As of January, more than 15,000 Larimer County residents qualified for Medicaid and 34,000 were eligible for subsidies in the Colorado Health Benefits exchange, according to the Colorado Consumer Health Initiative. The Family Medicine Center of Fort Collins, part of the University of Colorado Health, is doing its part to meet the needs of those with limited access to affordable health care, from babies to retirees.
“We see any patient in any setting,” said Dr. Janell Wozniak, a physician at FMC and a member of the faculty for its family medicine resident program. “We provide great services to the community for patients who otherwise wouldn’t have access.”
Creating a safety net
According to Wozniak, FMC is considered a “safety net” clinic, meaning that it accepts patients who are underinsured or uninsured. She estimates that FMC serves 8,000 unique patients every year, with 70 percent of those having either no coverage or a very limited variety. The latter is defined as depending on Medicaid, Medicare with Medicaid as secondary coverage, or Colorado Indigent Care Program (CICP), the state-subsidized program for patients who don’t qualify for, or cannot obtain, medical insurance.
In addition to traditional medical care, which can include home and nursing home visits, FMC offers counseling for individuals, couples and families, as well as lifestyle coaching and biofeedback. Other services include an integrated mental health program, on-site psychiatric services and counselors, and through a partnership with the Health District of Larimer County, access to social workers and a prescription assistance program. Through its lifestyle medicine program, FMC also offers free counseling services for issues like tobacco or smoking cessation, weight loss, diet, exercise and chronic illness management.
“There’s an added level of complexity to some of these patients,” Wozniak said, citing examples such as a lack of transportation, and an inability to afford medications or the electric bill required to run a home oxygen machine. “We find resources to help subsidize those things, funded through donations. We have to make sure that patients have access.”
Specialized prenatal care
Through its Poudre Valley Prenatal program, FMC works hard to serve a high-risk subset of those with limited healthcare coverage: pregnant women. Staffed by FMC residents and OB-GYN’s from the Women’s Clinic of Fort Collins, PVP provides specialized prenatal
care, helping to deliver about 500 babies a year, and totals 6,000 inpatient and 15,000 outpatient visits a year. No matter how a woman seeks prenatal care — through an emergency room, Medicaid offices, facilities like FMC or Salud Family Health Center (another Fort Collins safety net clinic), or area clinics — if she has little or no health coverage, she can access the program.
Dr. Breanna Thompson is a family physician at Salud who facilitates a group prenatal class that targets the same demographic seen by Wozniak and her FMC colleagues. Thompson says there is considerable data to show that pregnant women in lower socioeconomic brackets are at higher risk for dangerous conditions. As such, they tend to benefit most from education and support.
“Visits for prenatal care tend to result in higher birth rates, less preterm labor
and better control of gestational diabetes and preeclampsia,” Thompson said. “The (group) participants receive significantly more education about pregnancy because
of the amount of time that we’re able to spend with them. Rather than seeing each
of them for ten minutes, we see all of them together for two hours and they are able to
have a more enriching experience.”
Groups typically consist of about eight, and are led by a physician (Thompson, mostly), a behavioral health provider, and a maternal and family health coordinator. The sessions can take up to two hours, partners are invited, and childcare is provided. For Thompson, one of the greatest benefits for the participants is in creating bonds with others going through similar situations.
“The amount of help that people get from each other in a group setting is really significant,” she said. “It takes a village.”
Since the implementation of the Affordable Care Act in January 2014, Wozniak says that FMC’s patient list has swelled, including approximately 500 new Medicaid patients in the past couple of months alone, many of whom had no prior coverage. The increase in volume will require some adjustment, and dealing with complex social issues can result in more stress for providers. But Wozniak looks at it as yet another chance to help people who need it.
“It’s so much more rewarding for most of us who work in this setting when you’re able to help someone meet needs that they otherwise would not meet,” she said. “Accommodating this influx of volume has been and will continue to be a challenge for us, and we’ll continue to work internally and with the health system to see if there are ways we can expand access to this population of people.”
Andrew Kensley, the author of this article, is a local freelance writer and a physical therapist for Poudre Valley Hospital.