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 VCU hospitals. 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 VCU 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.VCU health systems will contribute over $500,000 to support these clinical services and the associated administrative structure of the programs.
Provision of clinical services for the testing and treatment of communicable diseases. This program is housed at the Public Services Building located on 10th Street. Specific programs that are continuing under Mach's management will include treatment for STDs, TB, General Relief Clinic, Refugee and Immigration Services.
Continuation of the services at the Hayes Willis Health Center (previously known as the South Richmond Health Center). The Hayes Willis Center was established in 1994 as a collaborative program between the Richmond City Department of Public Health (RCDPH) and VCU health system. The purpose of the program was to combine public health department services and primary care in one setting. After successfully demonstrating the reduction in the overall cost of care, it has been determined that this program should remain intact at its current location.
Development of a program to provide Women's and Children's public health services in VCU Hospitals clinics, VCU physicians' and community physicians' offices. This program has been named "City Care" and is anticipated to serve approximately 5,000 patients who are currently uninsured. Primary care physicians who are participating providers in City Care receive an "administrative fee" to manage the care of a defined population. In addition to this fee, physicians will have the ability to charge patients for services according to the guidelines established by the Virginia Department of Health.
Financial screening of patients who present for services in various locations (to include screening for Medicaid eligibility).
Enrollment of qualified patients into the City Care program. This includes assisting patients in choosing a primary care physician (PCP), distribution of City Care cards and a review of the benefits of the program.
PCP's receive timely communication regarding the patients that have chosen him/her as their provider.
All ancillary and specialty referrals should be made to VCU facilities. (There are no patientpayments associated with these services).
Medications and vaccinations that are currently provided for City Health Department patients continue to be available for City Care patients.
Establishment of a health care delivery model that supports the concept of continuity of care for patients.
Reduction in the inappropriate utilization of the VCU hospitals Emergency Room for non-acute services for a defined population of patients.
Reduction in the overall cost of health care through the integration of primary care and preventive health care programs.
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 VCU 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 VCU hospitalsH Pharmacy has developed mechanisms to incorporate the dispensing of these medications into its existing work flow.
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.
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 VCU hospitals.
The RCDPH will maintain a walk-in Immunization Clinic. However, VCU health will participated with the RCDPH, Bon Secours, Columbia, the United Way, and the VCU 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 VCU health and community Pediatricians and Family Practitioners.
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.
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.