Health Care for Low-Income Individuals and Families I. TOPIC Vermilion Area Community Health Care Organization II. LOCATION East Central Illinois III. SUBJECT Health Care for Low-Income Individuals and Families IV. SUMMARY In 1993, the East Central Illinois Community Action Agency received a $50,000 start-up grant from the Illinois Department of Commerce and Community Affairs to open the Vermilion Area Community Health Center. The center provides health care to individuals and families with limited or no health insurance. The health center was made possible through the collaborative efforts of a local church, which donated space in its basement for the clinic; the city of Danville; local financial, legal, and educational institutions; and several county-based organizations, including two clinics, two medical centers, a nursing college, a medical school, four pharmacies, and the county health department. Area physicians, physician assistants, and nurses provide basic health care services either for free or for a small fee. Services include educational classes, health maintenance programs, flu immunizations, glucose screening, group sessions on substance abuse, Lamaze classes, child care, and diet and nutrition information. V. SUCCESSFUL PRACTICE Built a broad coalition of partners to provide health care services to low-income families and individuals with limited or no health coverage, thus encouraging better personal health care practices and reducing health care costs for both the recipients and taxpayer-supported health care programs. VI. CONTACT Dwight A. Lucas, Chief Executive Officer Lanette Canady, Project Director East Central Illinois Community Action Program (A Community Action Agency) 56 N. Vermilion, P.O. Box 1335 Danville, Illinois 61832-1335 217-443-2705 217-431-0725 (FAX) VII. CASE STUDY The Problem: Vermilion County, a rural county of 88,000 people in east central Illinois, is experiencing high levels of poverty. Unemployment in the county is 8.6 percent, and the area's largest manufacturing facility, the General Motors Powertrain Plant, will close in 1996, laying off 1,000 workers in the process. Fifteen percent of Vermilion County's population lives below the federal poverty level. For children, the rates are even higher: 28.03 percent for children ages 12-17, 33.99 percent for children ages 6-11, and 32.06 for children under five. Nearly 6,000 workers earn less than $200 per week. Estimates show that 14,000 of the county's 88,000 residents are uninsured. In addition to their distress over the increasing number of people with no health insurance at all, a coalition of county residents was concerned that people on public assistance had to travel 30 miles or more to find physicians who would accept their public aid cards. The Approach Adopted: Vermilion County residents agreed that the county needed a community health center to serve those in need. The East Central Illinois Community Action Agency (ECICAA) volunteered to help establish the clinic. How They Implemented The Approach: ECICAA reviewed its client files and found that more than 50 percent of the people applying for services were uninsured. In 1993, ECICAA used this information as the basis for applying to the Illinois Department of Commerce and Community Affairs, which administers the state's Community Services Block Grant (CSBG). The state approved a $50,000 grant from its discretionary funds to establish a community health center. Additional funding came from the Robert Wood Johnson Foundation, the Gannett Foundation, the Vermilion County Health Foundation, the Webster Foundation, and local companies. In June 1993, the Vermilion Area Community Health Center (VACHC) incorporated as a nonprofit organization with a board of directors comprised of community leaders and representatives from participating organizations. The First Presbyterian Church of Danville donated space in its basement for the clinic. ECICAA served as financial agent and conduit of funds for the health center. Other partners and service providers include: Bettone Hearing, Danville Carle Clinic, Danville Polyclinic, Danville Polyclinic Pharmacy, Danville Area Community College, Gulick Pharmacy, Lakeview College of Nursing, RJ Hearing, Southtown Pharmacy, The Prescription Shop, United Samaritans Medical Center, University of Illinois College of Medicine and School of Nursing, Vermilion County Health Department, Vermilion County Medical Society, and Veterans Medical Affairs. Clinic services are available to people with no health insurance, no Medicare, restricted public aid cards (Medicaid), and who earn less than 135 percent of the federal poverty level. The targeted population consists of the working poor, working single-parent families, people with seasonal jobs, people striving to become self-sufficient and leave welfare, college students without family support, people residing at the Rescue Mission, Salvation Army, and other shelters, striking workers, and laid-off workers with no benefits. VACHC also provides shuttle bus service for people