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  Faces of the Safety Net: Metro Community Provider Network by Jessica Waclawski A camera crew tested their equipment in a corner of a busy waiting room, where an oversized check leaned against a wall. A clinic in Jefferson County was celebrating a generous donation from a local business, a story worthy of media attention. “We are honored by the donation which is not just for MCPN but for all women,” announced David Myers, MCPN’s president. Four women grasped onto the $55,000 check being donated by King Sooper’s as a part of its Pink Tag Campaign that began in October 2007. For most of these women, MCPN was their first point of care that initiated their cancer diagnosis and served as a referral source to needed specialty care. Dianna Vigil is one of these women. In 2007, she awoke with an intense pain under her left arm. She scheduled an appointment at the Jeffco Clinic (named for its location in Jefferson County), her usual source for primary care. The clinic immediately referred Ms. Vigil to a specialist. She was soon diagnosed with a rare and aggressive form of inflammatory breast cancer. Without Vigil’s immediate access to Jeffco Clinic, her cancer could have remained undetected because she was otherwise unable to afford the diagnostic procedures provided by the specialist clinic without the Jeffco referral. “I wait tables, I don’t get any benefits,” said Vigil. “I’m not sure I can even go back to work. I’m used to carrying close to 30 pounds on my left arm and I’m not supposed to lift anything heavier than 10 pounds. I’ve been waiting tables for over 30 years so I don’t know what I’ll do. You just can’t ‘teach an old dog new tricks.’” “If Dianna wasn’t able to get on Medicaid, she probably wouldn’t be here today,” said Doloras Schuster, Vigil’s sister-in-law and proclaimed “cancer companion.” The Jeffco Clinic is a Federally Qualified Health Center (FQHC) and one of the 16 clinics associated with the Metro Community Provider Network (MCPN). MCPN serves as a “doughnut” of health care around the city of Denver, encompassing all of Jefferson and Arapahoe counties and a portion of Adams and Park counties. “We’re one of the best-kept secrets of Jefferson County,” said John Reid, MCPN’s vice president of development. Looking at the bustling waiting room, one would have to question just how well-kept that secret was. Five medical providers utilize 23 exam rooms at the Jeffco Clinic, seeing more than 100 patients each day. Beginning in 1989, MCPN was established in response to an identified shortage of primary care for the uninsured in the metro area. MCPN has experienced steady growth over the 18 years of its existence, fulfilling a goal of providing a network of primary care providers in the communities surrounding Denver. “We’re hopeful that we can make a difference and that the communities we serve will realize there are affordable places to go for quality care,” said Reid. In 2007, 72 percent of MCPN’s patients were at or below the federal poverty level—an annual income of $20,650 for a family of four. Sixty-four percent of its patients lack any insurance coverage. Because clinic administrators believe that individuals should contribute some amount to their health care, patients are asked to pay for their visits on a sliding-fee scale. Half of MCPN’s income is derived from patient-generated revenue with additional grant funding provided through the U.S. Department of Health and Human Resources through the Bureau of Primary Health Care, approximately $4.5 million annually. Elaborating on the importance of collaborative partnerships with other health care providers, Reid noted that an important role of MCPN clinics is to alleviate the reliance on hospital emergency departments as an access point for primary care for the uninsured. “We’re trying to save everyone money by creating medical homes,” said Reid. “If everyone is in this together, we can reduce costs dramatically.” Throughout his time at MCPN, CEO David Myers has maintained data on the communities and patients his clinics serve. His records indicate that MCPN’s service area is “shifting toward poverty,” with the ratio of those below 200 percent of the federal poverty level increasing—about $42,000 for a family of four. “People aren’t necessarily realizing this shift in their purchasing power since all of a sudden they can’t make ends meet. More is now being spent on what was once considered basic necessities that were usually covered by available income. People don’t want to see themselves as poor, but the money just isn’t stretching like it once did,” commented Myers. These increasing economic strains in MCPN’s service areas signify a potential for increasing number of individuals and families seeking MCPN’s services. All of the MCPN clinics are currently at or near capacity and cannot accommodate many more patients. Oral health care is of particular concern to MCPN staff as the single dental clinic has a two-month-long waiting list.This one existing dental clinic is housed in a high-rise on the same floor as the Tri-County Health Department in Aurora. One of the two dentists, Dr. Randal C. Krumm, joined the clinical staff after retiring from the military. “It’s a challenge working here. Because our patients have received less preventive care and some have never seen a dentist before, our patients are in poorer oral and physical health,” noted Dr. Krumm. “Preventive care is critical, especially for kids. Dental hygienists should be more available in the schools and also for counseling patients with diabetes to ensure they understand the oral-physical health connection.” Dental care can be more expensive and more time intensive than visits to a medical provider. According to Myers, MCPN dentists see between eight and 10 patients a day, while medical providers see around 25 patients. “Dental care is critical for overall health and for success in life. If you have bad teeth, it is going to be that much harder to get a job,” said Myers. MCPN is expecting to hear in June whether it will receive an oral health expansion grant to support the hiring of more dental hygienists whose role would be to monitor at-risk patients such as diabetics and pregnant women and to increase the volume of cleanings currently performed. “We keep writing these grants reaching out for additional resources,” said Reid. “We are devoted to each of our clinics, taking good measure to treat them equally. They’re like our kids and they all need attention and nurturing.” Nearing completion, a new clinic is being built that will double the capacity of MCPN’s clinics in Aurora, Adams and Arapahoe counties. This modern facility will boast a 35,000 sq. ft. building on 10 acres of land with the capacity to grow as demand warrants. The new clinic facility will host 48 medical exam rooms and 10 dental operatories. “We’re literally ripping at the seams,” said Reid, sporting a hard hat and goggles as he walked toward the clinic’s construction site. “That’s why we are so excited about this new facility.” A sense of pride for the care provided at the MCPN clinics is apparent. “Quality of health care includes the physical environment,” commented Reid, who noted that regular remodeling efforts keep the clinics up-to-date while maintaining high standards of quality. “We want a true doctor’s office feel. No alienation should occur just because our patients are uninsured,” said Reid. “Everyone has pride and they should be proud to come to our clinics.” For Myers, the introduction of health information technology into the clinics has been a great contribution to MCPN’s overall efficiency and quality of care, especially the adoption of electronic medical records (EMR). Turning every paper file into an EMR and training physicians in their use has been a major investment of resources and time for MCPN staff. As the clinics convert to EMRs, physicians carry laptops into exam rooms and use EMRs to retrieve medical records whenever necessary. “With the adoption of EMRs we have easier access to a patient’s medical history and as a result we are better able to address their specific health care needs. We can now track whether the health care we provide is improving health because of the data we have available,” said Myers. “Previously, we couldn’t drill down to the patient level when a chart was 30 miles away.” Myers is working on a population-based disease database where he can pool data on patients with specific chronic illnesses such as diabetes for the purpose of monitoring their illness and treatment regimens. Looking toward the future, Myers envisions continued growth in the use of interdisciplinary primary care teams that are focused on a fully integrated health care system. MCPN anticipates doubling the capacity of its clinics in the next five years and hopes to hire 20 additional clinicians. Recruitment of qualified primary care providers and referrals for specialty care will be ongoing challenges and will likely require public policy interventions to solve existing shortages in both areas. “I love my job. I find these times exciting and see so many opportunities and dreams being made possible,” said Myers. “It all provides meaning to my life.”
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