The following feature from the spring 2017 issue of The Ohio Family Physician provides a spotlight on Lower Lights Christian Health Center in Columbus, OH. Lower Lights is a federally qualified health center (FQHC) serving 13,000 patients in six neighborhood locations throughout Columbus.
Look for other features from the issue in upcoming editions of the Weekly Family Medicine Update, on the OAFP website, and on the Academy’s Facebook and Twitter pages.
“Oh, I always see Dr. Dana—she’s my doctor. You’ll love her.” This was the patient chatter in the waiting room of Lower Lights Christian Health Center in the Columbus neighborhood of Franklinton on a very busy Friday afternoon. Dr. Dana is Dana Vallangeon, MD, chief executive officer of Lower Lights.
In 2015, FQHCs provided care to over 623,000 Ohioans and recorded over 2.1 million patient visits. Collectively, community health centers are the largest health care system in the nation, and are considered a highly efficient health care delivery model by the U.S. Department of Health and Human Services. FQHCs provide primary and preventive care to all patients regardless of a person’s insurance status or ability to pay. The wide range of assistance available to patients through FQHCs include medical, dental, vision, transportation, translation, pediatrics, behavioral health, substance abuse, health education, and insurance enrollment services.
Lower Lights, like most other community health centers, is more than a traditional family medicine practice. It is a full-service patient-centered medical home (PCMH) focused on whole person wellness. Available to all central Ohioans who need health care, Lower Lights accepts Medicaid and Medicare as well as most private insurance plans. For those without insurance, payment is measured on a sliding fee scale based on income, with most patients paying $10.
As patients in the waiting room enthusiastically discussed Dr. Vallangeon, others walked out carrying their medications in brown paper bags. The smiles on their faces showed their appreciation—they had just paid very little to nothing for their much-needed prescriptions. Other grateful patients surveyed the complementary hats and gloves behind the front desk—available to anyone needing warm winter gear for a cold day.
The state-of-the-art 16,000 square foot health center, the largest of the Lower Lights locations, is just a portion of a once abandoned 40,000 square foot warehouse transformed to a health facility featuring vision and dental centers, a fully-functioning pharmacy, nutrition consultation, a pregnancy center, and a nonprofit hair salon (yes, hair salon). Lower Lights plans to add a grocery store and a café in the near future. These ancillary services make the transformed warehouse a haven for health with its own medical neighborhood onsite.
“The FQHC model of care is, in a way, the model of care that the PCMH is based upon. It is the chief model for primary care,” said Dr. Vallangeon. “We are already ahead of the curve with all of our services. We have been a PCMH since 2010, and we already had the basics as a community health center in order to get PCMH recognition.”
Lower Lights became a PCMH in 2010 by participating in the AccessHealth Columbus (now Healthcare Collaborative of Greater Columbus) PCMH Improvement Project. From late 2011 to late 2014, the Centers for Medicare and Medicaid Services (CMS) funded a huge nationwide effort called the FQHC Advanced Primary Care Practice Demonstration Project to get FQHCs to level 3 National Committee for Quality Assurance (NCQA) recognition. While Lower Lights didn’t participate in all phases of the project, they did participate to get their second NCQA accreditation. Hundreds of FQHCs across the nation, including Ohio FQHCs, took advantage of this incentive to become PCMH recognized as a foundational method to be able to deliver advanced primary care to patients. Ohio now has 126 PCMH FQHCs statewide, making them one of the largest PCMH primary care networks in the state.
According to the Ohio Association of Community Health Centers, FQHCs are conceived, cultivated, and administered locally. As community leaders realize a need for health care and apply for federal funding, successful applicants receive annual grant money from the Bureau of Primary Health Care. This grant funding is used to serve the growing uninsured population. Furthermore, health center boards are required to have a 51% patient majority, and must be sensitive to the needs of their patients and community.
The No. 1 source of funding for Lower Lights comes from insurance claims and the second source is from U.S. Health Resources & Services Administration grants.
“We do get a small bonus for each of our sites being a PCMH, but beyond that there is no value-based payment for being a PCMH. We also receive payment for quality improvement measures from managed care plans,” said Dr. Vallangeon.
Despite being successful and highly functioning PCMHs, FQHCs are not eligible to participate in the CMS Comprehensive Primary Care Plus program. They are also not eligible to participate in either the merit-based incentive payment system or the advanced alternate payment model of MACRA. However, Lower Lights does plan to participate in the Ohio Comprehensive Primary Care program.
“A visit to Lower Lights is like visiting family,” one patient explained. “Everyone greets me with a smile. I feel the love.”
This PCMH, one-stop shop concept of whole person wellness truly defines the primary care model of caring for the patient—body, mind, and soul.