1. How to Start and Maintain a Free Health Care Clinic
Presented by:
Haakon Carlson, M.D.

2. How to Start and Maintain a Free Health Care Clinic
A Need was Identified and Researched

3. Need Identified and Researched
The need for free health care is almost a given But where to start?
Free health care in Haiti or Here at Home?

4. Need Identified and Researched
Reality Testing
Sharing the Idea with Confidantes
Spouse
Professional colleague and friend
Pastor
Hospital Foundation Administrator
Society of St. Vincent de Paul Administrator and two Board Members

5. Need Identified and Researched
Getting Facts and Figures with Research
Prairie Clinic, S.C. - the local primary family practice group (and my former group practice)
Sauk Prairie Memorial Hospital & Clinics - the community hospital
Society of St. Vincent de Paul - a very active social service force in the community
County Public Health Nurses - Sauk, Dane (Northwest), Columbia and Iowa
Statistical Publications
Federal Poverty Guidelines
Health Policy Center, The Urban Institute, Washington, DC
Wisconsin Family Health Survey, Center for Health Statistics
Division of Health, Dept. of Health and Family Services

6. Need Identified and Researched
How are Free Clinics Started?
National Free Clinic Foundation of America
1240 Third Street, S.W.
Roanoke, VA
Phone: (540)
Web:
Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region 321 West South Street
Kalamazoo, MI
Phone: (616)
Fax: (616)
Web:
Volunteers in Health Care (VIH)
Memorial Hospital of Rhode Island
111 Brewster Street
Pawtucket, RI
Toll Free: (877)
Web:
Jill Collier FNP, Wisconsin State Coordinator (Wisconsin Free Clinics)
Living Healthy Communicty Clinic
800 Algoma Blvd
Oshkosh, WI
Phone: (920)
Fax: (920)
John Vick, Administrator, Volunteer Health Care Program
Bureau of State Risk Management
PO Box 77008
Madison, WI
Phone: (608)

7. How to Start and Maintain a Free Health Care Clinic
A Need was Identified and Researched
An Informed Community was Marshaled

8. An Informed Community was Marshaled
Spreading the Word
A Public Forum was announced through the local newspapers and by
Individual Invitations for the presentation of plans for a free health care clinic
A Noon Meeting was hosted by St. John’s Church in the fellowship hall and Lunch was Catered by the Hospital
A Slide Presentation was given and Volunteer Forms were available

9. An Essential Ingredient
An Informed Community was Marshaled
An Essential Ingredient
The concept of a free health clinic has the unanimous support of the Sauk Prairie Memorial Hospital Medical Staff

10. An Informed Community was Marshaled
Need Assessment for a Free Clinic: The “Economically Poor” Federal Poverty Guidelines (FPG), April 1998
Source: Wisconsin Primary Health Care Association

11. Percent of County Population Below FPG - 1995 Estimates
An Informed Community was Marshaled
Percent of County Population Below FPG Estimates
Source: Wisconsin Primary Health Care Association

12. Percent of County Population Uninsured - 1994
An Informed Community was Marshaled
Percent of County Population Uninsured
Source: The Urban Institute, Washington, D.C.

13. Percent of Wisconsin Non-Metropolitan Population Underinsured - 1996
An Informed Community was Marshaled
Percent of Wisconsin Non-Metropolitan Population Underinsured
No insurance for part of the year - 6%
No insurance for the entire year - 7%
In 1996, 7-13% of the non-metropolitan population in Wisconsin was without adequate insurance.
Source: Wisconsin Department of Health and Family Services

14. An Informed Community was Marshaled
What is a Free Clinic?
Access
An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector.
Confidentiality and Quality
A clinic would serve people who are trying to improve their lives but do not have medical insurance or the ability to pay for medical care. It would be an evening, walk-in health facility where working people can seek medical care without having to take time off from work during the day without pay.

