Free primary healthcare for the uninsured of Greater Hartford - CONNECTICUT State Prize
Free, high quality primary health care services to an underserved population that has no other means of accessing the health care system, through the use of a mobile medical clinic. What began as a project to address episodic unmet health care needs has now, by necessity, become a community resource.
About You
Section 1: You
First Name
Barbara
Last Name
Bartucca
Website URL
Organization
Malta House of Care Foundation
Country
Section 2: Your Organization
Organization Name
Malta House of Care Foundation
Organization Website
Organization Phone
860-548-1593
Organization Address
19 Woodland Street, Suite 37
Is your organization a
Non‐profit/NGO/citizen sector organization
Organization Country
United States, CT
Your idea
Name Your Project
Free primary healthcare for the uninsured of Greater Hartford - CONNECTICUT State Prize
Country and state your work focuses on
United States, CT
Describe Your Idea
Free, high quality primary health care services to an underserved population that has no other means of accessing the health care system, through the use of a mobile medical clinic. What began as a project to address episodic unmet health care needs has now, by necessity, become a community resource.
Website URL
Innovation
What makes your idea unique?
In Central Connecticut, there is no completely free option available to the uninsured for medical care other than the existing hospital and community health facilities, which have been proven to be an extraordinary administrative and financial burden for these facilities. Even with the availability of federally-funded community clinics, the sliding scale fees are still more than many uninsured persons can afford. We estimate that for every dollar we spend, a hospital, clinic or community health center avoids spending not less than $3 and as much as $7 with three year projected savings of over $3 million. To a person who is unemployed, a student, or a person seeking to enter drug rehab this amount is extraordinary. MHC provides primary health care free, without discrimination, to persons from all economic, religious, and geographic backgrounds. Our service is unique in that it goes to where the people live to serve them. Many of the neediest have no means of traveling to fixed location clinics and do not feel comfortable in unfamiliar surroundings. We bring medical care directly to their neighborhoods through the use of the mobile van.
We would literally not exist without our volunteers. The free primary medical care is provided by the continuing contribution of time and effort from our volunteer doctors and other medical professionals which we value in-kind as over $1,000,000 annually. The mobile van is used to serve patients at four locations, four days of the week on Monday, Wednesday and Thursday afternoons each week, and Tuesday afternoons and evenings.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
Since opening day in 2006, Malta House of Care Mobile Clinic has grown and provided by the close of 2009 over 12,400 totally free patient visits: beginning with 477 in 2006; 3,364 in 2007; 4,456 in 2008;and, 4,183 in 2009 (the number of visits was slightly less than 2008 due to the number of days the old van was out of service due to mechanical problems). Demographically 5% of our patients are Asian; 10% are White; 15% are Black/African American; and 70% are Hispanic – the latter being two minority groups that report unique health profiles. CDC reports that Puerto Ricans suffered disproportionately from asthma, HIV/AIDS, and infant mortality while Mexican Americans suffered disproportionately from diabetes. In CT, Blacks or African Americans have significantly higher age-adjusted death rates compared with White residents for each of their six leading causes of death, including heart disease, cancer and stroke. It is a moral and economic imperative to address these racial and ethnic disparities in health outcomes through effective healthcare delivery. MHC has succeeded in addressing these individual diagnostic and treatment needs which has resulted in a positive impact on the health of our patients and the overall community. What began as a project to address unmet health needs through an urgent care model is becoming, by necessity, an established community resource linking area hospitals, clinics, grass roots organizations and private doctors' practices with patients who seek appropriate medical care for chronic health problems as well as prevention.
Problem
Hartford has experienced a dramatic increase in poverty since 1970 and is the second poorest city in the United States (behind Brownsville, TX). Of the nearly 125,000 estimated population of Hartford, 50% earn less than $29,293 annually; 30.3% live below the level of poverty (triple the national rate); 15% have no medical insurance protection; and, an infant mortality rate at 7.6 per 1,000 is nearly double the state and national figure. The MHC Clinic directly serves these vulnerable population groups providing free primary care, free diagnostic testing, free required pharmaceuticals and ongoing high quality care without discrimination.
Among the population of Greater Hartford, 31% report suffering from hypertension, 17% have asthma and 13% have diabetes. As 15% of the population of the greater Hartford area has no health insurance, many of our patients are impacted by these previously undiagnosed and untreated chronic illnesses which, once diagnosed by one of our volunteer physicians, require ongoing care and treatment. They carry a heavy burden of disease, living with a range of previously undiagnosed chronic medical conditions, including: poorly controlled diabe
Actions
• Conduct search for and appoint Medical Director (**Accomplished in 2009)
• Complete Clinic staffing: Certified Medical Assistants to work under supervision of new Medical Director. (**In Process)
• Address Health Literacy: Recognizing the importance of language, cultural competency and health literacy in reducing health disparities through certified medical interpreters; and bilingual staff. Patients will have access to appropriate care and information where providers will be culturally competent. (**Accomplished and In Process)
• Upgrade skills of volunteer physicians and nurses to attend to the needs of our patient population. Workshops in general computer literacy, EMR, twenty-first century management of complex chronic health conditions, and the patient centered primary health care approach. (**In Process)
Lack of communication between Hartford/state-wide governmental/non-governmental projects and programs that have missions similar to those of MHC may prevent success due to duplication in services provided to patients and thus a lack of holistic care.
