TRANSITION OF THE RICHMOND CITY DEPARTMENT OF PUBLIC HEALTH CLINICAL SERVICES

Overview.

Following a study of access to OB Services and to primary care physicians, performed by staff of the VDH while I was Commissioner, the Virginia General Assembly passed Senate Bill 179 in March of 1991 requiring that all local; health departments assess the current state of access to primary care for the residents in their health district, develop a plan to endure access for all the residents and report back to the VDH by July of 1992.

A  committee including representatives of all types of health providers in Richmond, including Sheryl Garland, developed a plan which was approved by the City Manager and City Council before sending the report to the VDH.  The plan was also shared with members of the city's representatives to the State Legislature.  We requested these legislators, as a first step,, to fund a survey of access to health care in the area of the city south of the James River. The assessment was performed and the results published in the Virginia Medical Journal.  Following the survey the members of the SB179 committee agreed that a primary care clinic should be developed in South Richmond. With the assistance of Dr. Lanier, Sheryl Garland, Dr. Hayes Willis, and a grant from the RWJF space was identified, matching money obtained from the Governor, and a clinic for primary care opened with services delivered jointly by the RCHD and the Ambulatory Services division of  MCV.  Clinical Staff from the RCHD were transferred to MCV staff (also a state agency at this time) and remaining public health staff provided WIC, immunization, a case-management services to support the clinical program.  The Clinic opened in late 1994 and in 1006 was named the Hayes Willis Health Center (HWHC) in memory of its first director, Dr. Hayes Willis.

.In the spring of 1997, after the Hayes Willis Health Center had become operational, when the cost benefits of the HWHC had been validated, the Richmond City Council asked MCV Hospitals to consider assuming responsibility for the management of the remaining clinical programs provided by the City's public health department clinics. In July 1, 1998, the Richmond City Department of Public Health transitioned its clinical programs. The City of Richmond has committed a total of $1.3 million to support this collaboration. MCVH will contribute over $500,000 to support these clinical services and the associated administrative structure of the programs.

The three (3) components of the program are:

The City Care program includes the following:

The goals of the City Care program are as follows:

  1. Establishment of a health care delivery model that supports the concept of continuity of care for patients.

  2. Reduction in the inappropriate utilization of the MCVH Emergency Room for non-acute services for a defined population of patients.

  3. Reduction in the overall cost of health care through the integration of primary care and preventive health care programs.

In addition to the services outlined above, the following have been incorporated into MCVH or programs:

    1. AIDS Drug Assistance Program (ADAP). This federally funded program provides prescription drugs to HIV/AIDS patients who meet certain financial and clinical criteria. The City had previously provided services to approximately 280 patients. It was discovered that approximately 90% were MCVH clinic patients that had been referred to the City Health Department to receive their medications. The State Health Department will cover the cost of the drugs. The MCVH Pharmacy has developed mechanisms to incorporate the dispensing of these medications into its existing work flow.

    2. Foreign Travel Immunization Program. Dr. Tom Kerkering, Division of Infectious Diseases, has run a Foreign Travel program in the ACC that complies with the CDC guidelines. In April, 1998, the RCDPH transitioned its entire Foreign Travel Program to Dr. Kerkering, with an anticipated volume of 1,000 visits/year.

    3. Contracts for PPD screenings. The RCDPH currently contracts with City agencies and private companies to perform PPDs for many of their employees. These contracts are being renegotiated by MCVH

    4. The RCDPH will maintain a walk-in Immunization Clinic. However, MCVH will participated with the RCDPH, Bon Secours, Columbia, the United Way, and the MCV School of Nursing in a City wide 'Back-to-School Immunization Program" during the summer of 1998. This was so successful that plans are underway to develop a similar program for the summer of 1999 with hopes of having increases participation from MCV and community Pediatricians and Family Practitioners.

    5. The RCDPH has maintained responsibility for Case Management, care for TB patients (except X-rays), WlC, contact tracing and tracking of patients infected with communicable diseases and compiling and submitting quarterly reports to the State Health Department.

The establishment of the partnership with the RCDPH has provided the opportunity to look at additional initiatives that will be beneficial to the Health Sciences campus.

 These include:

1. Development of outcomes measurement tools for the City care program to assist in evaluating the impact on the population that is served.

2. Establishment of stronger affiliations w/the community health care providers through the development of formalized referral relationships and communications linkages.

3. Development of partnerships with community-based organizations that could or do provide support service to the City Care population.

4. Development of a care coordination model that will create cohesive networks that span the continuum of care for patient populations.

5. Creation of opportunities for the Schools on the Health Sciences campus to collaborate on ventures to support populations in the City of Richmond.