Milwaukee’s central city is ground zero for the challenges in today’s health care environment. Progressive Community Health Centers is confronting these challenges straight on.
The Milwaukee-based organization is expanding the footprint of its Lisbon Avenue Health Center, located at 3522 W. Lisbon Ave. on the city’s north side, by constructing a new $11 million facility.
Progressive Community Health Centers has outgrown its current space in a deteriorating 100-year-old, two-story building where closets have been converted to offices, waiting rooms are used as education centers and every nook and cranny is utilized in some way, shape or form.
The new three-story building, now under construction next door to its current location, is set to open in February of 2015. It will significantly increase the organization’s capacity to impact a community that desperately needs its services. The new facility will be 42,000 square feet, compared with the existing 8,500-square-foot facility.
“We are getting much bigger,” said Sarah Bailey, director of fund development and marketing for the center. “We will be able to serve an additional 11,000 patients a year in the new facility, which is quite huge. Right now, between this facility and our Hillside facility (the Hillside Family Health Center at 1452 N. Seventh St.), we see about 7,000 patients a year. We are more than doubling our capacity to see patients.”
Ninety-three percent of the patients served at Progressive CHC are either uninsured or are on Medicare or Medicaid. Sixty percent of its patients are at or below the federal poverty level. More than 40 percent of the people who live in the organization’s service area do not have a primary care physician.
Progressive CHC is uniquely suited to meet the needs of that population. As a federally qualified health center, it is designed specifically to reach patients who are uninsured or receive public assistance for health care. The majority of those patients, said Jenni Sevenich, chief executive officer at Progressive CHC, are the working poor.
“We’re specialists in providing care to this population,” Sevenich said. “The population that we serve suffers from high levels of poverty and unemployment. The business community needs to care about their health so that they can work. It’s part of the total picture. We hear ‘education is the key’ or ‘jobs are the key,’ but if you’re not well, none of that matters.”
‘Access gap’
Sevenich said people need to understand that in addition to supporting uninsured and underserved individuals through taxpayer-funded public assistance programs, there is a need to address an “access gap” that exists in underserved central city communities where health care facilities are not always easily accessible.
“(The Lisbon Avenue Health Center) is an access point that’s in their neighborhood,” she said. “Most of the primary care providers – and most of the providers, not just primary care – are located in the edges of Milwaukee County, not in the central part where most of the population lives. We can provide an access point to care in their neighborhood, where they’re more likely to access care in a more appropriate place than, say, in an emergency room in a non-emergency situation.”
“Just because you have insurance doesn’t mean you have access,” Bailey said. “There’s a big difference, and there’s a big gap there.”
The access gap in the central city has a domino effect, impacting many other aspects of health care, Sevenich said.
“When people are not able to access care or are not able to get care that works for them, then they’re going to go to the emergency room, and they’re going to get admitted,” she said. “That’s what drives up the cost of health care. If they’re on Medicaid, that means more Medicaid payments. If they’re uninsured, it means we’re all paying – all of us who are covered with insurance, that just gets passed on to us with our premiums. That’s why premiums go up. (The business community) still needs to care. Even though, yes, you’re paying for Medicaid and Medicare through your taxes, and the Affordable Care Act does exist, you still need to care. It’s still important to the vitality of the community.”
Before coming to Progressive CHC, Sevenich worked as the director of mission integration at the Milwaukee corporate headquarters of Ministry Health Care. Her career changed course when in 2000, she went to a conference focused on racial and ethnic health disparities in Milwaukee.
“It had such a profound impact on me,” she said. “When I saw the data on the health disparities African Americans suffer from compared to the white population, the differences were striking.”
In Milwaukee County, 433,000 people – 46 percent of the population – are uninsured or receive public assistance for medical care.
“We can’t ignore it as a city,” Sevenich said. “We can’t. Look at our statistics. They’re shameful. This is the number one worst state for a black child to grow up in. That is disgusting. It’s not just education. It’s not just jobs. It’s a bigger picture than that. With the health disparities, it starts with the infant mortality crisis and goes until they die…If we don’t do something about that, shame on us as a city.”