Results
Health literacy is a fundamental component of reducing health disparities and avoidable healthcare costs (such as inappropriate emergency room visits). The degree to which an individual has the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding his or her health is dependent upon the patient's ability to comprehend and utilize health information.
Cultural competence will enable MHC to deliver appropriate, sensitive, and comprehensive care by understanding and relating care to peoples' beliefs, values, and concerns about health and illness. We know these are often culturally based, vary across groups and within families, and may be influenced by generational differences and acculturation.
Continuous quality improvement: The EMR and support for volunteer uptake of this technology will improve charting, recording and analysis of patient data in order to reach targeted standards of care and conduct outcomes based research to improve service delivery and outreach.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Few programs attempt to provide on-going comprehensive primary health care to a defined but often marginalized and transient patient population. Therefore, to be successful we need to create an integrated patient-centered medical home within the Malta House of Care, where our patients would access primary care providers as well as a multi-disciplinary team of nurses, nutritionists, social workers, oral and mental health professionals within the community. The specific goals of our project are to:
Year 1: Map the existing safety net of social, mental and health care services in the Greater Hartford area.
Year 2: Link the providers of these services through a "learning network" to share best practices as well as clarify roles and functions; and establishment of the infrastructure for the patient-centered medical home (comprehensive coordinated care) at Malta House of Care. Identify, analyze and case manage the individual needs of Malta House of Care’s 1,500+ patient population; establish care coordination with our partners as core business within MHC, achieving integrated primary health care and appropriate specialty referral for those not qualifying for benefits elsewhere.
Year 3: IT systems upgrades (enhancements to EMR systems now in use) which will include: implementation of a mechanism for tracking patient outcomes in these combined initiatives, training of volunteer personnel to collect and enter data, and support to analyze needs and measure outcomes; development of best practices for improved communication strategies between different regional programs and providing organizations, as well as between patients and care providers.
What would prevent your project from being a success?
Increasing clinical Costs: The pharmaceutical and diagnostic testing expenses required by our patients have exceeded anticipated costs. The need is growing and the costs are escalating. The current economic climate has resulted in many more individuals now seeking our help. A return rate of 80% indicates that our patients now consider MHC as their only medical home. We have become their family physician and they rely on us for comprehensive primary medical care and the resulting ongoing required prescriptions. We prescribe and pay for insulin, oral third-line medications for diabetes, asthma pumps, cholesterol-lowering agents, and multiple medications for hypertension--much of which are non-generic and costly--but are required by our patients who have failed treatment with other lower cost pharmaceuticals. We seek to provide high quality care to this marginalized patient population, as meets the community standards set for treatment of these complex conditions. To overcome this factor we will utilize a formulary of generic pharmaceuticals that address the chronic illnesses that are exhibited by our patient population. We have also been working to determine other measures which will address the rising cost of pharmaceuticals which are not part of the formulary. We have had success in utilizing a volunteer to work with individual patients who require expensive medications that are not part of the formulary by working with them to submit lengthy and complicated applications directly to pharmaceutical manufacturers who offer programs for free pharmaceuticals but which require levels of sophistication that our patients do not possess.
How many people will your project serve annually?
1001‐10,000
What is the average monthly household income in your target community, in US Dollars?
$100 ‐ 1000
Does your project seek to have an impact on public policy?
Sustainability
What stage is your project in?
Operating for 1‐5 years
In what country?
United States
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Malta House of Care Foundation
How long has this organization been operating?
1‐5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have any non-monetary partnerships with NGOs?
Yes
Does your organization have any non-monetary partnerships with businesses?
Yes
Does your organization have any non-monetary partnerships with government?
No
Please tell us more about how these partnerships are critical to the success of your innovation.
We have in the past and continue to collaborate with and refer patients to a number of community based providers. We treat our patients in a holistic manner and refer them to other organizations which can supplement our care for which we have no access while we remain their medical home. Certainly, all of the physicians, nurses, testing facilities, and other medical professionals who give their volunteer time are key to our program. Our on site volunteers and tertiary medical care providers come from local hospitals and many private practices. Outreach through a vast network of organizations to prospective patients has kept the MHC clinic days at capacity since the start of our project. MHC enables a corps of over 100 volunteers to bring primary care services to underserved communities; resulting in a continuing positive impact on the overall health of the community and enhancement of health services in Greater Hartford.
What are the three most important actions needed to grow your initiative or organization?
1) Operations: New Mobile Vehicle 2009-2010
The 16 year old mobile van (loaned by Saint Francis Hospital) had been in the service of MHC since 2006 and was in need of replacement. Our goal for 2009 was to acquire a new mobile vehicle so we could continue to meet our mission objective to provide quality healthcare to the underserved population who depend on us. We succeeded in a capital campaign to raise a total of $242,000 and received delivery of the new mobile vehicle in December 2009 which is now fully operational.
