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Cherry Street Health Services
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Wyoming Health Center  COMPLETED

Description

Cherry Street Health Services (CSHS) is a non-profit, 501(c)(3) Federally Qualified Health Center, based in Grand Rapids, Michigan, and providing services in Kent, Montcalm, and Wayne counties. CSHS has a primary focus of serving those who have little or no other access to health care. Cherry Street Health Services is committed to increasing access and removing barriers to ongoing, primary health care services including adult medicine, pediatrics, dentistry, vision, pharmacy, and behavioral health services, as well as integrated care for patients with multiple chronic health conditions. CSHS began with one Health Center in 1988 and now, after a 2011 merger with Touchstone Innovarè (mental health services) and Proaction Behavioral Health Alliance (behavioral health and substance use services), CSHS provides services in 25 locations. Cherry Street Health Services is a significant provider of health care to the medically underserved of the greater Grand Rapids area, providing care to approximately 65,000 medical, dental, and behavioral health patients annually.

 

The Cherry Street 2011-2015 Strategic Plan specifically identifies the Wyoming and southwest Grand Rapids area as underserved (over 32% of the service area is below 100% of the federal poverty level) and is earmarked by CSHS for expanded health care services. The satellite Wyoming Community Health Center will provide medical, dental, mental health counseling, nutrition services, and an array of other health programs, complementing the primary health care services. Support services (transportation, translation, education, and patient navigation) will be provided to assure Wyoming patients receive necessary eye health care and behavioral/substance use care at other CSHS sites. The facility at 2929 Burlingame is a former car dealership that will be transformed into 8,915 square feet of medical and dental services.

  • Location:  2929 Burlingame Avenue SW, Wyoming, MI 49509
  • Contact:  Vanessa Stevens, Site Manager | 616.965.8333
  • Project Cost:  $1.3 million
  • Size:  8,915 sq. ft.; 1 floor
  • Start Date:  July 1, 2012

Meeting Community Need, Increasing Access, Expanding Services

The Wyoming/southwest Grand Rapids area is designated federally as a high poverty funding priority designation and also qualifies for homeless funding. The service area census tracts have a population of 64,293 (2009 ACS update). Devastated by major employment losses, the community has been impacted by declining incomes, loss of health insurance and ability to access health services, and increasing poverty rates. In 2009, Grand Rapids had 46% and Wyoming had 37% of their populations living below 200% of the poverty level. This compares to 35% and 23% respectively in 2000. In 2009, 32.4% of the Wyoming/southwest Grand Rapids population was below 100% of the federal poverty level. Homelessness is a significant issue in this community. CSHS’ 2010 patient data through early November show 671 homeless people served from zip codes 49507, 49509, and 49548, the service area for this project. Patients indicated they were either doubled up with another family, in transitional housing or a shelter, or living on the streets. Compared to numerous national health status benchmarks, the Wyoming/southwest Grand Rapids area experiences poorer health outcomes. The Wyoming expansion of services will provide services to an additional 2,400 patients in the first year, with an anticipated increase in capacity each year thereafter. The proposed Health Center is located just off 28th Street in southwest Grand Rapids, on the bus transit system and close to three major pharmacies. Both major hospitals are located nearby, approximately 8 miles via the expressway. Ancillary systems (i.e. laboratory and diagnostics centers) are all located within the campus, with a Quest drawing station located west of the center within ¼ mile. Specialty practices are located near the downtown area within five miles.

Reaching Special Populations

Although limited health data exists for Grand Rapids’ homeless population (CSHS plans to research this further through a community-wide provider assessment survey), CSHS clinical data for existing homeless patients seems to corroborate national findings that homelessness is not only caused by health issues, but homelessness also causes health issues. The main health problems are co-morbid disorders, traumatic experiences, and mental health issues. According to CSHS data for existing homeless patients seen in 2010 from the proposed three zip code service area (Wyoming and southwest Grand Rapids), 1,370 patient visits occurred for issues that included child health, pregnancy, dental, optical, cardiovascular, diabetes, and mental health. CSHS expects to see co-morbid health issues presenting in the homeless population that reflect the Core Health Indicators (diabetes, cardiovascular disease, cancer, prenatal/perinatal health, child health and behavioral/oral health), as well as traumatic issues based on the volatility of homeless living, and mental health issues.

Improving Outcomes

Key Clinical Performance Measures and recent progress for existing patients of CSHS are identified below. Patient data from the Wyoming site will be incorporated into the ongoing assessment of all Clinical Performance Measures.

  • From calculated baseline of Hb A1c levels, a 1.94% increase is noted for those with Hb A1c less than 9%.
  • The 2008 calculated baseline for hypertensive patients seen at least two times was at 44.74% and has increased to 71.4%
  • CSHS’ cancer goal is to increase the percent of women 21-64 years of age receiving pap tests, from 64.2 to 65.28%. For 2009 samples, CSHS’ rate on pap smears was 80%.
  • For birth weights less than 2500 grams, CSHS’ goal was to decrease the occurrence from 6.8% to 5.8%. CSHS has surpassed this goal and reached 4.6%.
  • Women entering care in the first trimester improved by two percentage points. Two-year-olds with completed immunizations by age 2 increased by 3%.
  • For behavioral health, CSHS’ goal of responsiveness to patients is measuring the ratio of provider encounter to patients with a primary diagnosis of depression and other mood disorders. Baseline in 2008 was 1:1.78 and improved in 2009 to 1:1.99. This indicates more patients with the diagnosis are being seen by therapists.

