| Name | Kelly |
|---|---|
| Last Name | Arnold, M.D., FAAFP |
| Home Address | 901 Vine Street Chattanooga, TN 37403 United States |
| Organization Name | Clinica Medicos |
| Describe Your Role In The Organization | Founder + Medical Director Clínica Medicos Assistant Professor of Family Medicine University of Tennessee College of Medicine |
| Organization Address | 1300 E 23rd St Chattanooga, Tennessee 37404 United States |
| Website | https://www.clinicamedicos.org/ |
| Best Phone Number To Reach You | 423-779-7333 |
| Alternate Phone Number | 423-760-4000 |
| Email Address | kelly@clinicamedicos.org |
| Alternate Email Address | support@mmfchattanooga.org |
| Please Describe Your Project In Detail | This project is an expansion of affordable, bilingual primary care alongside behavioral health, obstetrics and dentistry for underserved communities. American Rescue Plan Act Funds would specifically be used for the physical renovation and build out of a larger clinic space at 1148 East 23rd St. into 17,000 sq. feet of medical mission space to serve the uninsured and underinsured community of Chattanooga and offset unnecessary use of the emergency room and destabilizing medical costs. Clínica Médicos is a comprehensive medical clinic with bilingual services catered to underserved communities, especially the underserved, uninsured Latino population. Historically, we have provided preventive care, pediatrics, obstetrics, urgent care and chronic management of disease to now COVID-19 testing, vaccination, and monoclonal antibody treatment. Founded in 2015, Clínica Médicos has served over 40,000 registered patients, >90% of whom are Latino, >50% of whom are uninsured, and >85% of whom are living below the federal poverty line. This work is done inside of a Monday-Sunday “mini-mission hospital” model to build trust and relationships, defragment care, and contribute positively to the financial stability of our patients by avoiding unnecessary emergency room visits and strategizing high cost procedures and specialty care. An additional highlight of our work is the delivery of 1000 infants whose mothers we helped acquire perinatal insurance via the Cover Kids program of Tennessee. The majority of these children stay part of our family care. Throughout 2020, while the delivery of healthcare was confusing and largely unavailable, Clínica Médicos met the demands of patients in need by staying open using safe practices, performing over 25,000 COVID-19 tests, administering over 15,000 COVID-19 vaccines, and building a dedicated COVID-19 unit and staff, all the while championing equitable testing practices, whether for the uninsured or undocumented population, so that our community remained as healthy and safe as possible. Clínica Médicos was the first community site in Chattanooga to receive vaccinations from the state of Tennessee, and, in addition to routing vaccines into our workflow of COVID testing, we also established a seven day a week drive-through service. We find it a success that based on relationships alone, 50% of our vaccines were administered to low-income families and 50% within communities of color, those with higher incidence of COVID-19 morbidity and mortality. Our vision is to adapt with creative solutions to urgent community health needs, especially in areas with unreachable or unaffordable services. Since January 2020, our vision has expanded to include integrating behavioral health, social services and dentistry. Even while engaging with the demands of the pandemic, we did not lose sight of these initiatives. We envision integration to include not only behavioral health professionals, but also care management and health navigators as we deepen and expand our capacity to address social determinants of health. We currently have three, full time staff dedicated to this initiative with more staff and services planned in the years to come, as we have more physical space. We also want to continue to deeply impact our city’s health by improving regional maternal/infant mortality through our obstetrics fellowship, which trains physicians in advanced patient skills along with the financial realities of private practice. Our vision is that every patient and family who walks through our doors receives comprehensive, compassionate care at a fraction of the common cost, seven days a week. |
| Please explain how your project meets the requirements of the American Rescue Plan | The expansion of our clinic and services directly impacts Chattanooga’s COVID-19 mitigation efforts, medical expenses, and behavioral healthcare service capacity, specifically for a disproportionately affected community. The construction of a larger and enhanced space for us to do our work is a time-limited investment that catalyzes on the work and impact we have already made, and positions us to continue to dynamically respond to urgent community health needs. We continue to expand our services because unmet social, mental, and physical needs impact health over a lifetime, starting pre-conception. Treating health conditions as early as possible, holistically, close to a person’s home and community, and in a culturally and linguistically appropriate manner leads to the best health outcomes. There is a high prevalence of mental disorders and chronic conditions, along with oral pathology. The pathways causing comorbidity are complex and bidirectional, a key component of health rarely effectively acknowledged or treated by our current healthcare system. Half of the care for common mental disorders is delivered in the general medical setting and primary care providers prescribe the majority of psychotropic