Partnering with an FQHC to deliver primary care: Lincoln St. Clinic

Providing comprehensive and affordable primary care for people living with addictions, who often suffer other chronic health conditions, is a top priority for many addiction treatment providers. One approach to integrating specialty care with primary care is to collaborate with a Federally Qualified Health Center (FQHC).

Spectrum Health Systems, a private, not-for-profit substance abuse and mental health treatment provider based in Worcester, Massachusetts, did just that, by co-locating a primary care clinic at its Lincoln Street Clinic, also in Worcester. Medical staff from the neighboring Edward M. Kennedy Community Health Center, provide primary care services.

Kristin Nolan, Executive Director of Outpatient Programs for Spectrum’s seven outpatient programs in Massachusetts and Lisa Blanchard, Director of Outpatient Operations, shared their experience in a workshop at the 2013 NIATx Summit and SAAS National Conference: “How to integrate primary care services by partnering with an FQHC.”

The Lincoln Street Clinic is Spectrum’s largest outpatient clinic, treating 1,050 patients daily in the Opiate Treatment Program. When space at the Lincoln Street Clinic became available—the reimbursement department that had occupied the first floor moved offsite—Spectrum saw an opportunity. “The space needed to be renovated anyway, and we thought that creating space for primary care would be the best way to use it,” says Blanchard.

Partnering with the Edward M. Kennedy Community Health Center, less than a mile away from the Lincoln Street Clinic, was a logical choice, since the two organizations were already sharing many patients.

The Kennedy Center was committed to the collaboration from the beginning, and Blanchard cites this as a key to the success of the project. Initial meetings took place in Spring 2011 to determine capacity, space, and a timeline.

Blanchard, a NIATx coach and certified change leader, also applied the first NIATx principle: To understand and involve the customer. “We conducted surveys to make sure our clients wanted this service,” she explains. Results showed that 49 percent of clients surveyed would use a primary care physician if services were available; 16 percent did not currently have a primary care provider (PCP).

Renovation of the Lincoln Street Clinic began in October 2011 and included renovations for the primary care suite as well as significant renovations to the first floor lobby and dispensing and medical suite. Funding for the $500,000 project came from Spectrum, grants, and private fundraising.

Blanchard formed a NIATx change team that included staff from both the Lincoln Street Clinic and the Kennedy Center. The team met regularly throughout the construction and implementation phases of the project. Regular walk-throughs of the space allowed for staff input on the location of workstations and phone lines. The change team also met to plan for estimated open dates, the referral process, scheduling, forms, and staffing.

The clinic opening was postponed from January to April 2012 due to unexpected delays in state licensing and insurance credentialing. “We knew these steps were required but did not anticipate how long they would take,” says Blanchard.

The clinic celebrated a grand opening in spring 2012.

The clinic consists of a small waiting room with a space for the receptionist, two full exam rooms, and a provider office. It offers two primary care clinics two mornings each week, staffed by a physician, nurse practitioner, and medical assistant from the Kennedy Center. Client preferences and physician availability determined the clinic schedule.

 “While Spectrum owns the space, the clinic is actually a satellite office of the Kennedy Center,” says Blanchard. “With this approach, we could stay focused on addiction treatment and didn’t have to take care of licensing requirements, primary care policies, or hiring physicians.”

NIATx principles have been built into the clinic’s processes. Site-based NIATx change teams, with staff from both agencies, meet monthly. During the clinic’s first year, NIATx change teams conducted ongoing rapid-cycle change projects to increase referrals and streamline the referral process. As a result, referrals more than doubled from October 2012 to June 2013. 

Blanchard sees a great opportunity to continue to increase referrals, especially from the nearly 300 Lincoln Street patients who do not have an active primary care physician.  Spectrum is also beginning discussions about using the clinic space to provide onsite high-risk prenatal care and HIV testing.

 “It is exciting to be part of offering a high level of integrated service to an underserved population,” adds Blanchard. “Spectrum strives to be a leader in behavioral health and addiction treatment, and this is one example of putting this goal in action to meet the needs of our clients.”