Adams Compassionate Healthcare Network (ACHN)/Hot-Spotting Initiative
Refugee populations in the United States are often unable to access healthcare services because of policies and payment schemes that create barriers to care. The Adams Compassionate Healthcare Network (ACHN) removes many of these barriers. While the concept of ‘free clinics’ is not new, having an interprofessional team that is particularly attuned to the needs of this particular population in a very small clinic is unique. The dedication and passion of the staff and volunteers, and the students receiving their clinical education, ensures our patients have the care and attention they need to move toward health and wellness.
ACHN is a free clinic in suburban Virginia. It seeks to provide high-quality, evidence-based healthcare to any person who is uninsured and lives in poverty. Most of our patients are immigrants and refugees from Muslim-majority countries. Our approach to healthcare is informed by the Chronic Care Model as most of our patients live with chronic conditions that are best managed through an interprofessional team in the clinic, and community networks.
Hot-spotting helps us to identify and provide targeted interventions for our highest-risk patients, including people living with uncontrolled diabetes or hypertension, or those who have mental health needs. Telehealth may be used to provide additional contact points between our patients and our providers.
The majority of our staff are volunteers with only three paid employees: a part-time Family Nurse Practitioner, and administrative assistant and the clinic director. We also provide clinical preceptorships for advanced practice nursing students, social work students, public health students and community health students. As a primary care site, we are able to provide care for the majority of our patients’ needs. Community partnerships with specialists and with social services that help address food, housing, and job insecurity ensure our patients are able to access the services they need to optimise their health and wellness.
The problem is refugees are often uninsured and have had little opportunity to access health care services in their countries of origin, often because of long-standing violence, poverty, and persecution. Even with the opportunity to access healthcare services at ACHN, some individuals still face barriers to accessing care, including transport problems. Most free clinics will see these individuals if they live in a specific geographic location or if they can provide proof of legal residency. These barriers cause individuals and families to forgo healthcare services in deference to obtaining food, housing and jobs. This leads to missed work time, and hospitalisations for uncontrolled diabetes, hypertension, cardiovascular disease, and undiagnosed cancers.
Most of our patients have had little to no healthcare services, especially preventive services such as a mammogram, colonoscopy, screening for diabetes, hypertension and hyperlipidaemia. Many have difficulty paying for medications, transport challenges and barriers related to illiteracy and language.
The services provided include:
- Primary care in the clinic; referral to specialty care and social services as needed
- Monitoring and evaluation of chronic diseases
- Impact assessment through chronic disease registry to help identify the highest-risk patients for targeted interventions (hot-spotting) and calculating the cost of care for all services provided.
- Advocating for Medicaid expansion and refugee-friendly policies
This model of care allows for holistic evaluation and treatment of all patients with targeted interventions for the highest-risk patients. Telehealth has been implemented as a tool to improve connection with patients and as a way to bring in translators as needed.
We do calculate the impact of the care provided in terms of the return on investment. Since the clinic started five years ago, nearly $1 Million dollars in services has been provided to care for 1,500 uninsured individuals ($500,000 in primary care services, $180,000 in prescriptions, $170,000 in referral savings, and $100,000 in volunteer services). In the past year, patient visits have increased 31%, volunteer hours increased by 207%, and an on-site physical therapy, eye clinic and pain management services have started.
A recent refugee from the Iraq presented with a six-month history of a breast lump that she had been unable to have evaluated because of lack of access to services. ACHN provided the diagnostic workup and care navigation into the treatment she needed to treat her breast cancer. We helped her apply for charity care at the local hospital and coordinated her specialist appointments. ACHN continued to provide primary care services throughout and after her treatment.