Health Van, well-woman services will be phased out

Responding to recent increases in the local availability of medical services for uninsured and low-income residents, the Board of Directors of the Health District of Northern Larimer County voted today to phase-out the agency's Health Van and Well Woman services over the next 10 months and help transfer patients from those programs to other community healthcare providers where they could receive similar quality care.

Board members also moved to keep dollars from those programs invested in direct primary care services by approving development of a plan that would help integrate badly needed mental health services into local "safety net" clinics that provide care to low-income and uninsured residents.

The vote followed a staff recommendation that was based on an extensive analysis incorporating local statistics and projections, as well input from nearly 100 community members.

Health Van is a mobile health unit that travels primarily to low-income neighborhoods in the Fort Collins area. It has been a Health District service since 1996. Well Woman Clinic provides free and low-cost screening for breast and cervical cancer to low-income and uninsured women.

"When Health Van started, people with low incomes had few choices available on where to get care. Health Van served them well and professionally, and it won a place in the community," said Tom Linnell, president of the Health District Board. "But the community has changed, and now there are good, viable choices for people."

"This community has the remarkable opportunity to move people into regular sources of care, creating significant savings while retaining nearly all of the services and assistance available to current patients," added Carol Plock, executive director of the Health District. Those savings, she said, could then be reinvested to further integrate care by focusing on the largely unaddressed burden of mental illness and combined physical/mental health issues in primary care. "The result would be a very significant net gain to the community."

The Health District analysis concluded that there was more than adequate capacity at area safety net clinics - and particularly at Salud Family Health Center - to accommodate all of the patients currently seen on Health Van. In 2002, 1,267 people received care on the Health Van.

Co-payments for patients were roughly equal at either Salud or Health Van, the report found, and through a "secret shopper" test using callers posing as patients, it was determined that the Salud clinic was able to see patients with more urgent needs within 24 hours.

Health Van operates an average of 15 hours per week, with clinics on Mondays, Tuesdays and Thursdays. Salud Family Health Center, located at 114 Bristlecone Dr., is open Monday through Friday, 8 a.m. to 5 p.m., with evening hours on Tuesday and Wednesday.

The report also concluded that the approximately 300 women seen annually by the Health District's Well Woman Clinic could be served at Salud Family Health Center, Family Medicine Center and Planned Parenthood. Salud and Planned Parenthood, like the Health District, participate in a state program that provides free breast and cervical cancer screening to low-income uninsured and undersinsured women. Planned Parenthood also has expressed interest in the possibility of managing grant funding from the Susan G. Komen Foundation that the Health District has used to pay for services not covered through other programs.

Both Health Van and Well Woman Clinic were established to fill gaps in existing services for low-income and uninsured residents of northern Larimer County. When Health Van was founded in the early 1990s, healthcare options for low-income residents were few. There was the Children's Clinic and Family Medicine Center (FMC), a primary care office run by Poudre Valley Hospital that houses a family practice residency program. FMC, though, is occasionally closed to new patients with low incomes, the result of its need to maintain a varied mix of patients in order to fulfill its educational mission.

Throughout its history, Health Van has endeavored to connect clients to a primary care "home," a regular source of care where patients could have an ongoing relationship with a primary care physician. Research has shown that this results in the best medical care for a person. Health Van has been hampered in its efforts, however, due to a lack of primary care providers in the community.

Health Van, whose weekly trips to different neighborhoods were intended to overcome transportation hurdles for clients, also became a popular choice for some people even when other sources of care were available -- so much so, in fact, that a majority of its patients now travel from outside their area of residence to attend clinics.

In recent years, several developments helped to increase local options for primary healthcare services, the most significant of which was the opening of Salud Family Health Center. Fort Lupton-based Salud operates a regional network of health centers whose primary mission is to care for the medically underserved. Salud took over the former Northside Health Center in 2002, and by 2003 it had greatly increased its ability to accept new patients.

Also by 2003, attendance at Health Van clinics had begun to decline, decreasing by nearly 30 percent at mid-year. The decrease caught the attention of the Health District Board of Directors, which then asked staff to investigate whether Health Van and Well Woman clients could be transitioned to other sources of care, thus freeing nearly $700,000 annually to address other unmet community health needs. That led to an exhaustive two-month investigation which encompassed a wide range of data and included interviews, meetings and correspondence with 95 key informants.

After discussions with physicians at Salud and FMC, Health District staff concluded that one of the most pressing needs facing those safety net clinics was appropriate care for patients with mental health and substance abuse problems. This was consistent with national studies indicating that nearly a quarter of the patients seen in a primary care setting have a diagnosable mental illness and that 59 to 70 percent of patient visits are for medical complaints that stem from psychological factors. Populations in poverty have even higher rates of mental illness.

Additionally, it is estimated that mental illness and substance abuse disorders take a heavy toll on Larimer County residents, accounting for more than one-third of the disease burden.

As a result, the staff report to the Board of Directors recommended the Health District develop a program that would help integrate mental health services into the primary care services provided at Salud and FMC. One potential model would place two teams of mental health providers (therapists, advanced practice psychiatric nurses and care coordinators) in each clinic, with a shared psychiatrist serving half time at each office. Benefits of such a model would include earlier diagnosis of mental disorders and better management of patients with mental illness and substance abuse disorders.

Under the timeline approved by the Board of Directors, detailed planning for the service changes would begin in January and continue through the spring. The goal is to have all clients transitioned to other care providers by October 2004, by which time Health Van and Well Woman services could be discontinued.

A total of nine staff positions would be affected by the closure of Health Van and Well Woman Clinic. An estimated five new positions would be created by the new mental health/primary care integration project.

The staff analysis and recommendation to the Board of Directors is available for viewing and downloading in both its complete 52-page version and as a seven-page summary on the Health District web site at www.healthdistrict.org.

The Health District is a public agency that provides medical, dental, mental health and preventive health services to residents of northern Larimer County. It also works collaboratively with other organizations to address complex community health issues.