Posted June 7, 20193:18 pm
CLEVELAND, Ohio – Social scientists refer to it as the “tyranny of the moment.” It’s when the demand to solve urgent daily problems is so great that people living in poverty are unable to plan for tomorrow.
At MetroHealth’s Buckeye Health Center on East 116th Street, it means no-shows and cancellations – patients skipping appointments because of a lack of transportation or childcare, or because other matters are just more dire, such as food scarcity or housing insecurity. In fact, more than half of the health center’s patients miss their appointments, leaving MetroHealth to balance its commitment to serving the families of one of Cleveland’s most impoverished communities against the cost of keeping the doors open at what amounts to a failing clinic.
So beginning June 10, the MetroHealth System will radically change how the Buckeye clinic serves the East Side neighborhood. It will go far beyond health care with wraparound services to tend to those other needs – food, domestic violence support, legal counseling, and personal developmental skills, among others – with the hope that doing so might release its patients from the tyranny of the moment long enough to see a doctor, too.
The service providers and non-profits that will make it happen will take up residence in the facility’s ground floor and will operate in the newly renamed Buckeye Community Resource Center rent-free, in exchange for a simple promise to serve the community to the best of their abilities. They are:
- Providence House: Provides case management and trauma-support services for children and families affected by personal crisis.
- The Greater Cleveland Foodbank: Provides help with food-benefit applications and nutritional and food education services.
- Domestic Violence Child Advocacy Center: Provides support services for victims of domestic violence and abuse and their families.
- Goodwill: Provides personal development skills, vocational services, financial literacy education, computer training, parenting skills and social service navigation.
- The Legal Aid Society: Provides on-site legal services to assist with matters related to children, housing, and other civil, legal needs.
- MetroHealth Trauma Recovery Center: Provides support services, health education, recovery mentorship, and ongoing community connection following a major, life-altering injury, trauma or victimization.
MetroHealth administrators see the transformation as the clinic’s best chance at survival.
“We decided we really have two paths we can take,” Julie Jacono, vice president of strategic operations for MetroHealth, said in an interview. “We either have to evolve, in a massive way, how we’re delivering wellness to that community, or we’ll have to accept the fact that we have failed in our ability to support the people and families of Buckeye. Because what we’re doing is not sustainable. It’s not getting good outcomes. All of the metrics that would define success in a business are declining. And more importantly, the health of the neighborhood is declining.”
The Buckeye clinic sits in the heart of a neighborhood that is home to one of Cleveland’s most vulnerable populations, where more than 70 percent of children are being raised in poverty, mostly by single mothers, and the infant mortality rate is about four times higher than the national average.
MetroHealth administrators say the outpost meets a critical need, providing prenatal, pediatric and geriatric care, along with a menu of other specialties. As Cuyahoga County’s “safety-net” hospital -- which cares for all county residents, regardless of ability to pay – MetroHealth sees improving the community’s overall health and wellness as central to its mission.
And yet, the patient no-show rate is more than three times higher than the average at MetroHealth’s facilities, system-wide. Most of those who miss appointments are single mothers, a demographic plagued by high infant mortality rates, Jacono said.
“I’m absolutely certain that the people who miss their appointments didn’t wake up in the morning and say, ‘How can I disappoint my doctor today?’” Jacono said. “More likely, they woke up and thought, ‘I’m already living at the edge. I’m facing all of these challenges, terrible things have happened. And now getting to that appointment -- it might as well be crossing the desert. I just can’t get there.’”
Jacono said MetroHealth has tried numerous strategies in the past to entice patients to their appointments. The clinic adopted a generous late policy, allowing patients to show up any time on the day of their appointment and still be seen by a provider. They sent text-message reminders of upcoming appointments. Doctors began making personal phone calls to patients, using scripts that emphasized the importance of the visit to the patient’s health. Still, they saw no uptick in patient attendance.
“It really boils down to a person’s hierarchy of needs in any given moment,” Jacono said. “When the world is crashing down on a person, coming to an appointment isn’t at the top of that list.”
MetroHealth administrators figured that if the Buckeye Clinic can provide for some of those other pressing needs, it might be worth the patient’s effort to “cross the desert,” Jacono said. MetroHealth looked to the success of a pilot program in Buffalo, New York, where a health-care organization offered space to agencies to meet the needs of its geriatric population, including Meals on Wheels, Medicare enrollment and other social services. The result was better patient attendance and engagement, Jacono said.
So MetroHealth consolidated its medical practices on the Buckeye building’s second floor and issued an open call for proposals from service providers and non-profits with something to offer the community on the facility’s 16,000-square-foot ground level. Jacono said that at first, the offer of rent-free office space must have seemed too good to be true, because there were no takers. MetroHealth had to issue the request for proposals three times and asked agencies that fund nonprofits to direct their applicants to consider submitting a proposal.
Finally, the applications began rolling in. And MetroHealth assembled a selection committee of local residents, pastors, patients and service providers from the Buckeye site. The half-dozen agencies that eventually signed contracts, committing to at least a year of service at the Buckeye Community Resource Center, will open their doors on Monday to patients and residents alike.
The schedule is still being finalized, but most of the organizations will offer services during health center hours, MetroHealth says. To support these services, the first floor will house a computer lab, counseling rooms and a food pantry area. The MetroHealth pharmacy, radiology and the Women, Infants and Children (WIC) Program also will remain on the first floor.
If successful, Jacono says, the resource center could become a model for hospitals operating in urban areas across the country. If it fails, MetroHealth is running out of options for Buckeye, she said. The hospital system has a fiduciary responsibility to use resources wisely, which means it could end up cutting back services at the site if the high no-show rate persists.
“In any other industry, we would close the doors if half of the clientele didn’t show up for appointments,” Jacono said. “But we have faith in all the reasons why this should work. Anchor institutions should bring together services that are important to the community under one roof to make navigation simpler. It’s a model that just makes sense.”