has seen by far the most growth, and many of them did not have access to health care,” McCarthy says.
That fact was a key driver in the creation of CHC because local hospital emergency rooms were being used as primary care facilities for ailments that could be prevented or treated much more cheaply elsewhere.
“It costs seven times more to serve a patient in an emergency room than in a primary health care visit,” McCarthy says. “An ER is the most expensive way to get medical attention.”
Since so many of its patients are Hispanic, CHC recruits doctors and staff members who are native Spanish speakers.
“Spanish is the first language of 70 percent of our patients,” he says. “To give the best care, the doctors need to be able to communicate clearly with the patients. Even within the Hispanic population, there are dialects and accents because of the different countries people come from.”
Eighty percent of the staff at both clinics speak English and Spanish fluently. Because CHC focuses on prevention and wellness, establishing long-term relationships between doctors and patients is paramount.
McCarthy says CHC does not ask for a patient’s citizenship papers, and he vigorously defends providing health services for those living here illegally.
“We don’t turn them away,” he says. “You don’t want to force them to go to an ER because that’s cost prohibitive.
“They are here, they are working and the health of our population is critical. We’re not isolated. If someone gets the flu, for example, because they had no access to immunization, that’s not smart. It hurts us all.”
Although nearly all CHC patients are considered poor or near poverty, CHC is not a free clinic. Patients help pay for their health care based on a sliding scale. The State of Oklahoma also has a fund to reimburse health care providers for treating low- or no-pay patients, yet the 2015 reimbursement level is just $8 per patient, a sum that McCarthy calls “ridiculous.”
Funding for a nonprofit like CHC remains tricky, but it is needed more than ever. In 2014, CHC served 10,000 patients; that number should be closer to 13,000 this year.
McCarthy, like many health care CEOs statewide, wishes Oklahoma had accepted the Medicaid expansion as part of President Barack Obama’s health care law.
Doing so would have made it possible for many more uninsured working poor to gain access to health care, including care at CHC, McCarthy says. However, he doesn’t see that happening with the state’s current political climate.
“Medicaid expansion would have a dramatic impact, but doing so under Obamacare poisons the well,” McCarthy says. “What we need is an Oklahoma plan that provides primary health care for the working poor, and I believe we eventually will have one.”
McCarthy says CHC submitted an application to receive Vision 2025 funding (should voters extend half of an existing .6 percent sales tax that would raise $300 million) to double the capacity of its east Tulsa clinic and make other patient care upgrades. He hopes to hear positive news on the application.
In September, CHC added an onsite pharmacy at its Lewis location and is looking into a delivery service as it provides pharmaceutical care to its Mingo location. The new pharmacy allows patients to fill their prescriptions immediately at a much-reduced cost. This convenience is a major boon for workers who cannot afford to miss work time to get their medications.
Although health care and immigration are two of today’s most contentious issues and CHC occupies a space where they come together, McCarthy argues that access to health care is in everyone’s interest.
“There is no reason in 21st-century America for anyone to be without access to primary health care,” he says. “There is no excuse for not minimizing the health risks to the majority of people in our community.
“It’s about protecting us all.”