|Family Health Center of Battle Creek|
Women's Services Center
Family Health Center of Battle Creek (FHC) is a Federally Qualified Health Center, dually-designated as a Community Health Center and Health Care for Homeless provider. FHC target populations are un(der)served, low/no income and un(der)insured residents of Calhoun County, Michigan. In 2012, the Center provided 130,054 services for 29,289 individuals (about 22% of the county’s population), 84.4% of whom were uninsured or Medicaid-enrolled.
FHC began in 1986 to provide access to obstetrical and gynecological care. Over the years, many health care specialties have been added in response to community need. FHC currently employs 250 staff delivering family practice, pediatrics, internal medicine, obstetrics and gynecology (OB), dental care, behavioral health treatment, substance abuse treatment, 340B prescription drug program, otolaryngology, audiology, translation, lifestyle counseling, and school-based portable dentistry services.
A new facility is being constructed on the current Family Health Center of Battle Creek (FHC) campus, next to the main facility, to allow FHC to expand its capacity for primary care and OB/GYN. Through redeployment of OB space at FHC’s main facility and creation of new OB space in a new building, and by hiring additional physicians/providers, FHC will provide an additional 16,000 primary care encounters and 15,000 OB encounters per year to 7,300 new users of FHC.
Meeting Community Need, Increasing Access, Expanding Services
FHC target populations are un(der)served, low/no income and un(der)insured residents of Calhoun County, Michigan. In 2012, the Center provided 130,054 services for 29,289 individuals (about 22% of the county’s population), 84.4% of whom were uninsured or Medicaid-enrolled. The demand for primary care at FHC exceeds the limits of capacity, rising by an average of 858 new patients per month in 2012. At the same time, inadequate access to OB services contributes to Calhoun County having one of the highest infant mortality rates of any county in Michigan. Making matters worse, there was a reduction in Battle Creek OB providers from 10.7 full-time equivalents (FTEs) in 2009 to 4.9 FTEs in 2011. This created an access problem for pregnant women in our community. Without capacity growth, women would be forced to seek services outside the community, which negatively impacts patients and our local community. Efforts in 2012 to recruit additional OB providers, including the addition of Certified Nurse Midwives at FHC, have been successful. FHC will expand its capacity for primary care and OB services by building a new facility. Through redeployment of OB space at FHC’s main facility and construction of new OB space, FHC will provide an additional 16,000 primary care encounters and 15,000 OB encounters to 7,300 new users of FHC.
Local statistics reflect the need for increased access to OB care and a more comprehensive approach to the pregnancy care system.
The most recent Fetal and Infant Mortality Review (FIMR) data, based on Calhoun County infant deaths from 2011, reflects the following:
By increasing access to OB/GYN services, and implementing evidence-based models of care, FHC plans to have a long-term impact on local health statistics, including the following:
Program Innovation / Model of Delivery
FHC is addressing service delivery capacity and health programming focused on improving the pregnancy and birth experience. FHC is leading efforts to develop an integrated, coordinated approach to the model of care for pregnant women in Calhoun County. Many local organizations have been meeting and working toward this common goal. A detailed plan, including focus groups, Turning Points presentations, and an online survey, were implemented to find out what women want from their prenatal and delivery care. A community-approach to care is being developed based on that feedback.
The new facility will allow for capacity expansion in obstetrics and gynecology. In addition, a comprehensive approach to care will allow pregnant women to receive services from multiple organizations onsite. The new facility will have a classroom, guest offices, breastfeeding room, group visit room, and a lounge—available to patients and partner organizations who want to provide services and/or connect with patients or clients on-site.
FHC will be implementing new models of care that will provide a strong foundation for efforts to provide a more integrated, coordinated approach to pregnancy and delivery care. FHC is implementing a midwifery service, which will provide a certified nurse midwife at the Hospital Birth Center 24/7. Centering Pregnancy is an evidence-based model of care that provides prenatal care in a group setting, which FHC will be implementing because it has proven to increase birth weight and gestational age of mothers that deliver preterm. FHC continues to explore other evidence-based programs that will allow us to improve birth outcomes and the ongoing health status of mothers and babies.
Community Collaboration / Service Integration
FHC’s goal of developing a community-wide, integrated, coordinated model of care for pregnant women requires collaborative partnerships with all organizations that serve pregnant women and infants in our community. All such organizations/agencies, including FHC, meet monthly to discuss maternal and infant health issues, including the infant mortality rate, causes and factors associated with infant deaths, and developing strategies to address the issues. In addition, FHC participates in many community workgroups that address specific concerns, such as the Pregnancy Care Workgroup, Infant Safe Sleep Coalition, Smoking During Pregnancy Workgroup, and the Breastfeeding Coalition. There is strong community collaboration around maternal and infant health in our community and FHC is seen as a leader in this work.
FHC also has a lead role in convening community leaders around other health issues. FHC’s President and CEO, Dr. AJ Jones, is the chair of the Access to Care Issue Action Group, which works to ensure that all residents have access to health care. In addition, Dr. Jones convenes the monthly CEO Forum, which allows CEO’s of local health care organizations to get together and network.
Impact on Social Determinants of Health
FHC has played a vital role in improving the health of Calhoun County residents living in poverty through the provision of medical, dental, and behavioral health care. Approximately 50% of adults and 75% of children with Medicaid coverage in the county receive their care at FHC. The University of Wisconsin Public Health Institute and the Robert Wood Johnson Foundation estimate that only 20% of health outcomes are determined by clinical care. (See http://www.countyhealthrankings.org/our-approach.) Impacting health outcomes more substantially requires us to address social and economic factors (housing, safety, literacy), health behaviors (tobacco use, nutrition, physical activity, unsafe sex), and physical environment (environmental quality, parks and recreation). Historically, these are areas of focus for public health departments and social service agencies. In the current fiscal climate, these departments and agencies do not have the resources to adequately address these issues. With the new facility, the partnerships being developed, and the evidence-based programming being planned, FHC has an opportunity to work collaboratively to address these issues for our patients and the most vulnerable residents of Calhoun County.
Innovation in Facility Design
Cost-effective green materials will be used as they are available. Construction waste will be closely managed and nearly 95% will be recycled. All interior finishes will be specified to meet the USGBC’s LEED requirements for recycled content and low VOC’s. A high-efficiency mechanical system has been specified to reduce energy use. An automatic lighting control system will ensure minimized energy use as well.
The Need for Capital for Facilities
The Affordable Care Act (ACA) recognized the valuable role of Health Centers and provided resources for their expansion. However, capital funding for capital projects fell far short of the amount needed, and this has already been allocated. Health Centers primarily receive funding for the provision of health care services; they are expected to utilize their revenue for the direct provision of medical services resulting in limited capital reserves and debt capacity. Health Centers’ need for capital investment is even more critical in times of expansion, such as this, in order to enable them to expand access and effectively utilize the increasing operational funds being made available. In order to meet this challenge, many facilities will need to be built, expanded, or renovated. Health Centers have proven to be well-run community businesses, efficiently planning and successfully completing capital facility and equipment programs. They are excellent development partners. However, there is need for substantial capital to build needed facilities to meet the projected demand for accessible, quality primary care services.