Innovation

At Hope Central (HC), there is a focus on responding to “felt needs” in the community and on “urban impact.” There is the establishment of a high standard of primary pediatric health care based on in-depth relationships with patients and their families. There is also the goal to establish a faith-based presence in primary care, to bring useful perspectives for healing from faith traditions. HC was founded in the context of an explicit vision of primary health care: to allow lengthy personal medical encounters in the context of philosophical commitments by providers and staff, here religiously oriented. The guiding approach is to make the providers’ church a blessing to the community and to channel these sources of personal inspiration to serve the community.

Executive director David Kwok described several key elements to HC’s model of integrated primary care. There is a value on humility. Providers and staff at HC try to not assume they know everything about patients’ lives. The entirety of a patient’s life is integrated into the health care encounter, to foster a feeling where patients feel cared for. This contrasts with an often reductionistic approach in primary care with brief health care encounters narrowly focused on specific signs and symptoms. The integrated approach at HC also extends to staff and recognizing the oft-stressful nature of primary health care. There are explicit steps to provide staff support in an atmosphere where help can be asked for. Steps to counteract burnout many times include prayer.

There are challenges bringing a religious philosophy into health care, or any publicly available service, especially into a neighborhood that is multi-ethnic with many religions. HC’s clinic sits amidst a postal zip code (98118, Seattle, WA) regarded as one of the most ethnically diverse in the United States. There are people from, or descended from people from, southern and southeast Asia, Africa and Latin America. African American churches, Catholic and other Protestant churches, mosques, Buddhist temples and Orthodox Jewish synagogues abound in the area. HC’s website does not emphasize religious matters, instead reaching out to patients and families based on a model of excellent patient and family-focused care. Intake forms contain questions about spiritual attitudes as these relate to health practices.

HC seeks to provide a sustainable model of primary health care. Even with the benefits of the Affordable Care Act, many times costs exceed income for health care businesses, this in an environment where the setting of prices can reflect local, state and national laws, and decisions by health insurance companies. Ongoing charitable fundraising is an integral part of HC’s business model. Fundraising includes an annual fundraising event (Dessert Fundraiser) and funding from foundations who are friendly to a faith based mission. David Kwok explained that there are considerable charitable efforts on behalf of high-end tertiary care facilities, especially for children. Examples of such care are seen in specialty children’s hospitals associated with most major medical schools in major urban areas. Further, these children’s hospitals, and other organizations, often conduct extensive fundraising to support research and uncompensated care. However, a similar approach is not taken for primary care, the setting where most people get most of their care most of the time. HC seeks to build a model where an integrated primary care clinic is supported by a diverse set of resources.

HC has moved away from a volume based business for primary outpatient care, a step often taken to cover expenses. HC seeks to hold primary health care to a higher standard and “cultivates a culture that recruits patients to become supporters” of their primary health care center. This is done through “fostering community among patients and providers.” The eventual goal of HC is to have two-thirds to three-fourths of costs met through fees and insurance reimbursement with the remainder of costs met through fundraising and donations.

Executive director David Kwok was asked about a high point in his work with HC. He answered without hesitation that it was the HC health care team coming together and continuing to work together in an atmosphere of mutual support and learning how faith motivates and affects their work. Stories are around hallway consults, between different providers. The term “warm handoff” is used in literature on integrated primary care when one provider can quickly talk with another and arrange for an on-the-spot consultation. David shared stories of cross disciplinary teamwork and coordination with meetings organized around mutual staff support.

Inspiration

HC in Seattle grew out of another community business, Rainier Health and Fitness, itself run by a non-profit religious group. About 10 years ago, two college athletes who lived in the Seattle area started this gym. While a gym, Rainier Health and Fitness had a health center emphasis. After Rainier Health and Fitness started, a medical doctor was recruited for an on-site clinic, although this clinic folded. Shortly after, in 2009, two local health care providers, physician Patricia Scott and psychologist T.K. Brasted, with personal visions of primary care came together, in part through their association at a local church. In 2010 they were joined by another physician, Christopher Jones, with a goal of integrating primary care with behavioral health care within the context of an explicit philosophical groundwork. David Kwok, the current clinic manager, previously working at a church in business technology was drafted into the vision of the founding health care providers.

