Caring for Vulnerable and Underserved Patients

When Mia Webster Cross, RN, BSN, describes the work she and her fellow clinicians and staff at Family Christian Health Center do each day, she uses words like “rewarding” and “mission-driven” and “meaningful.” But she’s also quick to say that the work can be very challenging.

Cross is the Director of Enabling Services and Programs at FCHC, a federally qualified health center in Harvey, Ill., a south suburb of Chicago that suffers from high rates of poverty and violence. The center treats more than 20,000 patients each year in its main center and two smaller satellite locations, providing services across a range of specialties, including family medicine, obstetrics/gynecology, pediatrics, behavioral health and dentistry. FCHC also has an on-site pharmacy.

“We try as much as possible to be a one-stop shop for our patients,” says Cross.

While that “one-stop shop” approach is one that many medical practices across the country are taking as they seek to differentiate themselves and retain patients, Cross says the center’s reasons are especially pressing. FCHC’s patient population is underserved and vulnerable, and by offering a range of services in one place, the center greatly increases the likelihood that its patients will receive necessary care.

“Many of our patients are indigent, they face violence and they have transportation and housing issues,” explained Cross. “Our area is also a food desert with no major grocery store nearby that sells high-quality food. A lot of our patients are regular users of local food pantries, but there is very limited access to fresh food.”

For Cross and the other 17 clinicians and 110 employees who work at the center, meeting the needs of those complex patients means looking for creative solutions to hard problems and making the most out of each patient interaction.

Who Are Underserved Patients?

FQHCs like Family Christian Health Center are safety-net providers that treat patients in medically underserved areas (MUAs) that have few primary-care providers and available health services. Underserved patient populations often face significant barriers to healthcare because of poverty, discrimination, violence, low health literacy and other factors.

These social determinants of health play a huge role in patients’ health behaviors and health outcomes and can mean the difference between a healthy life and one plagued by chronic disease and shortened by early mortality.

Cross sees the impact of social determinants of health first-hand every day. “Our patients face a lot, and it is not easy for them,” she says.

For instance, many of FCHC’s patients lack reliable access to transportation, making it very difficult to make it to specialist appointments.

“When you have to refer a patient out to a specialist, they often have to go to the city because the ones out here do not take Medicaid,” she explains. “That can mean three buses and three hours each way—or a delayed or skipped appointment.”

Meeting Patients Where They Are

To help surmount the steep challenges vulnerable patients face, Cross says it’s critical to really listen and respect them, build trust with them and recognize the realities that they face. She also emphasized the benefits of having clinicians and staff who reflect the patient populations they serve.

“We have to treat our patients holistically and meet them where their needs are,” Cross explains. “You can’t just give them directions, like ‘Go buy these foods,’ when they might not have any money. You need to build that relationship and make that 15-minute visit meaningful so they continue to come back.”

FCHC is also a Level 3 patient-centered medical home, she says, which demonstrates the center’s commitment to quality and strong relationships with patients.

Creative Problem-Solving

FCHC’s clinicians and staff have employed a wide variety of strategies to help meet patients’ complex needs, including offering pharmacy delivery services so patients without transportation can still get their medications, educating women on intimate partner abuse, teaching patients how to prepare healthier meals, and linking them with food pantries and housing services.

Additionally, the center is working on a grant to identify patients ages 13 and older who have been exposed to violence and linking them with behavioral health services.

And while these seem like tactics best-suited to FQHCs and other safety-net providers, the reality is most medical practices serve at least a percentage of vulnerable and underserved patients and can benefit from thinking more holistically and creatively about how to identify and help address the barriers they face.

Leveraging Technology to Improve Care

Technology plays a critical role in meeting the needs of underserved patients, according to Cross. The center was an early EMR adopter and is using telehealth to expand its reach. She also emphasized the benefit of collecting patient data automatically during the intake process, including income, family size, email addresses and phone numbers. The center is also looking at ways to consistently screen for health risks and social determinants of health.

“I think my top piece of advice for other organizations would be to use the technology that’s available to better understand your patients and connect them with the right services,” Cross says. “Beyond that, I would urge them to do a needs assessment for their population and to develop strong relationships with specialists. This is hard work, but it’s so rewarding to make a difference in these patients’ lives.”


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