At a spring hearing before the Subcommittee on Health in the U.S. Senate Committee on Labor and Public Welfare, a series of witnesses testified to five major problems in America’s health care system: 1) shortage and improper distribution of health workers; 2) inequality in care and access to care; 3) rising costs; 4) lack of emphasis on prevention; and 5) poor coordination, resulting in waste and duplication.
You might be thinking, No surprises here.
Until you learn that this hearing was held in 1971.
The Lessons of the Last 40 Years
“It’s a good thing Venice Family Clinic got started when it did, in 1970,” says Liz Forer, the Clinic’s CEO and Executive Director. “It took 13 years just to acquire a permanent home, and another ten years to open a second site. An organization like this doesn’t appear overnight.”
This point is particularly relevant in 2010. As Venice Family Clinic celebrates its 40th anniversary, the lesson to take is not that the Clinic is 40 years old but that it took 40 years to build.
In its early days, Venice Family Clinic was an entirely volunteer-run organization, operated in the evenings out of a donated dental clinic. Everyone involved, including its Founder, Phillip Rossman, MD, and its Co-Founder, Mayer B. Davidson, MD, considered it to be simply a stop-gap measure.
But permanence was thrust upon the Clinic over time by the combination of need in the community and failings in national health policy. And now, with more than 2,000 volunteers, 230 staff members, and nine sites, Venice Family Clinic is a cornerstone of the local health care system. Indeed, it is arguably the single most important agency to the low-income uninsured on the Westside of Los Angeles County.
“No one has given up hope that someday the health care crisis will end and everyone will have affordable coverage and access to quality care,” Forer says. “But if you’re one of the two million people in L.A. County who is uninsured, you’re not excited by ‘someday.’ You need a doctor, a diagnosis, and a prescription you can afford now.”
The Time Has Come (Again)
This ongoing urgency—some might say emergency—has compelled Venice Family Clinic to take a series of bold steps at critical times, beginning with purchasing its flagship facility in 1983, then expanding east on Rose Avenue in 1992, taking over two clinics the County was about to close in 1995, and adding five community-based sites in the last twelve years.
With more sites, more services, and more patients than ever, Venice Family Clinic has transcended its role as a health clinic and is now, in many ways, a health system. More than 24,000 patients visit the Clinic annually. They make an average of four to five visits per year, for everything from prenatal care to immunizations to health education to chronic pain management. And local hospitals rely on the Clinic to prevent unnecessary emergency room visits and readmissions. It is a stable place in an unstable environment.
“The reality is that, for most low-income uninsured residents of the Westside, Venice Family Clinic is their only means of getting the care they need, when they need it, on an ongoing and affordable basis,” Forer explains.
But Venice Family Clinic cannot reach them all. There remain thousands of people on the Westside alone who do not have a doctor, a dentist, or someone to talk to when they are stressed or depressed. Some have chronic diseases. Others live every day in pain. Some are children.
So Venice Family Clinic is enacting a series of strategic initiatives to address not just the need for more space and additional services, but also the mechanisms for providing better care than ever, to more people than ever.
New Sites, New Technology, New Resources
Over the course of 2010 and 2011, Venice Family Clinic will have completed five landmark initiatives:
- The construction of a new primary care clinic, the Irma Colen Health Center, in Mar Vista, to provide a medical home to residents of the most underserved neighborhood on the Westside
- The opening of an Early Head Start office in Inglewood, the Clinic’s first site outside of the Westside of Los Angeles County, for home visitors providing comprehensive early childhood development services to at-risk families
- The construction of a new dental clinic in Santa Monica, within the Simms/Mann Health and Wellness Center, to address the greatest unmet health need among the low-income uninsured
- The implementation of an electronic health record system, across all sites, to improve quality of care and facilitate ongoing innovation and expansion
- The reorganization of the Board of Directors and other organizational changes to enable the Clinic to qualify for community health center grants, an increasingly important source of federal funds
Viewed together, these initiatives mark one of the boldest periods in Venice Family Clinic’s history.
And they help lay the groundwork for implementation of the health reform law. The most sweeping changes contained in the law will take effect in just over three years, on January 1, 2014. If they were to take effect today, the health care system would not have adequate capacity to meet demand from the newly insured, especially in low-income neighborhoods. So whereas there once was a time when the Clinic’s leadership spoke longingly of the day when health care reform would put the Clinic out of business, it is now eminently clear that reform depends on providers like Venice Family Clinic—in particular, to care for people who qualify for the expansion of Medicaid (known as Medi-Cal in California).
At the same time, it is important to remember that the health reform law will not cover everyone. Once the law is fully implemented, an estimated 16 million people will remain uninsured. Plus, even if so-called “universal health coverage” is ever enacted, some people—such as the mentally ill and the homeless—will always fall through the cracks and need specialized assistance. Venice Family Clinic will continue to care for the most vulnerable populations, regardless of their insurance status.
But no matter what transpires at the national level—on the topic of the current health reform law or future legislation—it will always be up to communities to put forth answers to their own problems.
“If there is one thing we’ve learned over the last 40 years, it’s that we can’t wait for someone else to come in and fix what’s broken in our local health care system. We have to do it ourselves,” Forer says. “There certainly will come another day when we need to make more bold moves. That day might come sooner than anyone suspects.”
This story appeared in the Fall 2010 issue of Encounters. Click here to download the entire newsletter as a PDF.