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After one year, growing clinic still seeks new patients

Neighborcare Health marked its first anniversary at the Sunrise Ridge clinic late last month, and while officials count several successes in setting up the clinic and serving islanders, thousands of new patients are still needed to make it financially sustainable.

When the clinic opened its doors in late September last year, it was at a tumultuous time for health care on Vashon. Franciscan Health had announced in the spring that it would close the clinic in August, and several islanders and local government officials scrambled to find an entity that would serve the island. Neighborcare Health, a federally qualified health center, stepped forward and re-opened the clinic in a fraction of the time usually required. Now the clinic has six providers and 4,500 patients, and in addition to providing primary care, has set up a system for patients with urgent needs who must be seen on a same-day basis. Early-stage plans are in place to build a new facility or to significantly renovate the current one, but Neighborcare Health CEO Michael Erickson said last week that more islanders must turn to the clinic for care to ensure its sustainability. From the beginning of Neighborcare’s time with Vashon, the target patient number has been 7,500 — 3,000 more than the current number — and the number of patients at the clinic when the Franciscan system first took over.

“We remain and want to be the primary care system for the entire island. But we are going to need to get to 7,500 patients,” he said. “We are not where we want to be. We want to continue to welcome new patients and to take every opportunity to say we need to keep growing.”

He noted that new patients come to the clinic each month, and that before 2018 ends, Neighborcare officials would like to have met their mark — or be nearly there.

“It is a high bar, but is a place the clinic has been before,” he said. “We can and should be there again.”

At the clinic on a daily basis, medical director Dr. Jessica Wesch said it is a busy place and that Neighborcare and the team at the Vashon clinic have a lot to be proud of. Many of the patients seen there, including elderly people, people with disabilities and families with young children, would not have received care or would have had difficulty accessing it if they had to go off island to be seen.

“These are patients that would not have gotten care if we had not done the hard work we have done,” she said. “We really are Neighborcare. We are taking care of our neighbors.”

She believes the most important success the team has had at the clinic is creating the system and space to see patients — between 80 to 100 each week — who need care urgently.

“That is really critical for an island community,” she added.

One practitioner each day is dedicated to tending to them, and the other providers also leave room in their schedule for some urgent appointments. Additionally, Wesch said that Neighborcare has returned prenatal care to the island. She currently offers it and said if the need grows substantially, another provider could be added. The women who receive their prenatal care at the Neighborcare clinic deliver with Neighborcare midwives at Swedish Medical Center, or if they are high risk, with an appropriate team at the hospital.

Beyond those services, Wesch said the clinic has added behavioral health specialist Remony Henry, who works with patients on mental health, substance abuse and lifestyle issues, and said the hope is to grow that model of integrated care.

Additionally, she said that Neighborcare Health is working on ensuring all island providers, including Vashon Community Care, have access to the X-ray machine at the clinic.

“That is a resource we want the community to be able to access,” she added.

Neighborcare has a dozen primary care clinics in Seattle, and Erickson noted that the patient mix on Vashon is different than in other clinics. At this clinic, he said, 34 percent of the patients have Medicare; 16 percent are covered by Medicaid; 43 percent have private insurance, and 6 percent are uninsured. At other Neighborcare clinics, he said, 58 percent of the patients are covered by Medicaid, 9 percent by Medicare, and 15 percent have private insurance. Eighteen percent do not have insurance — largely because they are immigrants who have not become eligible for state coverage.

The different patient demographics on Vashon are significant in part for planning purposes, Erickson said. With seniors making up such a large percent of the population, it raises questions about what other services should be offered. Having a significant portion of the population that commutes off the island raises other types of questions. For example, he said, is it possible a new facility could support telemedicine and meet some of the commuters’ primary care needs?

“Maybe we would get 9,000 patients,” he added.

In planning for the future, Neighborcare officials are including facilities in the picture. However, Erickson noted that planning for a new facility is tied up in the state’s capital budget, which approves money for the construction and repair of buildings and for other long-term investments. In this year’s capital budget — which legislators did not pass — $3 million is earmarked for a clinic on Vashon. It is possible that budget will be approved in January, and if so, plans for a new clinic will move ahead.

“When we hear from our representatives that it has been approved, we will move into an active phase and determine the right solution, either building a new place or refurbishing the current one,” Erickson said.

As part of that process, it is possible a capital campaign would be launched, he said, as $3 million would not be sufficient to build a new clinic. Also, if Neighborcare is not on a track to having 7,500 patients at that time, a building could be designed to expand as needs would grow. There are rumors on the island that Neighborcare hopes to add emergency services to a new facility, but Erickson quashed those, saying it would be cost prohibitive to do so

Fully aware of Vashon’s history with Franciscans Health, he said that Neighborcare is committed to continuing to serve the island and that it would pursue “any and all avenues to be a solid and good partner” should the sustainable threshold not be reached. He noted those conversations would include reaching out to the local community as well as to county and state officials to see how that sustainability could be achieved. He noted King County in particular has a stake in the island having a clinic.

“Communities are healthier when there is health care present,” he said.

Currently, islanders have an important role to play and can help by using the clinic, Erickson added.

For her part, Wesch stressed the importance of primary care, for patients with chronic disease, for illness prevention and for the overall well-being of a community. She noted it is beneficial to have a long-term relationship with a provider — an opportunity the island clinic offers.

“We want to be here when you need us,” she said.

She also reflected on the past year and the challenges and opportunities that arose.

“It has been exhilarating,” she said. “It has been a lot of fun, and there are more good things to come.”

School-based clinic services are up and running

Neighborcare launched a school-based clinic at the start of the school year, and reports are that it has been well received so far.

As of last week, more than 150 students were registered, and over 130 visits had been provided to more than 60 students, according to Alyssa Pyke, the Neighborcare’s school-based clinic manager.

“September is usually a slower start. It has been quicker than I anticipated on Vashon,” she said.

The clinic was funded by a Best Starts for Kids grant and offers medical, dental and mental health care. Pyke noted that personnel involved are doing outreach and dispelling myths during these early weeks. Along those lines, she stressed that any school-age student on the island, regardless of where they attend school, can be seen at the clinic. Also, parental consent is needed for medical care and treatment. However, the clinic also follows state law, which allows students of various ages to provide consent themselves for services related to reproductive health, mental health and substance abuse.

Many referrals for services have been coming from school nurse Sarah Day, Pyke said, noting that parents are typically notified before an appointment is made and that they are welcome at the appointments if they wish. Before any prescriptions are written, a treatment plan is discussed with a parent or guardian.

Currently, a provider is at the clinic four days a week, but soon that will increase to five days.

Pyke added that Neighborcare is hoping to offer its first dental screening this month and will then determine what services are needed.

For all clinic services, insurance is billed, but no one will be turned away for lack of funds, and no co-pays or other fees will be charged.

The school clinic is open before, during and after school and can be reached at 206-548-7550.

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