drugs for children and adults, yet mental disorders often go undiagnosed, untreated, and/or under-treated in primary care. Referrals from primary care to specialty mental health are often not completed or followed up on, especially with the limited English proficiency population where there is a severe, nationwide shortage of bilingual, mental health professionals. When patients do have contact with mental health care, specialty mental health providers often have difficulty providing adequate medical care to patients with co-existing mental and physical illnesses. This is an especially salient area of concern as we continue to experience the long term medical and psychological effects of COVID-19. Racial and ethnic minority populations are more likely to seek and receive health care in primary care settings. There are also many inequities in social determinants of health that put our families at increased risk for destabilization and difficulty accessing services, such as discrimination in healthcare, housing, criminal justice, finance, and education, in addition to the disproportionate impact of COVID-19. These inequities lead to chronic and toxic stress and shape the social and economic environment where our patients live, work and play. The long term effects of the pandemic are still unknown. We plan to be an accessible place to triage the ongoing, unknown, and often unmet needs of long-haul COVID, both physically and psychologically. |
| Where would your project take place? | 1148 East 23rd Street Chattanooga, TN 37404 |
| How much will your project cost in total? | 5500000 |
| Do you have any matching funding sources from other local governments, private entities, non-profits, or philanthropic entities for your project? | Yes |
| Please describe the source and list amounts of any other funding. | We launched the silent portion of our funding campaign in Q3 2021 with fundraising to continue throughout 2022. Our hope is that public sector support for our physical plant will be made available in Q2 and construction commencing in Q3 2022. We plan to use private partnerships to cover operational aspects of this project ranging from ensuring years of fellowship training for physicians, purchase of equipment used to outfit dentistry, and patient financial assistance for medical and mental health services. *City, County, State Delegation--use of federal ARPA funding 4 million (physical plant) *Private Donor(s) Brad Martin, $250,000* Anonymous Donation (Received) $50,000 *Pending Applications (both submitted and submission pending) Lyndhurst Foundation - pending Benwood Foundation Maclellan Foundation- pending United Way of Greater Chattanooga- pending Robert Stone Foundation Footprint Foundation Tucker Foundation Care Foundation of America The Howard Fund Schillhahn-Husky Foundation Blue Cross Blue Shield of Tennessee Foundation- pending |
| What portion of the project are you asking the city to fund? | Approximately 36%, specifically renovation and build out of our physical plant. |
| If funded, when would your project start? | July 1, 2022 |
| How long would your project take to complete? | 12 months |
| What milestones would you use to measure your project’s progress? | Our first step is the completion of the renovation of 1148 East. 23rd St, which we intend to have completed by Q3 2023. During the renovation, we will be working on increasing capacity for our clinical operations of behavioral health/social services, obstetrics, and dentistry, alongside the comprehensive services we already provide. These initiatives will be on-going in terms of multiple levels of commitment from our team, but with a planned, start-up phase of roughly three years. Part of our strategic plan involves exploring every avenue for sustainability, continuing our transparent and low-cost pricing model for patients and capturing third party payments for services rendered. We aim for financial solvency by year three, approximately Q3 2026. |
| How would you ensure accountability and transparency throughout the project lifecycle? | We have board oversight through Medicos Mission Fund (the non-profit arm of our clinic) and a fundraising advisory board of community leaders. In addition, we are committed to multiple reporting processes through our public and private partnerships, as well as an internal strategic plan that guides our metrics for success. Strategic Plan: Goal: Innovative and Equitable Pandemic/COVID 19 Response Initiatives: Purchase of 1148 East 23rd street for expansion of pandemic relief services 7 day a week equitable PCR testing and COVID 19 vaccination First Community Monoclonal antibody administration site for treatment of COVID 19 Performance Indicators: Development of 1148 drive-through space with 7d/week operations and staffing Services provided to 50% uninsured and 50% minority communities Acquisition of Regeneron from TN DOH and establishment of community treatment protocols Goal: Establishment of Integrated Behavioral Health into Primary Care Services Initiatives: Create a team of bilingual behavioral health care specialists Provide bilingual, mental and behavioral health services 7days a week that address barriers to care such as cost, language, access, etc., and operate in tandem with the provision of medical care Increase our capacity to address social determinants of health with on-site services and robust community partnerships Explore continued innovation in the delivery of bilingual, mental health services in our community Performance Indicators: Increase in number of visits a month for BH Increase in number of uninsured, registered patients accessing BH services Develop a culturally-adapted program for quantifiable tracking of patient status through treatment plans including validated clinical scoring systems, as appropriate. 