When states first began to implement the Affordable Care Act, much of the conversation was about getting people coverage. Two years later, and the conversation has shifted, somewhat, toward quality of care. More people are insured than ever before, but they aren’t necessarily healthier.
There are a variety of reasons for this.
People with low incomes are less likely to have jobs that offer sick leave and might not be able to get to a doctor's office. In addition, primary care doctors can have weeks-long wait times. So people will turn to 911 when they need a doctor immediately.
In California, 80 percent of calls to the fire department are for health issues, according to the California Healthcare Foundation. So in November, health officials in Alameda County worked with the Hayward Fire Department to open the Firehouse Clinic, the nation’s first health clinic built next to and working with a fire department.
“The truth is, we’ve got more patients than we ever did before because of Medicaid expansion," said David Vliet, chief executive officer of the Tiburcio Vasquez Health Center, which is the health organization overseeing the Firehouse Clinic. "So we were looking at the different things that were driving up health-care costs and decided it was time to try a new approach."
The ultimate goal of the Firehouse Clinic, Vliet says, is data-sharing. Fire departments often have valuable information about a city’s sickest residents but rarely share that information with medical providers.
“Once we can identify the most frequent 911 users, then we can put that person in a managed care situation to make sure they are getting health care that fits their needs -- so they aren’t calling 911 once a month,” Vliet said.
While data-sharing could happen regardless of where the two services are located, being in such close proximity might help facilitate it. A system hasn't been implemented just yet, but "eventually we want firefighters to go up to our health workers and say 'Ms. Rodriguez called 911 for the fourth time this month because of her diabetes issues. Can we assign her to case worker?" Vliet said, noting that placing the frequent 911 users in better care will hopefully make for a healthier population.
The Firehouse Clinic (Tiburcio Vasquez Health Center)
Hayward’s firefighters won’t be working inside the actual health clinic or with patients directly because “it won’t be an urgent care unit,” Vliet said. Instead it’ll offer the range of primary care services, with a 72-hour access to care promise.
The clinic offers basic medical services. The institution provides everything from blood pressure checks and immunizations to wound care. It accepts insurance and will even offer some services to the uninsured.
The Firehouse Clinic’s duel fire department and health center campus is certainly new, but the idea of combining community health clinics with other city services has become popular throughout the U.S.
A community health center in Chicago opened a food pantry on its grounds earlier this year. Chapel Hill, N. C., opened a co-locating community health clinic and homeless shelter earlier this year. Laurens County, S. C., merged its community health clinic with the county emergency department in August.
According to Amy Simmons, communications director for the National Association of Community Health Centers, combining health centers wiht other services is going to become more common in underserved areas.
“In order to have a truly healthy population you need to have health insurance, but you also need timely access to care," she said. "Now that more people have health insurance than ever before, we’re seeing real innovation in terms of illness prevention. Health workers can just focus on the care aspect of health care, and are looking at the best ways to serve their particular community."
The idea of integrating health clinics with other services is a popular concept in the health community, but is still very new, said Sandra Shewry, vice-president of external engagement for the California HealthCare Foundation.
“There are all kinds of innovative ways people are using resources to tailor to a community’s health needs, but the Firehouse Clinic is really the first of its kind,” she said.
Vliet says that he's already looking at expanding hours to accommodate weekend visits. There is also the potential to open more similar clinics in the area in the coming years.
“For people who have no real access to care, these sorts of community partnerships are the answer to that,” he said.
*This article has been updated to clarify that the Firehouse Clinic stands next to a fire department run by the city of Hayward -- not Alameda County.