More than 80 percent of the patients Progressive CHC serves are African American.
“There is institutional racism (in Milwaukee),” Sevenich said. “That cannot be denied any longer. I certainly experienced it with people I’ve worked with.”
Bailey said work being done at Progressive CHC’s current facility mainly focuses on primary care and includes family medicine, internal medicine, pediatrics, financial counseling, onsite lab services, women’s health services, education programs and dental services.
Progressive CHC has a licensed clinical social worker on staff to assist patients in a variety of ways.
Translation and interpretation are other key parts of Progressive CHC’s ability to provide care to those in its neighborhood. According to the Wisconsin Primary Health Care Association, 32 percent of all patients seen at Milwaukee health centers (in 2013) were “best served” in a language other than English.
“In this area, especially right around Vliet Street near the Hmong American Friendship Association, there’s a high concentration of Hmong families and Somali immigrants as well,” Bailey said. “They’re moving into this area because they can get large housing stock, because they have large families, and they can get it at a pretty decent cost.”
Dental care is key
The range of providers at Progressive CHC includes medical doctors, family nurse practitioners, physician assistants, registered nurses, medical assistants, an obstetrician/gynecologist, women’s health nurse practitioners and dentists.
The new facility will make room for an expansion of all of those services. It will also add 24 primary care suites, six OB/GYN suites, three specialty care suites, administrative office space, a phlebotomy laboratory and 13 dental suites.
Dental services are “huge for the community,” Bailey said, and will make up the entire first floor of the new facility. Progressive CHC is among the very few facilities to provide dental services to the uninsured population.
“There’s a big shortage in dental access, especially for those who are uninsured and for low income populations,” Bailey said. “There are not a lot of places people can go if they don’t have insurance to get proper dental care, especially considering most of our patients need more than just a cleaning. Most of them have never been to a dentist or they haven’t been in quite some time, so they come with a lot of chronic problems that take a while to address.”
In addition, Progressive CHC is looking to add more mental health and behavioral health services at the new facility, and the expansion of those services is currently pending with a federal grant application.
“The thing that I’m most excited about is doing more health education,” Sevenich said. “We’ll have the health education center so we are really going to go after those root causes in a more robust way.”
Vital partnership
More services are provided through Progressive CHC’s close partnership with Froedtert and the Medical College of Wisconsin. The health system provides significant financial support and various resources, as well as additional specialty clinical services.
Froedtert committed $2 million toward the construction of the new facility, and is heavily involved in both Progressive CHC and the Washington Park neighborhood that surrounds it.
John Balzer, vice president of facility planning and development for Froedtert Health, also is the vice president of the board of directors at Progressive CHC.
“It’s the most important investment we’re making in the community,” Balzer said of Froedtert’s involvement with Progressive CHC. “Being able to provide preventive coordinated care is really key to improving overall health – reducing hospitalization and reducing unneeded ER visits that drive up the cost of health care. That’s certainly where a lot of these individuals would end up if not for the neighborhood opportunity.”
Balzer said Progressive CHC is a “terrific” organization.
“There’s an incredibly passionate and dedicated staff working on that site,” Balzer said. “Everyone at Froedtert and the Medical College of Wisconsin is really excited about this new building. Currently, we know we’re providing high-quality care, but patients will be getting that care in an environment that is much more appropriate (at the new building).”
Froedtert’s investment also extends into the Washington Park neighborhood.
“What Froedtert has chosen to do is focus on a neighborhood,” Sevenich said. “Not only do they look at the clinical health care, but they look at the health of the neighborhood, as well. … All of their executives take a tour of the Washington Park neighborhood. Froedtert will often fill a bus with their managers and executives and bring them on a tour of the whole neighborhood, including here, so the executives understand their investment in the City of Milwaukee.”
Froedtert also funds a full-time nurse at Westside Academy, a public school on the same block as Progressive CHC, and participates in several other education and outreach programs in the neighborhood.
Recently, Progressive CHC has also been tasked with providing enrollment assistance for the Affordable Care Act and received about $75,000 in federal funding to hire additional financial counselors to assist in enrollment activities, Bailey said.