7 day/week coverage Goal: Obstetrics Fellowship Initiatives National Recruitment of physicians for Surgical Obstetrics Fellowship Surgical Obstetrics curriculum in partnership with the Camellia Foundation for academic achievement through board certification Physician retention upon graduation for Clinica Medicos Performance Indicators: 1-2 Fellowships annually filled Board Certification through the ABPS Hiring of a Clinic Medicos Fellowship graduate every 5 years Goal: Integrating Dentistry into Primary Care Initiatives: Explore and create dental and orthodontic partnerships Equip dedicated dental space in 1148 Expansion with appropriate supplies and equipment Change clinical and administrative systems as needed to support integrated dentistry efforts Performance Indicators: On-site dentistry and orthodontic services 3,000 registered, uninsured and Medicaid patients accessing dentistry services 1,000 registered, uninsured and Medicaid patients to receive medically necessary orthodontic services |
| If successful, how would your project benefit the community? | Our mission is to not only treat disease, but also prevent it and promote wellness. Studies have shown that integrating behavioral health services into primary care clinics improves patient health outcomes, patient satisfaction, provider satisfaction, and decreases health care costs overall. Our three-pronged expansion of services seeks to serve our patients and community through enhancing our capacity for intervention from the beginning of life for vulnerable pregnant women with our obstetrics fellowship, early intervention and comprehensive treatment through integrated behavioral health and addressing social determinants of health, and increasing access to dental treatment. We know our patients are disproportionately affected, not only by the medical and psychological impact of the pandemic, but also by the economic costs. A July 2021 New York Times Article reported that Americans owe nearly twice as much medical debt as was previously known, making it the largest source of debt (58%) in collections. 1 in 4 Americans are in debt collection, with 60% of those bills under $5,000. Our dedication to financial transparency within our clinical model, as well as our high touch, low-cost services, helps patients avoid unnecessary ER visits and protects them from predatory financial systems. Our model is a closed loop, return to work system where patients and families can get comprehensive care every day, which has a direct impact on their financial and occupational wellbeing. They aren’t lost to follow up because, when outside referrals do occur, our social services team assists them through every step of that process and keeps track of the outcomes. Our model helps stabilize families because patients who have stable medical homes, less financial distress, and increased access to services, including mental health, have better participation in schools, improved academic metrics, and more resilient progress in economic mobility. We hope to have completed construction by Q3 of 2023 with the arrival of the first patient in our new building, but there is no end to the spectrum of patient care, especially with the on-going impact of the pandemic. We remain committed to leading the charge for the underserved in our community. |
| How will you attract community buy-in for your project? | We will continue to build on the trust we have already established in the community, evidenced by a continuous patient increase of 10-15% every year that we have been in operation. We attribute this growth in patient trust and confidence to the outstanding quality of our care and the four foundational values which guide our work: Cultural Competence :Clínica Médicos is familiar, welcoming, and comfortable, while rigorously committed to the highest professional standards of care. Economic Affordability and Transparency: We are affordable, honest, and transparent. Logistical Ease: We are open seven days a week and patients may arrive with or without an appointment. Language: Patients can communicate in their own language, building more trusting relationships and improved outcomes. This often eliminates duplication of services and ER visits. All staff members are bilingual. We have partnered with agencies such as United Way, La Paz, Life Spring Pediatrics, Cherokee Health Systems, NAMI Chattanooga, Hamilton County Health Department, Step Ahead, and City/County/State delegations. Our behavioral health navigators are in touch daily with additional community partners assisting in navigating healthcare challenges for patients, whether medical or behavioral. |
| Name | Aline Defiglia LCSW, MPH, Consultant and Grant Writer |
| Contact Information | alinebethea@gmail.com |
| Name | Kerry Hayes, Consultant |
| Contact Information | kerry@coeonow.com |
| Is there anything else you would like us to know about your project? | We have additional staff and community partners working with us on this project. The names listed above are those directly involved in this application. Positive recognition, both locally and nationally, has been growing for Clinica Medicos. These recent articles about our work in the Chattanooga community are two such examples: https://www.timesfreepress.com/news/local/story/2021/oct/23/clinica-medicos/556657/ https://www.forbes.com/sites/billfrist/2021/09/15/clnica-mdicos-an-unassuming-clinic-is-reinventing-community-healthcare-in-chattanooga-tennessee/ |