community health programs visited by task force february 1969 through september 1971 The narratives presented in this section contain information that was accurately recorded at the time of the site visits by the Task Force. It is recognized, however, that vital changes in the operation and sponsorship of some of these community health programs may have occurred in the time that elapsed from the time of the site visits to the publication of these narratives. The community health programs are presented in alphabetical order by city location instead of by chronological order of site visits. PROJECT AND LOCATION Atlanta, Georgia: Atlanta Southside Comprehensive Health Center Baltimore, Maryland: East Baltimore Medical Plan Boston, Massachusetts: Bunker Hill Health Center Harvard Community Health Plan Health, Incorporated Tufts-Columbia Point Health Center Bronx, New York: Hunts Point Multi-Service Center Corporation Health Center Chicago, Illinois: Illinois Masonic Medical Center Martin Luther King Neighborhood Health Center Columbia, Maryland: Columbia Medical Plan Denver, Colorado: Denver Neighborhood Health Program Estancia, New Mexico: Hope Medical Center Fresno County, California: Fresno County Medical Society-Firebaugh and Mendota Health Care Jacksonville, Florida: East Jacksonville Neighborhood Health Center King City, California: King City Health Center Lafayette County, Florida: Lafayette County Health Center Los Angeles, California: Watts South Central Multipurpose Health Services Center Miami, Florida: University of Miami Projects New York City, New York: Brooklyn-Cumberland Medical Center East Harlem Triangle Community Health Project Phoenix, Arizona: Samaritan Health Service Surgicenter San Francisco, California: Mission Neighborhood Health Center Santa Fe, New Mexico: Presbyterian Medical Services Remote Area Health Project Wakita, Oklahoma: Wakita Health Center Washington, District of Columbia: Upper Cardozo Health Center George Washington University Medical Center Delivery System ATLANTA SOUTHSIDE COMPREHENSIVE HEALTH CENTER The Atlanta Southside Comprehensive Health Center is funded by an Office of Economic Opportunity grant. The Fulton County Medical Society is the administrating agency, and it subcontracts the authority and responsibility for operating the Center to the Department of Preventive Medicine and Community Health of Emory University. The director of the Center reports to that department. The policy-making board for the Center initially had been the Emory University Board of Directors; however, the community advisory group has become the Board of Directors of the community health corporation. The Center was founded to provide higher quality comprehensive health care to the residents of the Price area, which is a concentrated poverty area. The Center has a target population of 28,000 persons, of whom 19,722 were registered at the Center as of July 31, 1971. Prior to the establishment of the Center, there was one physician and no dentist in the community and rates of disease were high. A broad range of services is provided by the Center, including family medicine, dentistry, psychiatric counseling, physical therapy, minor surgery, xray, laboratory analysis, and pharmacy. Emergency treatment is also available at the Center. Social services are provided by the outreach personnel. The Center maintains 14 vehicles that provide transportation to the Center about 12 hours per day for patients when ordered by a physician. There is also public bus service within the area. Inpatient care and other backup services are provided by Grady Hospital, a city-county hospital operated as one of Emory University's teaching hospitals. A system has been devised that permits Center personnel to prepare admission forms for patients who must be admitted to the hospital. In addition, a special "referral team" at the hospital coordinates the admissions of patients referred from the Center. The staff of the Center utilizes a team concept for the delivery of health care. Each team consists of 31 members, including two physicians (an internist and a pediatrician), nurses, clinic health assistants, community health assistants, social worker assistant, dentist, dental hygienist, and dental assistants. A team director coordinates their administrative functions with a team manager handling routine matters. Patients are assigned to a specific team according to their geographic location, and this allows for an equal distribution of patient load. The health care facility is an old factory, leased and renovated with funds from OEO. There are six waiting rooms. Letter symbols and color codes are used to denote the various areas of the facility. The atmosphere inside is more personalized and cheerful than most public hospital waiting rooms. The Center is open from 8:30 a.m. to 9:00 p.m. on Monday and Tuesday and from 8:30 a.m. to 5:00 p.m. on Wednesday through Friday. Target area residents are given priority for employment at the Center. Sixty-five percent of the staff is Price area residents. Whenever possible, onsite training programs are conducted, for example, a 12-week "health assistant" training program prepares area resident employees for work at the Center, either on the health care teams or in the outreach component. Approximately 98 area residents have been trained as community health assistants through this program. In-service and continuing training is available for employees to provide them with an opportunity for upward mobility. EAST BALTIMORE MEDICAL PLAN Baltimore, Maryland The East Baltimore Medical Plan is a program designed and administered by the Johns Hopkins University Medical School to offer comprehesive health services to disadvantaged residents of the East Baltimore area. Financing for the overall planning and development of the program was provided through a $75,000 grant from the U. S. Public Health Service. A planning task force began actively functioning in May 1969 and developed a program for a community-owned, prepaid group practice health center financed through enrollees and private, local, state, and federal sources. The program is planned in two phases. Phase I is the creation of a temporary facility to serve 5,000 persons drawn from residents of four Baltimore city housing projects. Phase II involves the establishment of a permanent facility on a site selected by the East Baltimore Community Corporation about seven blocks from the Johns Hopkins medical facilities. The areas for both facilities contain a large concentration of young people, with 46 percent being under 21 years of age. The population is