A CARING SPIRIT: Thanks to volunteers like student nurse Marissa Roberge, left, and nurse practitioner Rebedda Carley, right, Rhode Island Free Clinic CEO Marie Ghazal has been able to expand the number of clinic visits 400 percent since 2008.
As it has for more than a decade, Rhode Island Free Clinic is pushing hard on all fronts to extend health care to poor Ocean State residents, despite the hope and promise of a fully operating Affordable Care Act in 2014.
Even with help from Obamacare, “the statistics are showing that around 70,000 people in our state will still be uninsured in 2014 and beyond,” said Marie Ghazal, CEO of the clinic, referring to people who are young, underemployed, jobless, homeless or newly arrived to the country. “We will continue to be a part of the health care landscape to fill that gap.”
Since its founding in 1999, the clinic has provided a health care safety net for needy adults by mobilizing a corps of doctors, medical professionals and others – now at a total of 800 people and organizations – to provide medical care. In contrast to a walk-in clinic or hospital emergency room, the Free Clinic provides coordinated care that includes follow-up contact, health coaching for patients and referrals.
The Free Clinic has seen a remarkable growth in need from poor people in Rhode Island since 2008. In response, it has expanded its services dramatically, even as its budget has decreased – for example, by 13 percent from 2011 to 2013.
The clinic operates on a $1 million annual budget, secured entirely from donations. In its current budget, it leverages $3.4 million in donated resources, like lab work and services from community partners, volunteer hours from its doctors and support staff, the work of seven AmeriCorps VISTA volunteers, and $400,000 in medicine from the Patient Assistance Program and CVS Caremark Corp.
Ghazal and her colleagues at the Free Clinic are painfully aware that Rhode Island still has a high unemployment rate. During times of economic decline, when the need for vital social services rises, individual and corporate donors often have to tighten their own purse strings. This can prove challenging for nonprofit social service agencies such as the clinic, which rely on those funds to cover their costs.
Ghazal said it is critical that the clinic continue to leverage its connections not only to raise funds, but also to get contributions of time and nonfinancial resources to help the organization’s client base.
“Our creative partnerships reduce the bottom line of the clinic,” Ghazal said. “We consider these partnerships [necessary to sustain us].”
The clinic’s aim toward diversification of donated resources and creative partnerships seems to be paying off, even in the face of challenging economic times. Statistics offered by the clinic show that since 2008, patient visits have increased 400 percent to nearly 8,000 a year. Physician and volunteer networks expanded 200 percent, including primary care physicians as well as specialists.
The clinic also expanded its hours of operation, stretching them to five days a week, including 13 hours each Tuesday and Thursday, with extended hours on many Monday and Wednesday evenings as well. It has been able to achieve all of this while still spending only 10 percent of its total budget on administrative costs.
“We’re very ambitious,” said Ghazal. “It’s like a big puzzle, and each person and partnership is a piece of that. We have the spirit of volunteerism at the clinic, and through that spirit, there’s a generosity of people’s time and people’s help and ideas. It’s not just about fundraising.”
A major piece of this puzzle is the clinic’s reliance on medical and nursing students, for whom it also operates as an invaluable resource in their own real-world training. The symbiotic relationship allows students from local medical and nursing schools to come to train and run clinics.
In 2013, 200 student trainees will use the clinic to complete more than 6,000 hours of on-site training while providing a vital service to those who need it most. “Hopefully, we’ll inspire future generations to do what our volunteer doctors, nurses and nurse practitioners do here,” Ghazal said. “There’s a moral obligation, a role we all should play in society to ensure that everyone gets the care they need.”
Like its philosophy on partnerships and holistic approaches to amassing resources, the clinic takes a similar tack when it comes to providing actual medical care. Ghazal noted that while walk-in clinics and emergency rooms are heavily used by people who are uninsured and without primary care, the clinic aims to offer more than stopgap medical measures. It seeks to focus on prevention, with an eye toward reducing long-term health care costs – not just for the individual, but for society as well.
Ghazal used the example of a diabetic who may be scared and on some level aware that he has a chronic condition, but ignorant of how to manage it or unable to pay for that management. So that patient may go to the emergency room and receive acute care and advice to go to a primary-care doctor, get medication and insulin, get his eyes examined and so on. “But the person has no money to do that,” she pointed out.
In the case of the Free Clinic, that same patient can expect ongoing care, follow-up visits, specialist attention and free and accessible medications from the CVS Caremark partnership. That patient will have access to nutrition classes and exercise classes, Ghazal added, ensuring that the patient is encouraged to focus on changing lifestyles and behaviors that will keep him in good health.
“We’re reducing the cost not only for that patient but for people who have insurance and have to pay increasing premiums to cover the cost of people who have to go to the emergency room. The costs are going to go down for hospitals, they’re going to go down for insurance companies, and they’ll ultimately go down for consumers who purchase insurance,” Ghazal said.
The philosophy of prevention and wellness has a further positive ripple effect, said Ghazal. When clinics like the Free Clinic were opened, it was largely to serve the working poor. By keeping those people healthy, Ghazal said, it makes it easier for them to stay at work or be able to return to work, ultimately avoiding stress and expense for other social service programs.
Finally, as an individual’s health stabilizes, so will his quality of life, said Ghazal. And regardless of where one falls on the political spectrum, she believes that it is a moral obligation for society to take care of its own.