The motivation for the innovation is a core philosophy based on a movement named Christian Community Development (CCD, www.CCDA.org). CCD, as elaborated by John Perkins (www.en.wikipedia.org/wiki/John_M._Perkins, www.spu.edu/depts/perkins/about ) is based on 8 core ideas: just distribution of resources, living among people who you serve, reconciliation, developing leaders, empowerment, addressing needs holistically, nurturing communities of faith, and listening to the hopes and dreams of others. There was concern about health disparities: involving differential outcomes in access to health care, provider-patient interactions and health outcomes based on factors such as income, ethnicity and location. In turn, HC is associated with the Christian Community Health Fellowship (CCHF, www.cchf.org) which focuses on provision of healthcare amongst the poor and other marginalized groups of people. At HC there is the goal of providing high quality and integrated primary care to families who are many times under-served. An important part of HC’s service model is operating in a culturally diverse milieu and foundational training involved consultation with local experts in cross cultural health services provision.

Overall impact

HC is unique in my AI interviews with businesses meeting one or more of the UN goals for sustainability. HC’s primary product is a service (health care) addressing a fundamental and ancient human need. Unlike most products and services, HC’s “product” is increasingly regarded as a human right. Historically, health care service models stressing profit, especially serving a diverse clientele, have been difficult to implement and sustain. There is growing government involvement in health care, at least since the creation of Medicaid and Medicare up through changes that have come with the Affordable Care Act, requiring unique planning and management demands. HC explicitly offers its service in a cross-cultural context requiring unique adaptation and service delivery methods. While all of the businesses I have interviewed in my AI studies grew out of guiding philosophies, HC is unique in how its sources of inspiration grew out of and reflect deeply held religious beliefs and addresses how to bring that core of belief to its business. Finally, HC is unique in its attention to workplace conditions. Mutual support, self-care and ongoing reinforcement of guiding visions are integral elements of the work environment.

Business benefit

Impact on business: There is a spectrum of integration that is in the mix for every patient. It is recognized that the model is unfolding over time and that the model is subject to ongoing evaluation. There is a culture of self-care for providers and clinic staff. There is a business geared to serving groups historically under-served. At this point, about 60% of patients have publicly funded health insurance (Medicaid) and 40% with other insurance. There is an active fundraising arm of the clinic. Over the past 12 months HC has provided more than 2800 medical and behavioral health encounters delivered to over 650 unique patients from infancy through age 18 by a staff of 4 physicians, one psychologist, one medical assistant and one registered nurse. Around 30% of encounters are for behavioral health services, including evaluations for autism. HC’s budget is around $500,000.

Social and environmental benefit

Impact on society: Integration of health care is now encouraged through applicable Federal laws, such as those describing medical homes. HC is on the forefront of models of health care delivery, “extended primary care”. This is most notable in HC’s integration of behavioral and mental health with physical health. With on-site high quality behavioral health providers on staff, needs can be addressed in a familiar and safe setting, with reductions of administrative and adherence problems so often seen when an outside referral is made. Plans are underway to apply an integrated model to other health conditions, notably chronic disease such as diabetes and asthma. These conditions are unique in their need for ongoing medical management. Each condition, like so many chronic illnesses require behavior change, self-management and social support. Additionally, it is HC’ hope to integrate other specialty providers into their primary care model. David Kwok was asked about the underlying Christian orientation of the providers and founding philosophy of HC. He stated that this is not presented directly to patients and that many families or several religions who are observant appreciate the opportunity to discuss these matters as a part of health care encounters.

Interview

David Kwok, Executive Director