|Family Medical Center of Michigan|
This project will involve the construction of a new 16,900 square foot building in Adrian, Michigan, located in Lenawee County. The project will allow for the provision of medical and dental services in one facility— services currently provided in two separate, older buildings located approximately two miles apart. The new facility will improve accessibility to not only dental and medical services but will also increase the capacity of Family Medical Center to provide integrated primary and behavioral health care services in collaboration with the Lenawee County Mental Health Authority.
Meeting Community Need, Increasing Access, Expanding Services
Family Medical Center of Michigan, Inc. (FMC) proposes the construction of this facility to improve access to quality health care in Lenawee County. FMC presently provides comprehensive quality services to over 18,000 patients annually regardless of insurance or ability to pay. A new, expanded facility will allow FMC to provide services to an estimated additional 4,900 medical patients and 1,750 dental patients and increase encounters by over 10,000 annually. By 2014 Family Medical Center anticipates that, with a new building, up to 19,000 patients will be treated annually in the new facility. In the existing medical facility, 2.5 FTE providers share three exam rooms. A new, larger facility will allow FMC to provide better access to services to accommodate the growing health and medical needs of Lenawee County.
Reaching Special Populations
As a Federally Qualified Health Center (FQHC), FMC is located in designated medically underserved areas, serving identified underserved populations. It utilizes an integrated, team-based model of care delivery to meet both general and special patient needs. FMC provides care utilizing a sliding fee scale discount program to make fees affordable to all. Nearly half (48.5%) of all FMC patients have incomes below the federal poverty level (FPL); 70.8% have income below 200% of FPL; 37.3% are Medicaid recipients and 39.7% have no insurance coverage.
According to Michigan BRFS data 2008–2010, 37.6% and 41% of Lenawee County residents report being obese and overweight respectively compared to 30.9% and 35.3% statewide. Weight is a major risk factor for many chronic diseases including Diabetes. In Lenawee County, 9.9% of residents report being told by a physician that they have diabetes, higher than 9.5% statewide. Additionally, 10.6% of residents reported having no personal health care provider. In 2010, FMC provided primary care services to 2,056 patients. Access to dental services is also critical for the uninsured and Medicaid populations in Lenawee County. According to Michigan BRFSS data 2008-2011, 76.3% reported at least one dental visit in the past year compared to a slightly lower 73.8% in Michigan. However, while 13.8% statewide reported having lost six or more teeth, 14.4% in Lenawee County reported the same. This could indicate a delay in seeking services due to limited access. FMC is the only dental provider in the county to accept Medicaid and offer a sliding fee scale. In 2010, FMC was able to provide dental services to 2,255 patients in the county. Finally, health screenings on current mental health consumers indicate they are at increased risk for some chronic health conditions than the general population. Nearly 60% of emergency psychiatric hospital admissions are new patients and uninsured. Almost all report having no primary care provider. Many find fragmented health services confusing and delay seeking services until they require emergency room treatment. This project will provide a patient-centered medical home for residents of Lenawee with Medicaid and those who are uninsured. It will allow for the provision of multiple services to patients in a single visit and expand FMC’s capacity to effectively serve the community. FMC monitors health outcomes including hypertension, diabetes, and prenatal care. With improved access to primary care prevalence of chronic disease in Lenawee County among the low income population will decrease.
Program Innovation / Model of Delivery
Under the direction of the HHS’ Health Resources and Services Administration, FQHCs implement quality programs utilizing evidence-based practice and the chronic disease model. Specific quality outcomes are reported to HHS via a standardized reporting system (Uniform Data System, or UDS). Multiple studies have reported that Health Centers provide high quality care; improve access to care for the underserved; virtually eliminate health disparities for minority populations; improve overall health status; and reduce the global cost of medical care to comparable populations significantly. FMC has over 32 years of experience serving Monroe, southeastern Wayne, and Lenawee Counties. It is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It serves as the medical home to over 18,000 patients, providing comprehensive primary care and integrated medical, dental, behavioral health and related services. Additional services include health screening, nutrition, obstetric and preventive health screening, x-ray on-site, and discount pharmacy services. Enabling services include language translation (Spanish, Chinese), eligibility assistance for multiple programs, and transportation assistance.
Community Collaboration / Service Integration
Family Medical Center of Michigan collaborates with many state, federal and community services to provide its patients with optimal care and benefits. As an FQHC it collaborates with HHS HRSA for the resources to provide high quality care to all. This facility project co-locates and further integrates FMC’s comprehensive medical, dental and behavioral health services with the services of the Lenawee County Mental Health Authority. FMC also partners with Lenawee County Health Department and Bixby Hospital and Herrick Medical Center, a designated Critical Access Hospital (CAH), both part of ProMedica Health System. FMC also works closely with the Michigan Department of Human Services to ensure its patients enrollment in programs for which they qualify, as well as jointly piloting the Michigan Benefits Access Initiative, and working with the Supplemental Nutrition Assistance Program (SNAP). FMC also has cooperative relationships with several universities and teaching hospitals, and provides medical referrals to M-Care, University of Michigan’s program providing indigent care to low-income and uninsured patients. Other collaborations include: Community Action Agency; United Way; Migrant Health Promotion; Telamon and the Southeastern Migrant Health Resource Council.
Innovation in Design
FMC leadership believes that creating sustainable buildings starts with proper site selection. The location, orientation, and landscaping of a building affects the local ecosystems, transportation methods, and energy use. FMC will incorporate the following principles into its design: optimize energy use; protect and conserve water; use environmentally preferable products; enhance indoor environmental quality (IEQ); optimize operational and maintenance practices. The decision for FMC to include geo-thermal heating and cooling system in the project is based upon our commitment to reduce our energy foot-print and our experience with the geothermal system we recently installed at our new Temperance site building. The project will be designed and constructed in the spirit of the US Green Building Council LEEDv3 2009 rating system. A perspective of life cycle return on investment shall guide our investment of first cost capital expenditures with a performance of reduced utilization of water, gas and electricity over the life of the facility. Our professional engineering team will reduce external loading, minimize internal loading. Upon completion of our facility our operations shall exhibit environmental stewardship to the region and will uphold the health and welfare of our employees and patients through provisions of human comfort, fresh air and day lighting. By expanding and improving patient flow, the new Lenawee facility will allow staff to more efficiently serve more patients and provide additional services not currently offered. The new facility will also be designed to be more energy and operationally efficient using water saving fixtures, better insulating building materials, and higher efficiency heating and cooling equipment. With regards to efficient design, the proposed facility meets all requirements for the efficient delivery of medical, dental, behavioral and mental health services. Hooker DeJong, an experienced architectural firm, familiar with FQHCs was engaged to design the facility.
Impact on Social Determinants of Health
Health Centers are economic engines. They are very significant businesses, particularly in rural areas. FMC is a significant provider of well-paid jobs and benefits in this underserved area. The development of this proposed facility project - the jobs and funding it will create in the community and the expanded services it will provide - will be an anchor for community stabilization and development. In a county experiencing 11% unemployment, this is an important factor. In addition, integration and collaboration with community services noted above provides patients access to many supportive services. Examples include FMC’s work with the Michigan Department of Human Services and coordinating referrals with Supplemental Nutrition Assistance Program (SNAP) as well as the Women, Infants and Children program (WIC).