Like a food desert, a health care desert is a place where it’s difficult to access affordable, high-quality health care. Nearly two decades ago, Lexington, Missouri was a health care desert.
Today, this rural town of roughly 4,555 residents is a national rural health care model. And in a few months one of its clinics will be the first federally qualified health centers (FQHC) to transfer ownership from one provider to another. This was the topic of a recently held community forum in Lexington.
But ask Samuel U. Rodgers (SURHC) Health Center CEO Faisal Khan or Health Care Collaborative (HCC) of Rural Missouri CEO Toniann Richard about the timing, and they’ll both say this transition is years in the making.
It all started when some well-intentioned community advocates appealed to the federal government to help the area establish a primary care facility. This launched an effort to recruit a health care provider from Kansas City, Missouri’s urban core to rural Lexington in Lafayette County.
Established health centers and hospital systems were asked but they declined.
A call to action
However, SURHC, located near downtown Kansas City, answered the call. This assignment, Khan said, aligned with their founder’s mission, the late Dr. Samuel U. Rodgers, who exuded an Albert Schweitzer modus operandi—to serve, show compassion, and have a willingness to help others.
With $200,000 in seed money, SURHC opened the clinic in the newly built Lexington 4-Life Center, about an hour away from its urban base.
Not long after that, Health Care Collaborative of Rural Missouri, formerly called Health Care Coalition of Lafayette County, was formed and incorporated as a 501 (c) (3) nonprofit. With seed money from Health Resources & Services Administration (HRSA) and the Health Forward Foundation (formerly known as the Healthcare Foundation of Greater Kansas City), the two-person rural health network launched grassroots initiatives to promote health and wellness throughout Lafayette County.
The ultimate proposition
As the fledging nonprofit was establishing roots, the REACH Healthcare Foundation approached HCC with a proposition: design and implement a program in Lafayette County to address unmet needs in a manner that maximizes impact. REACH called it the Rural Health Initiative (RHI). HCC was one of two nonprofits in Missouri to participate along with another in Kansas.
“It was the very first time that a funder ever came to us and said, ‘Tell us something that would be really cool to do, and we want to fund that,’” Richard said. “And I remember thinking, ‘What …? You want us to come with an idea, pitch it and work it?’ It was great.”
As a result of RHI, HCC created programs that addressed social determinants of health. The Initiative was the catalyst for HCC’s Connectors program that tackles transportation barriers, food insecurity, and social care services. RHI was also the springboard for HCC’s community warehouse, Project Connect events in Lafayette and Eastern Jackson counties, and its community health worker program.
In 2013, the pendulum shifted. HCC seized an opportunity to open its first rural health clinic with dental services in Waverly, Missouri, with support from Lafayette Regional Health Center. Later that year FQHC status was granted, and three additional federally qualified Live Well Community Health Centers were launched in Concordia (2014), Buckner (2016), and Carrollton (2016), along with two school-based centers.
HCC’s health care footprint is now firmly planted in West Central Missouri and has morphed into an organization of more than 70 staff members with several professional consultants. Richard and her staff are fixtures in the community, with solid healthcare partnerships, and long-standing relationships with funders vested in the nonprofit’s mission to assess and address access barriers to health care in rural Lafayette and Eastern Jackson Counties.
Several years have passed since SURHC’s Lexington debut. But, the logistics of maintaining and operating a rural FQHC became increasingly difficult to reconcile. “It doesn’t make sense,” Khan said. “You have to reside in and be a part of the community that you serve. We are based in downtown Kansas City.”
SURHC and Lexington stakeholders have been aware for years that something needed to give. However, federal restrictions, penalties, and other barriers circumvented SURHC from transitioning or relinquishing the site.
With open minds and open hearts, Khan and Richard revisited the idea, recruited staff and consultants to serve collectively as a transition team, and developed a plan. Both organizations are framed by a similar mission, which is one reason this this collaboration works. Khan said it’s also something else.
“Toniann, by force of personality, managed to persuade a lot of colleagues from the Missouri Primary Care Association, REACH Healthcare Foundation, and the Health Forward Foundation to agree to offer support,” Khan said.
Two healthcare leaders bridge an urban-rural divide
Richard and Khan attempted something that had never been done in Missouri – relinquish an urban FQHC to a rural FQHC. They ended up in Washington, D.C., and appealed to HRSA and others to authorize the transition. Long story short, the feds applauded the transition plan and noted federal rules and guidelines will be rewritten to accommodate the switch.
“We were able to defuse and set aside all the burdens of the past in terms of territoriality, and this is mine and this is yours,” Khan said. “None of that is going on.”
Richard agrees. “Faisal is a tremendous friend, colleague, and confidant,” she said. “When he said, ‘Let’s figure out how to best serve the community,’ it was music to my ears. It’s also important to acknowledge that Samuel U. Rodgers Health Center came into the Lexington community and provided primary care, dental care, and other safety services when there was none. Their willingness to serve our rural community and meet the needs of the underserved will not be forgotten.”
“I was involved in the initial development of the Samuel U. Rodgers Health Center Lexington site,” said Missouri Primary Care Association CEO Joe Pierle, MPA. “This is one of the best examples of real leadership I’ve witnessed over the past two decades. Leaders from an urban and a rural Health Center coming together, putting aside self-interest, and doing what is in the best interest of the residents of Lexington and surrounding communities.”
“REACH Healthcare Foundation is pleased to support the transition of the Lexington clinic from Samuel U. Rodgers Health Center to the Health Care Collaborative of Rural Missouri,” said Carla Gibson, REACH Senior Program Officer. “These two REACH core partners are demonstrating leadership and true partnership to ensure community needs remain the central focus.”
As for clinic patients and the Lexington community, Khan and Richard said to expect a seamless transition with no anticipated lapse in care. “The only thing that will change is the sign on the door,” Khan said. “Our staff members who live and work in Lexington and opt to continue their employment with HCC will be allowed to do that.”
Current providers will also remain in place.
Next year, Richard said the Lexington site will be outfitted with telehealth, along with mental health services, the 340B Discount Drug Pricing Program, and a team of community health workers.
“As a longstanding partner and funder to both HCC and SURHC, Health Forward understood the importance of providing support to the plan that ultimately resulted in a successful transition,” said Graciela Couchonnal, Vice President of Programs at Health Forward Foundation. “We believe this transition will continue to benefit residents by providing access to integrated and expanded services under one system of care.”
The target date to officially transition ownership to HCC is slated for June 1, 2020. The site will be renamed Live Well Community Health Center – Lexington.