Clinic Leaders Add Mental Health, Support to Primary Care

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For 30 years, a group of small clinics have provided primary healthcare to residents in Maricopa County, Ariz. (30% Latino population).

A few years ago, the leadership of those clinics—Dr. Avein Saaty Tafoya and Lisa Blue—recognized that local residents continued to face cultural, language, financial, and other barriers to proper comprehensive healthcare.

They felt compelled to change the entire approach of their clinics.

Adelante Healthcare System began to seek grants and partnerships to add personnel to expand beyond their historical focus on primary care.

Today their new team—primary care physicians, specialists, health coaches, mental and behavioral health social workers, and others who connect families to insurance, health education, and more—provide more personalized care that engages patients in preventing health problems.

Latinos and Barriers to Healthcare

Many Latinos in Maricopa County suffer higher rates of disease, more obesity, and mental health issues.

Why?

Latinos, compared to non-Latino whites, tend to have less education, less income, and face greater barriers to healthcare, including less insurance coverage, more poverty, and cultural and language issues.

Clinica Adelante had aimed to improve the health of the community since 1979.

They focused mostly on primary care.

But it became clear they needed to extend beyond primary care, said Dr. Avein Saaty Tafoya, CEO of Clinica Adelante, which became Adelante Healthcare System in 2009.

Lisa Blue, who joined the system in 2012 as director of clinical programs, said she noticed right away that patients “didn’t understand what part that they played in managing their chronic diseases.”

Once people got insurance, they simply didn’t know what to do with it.

They didn’t understand their benefits, didn’t understand the need or purpose for well visits, and were not familiar with what their healthcare providers could actually do for them.

“This became even more complex when barriers came into play,” Blue said. “Things like language barriers, financial barriers, and other things in place that prevent access to care. I felt there was a way we could do what we were doing better.”

They had an idea to create what Tafoya called “sustainable health care.”

“We believed that healthy families make for healthy communities,” said Tafoya, who leads nine clinic locations in Phoenix, Mesa, Peoria, and other Arizona cities. “We started out from really humble beginnings, but we always believed in that concept.”

But how could they create a sustainable, patient-centered model of care?

Adelante Healthcare Systems Director of Clinical Programs, Lisa Blue, was a major factor in implementing the new sustainable model of health for patients in Arizona.

How to Create Sustainable Healthcare

Recognizing how much economic and social factors were preventing proper healthcare in their community, the Adelante Healthcare System team began to explore ways to create sustainable health among their patients.

Education and patient-centered care became a central component.

“There was a lot of education that we needed to do beyond health care,” Blue said. “We needed to teach people how to use their [insurance] benefits.”

In 2009, they applied for and received a grant that would help them reach individuals with chronically uncontrolled diabetes in their clinic in Phoenix (41.3% Latino population). The plan was to teach them how to use their health coverage to care for themselves. By the spring of 2009, they began to put into practice their new philosophy of care.

Soon they wanted to do even more—but they needed a bigger workforce to do it.

Health Coaches & More

So Tafoya and Blue worked to get grant funding to add “extended care” personnel.

With grants, they started to hire “health coaches.” These coaches help all patients and their families through the healthcare system by acting as a patient advocate and navigator. They facilitate patient education sessions, provide referrals to outside groups, and manage high-risk patients.

Plus, health coaches are bilingual.

“We wanted to eliminate this barrier right from the beginning,” Blue said. “All the health coaches we hired would be able to engage the patients in their native language. The goal was to minimize as many of the obstacles to care that our patients had as possible.”

The team also hired registered nurse care managers and traditional community health workers.

They also brought on “integrated behavioral health” social workers. This position teams with the larger extended-care team to provide patients with help developing healthy habits (like quitting smoking or being more physically active), managing mental health issues (like reducing stress or coping with anxiety or depression), and reducing disease symptoms.

Together, this extended care team would contribute to Adelante Healthcare System’s sustainable health goal and the idea of a “patient-centered medical home.”

“With this model we would have this extended care team that truly supports the patient.”

Adelante Healthcare CEO Avein Saaty Tafoya has been a driving force in changing the culture of health for Latinos in Maricopa County, AZ.

A Patient-Centered Approach in Action

The new patient-centered model has taken root at Adelante Healthcare System clinics.

“This approach focuses on support of self-management for patients with chronic disease and health promotion for preventative care for our entire population,” Blue said. “Whether it’s helping patients cope with chronic disease or making sure they were up-to-date with their wellness visits, our team worked hand-in-hand with the patients every step of the way.”

And it’s already paying dividends for patients.

“We really started to see a difference,” Blue said. “Our patients understood what was going on and what they needed to do on their part.”

“We got them to understand that taking care of yourself is more than a one-day visit to the doctor.”

Tafoya agreed.

“Our small-town roots evolved into the way we deliver healthcare services in a modern system of personalized care,” Tafoya told in healthcaredesignmagazine.com.

With their early results in hand, they were able to obtain additional funding which allowed them to spread the model to all the clinics that are part of Adelante Healthcare System across Arizona.

Today they have more than 30 extended-care staff, who are part of the sustainable health model, serving more than 45,000 patients in Arizona.

“The way we do things now, with this model, it allows each of us to have the type of care that our patients truly need,” Blue said. “This helps us to prevent chronic disease whenever possible and help those that have chronic disease to manage them better.”

“Everyone is utilizing the resources we have more efficiently and in the end, everyone is healthier and better for it.”

By The Numbers By The Numbers

46

Percent

of all Latinos are homeowners. That's far fewer than Whites (72%).

This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.

The stories are intended for educational and informative purposes. References to specific policymakers, individuals, schools, policies, or companies have been included solely to advance these purposes and do not constitute an endorsement, sponsorship, or recommendation. Stories are based on and told by real community members and are the opinions and views of the individuals whose stories are told. Organization and activities described were not supported by Salud America! or the Robert Wood Johnson Foundation and do not necessarily represent the views of Salud America! or the Robert Wood Johnson Foundation.

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