Building a One-Stop-Shop for Health in Eastern Kentucky
By Emily Loehmer, University of Chicago (National Program Office)
August and September were busy but exciting as I was able to visit three of the eight Bridging the Gap grantees. My second site visit was in Whitesburg Kentucky, where I spent three days with the Marshall University and Mountain Comprehensive Health Corporation (MCHC) teams. Beyond the natural beauty of the area, one of the most striking things about the MCHC facility was how well it lived up to its name—the facility is indeed comprehensive!
MCHC has invested in becoming a ‘one-stop-shop’ to be able to better serve their patients, even when there has been neither upfront investment nor immediate financial incentives to do so. Within the Whitesburg clinic, patients have access to a clinical pharmacist, registered dietitian, licensed diabetes educator, as well as services for dental, podiatry, behavioral health, optometry, pharmacy, cardiology, vascular services, and neurology. On-site lab and x-ray facilities further streamline and expedite care for patients. To top it all off, patients are scheduled for their appointments on the same day whenever possible, reducing the burden on patients to find transportation to the clinic. Community health workers connect with high-risk patients with diabetes through weekly home visits and help to address medical and social needs that impact self-management.
Tele-health software enables remote clinical healthcare providers to capture and share medical device data, exchange documents and medical images in real-time, and participate in live video conferences with one another. Telehealth is currently available in all MCHC clinics across 5 counties, connecting patients with services that may not be available in their local clinic. The behavioral health staff are able to use the service to aid patients in making lifestyle changes to improve diabetes outcomes. In light of local barriers to transportation in the area MCHC providers and staff have found tele-health to play an important role in helping patients access healthcare services.
In addition to the robust clinical services offered, MCHC also provides access to low-cost medications and diabetes-related supplies through the 340b prescription pricing program and indigent medicine program and also provides access to free medication, glucometer samples, and medication coupons. MCHC also started a Food Farmacy program in collaboration with the Whitesburg/Letcher County Farmers Market. Income-eligible patients receive a weekly “prescription” for fresh produce in the form of vouchers. It is estimated that 75% of the total market sales come from this effort, contributing to patient health as well as the local economy. These programs help to further reduce barriers to care.
All of these services enable MCHC to care for patients medically, while addressing significant barriers to care such as food insecurity, lack of transportation, and limited financial resources. The MCHC leadership team has invested in services that truly serve the patient, even when it is not financially advantageous upfront for the organization. Payment reform that incentivizes comprehensive care to support healthy populations instead of reimbursing for services regardless of health outcomes in primary care will play a vital role in supporting and sustaining services for patients with diabetes at MCHC. We are excited that grantees in the Bridging the Gap program are working on ways to sustain interventions that yield positive outcomes for patients, and look forward to providing grantees with opportunities to share their successes and learn from one another about challenges and solutions.