South Valley test

A new approach to expanding access to health care has the potential to heal one of the state's worse social ills.

ALBUQUERQUE -- The South Valley is known for its rough edges.

Rustic building facades and wooden corrals meld with unpaved roads and century-old homes. The lack of sidewalks and other infrastructure in this semi-rural pocket next to Albuquerque is a glaring testament to its geographic and financial separation from the city.

Another one of those rough edges is the area's high number of underserved residents when it comes to basic health care, a fact of life that may be changing due to an innovative new model of delivering care for those who otherwise don't get it.

The South Valley Health Commons opened its doors in March of this year and is already nearing capacity. Efforts to copy this approach are underway in different areas around the state. In 2002, the President's Health Center Initiative was passed, giving a huge boost in funding to Community Health Centers (CHCs) and setting the stage for innovations like the health commons model.

Albuquerque's South Valley is representative of much of New Mexico in terms of its lack of access to basic services, notably health care. In fact, more than 20 percent of New Mexico's population is uninsured, one of the highest rates in the nation. Even those with insurance in New Mexico's rural and semi-rural areas face limited access to primary health care. A large percentage of New Mexicans only enter the health care system through emergency rooms (ERs). When ERs are used for basic medical care, it puts a big strain on hospitals both financially and in the quality of service they can provide to the patients in actual emergencies.

In spite of many challenges, the South Valley Health Commons is addressing the complex medical needs of its community with a cutting edge approach to primary and preventative care. It features a 43,000-square-foot, $13 million state-of-the-art facility that houses primary medical, dental and behavioral services. It is also home to WIC, Public Health and Medicaid enrollment offices and its own pharmacy. Future plans call for adding child day care. The three-month-old institution aims to be a leader in primary care for indigent communities.

Removing barriers

In an effort to provide continuity of care, patients are offered a variety of services in a single visit. The common location of these services removes many of the barriers indigent populations face in receiving primary care, such as transportation needed to drive from one provider to another, time off from work and basic education about what services are available.

 
As New Mexico struggles with the direction of its health care reform, policy makers can take note of the approach -- and they are.

"It's absolutely a good model," says Sen. Dede Feldman, D-Albuquerque, a longtime advocate for reforming the state's health care system. The health commons approach "is less about financing and more about delivery."

During the 1960s, President Lyndon B. Johnson's "War on Poverty" gave rise to Community Health Centers throughout the nation. According to the Health Resources and Services Administration's Web site, "These centers were designed to provide accessible, dignified personal health services to low-income families." Federal grants were allocated to local health care nonprofits, and the resulting CHCs flourished in New Mexico due to the state's high percentage of rural poor. CHCs came to act as safety nets for the population they served and they are often referred to as "stakeholders in the community." There are currently over 100 CHCs in New Mexico.

One of the major community stakeholders in the South Valley is First Choice Community Healthcare, which has been serving the area since the early 1970s. First Choice maintains a working relationship with UNM Hospital (UNMH). "The relationship between the university and First Choice goes back many, many years and it's grown over the years," Art Kaufman, head of UNM's Department of Family and Community Medicine, tells NMI. Kaufman was one of the authors of the study, "The Health Commons and the Care of New Mexico's Uninsured." In it he discovered that although CHCs were providing critical access to health care in underserved areas, there was little effect on high-risk patients with various ailments. "Focusing only on medical services failed to address this population’s underlying behavioral and social causes of disease," he explains.

That realization has led to the notion of a health commons model of service focusing on a continuity of health care services.

"In an indigent community, when they bring their medical problems, often their needs are social and behavioral, issues of poverty, housing, access to jobs," Kaufman says. "If you're going to actually improve health, you have to have access to all the resources necessary for that kind of complex need in the community... We're not just going to have a patient come in, see a doctor and go home."

Dr. Saverio Sava, a family medicine practitioner at a First Choice Healthcare center in Edgewood, co-authored the study with Kaufman and is currently working on bringing a health commons to the East Mountain area.

"I think the model of how primary care is done is changing in America and people are looking for what works. It's really saying that the old model of just a doctor in an exam room with a patient isn't really meeting all the needs of patients," Sava says. "What are the other layers we need to put on there? How do we partner with public health, how do we partner with WIC? So we're really looking at this in a collaborative way so the health commons becomes a common ground where the entities work together and that means actually talking about how to better deliver these services."

Importance of partnerships

Like the initial work of the CHCs, the primary component for success revolves around partnerships and collaborations. Those connections, in turn, help provide a continuity of services available to patients that can maximize efficiency. Meanwhile, entities that once acted as competitors -- hospitals and health centers -- now act as partners in a wider understanding of returns for the community and their resource output.

The financial investment in the South Valley Health Commons was divided between government and private partners: the state of New Mexico, Bernalillo County and UNMH contributed $8 million and the federal government $5 million.

Beyond the issue of adequate fuunding, turnover and retention have long been another issue for CHCs for varied reasons. The most common reason has been practitioners not having an stronger investment in the community they serve. The health commons model addresses this by offering various job opportunities for members of the community as well as placing young doctors and residents to train in these facilities.

"The thing that's most important about this relationship is that when we look for models of training which would attract young students and residents to primary care," Kaufman says. He adds, "First Choice is one of the top locations for attracting that health workforce for the future."

More health commons throughout the state may prove to be part of the solution for the many rural and semi-rural communities battling the lack of primary care access.

One of the key characteristics of the health commons model is its ability to utilize resources that may already be on hand to enact positive outcomes for indigent communities. Unlike pushes for universal health care and other proposals to restructure the delivery or financing of heath care, the health commons model does not require systemic reform.

Looking forward, New Mexico's large uninsured population coupled with geographic and socioeconomic barriers may present a golden opportunity to better provide quality health care to communities most in need.

South Valley residents, like the adobe structures of the area, have a character and a history that runs deep.

"We're a very proud people in the South Valley," says Paul Sanchez, a prolific artist based there who is well-known for his colorful acrylic prints of Santuario de Chimayo, many of which hang in businesses and waiting rooms around the state. Sanchez's family has been in the area for more than 500 years.

But he offers one lament: "We've always seen what every one else has and we wonder why we can't get the same."

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