predominantly black and exhibits many of the socioeconomic characteristics of the urban poor. The median family income is approximately $2,900 per year. Nearly 40 percent of the population is receiving public assistance. The average educational level is approximately 8th grade. In the East Baltimore community, there are 11 physicians for 100,000 persons. All but three of these physicians are in their 60s. Approximately one sixth of all Baltimore residents receive some medical services at Johns Hopkins Hospital. In a recent year the number of emergency service visits reached 119,000, with about 70 percent of the patients using the emergency room for nonemergency complaints. Although the emergency cases are treated immediately, the less acutely ill can wait as much as 41⁄2 hours. Once examined, patients are often given appointments at specialty clinics, and an average delay of 14 days is reported. The East Baltimore Medical Plan offers a broad range of services including laboratory and x-ray services, emergency care, prescription drugs, alcoholism treatment, family planning services, drug addiction treatment, mental health care and counseling services, in-hospital care, immunization services, vision and hearing examinations, routine checkups, prenatal and postnatal care, and nutritional services. The hospital care benefits will include unlimited days of hospital care in a semiprivate accommodation at the Johns Hopkins Hospital, complete physician's care, ambulance service when ordered by a physician in the program, and all medications. Hospital benefits also cover obstetrical and psychiatric care. Social services include those traditionally provided under Medicare and Medicaid. The East Baltimore medical facility will be open from 9:00 a.m. to 7:00 p.m. five days per week and for three or four hours on Saturday. A physician's assistant will be on call 24 hours a day. The Plan utilizes the health team concept. Each of the teams consist of two primary care specialists, one primary care assistant, a pediatrician, an internist, two health associates, and four family health workers. Teams are supported by a common administrative staff. Team physicians have scheduled office hours, supervise inpatient care, train allied health personnel, and participate in team conferences. The health associates establish continuity of care by assisting physicians during examinations and treatment, and also by registering patients with the Center. Family advocates are persons from the community employed by the project who will act as "mini-social workers." Training of personnel for the East Baltimore Medical Plan is coordinated within the Hospital and the Health Services Research and Development Center of Johns Hopkins. One unusual aspect of the East Baltimore Medical Plan is the prepaid group practice arrangement with the state, in which a system of per capita payments for Medicaid-eligible patients was approved for the community residents by the Maryland Legislature. Prior to the East Baltimore Plan, health care financing was fragmented and disorganized. The Plan is attempting to combine the present sources of financing medical care, such as Medicaid, Medicare, Comprehensive Health Planning-314(e), Children and Youth Project 609, and the Blue Cross, commercial insurance, and private payments under a single administrative structure. In Phase II of the program, Blue Cross will be heavily involved and pay the capitation rate for their subscribers. Under an incentive program, the physicians of the Plan will attempt to reduce utilization and cost of medical care delivered and thus will be allowed to retain a portion of the difference between the capitation payment and the cost of providing medical services. BUNKER HILL HEALTH CENTER The Bunker Hill Health Center of the Massachusetts General Hospital is a community health center operated by the Massachusetts General Hospital. Realizing that the major health problems in the health care delivery system revolve around the four basic issues of access, cost, manpower, and quality, the Massachusetts General Hospital decided to become involved through a decentralization of health care delivery. The Center represents a major partnership endeavor between the Boston Department of Health and Hospitals, the Boston and Archdiocesan School Departments, and the Massachusetts General Hospital. The City of Boston public health services, such as well-baby clinics and tuberculosis control, have been assigned to the Massachusetts General Hospital. Responsibility for school health programs in the Charlestown area has been delegated to the Center physicians. The Bunker Hill section has many characteristics that contribute to a good health demonstration program. It is approximately one mile from Massachusetts General Hospital, has the second largest and oldest housing project in the Commonwealth, has a cross section of income, and is a relatively isolated community. Its 16,000 residents include about 7,000 children, 6,000 middle-aged, and 3,000 elderly. Ethnic characteristics of the area served are 65 percent Irish, 25 percent Italian, and some Puerto Rican. The median family income is approximately $5,000-$6,000, and principal types of employment are government, dock work, and trucking. The median education level is high school, with less than 10 percent having gone to college. The Center offers primary health care to all who wish to use its services. There are no restrictions based on income or age. The primary care units are two health teams, each consisting of a full-time internist or family physician, pediatrician, nurse, nutritionist, and social worker. Part-time physicians supplement these teams. There are full-time dentists and ophthalmologists at the Center. Twenty-five percent of the space and the personnel in the Center is devoted to psychosocial health. A full-time psychiatrist, a psychologist, and mental and social health workers support the health team. Other specialists are regularly scheduled as the need is identified. All physicians have appointments at Massachusetts General Hospital in their respective specialties. The Bunker Hill Health Center also has its own x-ray and laboratory. Inpatient care is provided at Massachusetts General Hospital. There are a number of special health programs available to the patients, including speech and language therapy and physical therapy. A major project is the nutrition program, which works with 200 patients per month. This program concentrates on counseling and consumer studies, with a great deal of nutritional integration into all health programs. The nutritionist has |