While states and the federal government grapple with how to implement the Affordable Care Act, one health clinic in Brockton is well on its way to achieving the outcomes sought after by the rest of the nation.
On a breezy summer afternoon, community health worker Deika O’Garro is making a house visit.
O’Garro is visiting Carmen Valera, a 67-year-old from the Dominican Republic with hypertension and a bum knee. Since 1986, when Valera was hit by a car, she’s undergone several surgeries to return some range of motion to her knee.
Before Valera met O’Garro, she was living in a one-bedroom apartment that was not handicapped-accessible.
"She had difficulty walking, so in that apartment where she was living, she had a hard time moving around, taking a shower it was very hard for her," O’Garro explained. "She was getting so depressed. Lack of housing, no one to talk to."
And when she did have someone to talk to, it was a case worker, who didn’t speak Spanish, and Valera doesn’t speak English. That’s when O’Garro got involved. O’Garro works with Spanish speaking patients over 60 at the Brockton Neighborhood Health Center. With O’Garro’s help, Valera moved into subsidized housing in the center of town.
Today, O’Garro is here to help Valera pay bills over the phone.
"At the beginning, I will do it for her, and then maybe second we can do some kind of mock play, and for her to do it herself, because that’s what we do: self management," O'Garro said. "To see if she can learn how to do it by herself. And that’s how she learned to take the bus too. That’s part of the community health worker work."
Community health workers are just one of the many innovations at Brockton Neighborhood Health Center, which is a pilot for the state’s Patient-Centered Medical Home Initiative. Medical homes are a hot topic right now, in the run-up to the implementation of the Affordable Care Act. They’re meant to increase quality of care, while decreasing inefficiencies and cost, by taking a team-based approach to primary care. In many ways, health clinics, which focus on treating the poor and minorities, are leading the nation in this model of care.
"We really see ourselves as a piece of the solution," said Sue Joss, executive director of Brockton Neighborhood Health Center. "If you keep people healthy, it costs less. It’s not only better care and better quality of life for a patient, which is our main priority, but at the same time we’re keeping patients out of the hospital."
Joss has been working at the clinic for 19 years.
"We’re keeping them from needing the higher-end test," she said. "An emergency visit is two or three times what a primary care visit is. Certainly, if you end up with an admission you prevent, that’s thousands and thousands of dollars."
What started with one van treating people in a church parking lot has grown into a five-story building complete with primary care, OB-GYN, pediatrics, mental health, a dental clinic, an eye clinic, a pharmacy, and a lot of social workers.
"We have social workers right on all the floors, so if one of the providers identifies that a patient would benefit either from social services or mental health services or both, they can just walk them right down the hall rather than make a referral to another department or even another building," Joss said. "They are right here to provide that."
So, in Valera’s case, her primary-care doctor realized she was struggling at home, so during a visit to the clinic, the doctor walked Valera down the hall to a social worker who, after assessing Valera’s needs, connected her to O’Garro, the Spanish-speaking community health worker.
"We’re wrapping the services around patients that they need to address their health issues," said Kathy Cowie, who runs social services at Brockton Neighborhood Health Clinic, where 70 percent of the patients have incomes below the federal poverty line.
"It’s hard for people to take care of their physical health if their basic needs of food, clothing and shelter aren’t met," Cowie said. "If they don’t have food, they don’t have jobs, they can’t afford to feed their kids. Coming to the doctor’s is not gonna be a high priority."
That’s why the health clinic has as one of its high priorities cultural competency. The majority of the clinic’s patients are immigrants – mostly from Cape Verde, Haiti, Brazil, Guatemala and Ecuador. At least two-thirds of the staff speak the same languages and are from the same cultures as the patients they serve.
Another innovation at Brockton Neighborhood Health Center are “lifestyle groups,” where patients meet to learn about everything from fire safety, to healthy cooking, to yoga.
"Right now we’re doing yoga, which is helping them with mental issues they have, they know how to release stress, pain, and they’re learning a lot, because its new to our community, because we really don’t practice yoga because of our culture," O'Garro said.
Thirteen senior citizens stand in two rows, holding onto chairs on the second floor of the Messiah Baptist Church across the street from the health center. At the front of the room is the yoga instructor, flanked by O’Garro, who translates into Spanish, and another woman who translates into Cape Verdean Creole.
Nearby O'Garro, Valera practices her balance. By attending the lifestyle groups, Valera is taking a central role in her own healthcare, thus achieving one of the main goals of patient-centered care.