When the San Francisco Bay Area's winter weather turns damp and cold, life at Linda Simpson's home — a tent pitched illegally in Hayward — can be pretty bleak. A gas heater and many blankets keep her warm enough to survive, but degenerative arthritis makes it hard to move around. Sometimes Simpson, 55, gets depressed and goes into a kind of hibernation state, staying put unless it's absolutely necessary to go out. During those stretches, she doesn't get needed care for painful joints in her shoulders and knees, or for her high blood pressure and elevated cholesterol.
Fortunately, the picture brightened for Simpson in January, when the Firehouse Clinic in South Hayward, located on the grounds of Hayward's first new fire station in nearly 20 years, opened its doors to new patients. Now, instead of enduring long van or bus rides to clinics in Fremont and unpredictable waits in hospital emergency rooms, Simpson says being only two bus rides (each way) from care makes her life easier. "Health-wise, this means everything," Simpson said. "I could feel myself going down, and I don't want to die this young. I don't want to die. I'm tired of living out there like this, and I know the only way to do it is to starting taking care of myself and get back into health."
The Affordable Care Act (ACA) has brought about many major changes in the coverage system — making millions more Californians eligible for Medicaid and allowing for a greater segment of the population to be publicly insured. But the public sector still faces a significant challenge in integrating patients like Simpson into care. The reality is that eligibility for coverage does not mean enrollment, and enrollment does not guarantee access to health care that meets the unique needs of patients like Simpson.
Like other regions of the country, Alameda County faces a shortage of primary and preventive care services for all segments of the population, but particularly for those who are publicly insured or uninsured. The Firehouse Clinic is one Alameda County project aimed at improving access to health care for this vulnerable population. It is a full-service primary and preventive care clinic co-located with a fire station — a public service that is strategically sited in every community. Coupled with extended clinic hours, the Firehouse Clinic design enables providers to deliver care at a time and place convenient to residents.
More than a simple outlet for primary care, the Firehouse Clinic integrates care by increasing communication, data sharing, and coordinated services among emergency medical services (EMS), first responders, and primary care providers. This approach leverages the expertise and trust that residents have in the fire department and emergency medical services (EMS) while offering patients an alternative to the hospital emergency department (ED), reducing the need for costly and often preventable visits.
The Firehouse Clinic concept was based as much on common sense as on innovation and ingenuity. Through needs assessments and feasibility studies, including some supported by the California Health Care Foundation, the Alameda County Health Care Services Agency (HCSA) found that areas in the county with the highest levels of poverty also had the highest rates of hospital overload, ambulance diversion, and avoidable ED visits. Given the experience that the fire department and EMS have in the provision of these services and the known trust that communities have in them, Alameda County seized an unprecedented opportunity to collaborate with the two services to bridge acute care and community health centers, and to take advantage of potential efficiencies. The ultimate objective of the Firehouse Clinic is to deliver a new access point that addresses the triple aim of the ACA in improving patient experience, improving population health, and reducing per capita costs of health care.
When the Hayward Fire Department and Tiburcio Vasquez Health Center stepped forward as partners, Alameda County was able to invest Measure A dollars allocated for the project in the build-out of the clinic, which is in an area with a dearth of health care services. Tiburcio runs the clinic and coordinates and integrates core services, including primary and preventive medical care, behavioral health, health care navigation, health education, and emergency department and hospital discharge follow-up services, and eventually, emergency dental services as well. Designated funds from Alameda County's Measure A are being used to provide medical, mental health, and public health services for indigent, low-income, and uninsured adults, children, seniors, families, and other county residents seeking care at the Firehouse Clinic.
The Firehouse Clinic is projected to provide health services to about 5,900 new clients (about 2,400 clients in Year 1 and 3,500 in Year 2) through a minimum of 9,450 visits (3,850 visits in Year 1 and 5,600 in Year 2) by September 31, 2017. Based on these projections and with blended public funding and third-party billing of Medi-Cal and Medicare, the Firehouse Clinic's operational model could be scalable and sustainable in other communities.
Simpson has only been to the clinic a few times, but she already can tell the difference. After the clinic staff wrote her prescription refills, Simpson said she quickly felt a lot better. "I notice it big time," she said. "I don't hurt as much. I can get up and down without feeling like I'm falling over."