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January 11, 2011 Portlandbiz

New clinic CEO aims to broaden patient base

Photo/Rebecca Goldfine Leslie Brancato, the new CEO of the Portland Community Health Center, says the center can be a resource for employers

On a recent morning at the Portland Community Health Center on Park Avenue, the few patients waiting to see doctors in the yellow-walled lobby were having quiet conversations in three languages -- Somali, Arabic and English.

The staff and health care providers at the clinic have no problem treating the many non-English speaking patients who come through their doors, because they can hire translators to help these patients communicate. What presents a greater problem instead, at least in Leslie Brancato's eyes, is that people are waiting at all.

"People don't want to wait," Brancato says. "The challenge for us is to think differently, and how to deliver health care in a way that really satisfies the community."

Brancato is the new CEO of the Portland Community Health Center, which has a mandate to provide affordable, high-quality care to any patient, no matter his or her health insurance coverage or ability to pay. She says she and her 15 staff and health care providers are trying to take steps to shorten the time between when someone calls for an appointment to when he or she walks through the clinic's door and sees a provider.

Thinking creatively about how to improve health care -- even about such seemingly unavoidable fates as hanging around a waiting room -- is what Brancato is striving to do in her new position. (She is also the director for Health Care for the Homeless Center, a 19-year-old sister clinic on Portland Street.) The 55-year-old replaced the center's first director, Carol Schreck, who resigned last spring, and left her position as head of Community Counseling Center in Portland, where she had been since 2001. Brancato is from Austin, Texas, and has a master's degree in social work.

"When I heard about the opportunity, my heart opened up to it," she says. "What was exciting and drew me to it was all of the innovation, and how we can approach people's health care from a holistic perspective. It is an incredible opportunity to build an organization and a vision of care."

Portland's community health center is the first federally qualified community clinic in Cumberland County, and this status entitles it to higher Medicaid reimbursement rates and allows it to treat underserved and vulnerable populations. After being open for about 14 months, it now sees more than 1,200 patients. But health care experts say as many as 4,400 to 4,800 people in Portland still lack access to primary care.

Doug Gardner, director of the Health and Human Services Department for the city of Portland, which helped the center apply for federal funding, says up to this point the center has focused on developing the board and hiring qualified providers. Part of Brancato's job will be to grow the center and get the word out. "Now we're at a place ... where we'll focus on marketing outreach to the underserved communities," Gardner says. "It is the next incremental step in the evolution of the health center."

Brancato says in particular she wants to reach out to employers.

"We're an excellent resource for employers," she says, explaining that companies are not always aware that they have employees who are on MaineCare (the state's version of Medicaid), or have staff who, even with a company health insurance policy, still struggle with their co-pays, perhaps because they have a child with special needs and high medical bills.

Portland's break

For years, Portland was not considered a needy spot for a federally qualified center because of its two hospitals and many medical services. The city was even denied federal money in 2008 when a group of stakeholders in the Portland medical community applied for a Health Resources and Services Administration grant to open a center. But when economic stimulus money became available to pay for such health clinics, Portland's application was dusted off and funded.

Portland received $1.3 million in startup funding and opened in November 2009. HRSA will be a continuous source of funding, based on whether the center continues to demonstrate its success in providing health care to the poor.

But along with treating Medicaid patients, which many clinics cannot afford to do, and offering a sliding scale to people with no insurance, the Portland Community Health Center also wants to attract people who have private insurance and want more health care options.

"The intention is to have a full mix [of patients]," Brancato says, by providing quality care that will bring in patients from different socio-economic backgrounds.

The center's current annual budget is $1.7 million. One-third of the center's funding comes from HRSA grants, with the remainder coming largely from MaineCare (about 60%) and then Medicare, private insurance, self-pay and small grants, according to Brancato.

At the moment, the center offers physical and mental health services, substance abuse addiction and osteopathic therapy. By next year, it hopes to offer dental care onsite as well.

Unlike the free clinic on India Street, which is staffed by volunteers, Portland Community Health Center is designed to be a "primary medical home," as Brancato puts it, "offering comprehensive high-quality care throughout a patient's life."

The center will emphasize patient-provider relationships. "The more that providers know patients, and treat them holistically [by looking at mental health and substance abuse as well as physical health, for example], the more likely they'll stay out of more expensive care," Brancato says.

Community health centers are seen as central to solving the current health care crisis, explains Brancato. It is believed 56 million Americans lack access to basic health care, according to the National Association of Community Health Centers. Centers such as Portland's focus on early treatment, screening and seeing patients who might delay seeking health care until their medical issue lands them in an emergency room or has advanced to a severe stage.

The National Association of Community Health Centers also estimates that health centers save the health care system $9.9 billion to $17.6 billion a year.

The health care providers at Portland's center are salaried, so they're not under the same kind of pressure to bill for procedures, Brancato explains, allowing them to spend as much time as they need with a patient. Two weeks ago a very ill man came into the clinic, and ended up spending six hours there receiving treatment.

"That wouldn't be doable in a regular setting," she says.

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