“We as community health centers across the nation were really charged with enrolling as many people as possible into the marketplace,” Sevenich said. “We’re very proud to say we enrolled more than anyone in the city.”
Remedial education
In addition to enrollment, Progressive CHC has educated the population it serves on the basics of health insurance.
“Prior to enrollment is education. What does it mean to have insurance? What is a premium? What is a deductible? What is a co-pay?” Bailey said. “People (we serve) don’t have email addresses. (We have been) teaching them how to use email, how to sign up for an email address and how to check it. So it’s very remedial education with regard to insurance, and that’s ongoing.”
The Affordable Care Act and changes to Wisconsin’s Medicaid program have impacted Progressive CHC and the population it serves. Even being insured through the Affordable Care Act marketplace, however, does not always solve all problems, Bailey said.
“A key point about the Affordable Care Act, which I think has come to light for most people now, is that it does not mean that everybody is going to have insurance, especially for a population like ours,” Bailey said. “For those people who are maybe 100 to 150 percent of the federal poverty level, they’ve now gotten kicked off of Medicaid. Many of them are not going to be able to afford their premiums for private insurance on the marketplace. So now, they’re uninsured. They’re going to remain uninsured.”
Sevenich said Wisconsin Gov. Scott Walker’s rejection of a federal expansion of Medicaid through the Affordable Care Act will have a “significant impact” on Progressive CHC.
“(Medicaid expansion) would make a big difference in terms of continuity of care and getting people ahead of the curve instead of always being so chronically sick,” she said. “When people are healthy, they are able to share their gifts. They’re able to work. When they’re not healthy, and when they can’t access their health care and when they have things like diabetes and hypertension that are keeping them disabled, they’re going to end up on disability. So you’re going to pay for them forever. So pay now. Get them on Medicaid up front. Get them healthy so that they can work. Or pay later for the rest of their lives.”
While Wisconsin recently chose not to implement a Medicaid expansion that was part of the ACA, which resulted in the removal of thousands from state BadgerCare Plus coverage, the state simultaneously expanded Medicaid access for thousands of low-income childless adults.
To construct its new building, Progressive CHC received a one-time, $5 million grant through the ACA. Additional funding has come from Froedtert ($2 million), the Milwaukee Health Care Partnership ($500,000), a City of Milwaukee block grant ($100,000) and the Elizabeth Elser Doolittle Trust ($25,000).
Sevenich said Progressive CHC did a new markets tax credit financing deal with the help of Whyte Hirschboeck Dudek S.C. and worked with IFF, a community development lender, on a permanent loan.
Expanding into the new facility is a five-year plan that will incrementally add 35 new jobs, Sevenich said.
Construction on the new facility began in winter, and has picked up rapidly after struggling with severe weather and other unexpected challenges at the outset.
Progressive CHC will continue to face funding challenges in its effort to accomplish its goals. It receives a base grant through the federal government – largely to serve its uninsured patients – that is about $1.5 million annually, Bailey said, and amounts to about 25 percent of its overall budget.
The Affordable Care Act has also allocated federal funding for community health centers around the country, Bailey said, because “it’s a model that works.”
“Traditionally, community health centers have garnered bipartisan support,” Bailey said. “President George W. Bush was one of the biggest supporters of community health centers. He did the math. The math showed that sending people to community health centers, building community health centers and providing those services is the most cost-effective way to take care of people, especially populations like ours that probably need a little more support going through the process.”
Receiving federal funding, however, is never a certainty.
“Every year, we’re always at risk of losing our funding,” Bailey said. “The way the federal budget is passed, there’s always a chance that they could axe our funding. We hope that it’s an unlikely chance, but we never know.”
Sevenich said she is tired of Milwaukee’s prevalent “us and them” mentality, which impedes progress in the city.
“Whether it’s racial, whether it’s economic, whether it’s city and suburb, or political – and the political one is huge – enough of that,” she said. “Enough. Let’s all get in the sandbox and play nice together. Let’s quit throwing sand at each other and let’s build a castle.”