Program Innovation / Model of Delivery

The Wyoming location will have three services offered—primary medical, dental and behavioral health services.

  • Integrated care will be paramount, given the institutionalization of this approach throughout the CSHS network. Integrated care will be particularly important for the homeless community, who are uniquely susceptible to co-morbid disorders.
  • Dental services will be provided at the Wyoming site.
  • Mental health therapy will be provided by a LMSW.
  • Access to contracted laboratory services will be available through the accredited labs, Quest Diagnostics. After hours, staff will have access to ordering through Quest’s web-based computer system and will draw and prepare specimens to be couriered back to the lab processing centers. This collaboration ensures no patient in need of services has barriers to care.
  • Fees and services are rendered with special consideration for the under and uninsured by providing discounted rates similar to Community Health Center policies.
  • This site will have oversight by a facility manager who ensures that operations are standardized and accessible. Professional staff and support are managed through pods or teams so that patients have consistent access to the same providers. A mix of Physicians and mid-levels are utilized. Dentists at the Wyoming site have an assistant to ensure an efficient turnover of operatories that function well.
  • Most services are by appointment, but walk-in services for emergencies will be available every day for dental services and open access for medical appointments.
  • The Wyoming Community Health Center and all CSHS locations have access to resources such as 340B medications, assistance with applications for Medicaid and County health plans, and have Patient Navigators to assist clients. Translators and transportation are available at all locations.

Community Collaboration / Service Integration

CSHS has a positive reputation built on its ability to collaborate with other organizations with like missions, as well as systems of care that provide adjunct services, such as those from the health department, hospitals and social/behavioral service agencies. The most significant collaborative activity in the last year was the merger with Touchstone Innovarè and Proaction Behavioral Health Alliance. The resulting integration of physical, mental and behavioral health services is significant for the Wyoming site. CSHS has extensive relationships and referral arrangements with organizations in the community that provide public benefit assistance, financial stability counseling, job training, etc., particularly important given the focus on serving the homeless population. Cherry Street Health Services’ own AmeriCorps members (Patient Navigators) are specifically trained and prepared to work with patients in identifying, applying for, and facilitating their access to the community supports needed to enhance their overall health and well being. The AmeriCorps team works closely with community support organizations to create a bridge for our patients in receiving necessary services. CSHS’ Patient Navigators are a critical service delivery link in patients’ access to broad community supports. A sampling of community organizations that have specifically reinforced their collaborative support for the Wyoming Community Health Center include the City Council for the City of Wyoming (resolution of support), Dwelling Place (affordable housing, support and neighborhood revitalization), Godfrey-Lee Public Schools/Spectrum Health, Godwin Heights Public Schools (3), Grand Rapids Area Coalition to End Homeless, Mel Trotter Ministries (homeless shelter, substance abuse treatment), Michigan Family Resources Inc., Michigan Primary Care Association, The Salvation Army Booth Family Services (housing assessment, community center and health clinic), St. Mary’s Health Care (hospital and health system), Spectrum Health (hospital and health system), Michigan Department of Community Health, state and local representatives.

Innovation in Design

Cost effective green materials (renovation and equipment) will be used as they are available.

Impact on Social Determinants of Health

According to the Grand Rapids Area Coalition to End Homelessness, of which Cherry Street Health Services is a Core Partner, over 5,000 people in Grand Rapids were homeless in 2009. In the first half of 2010, Grand Rapids experienced 8,020 foreclosures (the highest in Kent County), followed by 2,745 foreclosures in Wyoming. CSHS’ 2010 patient data through early November show 671 homeless people served from zip codes 49507, 49509, and 49548, the service area for this proposal. Patients indicated they were either doubled up with another family, in transitional housing or a shelter, or living on the streets. Just over 25% of the patients at the Wyoming Community Health Center are expected to be homeless, primarily recent immigrants who are doubled up with relatives or friends. Cherry Street Health Services is a core partner in the Grand Rapids Area Coalition to End Homelessness and has taken a lead role on the Behavioral/Physical Health Project Team. Moving from homeless management to prevention is an approach that resonates with CSHS. Providing a health care home for individuals experiencing homelessness in the Wyoming/southwest Grand Rapids area would be in the context of a much larger community Coalition that is facilitating positive community changes. For example, the Coalition’s 2009-2010 accomplishments include 1) $4.4 million awarded in HUD funds for homeless prevention, 2) implementation of a service delivery case management model linking those in crisis with housing resources and services, 3) realignment of more than $1.2 million for homeless prevention, re-housing and new system infrastructure, 4) completion of a housing affordability study analyzing supply and demand in Grand Rapids and Kent County, and 5) convened 19 systems to coordinate housing supports and resources. In the housing affordability study mentioned, the Coalition also calls for better coordination and collaboration between the region’s housing and transportation systems. The report also recommends increasing the access and availability of public transit to reduce transportation costs, which would provide more affordable housing options in the area.

 

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