HOSPITAL/CLINIC UPDATE: Marin Community Clinics

Georgianna Farren, MD

Note: Each issue of Marin Medicine includes a self-reported update from one local hospital or clinic, on a rotating basis.

In last year’s update in these pages, I wrote that “change is the only constant for Marin Community Clinics as we adapt to community needs and a profession in flux. With an enthusiastic staff and tremendous community support, our organization is expanding services to meet the growing need for affordable healthcare.” That statement is as true now as it was then. Change continues to be the only constant at our clinics.

Marin Community Clinics--a Federally Qualified Health Center with medical clinics in Greenbrae, Novato and San Rafael and dental clinics in Novato and San Rafael--is celebrating its 40th year of serving as a vital part of Marin County’s healthcare safety net. Most of our patients are low income, and many of them receive public insurance such as Medi-Cal.

Over the past year, we have undertaken several initiatives to improve care and access to care at our clinics. We recently finished implementing NextGen electronic health records (EHRs) in all our medical clinics; our dental clinics have used the Dentrix system since we began providing dental care in 2008. The process was varied, with some clinicians starting EHRs with only a couple of patients per day, and others taking the “big bang” approach of selecting a target date to begin using EHRs with all patients. We have now begun to refine data collection and implementation of registries for disease management, and we expect to have many opportunities to improve care as we begin to use the newly available patient data.

Joining a national movement, we are also creating a Patient Centered Medical Home. In the PCMH model, the focus is on patient access, self-management, chronic disease management and team care. Patients are now being assigned to one primary care physician with a specific medical assistant. The PCMH relies on proactive staff members who engage with the patient to maintain or improve health. The timing is ideal, as we now have access to data and technology that allows for patients to be reminded of recommended preventive care, along with follow-up care for chronic problems.

This past year we had our most comprehensive reporting on quality measures ever. Partnership HealthPlan brought its Medi-Cal managed care system to Marin County in July 2011 and has an incentive program with targets for various healthcare outcomes and prescribing practices. As a result, we have had our first potential financial incentives for achieving quality targets. Medicare’s EHR Meaningful Use measures also require reporting on and meeting numerous quality criteria. Both the Partnership and Medicare programs clearly signal changes in the way medical services in primary care settings will be reimbursed in the future. The focus on quality measures is a welcome change.

We have also just completed our first full year of obstetric care in San Rafael. Together with Marin General Hospital and Prima Medical Group, we offer coverage of deliveries at the hospital. Patients may have a hospital delivery with either a physician or a certified nurse midwife. Our obstetric services team includes a licensed clinical social worker, Comprehensive Perinatal Services Program counselors, certified nurse midwives, obstetricians, and dental providers. We also offer the Sweet Success program for women with pre-existing or gestational diabetes. We will launch a smaller obstetric program in our Novato Clinic this fall.

For over 20 years, our Greenbrae Clinic has been located in a double-wide trailer on the grounds of Marin General Hospital--and the trailer is becoming less attractive by the day. We are actively looking for a site and the necessary funds to relocate the clinic in close proximity to the hospital. We not only want a better environment for staff and patients, but would also like to vacate the trailer to accommodate the hospital’s plans to use the space where the clinic is located.

The Supreme Court’s recent decision to uphold the Affordable Care Act should have a positive impact on access to healthcare for many of our safety net patients. Many currently uninsured Marin County residents will be able to get health insurance when the new insurance exchanges open and the requirements for Medi-Cal change from 100% to 133% of the Federal Poverty Level. The number of people eligible for Medi-Cal could increase by as much as 30%.

This increase in insured patients will allow for improved care and prevention for some of the more vulnerable residents of Marin County. Since the Affordable Care Act was passed in 2010, we have been taking steps to prepare for the changes it will bring, including newly insured patients seeking care. The relocation of the Greenbrae Clinic will be a crucial step in enabling us to accommodate larger numbers of patients.

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Dr. Farren, president-elect of MMS, is chief medical officer for Marin Community Clinics.

Email: gfarren@marinclinic.org