living in outlying areas of the county. The Center asks patients to make a $5.00 donation for services if they can afford it, but there is no requirement of payment. VACHC distributes fliers and general information on its services and income guidelines to area social service agencies, businesses, and churches to publicize its services. VACHC also conducts yearly orientations for social service agencies' staff on VACHC services, protocols, and procedures. The VACHC volunteer medical corps consists of general practitioners, family physicians, and ear/nose/throat specialist, internists, pediatricians, general surgeons, plastic surgeons, and obstetricians/gynecologists. VACHC has recruited 40 physicians, 10 nurse practitioners, and five physician assistants to provide services free of charge. Medical providers donate 10 hours per week. VACHC provides primary care, preventive health educational programs, limited chronic care, pre-school physicals, employment physicals, hearing tests, x-rays in some cases, and limited lab testing. Two local clinics, the Danville Carle Clinic and Danville Polyclinic have each pledged to provide diagnostic laboratory and x-ray services. VACHC has limited agreements with six local dentists to provide emergency dental services, such as tooth extractions, but not preventive care. Each of the dentists will see one patient per week. If necessary services, including referrals to specialists, are not available for free at VACHC or the participating clinics, the VACHC staff works with the patient to find financial assistance. A local hospital, United Samaritans Medical Center, has a patient assistance program to determine if patients have the resources to pay for services. VACHC maintains a medicine cabinet of samples donated by area physicians and pharmaceutical companies. For prescriptions not available in the Center's medicine cabinet, VACHC pays for prescriptions from four local pharmacies. These pharmacies agreed to charge the Center only the actual cost of the medicine plus $1.00. Among the Center's special services are a registered nurse trained to assist patients suffering from diabetes. The specialist checks sugar and glucose levels and counsels patients on managing their condition. The Center also has two volunteer dietitians who provide education and counseling on high blood pressure, cholesterol, hypertension, eating habits, shopping habits, and exercise programs. The Center itself has a waiting area for patients and a play area with books and toys for children. The medical area has two fully equipped examining rooms and space available if more examining rooms are needed. The Center also has an examining room that is accessible to people with disabilities. Lakeview College of Nursing provides as many as six student nurses per week to the VACHC. These students, who work for eight hours per week, support VACHC's volunteer doctors and nurses and gain valuable hands on training experience. Local residents and students from Danville Area Community College and the vocational/technical school donate their time to work in VACHC's office. These volunteers schedule patients, screen patients for eligibility, prepare charts, answer phones, help with fund raising, and support the Center's director. All VACHC volunteers receive a volunteer manual describing VACHC's daily operations and procedures. Volunteers also attend quarterly in-service training sessions for updates on new policies, board of directors decisions, and services provided. Volunteers share ideas, identify problems, and discuss successful practices. Guest speakers from other service providers explain their services and eligibility requirements. VACHC strives not to duplicate services already available in the area. Therefore, the Center does not provide drug testing, abortions, physical therapy, second opinions, controlled drugs, dental care, eye care, Hepatitis screening, Well Baby checkups, family planning, immunizations, and care for sexually transmitted diseases. Most of these services are provided by the Vermilion County Health Department. VACHC seeks to treat the entire individual. Therefore, it also provides a Patient Advocate to help clients gain access to services to meet other needs they may have, e.g., housing, employment, food, utility concerns, child care, transportation, and clothing. The Patient Advocate works with patients and various social service agencies to obtain appropriate services. Results: More than 50 area physicians, physician assistants, nurse practitioners, registered nurses, and student nurses volunteer their time to provide quality medical care to the low-income population of Vermilion County. During its first year of operation, VACHC treated 1,161 patients. It treated more than 1,300 patients in 1994. VIII. KEY WORDS Clinics Coalitions Coalition-Building Community Action Agency Community Health Center Dental Care Health Care Health Education Health Insurance Insurance Medicaid Medicare Nurses Physician Assistants Physicians Prescriptions Unemployment Volunteers Working Poor