15. An Informed Community was Marshaled
What is a Free Clinic?
Governance
A private, non-profit, autonomous facility governed by a board of directors.
Operations
A relatively cost efficient facility relying on private contributions for the majority of the operating expenses and professional volunteers to deliver medical care. A small, dedicated staff is necessary to coordinate the daily operations of the facility.
Community Support
A well organized facility which must have the support of the medical community as well as the community-at-large.

16. Who Does a Free Clinic Serve?
An Informed Community was Marshaled
Who Does a Free Clinic Serve?
Patients referred from physicians, hospitals, schools, social workers, home health RN’s, clergy and others.
Those in financial need
Minimum wage workers
People between jobs
Single parent families
People who are trying to get on their feet
Those who are working two or three jobs
Senior citizens who cannot afford medications
Those who do not have any third party coverage
Those who cannot afford private care

17. Who are the Providers in a Free Clinic?
An Informed Community was Marshaled
Who are the Providers in a Free Clinic?
Volunteer health care workers
Management and office staff
“People” people
Other professionals

18. What are the Services Offered?
An Informed Community was Marshaled
What are the Services Offered?
Evaluation and treatment of acute/chronic health care problems
Health maintenance and education
Assistance for people requiring eligible health care from other providers
Eye care
Dental services
Other services

19. What providers of a free clinic DO NOT do:
An Informed Community was Marshaled
What providers of a free clinic DO NOT do:
Admit to the hospital
Obstetrics
Encourage emergency care
Surgery
Provide second opinions
Duplicate services
Other

20. Where is a Free Clinic Housed? What are the Hours?
An Informed Community was Marshaled
Where is a Free Clinic Housed? What are the Hours?
Accessible site
Hospital and professional clinics
Churches
Free standing buildings
Service organizations (St. Vincent DePaul, Salvation Army)
Hours based on need - possibly starting with one evening per week

21. How Will the Free Clinic be Financed?
An Informed Community was Marshaled
How Will the Free Clinic be Financed?
Local Support
Hospitals & professionals
Churches
Service organizations
Private donations
Local governments
Token co-pays from those who can afford it
Grants
State and Federal aid

22. An Informed Community was Marshaled
Where Do We Go From Here?
Informal, temporary steering committee selects an acting board of directors:
Made up of a small number of qualified people
Establish an executive committee with skills in organizational planning, budgeting, marketing, etc.
Appoint a medical director, head nurse, office manager

23. How to Start and Maintain a Free Health Care Clinic
A Need was Identified and Researched
An Informed Community was Marshaled
An Organization was Formed

24. An Organization was Formed
A Steering Committee
That became, in large part the Board of Directors, was formed from the returned volunteer forms
President
Vice-president
Secretary/Publicist
Treasurer
Medical Director
Clinic Director
Board Member (Attorney)
Board Member (Member of Society of St. Vincent de Paul Board)
Board Member (Pastor Don Wendt, St. John’s Church)

25. An Organization was Formed
The Clinic Became a Reality
The Name: The Goodneighbor Clinic of Sauk Prairie, Inc. (Incorporation of a tax exempt, not-for-profit, 501 (c) (3) corporation
The Site: The Educational Unit of St. John’s Lutheran Church
Hours of Operation: One Day per Week (Monday) 1:00 - 7:00 pm
Equipment: Donated by the hospital, St. Vincent de Paul and Prairie Clinic
Staffing: All volunteer professional (MD’s, RN’s, Pharmacists, Dentists, and Optometrists) and numerous “non-medical” personnel
Support Services: Diagnostic tests (lab and imaging) and various support needs are donated by the hospital and Prairie Clinic

26. An Organization was Formed
The Clinic Became a Reality
Publicity: An Ongoing Effort
Financial Support: Comes From the Community
Individuals
Service Clubs
Churches
Community Banks
The community United Way
School Children
Grants
Future Growth:
New Location - St. Vincent Service Center
Open two days a week

