Rocio Bautista Hernandez feels good, but tired. The 45-year-old mother and Southwest Detroit resident is battling cancer, but when she looks in the mirror each morning, she knows she is not fighting cancer alone. Others are fighting with her, namely the medical providers at Community Health and Social Services Center (CHASS) and Henry Ford Health System who have cared for her from when she was first diagnosed with breast cancer in 2010.
CHASS, which turns 50 this year, is a community-based, Federally Qualified Health Center (FQHC) in Southwest Detroit that provides care to underserved African American and Latino populations. It serves close to 11,000 patients a year, 70 percent of whom are Spanish speaking.
Henry Ford Health System, an early partner with CHASS, has not only contributed to better patient care through its specialty providers, but by supporting brick-and-mortar facilities. The health system contributed the first $3 million of the $17 million, 48,000-square-foot clinic located on Fort Street, which opened in 2012.
At the time of Hernandez’ diagnosis, CHASS helped her to enroll in the Henry Ford Hospital Voucher Program so that she could see Henry Ford oncologists for her cancer treatment. The program allows people who are low income and uninsured to obtain some of the specialty care needed through the Henry Ford network. Hernandez, who worked at a laundromat before falling ill, qualified. Minimal copays have allowed her to access treatment. Since her original diagnosis 10 years ago, the cancer spread to her lungs and now to her brain.
Hernandez says that she would not be alive today without the voucher program.
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Dr. Felix Valbuena is chief executive officer at CHASS.
Dr. Felix Valbuena, chief executive officer at CHASS, says the voucher program started around the early 1980s. Henry Ford’s leadership was committed to helping CHASS keep the community healthy, but at that time approximately 86 percent of CHASS patients were uninsured. The idea was to help CHASS serve patients on the front end so fewer people would end up in Henry Ford’s emergency room or ICU.
While the program has evolved over the years, the purpose remains: for patients to receive the care they need for minimum cost, with CHASS physicians referring to Henry Ford specialists. CHASS is a not a free clinic; its fee schedule is designed for patients to participate on an affordable, sliding scale, with a minimum payment of $20 toward their bill per visit.
Hernandez, for example, has an arrangement with Henry Ford to pay $600 a month for her chemotherapy. After a recent surgery to drain fluid around her brain, she also was provided with a walker to support her increasingly frail body.
Affordable pharmaceuticals
Hernandez also uses the CHASS pharmacy, which is federally subsidized to keep prescription expenses down for patients.
With the rising cost of prescription drugs, the CHASS pharmacy is a huge perk for patients like Hernandez who have a primary care provider at CHASS (it’s not open for use by the general public).
Filling about 48,000 prescriptions a year, the in-house pharmacy receives special, discounted pricing on drugs through the federal 340B Program, which offers safety net health care providers, like CHASS, access to low-cost medications for the most vulnerable patient populations.
Valbuena says that it’s an important service for uninsured patients who likely are without the resources to pay for medicine, as “it doesn't help to write a prescription if it can't get it filled.”
CHASS patients use the pharmacy for everything from insulin to help manage chronic illness, to prenatal vitamins to support healthy pregnancies.
Beyond medical care
As a community-based clinic, CHASS employs community health workers, who coordinate care for underserved individuals well beyond the medical care provided by doctors and nurses. CHASS’s community health workers primarily work with patients with diabetes, high cholesterol, and asthma. They bridge individuals in the community to medical, mental health, government, and social service systems.
There is also a dental clinic, prenatal and pediatric care, Special Supplemental Nutrition Program for Women, Infants and Children (WIC), transportation, a fresh fruit and vegetable market in the warmer months, and a domestic violence program call La Vida on site. Another huge asset for people seeking medical care at the clinic is behavioral health services.
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The CHASS waiting room
The behavioral health counselors are more integrated than in a traditional clinic setup, says Valbuena. Counselors spend time in the medical unit. “So if I see a patient who I think is depressed or has some behavioral health issue, I actually have the counselor that's going to take care of them right there on the floor,” he says. “We call it a warm handoff.”
The doctor presents the patient to the counselor for a brief 10-minute assessment, so patients actually meet the person face-to-face that they will see, if agreed, for counseling.
Hernandez has taken advantage of the behavioral health program at CHASS for her 10-year-old son, who is struggling with his mother’s declining health condition. He has been seeing a counselor every two weeks. She says it’s helping tremendously, and she has seen a big change in him.
Beyond the care people like Hernandez and her family have received at CHASS is a sense of community. Hernandez met her best friend Maria Carranza at CHASS when they were both pregnant; Carranza drives Hernandez to her appointments.
Hernandez calls the people who work at CHASS angels. “As soon as I walk in, everyone is nice, polite. They sit down with me and answer questions,” she says through a translator. “I feel supported emotionally; if not for that, I would be depressed.”