How one ru­ral town im­proved health­care through closer ties to the busi­ness com­mu­nity

Modern Healthcare - - COMMENT - By Rene Men­dez

When it comes to pro­vid­ing ad­e­quate ac­cess to health­care, ru­ral com­mu­ni­ties of­ten rank at the bot­tom of the bar­rel. A few years ago, the farm­ing town of Gon­za­les, Calif., trailed even the ru­ral av­er­age of doc­tor-to-pop­u­la­tion ra­tios.

Not any­more. To­day Gon­za­les boasts a doc­tor-pop­u­la­tion ra­tio that is well above the na­tional ur­ban av­er­age thanks to the re­cent ad­di­tion of two new clin­ics and sev­eral new doc­tors and den­tists.

How Gon­za­les—a town with a pop­u­la­tion of less than 9,000 and a rel­a­tively low av­er­age in­come level—man­aged this feat can be in­struc­tive not only for other ru­ral com­mu­ni­ties grap­pling with sim­i­lar is­sues, but for oth­ers seek­ing to ex­pand health­care ac­cess. What we found in Gon­za­les was that am­bi­tious health­care ac­cess goals are at­tain­able by cre­atively lever­ag­ing pub­lic-pri­vate part­ner­ships.

The first step was un­der­stand­ing the prob­lem. Us­ing a Com­mu­nity De­vel­op­ment Block Grant, the city com­mis­sioned the Gon­za­les Com­mu­nity Health As­sess­ment 2012, which col­lected and an­a­lyzed avail­able data, in­clud­ing sur­veys of lo­cal res­i­dents. Among the con­clu­sions: We were in a fed­er­ally des­ig­nated health pro­fes­sional short­age area, with an es­ti­mated 1 in 5 res­i­dents hav­ing no clinic or physi­cian for rou­tine or pre­ven­tive care. Sali­nas, the clos­est city with a full com­ple­ment of med­i­cal ser­vices, is about 20 miles away, and many of our res­i­dents lack trans­porta­tion.

We not only needed bet­ter ac­cess but we needed a well­ness cen­ter to serve low-in­come, pri­mar­ily Span­ish­s­peak­ing res­i­dents.

With lim­ited city re­sources, we searched for part­ners who could as­sist us. We iden­ti­fied sev­eral: Sali­nas Val­ley Me­mo­rial Health­care Sys­tem, a hospi­tal and clinic oper­a­tor in the re­gion that had a goal of ex­pand­ing care to un­der­served pop­u­la­tions; Clin­ica de Salud, a not-for-profit or­ga­ni­za­tion that fo­cuses on bring­ing health­care to farm work­ers with a fo­cus on Spanish-speak­ers; our one res­i­dent physi­cian, Dr. Chris­tine Ponzio, who was over­whelmed by de­mand; and our lo­cal farm com­pa­nies, whose work­ers could ben­e­fit from im­proved nearby health­care ac­cess. The mayor of Gon­za­les and the city coun­cil, to­gether with the city ad­min­is­tra­tion, be­gan not just en­cour­ag­ing the var­i­ous play­ers to ex­pand in Gon­za­les but as­sist­ing when­ever we could.

We leased of­fice space in city­owned prop­erty to Dr. Ponzio for her prac­tice. We then pre­sented our case to the Sali­nas Val­ley board for a new clinic. Sali­nas Val­ley joined with Ponzio in a plan to move her prac­tice into the pro­posed new clinic to be built on for­mer farm­land that the city des­ig­nated for com­mer­cial de­vel­op­ment. City of­fi­cials worked with the land owner to ad­vance the project, in­clud­ing a project pre­sen­ta­tion to a bank loan com­mit­tee.

To help finance the project, Sali­nas Val­ley ap­pealed to lo­cal busi­nesses. A ma­jor em­ployer in town, Tay­lor Farms, do­nated $1 mil­lion. Gon­za­les of­fi­cials worked with Tay­lor to fast-track a ma­jor veg­etable pro­cess­ing fa­cil­ity that draws power from a gi­ant wind tur­bine erected by the city. The tur­bine project es­tab­lished a re­la­tion­ship with Tay­lor that ul­ti­mately proved ben­e­fi­cial in get­ting the clinic built, pro­vid­ing bet­ter health­care ac­cess for work­ers and their fam­i­lies and also bur­nish­ing the com­pany’s rep­u­ta­tion for giving back to the com­mu­nity.

We ran a par­al­lel ef­fort with Clin­ica de Salud, work­ing for years with its ex­ec­u­tives to de­velop a sec­ond clinic and well­ness cen­ter on a rede­vel­op­ment par­cel con­trolled by the city. We ul­ti­mately sold the par­cel to the or­ga­ni­za­tion at nom­i­nal cost. Clin­ica de Salud has now opened tem­po­rary quar­ters on the site as it moves for­ward on a per­ma­nent fa­cil­ity.

New doc­tors and den­tists soon be­gan ar­riv­ing. In four years, Gon­za­les went from one full-time doc­tor and one den­tist to six doc­tors and four den­tists. We now have about 1 doc­tor for ev­ery 1,500 peo­ple, a bet­ter rate than the na­tional ur­ban av­er­age of 1 per 1,900. Sim­i­larly, Gon­za­les now has about 1 den­tist for ev­ery 2,250, which sur­passes the ur­ban rate of 1 per 3,300. These changes were ac­com­plished with­out new taxes or spe­cial as­sess­ments.

The Gon­za­les ex­pe­ri­ence demon­strates the im­pact that con­sis­tent and per­sis­tent lo­cal gov­ern­ment sup­port and part­ner­ships with busi­nesses and other or­ga­ni­za­tions in the com­mu­nity can have on health­care ac­cess, even with­out ma­jor in­vest­ment of lo­cal tax dol­lars.

Rene Men­dez is city man­ager of Gon­za­les, Calif.

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