2). Initially sustained by an enthusiastic board of founders and a small cadre of volunteers,
the MHC needs to transition to enhance its clinical operations to provide more holistic and integrated care through an experienced family physician serving as Medical Director, now over 100 medical professionals and administrative volunteers and three paid multi-lingual medical assistant staff.
3. Complete IT/Telecommunications infrastructure: We will utilize the EMR to direct, monitor and track patient care and wellness and aim for continuous quality improvement by: monitoring health of returning patients and numbers of new patients; conducting surveys of patients’ progress and needs for continuing care; and, developing practice guidelines for common medical conditions seen within our patient population. Over the past four years of operation, we have earned the respect and trust of our patients, community colleagues, partnering health and educational institutions as well as other safety net providers, who are keen to work with us to consolidate our mission, enhance our services and foster integration across care provision.
The Story
What was the defining moment that led you to this innovation?
We believe that everyone is entitled to primary health care without discrimination. Though many in this country have enjoyed substantial improvements in their health, this is not true for everyone. In particular, the health status and outcomes of minority groups and low-income individuals have persistently lagged behind. These disparities in health are evidenced by higher rates of illness and mortality and lower life expectancy. Six years ago, not satisfied with waiting for policy reform to address the problem of disparities in the access and delivery of primary healthcare in the Greater Hartford, Connecticut area, a group of concerned community leaders established and continue to operate the Malta House of Care free mobile medical clinic. The Malta House of Care, Inc. (MHC) and the Malta House of Care Foundation, Inc. (MHCF) are 501c(3) organizations with the MHC providing the medical services and the MHCF providing funding to support the services.
The Malta House of Care Mobile Clinic in Hartford is intended to serve as a demonstration project serving as an effective model for continuous comprehensive care to reduce racial and ethnic health disparities; and as an effective template for the development of additional medical homes in similarly challenged communities across the state and the nation by addressing healthcare access, health information, reducing health disparities and cost effectiveness. A key component of our work is diagnosing, managing and treating individuals with major chronic illnesses in a continuous culturally competent way. MHC serves as such a demonstration model having been designed as a template for replication in other cities in the state and in future across the country. The second MHC mobile clinic will be operational in the city of Waterbury during the third quarter of 2010, utilizing the successful model of the Hartford clinic.
Hartford is the second poorest city in the United States. Of the nearly 125,000 estimated population of Hartford, 50% earn less than $29,293 annually; 30.3% live below the level of poverty (triple the national rate); 15% have no medical insurance protection; and, an infant mortality rate at 7.6 per 1,000 is nearly double the state and national figure. 31% report suffering from hypertension, 17% have asthma and 13% have diabetes. As 15% of the population of the greater Hartford area has no health insurance, many of our patients are impacted by these previously undiagnosed and untreated chronic illnesses which, once diagnosed by us, require ongoing care and treatment.
Tell us about the social innovator behind this idea.
Six years ago, not satisfied with waiting for policy reform to address the problem of disparities in the access and delivery of primary healthcare in the Greater Hartford region, a group of concerned community leaders, were determined to address the need for primary medical care to poor and sick uninsured individuals of the Greater Hartford area, and address the overburdened use of emergency rooms and needless costs associated with care given to people who require specifically primary care services for the diagnosis and treatment of both acute and chronic health problems. Jean Pierre van Rooy, retired CEO of Otis Elevator and Peter G. Kelly, Esq. of the firm Updike, Kelly, Spellacy defied the naysayers who said it could never be done, and created a mobile medical clinic manned by volunteer nurses and physicians, insured by the TORT Federal Liability Insurance and travelling to four Hartford neighborhoods to deliver the free care. They dreamed of providing respectful, secure, trust-evoking and professional care to a vulnerable population that might not otherwise seek medical care because of their confusion about medical services or inability to seek care because of their socio-economic circumstances, language or financial barriers. Their dream is now a reality and MHC has become a true community asset that is making a real difference in the lives of Greater Hartford’s most vulnerable.
How did you first hear about Changemakers?
Personal contact at Changemakers
If through another, please provide the name of the organization or company
50 words or fewer
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| mhc_van_interior.JPG | 162.96 KB |
| MHC_Van_exterior.JPG | 757.84 KB |
| mobile_van_campaign.JPG | 134.11 KB |
| testimonials_1.JPG | 209.44 KB |
| testimonials_2.JPG | 236.25 KB |
 | 97 weeks agoFree primary healthcare for the uninsured of Greater Hartford. has been chosen as a winner in Revelation to Action: Your Place. Your Idea. Your Change.. |
| 104 weeks agoAlexis Ditkowsky said: Hi Barbara, Thanks for sharing your ideas for providing much-needed healthcare services to vulnerable populations. I'd love to hear ... about this Competition Entry. - read more > |
| 109 weeks agoBarbara Bartucca updated this Competition Entry. |
| 109 weeks agoBarbara Bartucca submitted this idea. |
