Grace Medical Home achieves national significance as PCMH with spiritual care
Susie Richetti, a mother of four who’s also a full-time student, was dismayed when her husband’s business took a financial hit. Faced with an already shoestring budget, she didn’t know where to turn until she learned about Grace Medical Home, a low-cost clinic for uninsured patients in Orlando.
“Depression kinda sneaks up on you,” admitted Richetti. It’s great to have “an outside perspective that says, ‘Hey, you have a lot going on. It’s OK that you feel overwhelmed.’”
Grace Medical Home, which opened to patients in May 2010, is unique with its offering of spiritual care as a medical home component.
“We weren’t able to address all we wanted with our patients … it broke our hearts,” said Orlando pediatrician Marvin Hardy, MD, founder of Grace. “Spiritual care is about tending to the heartbeats of the patient. It sums up why we’re here. If we didn’t have that aspect, we’d feel pretty empty about our accomplishments.”
A $135,000 grant from Dr. Phillips’ Charities allowed the free clinic to launch a spiritual care program.
“We’ve talked a lot about what we offer medically, but we’re also here because we feel strongly that God loves all people and calls us to love all his children, no matter what’s going on in their lives,” said Hardy, noting that 70 percent of Grace’s nearly 2,000 patients report feeling closer to God since becoming a patient. “Who follows up with the patient in the exam room whose husband just lost his job, or may need to leave their home, or received a bad diagnosis, or might be thinking dark thoughts or considering drugs?”
Grace set the bar high before it opened. Stephanie Garris, JD, executive director, joined the free clinic in November 2009, with the idea of pursuing the highest national designation possible for its patients.
“If we were going to call ourselves a medical home, which we considered an ideal model, we needed to become a nationally certified PCMH,” said Garris. “Our board thought, wouldn’t it be cool that the low-income, uninsured would have a place like that? We set the standard to pursue that goal.”
In 2011, Grace teamed up with the University of Central Florida (UCF) College of Medicine’s Regional Extension Center (REC) to demonstrate evidence-based, patient-centered care that combines teams of healthcare providers and health information technology to help patients become more actively engaged in their own care. The National Committee for Quality Assurance (NCQA) tasked RECs nationwide with helping clinics achieve recognition as a Patient-Centered Medical Home (PCMH).
“Most free clinics have limited hours, or are open certain nights, but we’re very fortunate to be open every weekday, from 8 am to 5 pm,” said Garris.
When Grace received a three-year, Level 2 accreditation in October 2014, it became one of only 10 free clinics nationwide PCMH-designated. It may be the only free clinic in the nation to have PCMH certification and offer spiritual care.
“Many people go for the PCMH designation because they get a higher level of reimbursement from insurance companies, but we don’t get any incentive more than a plaque on the wall,” said Garris. “We knew it was the right thing to do.”
At the heart of a medical home are relationships, added Hardy.
“In particular, medical relationships,” he said. “A doctor’s office gets to know its patients. That’s exactly what the uninsured struggle to find. Nationwide, about 86 percent of uninsured aren’t part of a medical home. Grace is a place where their name is known, their chart is kept, and they return over and over.”
The average patient with chronic medical problems visits Grace 10 times a year for primary care, and three times for specialty care.
“This is care they couldn’t afford to receive before becoming a patient,” said Hardy.
Garris, the only Floridian on the 12-member board of the National Association of Free & Charitable Clinics (NAFC), said Grace has had a waiting list since it opened.
“Once you become a patient, you’re able to get in same day sick visits,” she explained. “The longest time to wait is to become a patient. We add to the waiting list every single month, from 20 to 50 patients.”
Last year, Grace reported 8,500 patient visits. ER visits by Grace patients dropped 51 percent after becoming a patient, and non-urgent visits dropped 65 percent.
Grace board members, with representation from Florida Hospital and Orlando Health, initially came together while mulling ways to help the one in four Orange County residents who are uninsured.
“Everyone on the board grew up in Orlando, and several of us have been on international mission trips together,” said Hardy. “We began to assess needs in our backyard, meet with community leaders, and dream about opening a medical home for uninsured, low-income patients.”
Nearly a dozen primary care physicians volunteer at the clinic weekly, along with 20 specialists once a month, accounting for 12,035 annual volunteer hours. In 2012, the value of prescription medications secured was $1.11 million.
“If a female patient has an abnormal pap smear, a colposcopy can be done here,” said Hardy. “Diabetics who are difficult to manage can see an endocrinologist here. Patients can get primary and specialty care, mental health counseling, labs, spiritual care … all under one roof. If we need to refer patients for a colonoscopy or MRI, we call on our community partners.”
For now, Grace is located in two adjacent buildings. Rather than open a second clinic, the board would perhaps consider a larger facility. “We’re almost at capacity now,” said Garris.
Concurrently, Grace is collaborating with UCF College of Medicine and University of Florida College of Pharmacy to run a night clinic funded by the Diebel Legacy Fund, ironically called KNIGHTS (Keeping Neighbors in Good Health through Service). Medical students, from first- to fourth-year, operate the clinic under the supervision of attending and volunteer physicians.
“It teaches medical students how to care for the underserved in the community,” said Hardy.
To augment Grace’s $1.7 million annual budget, privately funded, the clinic an annual fundraising event – Let’s Say Grace – a few weeks before Thanksgiving.
“We’re so fortunate to have such incredible community support,” said Garris. “We could never envision Grace Medical Home would grow to the total holistic care for uninsured, low-income patients.”
On Saturday, Nov. 8, Grace Medical Home will host its singular annual fundraising event. Let’s Say Grace, a creative dinner benefitting the free clinic, will open at 5 pm for participants to set up tables. “It’s entirely up to the table host and guests to plan the theme, menu, decorations and attire for the table,” explained Stephanie Garris, executive director of Grace. Fellowship begins at 6 pm and includes a tour of the facility. After blessing the meal, dinner will be served around 7 pm, followed by a program and the result of table awards. In 2013, “Peter Pan” won the People’s Choice Award; “Roller Derby” was named Most Humorous; “The Sound of Music” Most Beautiful; “Instagram” Most Original; and “Despicable Me” Best Costume. For more information on the 2015 event, visit GraceMedicalHome.org.