Underserved Communities Can Be Served
By Russell Certo, PT
At our core, rehabilitation experts account for disease and dysfunction when developing appropriate exercise and recommending lifestyle changes.
This service can be successfully implemented in just about every setting a rehabilitation expert can be found. A single-site private practice can deliver these services in collaboration with primary care. A multi-site office or a corporate entity with hundreds of offices can use these programs to differentiate itself in the marketplace. Hospital-based physical therapy can easily collaborate with the hospital’s wellness center, occupational therapists, behavioral health departments, neurologists, orthopedists, and primary care physicians. School-based therapy and industrial-based therapy can adopt medical fitness programs and deliver them to students and employees.
For 12 years, Trilogy Wellness has been interested in the overall health and wellbeing of the individual. This approach to patient care became known as our “medical neighborhood” and includes managing the services of physical therapy, the medically oriented gym, behavioral health specialists, nutritionists and dieticians, sleep centers, massage therapists, primary care physicians, exercise specialists, pharmacists, financial planners and other like-minded professionals. The Medically Oriented Gym (MOG) was the first entry into developing this collaborative interdisciplinary model. It was born out of the frustrations associated with decreasing reimbursements and the inability for physical therapy to complete the entire plan of care. Since most patients who attend physical therapy for a musculoskeletal dysfunction have at least one chronic disease that could be managed with lifestyle changes, it became evident that a medical fitness service would be an asset. No longer did we use our physical therapy services to treat only orthopedic issues, we began addressing basic health measures and providing a treatment plan that managed obesity, high blood pressure and chronic diseases. The physical therapist, in partnership with a primary care physician and the MOG staff, was now creating a plan to effectively treat the whole patient.
The MOG was founded on the principle that service to the individual and their health concerns takes precedent. It could not and would not follow the business model of the traditional fitness club industry, which was concerned about selling memberships and personal training from unqualified staff. In many situations, the staff of the traditional fitness club industry could not successfully manage the needs of a person with chronic disease and movement disorders. The staff at a traditional fitness center typically does not collaborate with other health experts in providing a holistic service and communicating the needs of their club member to medical professionals.
PROOF OF CONCEPT
In collaboration with our patient-centered medical home (PCMH) partner, a large insurance company in our community offered to track the total cost of care of patients participating in scheduled wellness visits with the primary care providers and the PT/MOG model for 12 months. We were provided a list of moderate- to high-risk patients who were subscribers to the insurance plan and under the care of the PCMH. From that list we engaged 102 patients into this pilot project. The insurance plan monitored the cost of care for the 12 months of project participation and compared that cost of care against what their algorithms projected for the typical total cost of care.
The results of the project, of which 74 patients finished the plan, resulted in a 15% improvement in health markers, reduction in depression scores, and a significant change in the MOG fitness scores. In addition, participants experienced decrease in their BMI (53%) and saw a decrease in their Body Fat (58%) . From the payer perspective, our pilot project was able to reduce the total cost of care by an average of $4,000 per participant relative to the predicted cost of care. Additionally, we showed a 20% migration of patients from high-risk pools to moderate-risk pools. Imagine what a self-insured company would think of these results in a “wellness” program!
JERICHO ROAD COMMUNITY HEALTH CENTER
Five years ago, we were approached by Jericho Road Community Health Center (JRCHC) about participating in a new project that would bring a collaborative model of health care to underserved populations. JRCHC was familiar with our success in managing chronic disease and was interested in developing a similar model. Initially we were skeptical about our ability as a small business to provide our services in a challenging reimbursement model. However, as a partner of JRCHC, and with our outcome data in hand, we were able to capture $850,000 in grants from two insurance foundations. The caveat was we had to design, track, and deliver health statistics on 200 participants that comprised patients and employees of JRCHC, as well as the local community. We understood this would be a challenge, even more so because we had to deal with 200 different languages using interpreters and managing various cultures.
In 1997 Jericho Road Family Practice (JRFP) was opened with the stated goal to “provide excellent medical care to all who walk through the doors, regardless of their ability to pay.” In addition to serving patients from Buffalo, New York, JRFP began caring for many refugees, most of which had never seen a doctor or received proper medical care before coming to America. Providing excellent medical care was not enough; the founders recognized the connection between physical, mental, and spiritual well-being. As an expansion of services and outreach into the community, JRFP began offering behavioral health and pharmacy services as well as a spiritual ministry service. To create a larger healthy community, JRFP began to plan for the addition of a new campus in another equally depressed neighborhood in our city.
JRFP evolved into the JRCHC and is designated as a Federally Qualified Health Center (FQHC). According to the Health Resources and Services Administration (HRSA), FQHCs:
- Qualify for funding under Section 330 of the Public Health Service Act (PHS)
- Qualify for enhanced reimbursement from Medicare and Medicaid*, as well as other benefits
- Serve an underserved area or population
- Offer a sliding fee scale
- Provide comprehensive services (either on-site or by arrangement with another provider) including:
- Preventive health services
- Dental services
- Mental health and substance abuse services
- Transportation services necessary for adequate patient care
- Hospital and specialty care
- Have an ongoing quality assurance program
- Have a governing board of directors
SERVICE GROWTH AT JRCHC
The newest addition to the JRCHC are 10 “nonprofit” agencies that are now co-locating onto the campus. These 10 nonprofits have partnered under the moniker of the Care Management Coalition of Western New York. Several leading foundations have supported the JRCHC and the Coalition with $4 million of up-front funding. The additional services offered by the Coalition are:
- Education for parenting
- Individual and Family support with mental illness
- Pro-Bono legal services
- Family support for special education
- Academic enhancement
- Peer to peer intellectual developmental training
- Connecting clinical services for substance abuse
- Empowering youth through sports opportunities
- Project Hope crisis management
It is easy for private practice businesses to avoid these depressed, underserved neighborhoods because we assume there is no way to financially support the services we should be providing. Beyond the support of the Foundation, as an FQHC, JRCHC was able to secure a better reimbursement schedule to support the physical therapy services. Three years later we have found success in patient and community engagement resulting in better health outcomes in this underserved population. Two important take-aways from this experience:
- We discovered that these communities are just as eager and willing to engage in a relationship with health experts and have a personal connection with the staff. This relationship provides for healthier patients and communities.
- Despite low reimbursements paid directly to physical therapy, we can sustain a business entity in the neighborhoods when partnering with larger community-based health centers.
We as a profession should be working harder to bring our skill and talent to all communities. As a business owner I understand the challenges to maintain profitability. However, our profession has always been problem solvers to find ways to provide our services in challenging environments. These underserved communities need us, and we should not ignore them because we assume there is not a solution or a profit to be made.
Russell Certo, PT, a physical therapist for 35 years, is the Founder of Trilogy, MOG National, and Grand Island Physical Therapy. He designed and developed the idea of an integrated physical therapy practice and medically oriented gym (MOG).