27. A Quote . . .
It helps, now and then, to step back and take the long view . .
We plant the seed that one day will grow . . .
We lay foundation that will need further development . . .
We cannot do everything, and there is a sense of liberation in realizing that.
This enables us to do something, and do it very well.
It may be incomplete, but it’s a beginning.
Oscar Romero

29. 3A Determining Cost Savings to Hospitals
James Walton, DO &
Adam Chabira, MHA

30. Charity Clinic Outcomes: Determining Impact on Hospitals
Jim Walton, DO
Adam Chabira, MHA
Baylor Health Care System – Dallas, TX

31. Introductions Jim Walton, DO Adam Chabira, MHA
VP and Chief Health Equity Officer
Baylor Health Care System – Dallas, TX
Adam Chabira, MHA
Program Manager
Office of Health Equity
Baylor Health Care System

32. Purpose of Presentation
Discuss the importance of outcomes reporting
Present analysis methodologies for hospital impact
Key indicators/variables
Present examples of hospital impact analyses
Discuss strategies for collecting and analyzing hospital data

33. Data Collection: Metrics vs. Impact/Outcomes
Quantitative
Answer the Questions:
How many?
How much?
Examples:
# of visits
# of unduplicated pts.
# of Rx’s dispensed
Impact/Outcomes
Qualitative or Quantitative
Answer the Questions:
What difference are we making?
How are we impacting our community?
Examples:
Improved health of pts.
Reduction in unnecessary hospital use

34. The Importance of Impact/Outcomes
Outcomes are important to:
Your Boss/Board of Directors
Funders
Potential Partners
Policy Makers
They tell the story of your work
How you’re impacting lives
How you’re impacting the community

35. Charity Clinic Impact on Hospitals
Fundamental Principles:
Providing primary and preventive care to patients will reduce dependence on hospitals for obtaining care
When patients do require hospitalization the severity/complexity of their conditions will be lower because they are receiving primary care

36. How do we Demonstrate Impact on Hospitals?
Show a reduction in the following Key Indicators:
Utilization
ED Visits
Admissions
Outpatient Visits
Average Length of Stay (ALOS)
Costs
Total Costs
Direct Costs
Indirect Costs

37. How do we Demonstrate Impact on Hospitals?
Two methodologies:
Before & After Analysis – compares hospital utilization and costs before and after enrollment in an intervention
Comparison of 2 populations – compares the hospital utilization and costs between a population receiving an intervention and a similar population not receiving the intervention

38. Project Access Dallas

39. Before & After Analysis

40. Before & After Analysis (cont.)
∆ = -22%
∆ = +50%
∆ = -74%

41. Before & After Analysis (cont.)

42. Before & After Analysis (cont.)
∆ = -58%
∆ = -63%
∆ = -2%

43. Central Dallas Ministries Community Health Services

44. Two Population Comparison
48%

45. Two Population Comparison (cont.)
29%

46. Two Population Comparison (cont.)
20%

47. Data Collection
Provided hospital decision support staff with a roster of patients enrolled in an intervention. We provided enrollment dates for Before & After analysis.
Requested utilization and costs for these patients for a given timeframe
Results were returned in summary format without patient identifying information

48. Data Collection Tips
Ask for summary data without patient identifying information
Be prepared to produce patient consent to share health-related information

49. Analytical Tips Provide data in tabular & graphic formats
Provide aggregate data and per patient data (total costs/# of patients)
Use a static timeframe for Before & After analyses (1 yr. before/1 yr. after)
Calculate percent change
(After Costs-Before Costs)/Before Costs

50. Analytical Tips
Comparison population should be as similar to your population as possible
Uninsured
Demographically
Geographically
Same time period

51. Summary
Impact on Hospitals can be measured by showing changes in utilization & costs
2 primary methodologies:
Before & After analysis
Comparison of 2 populations
Next steps: documenting preventive health care services

52. Chippewa Valley Free Clinic
Brent Hafele, MA
Executive Director
Chippewa Valley Free Clinic
421 Graham Avenue
Eau Claire, WI