In an unremarkable hallway on the second floor of Mid-City's First Grace United Methodist Church, Pastor Shawn Anglim sees what isn't yet there. He gestures excitedly at the space — tiled ceiling and linoleum floors, lit by the mustard glow of old fluorescent fixtures.
"This could be a reception area," he says.
Down a hallway, in empty rooms where a green chalkboard is the only evidence of the Sunday school classes that were once held here, Anglim sees examination rooms and doctors' offices.
This space will soon be home to the New Orleans Faith Health Alliance (NOFHA), a holistic primary-care clinic on a mission to provide "physical, emotional and spiritual health care" to the working uninsured. By early summer, old classrooms will be retrofitted as topnotch doctors' offices.
The project is the result of an unusual partnership between local religious organizations, a Memphis clinic and a California-based HMO. And its organizers hope it will become a resource for patient populations still falling through the cracks of New Orleans health care.
Janet DiLeo Wade, a registered nurse who had worked in community health across the city for more than 20 years, packed up her car and her son as Hurricane Katrina threatened the city and evacuated to her sister's house in Memphis. Once there, she responded to a call for volunteers to help with the other 45,000 evacuees in the Tennessee city. She was placed in the Memphis Church Health Center, a faith-based primary-care clinic with a mission to "provide health care for the poor and promote healthy bodies and spirits for all."
What she saw there was nothing like her experiences in New Orleans.
The 50,000 patients at the center were poor and uninsured , similar to the populations Wade was accustomed to back home. "(But they) were being empowered to take care of themselves," she says. "I was so impressed."
The center integrated case management and social support into the clinic, linking patients to exercise plans and support groups outside the doctor's office. All patients paid fees on a sliding scale and agreed to be active participants in their own health. Staff and volunteers described it as a "hand up, not a handout."
"It offered a medical home for people; it offered a continuity of care," Wade says. "It was really the whole picture for me."
She thought the model could work in New Orleans and attended one of the center's replication seminars, an intensive crash course on how to start a faith-based clinic.
In New Orleans, Wade shared the idea with Catholic Charities, where she had been director of health education. Guy Fournier, who was then director of project planning for Catholic Charities, jumped on the project. Out of those conversations, the New Orleans Faith Health Alliance emerged as its own entity, separate from but supported by Catholic Charities. NOFHA then received a $250,000 exploratory grant from Baptist Community Ministries.
"It just made sense to do this," says Fournier, director of project planning for NOFHA. "There is a historically high rate of uninsured."
Before Katrina, Louisiana's uninsured rate was one of the highest in the country at 21 percent. According to a 2008 Kaiser Family Foundation study, 27 percent of low-income adults in New Orleans are uninsured, and some fear that number could rise if the economy weakens.
One of the city's working uninsured is NOFHA board member Fernando Arriola. A general contractor and head of New Beginnings Enterprises, Arriola used to spend $900 every month on a BlueCross BlueShield catastrophic insurance plan for himself, his wife and his two children. When business was lean, he temporarily dropped the policy, and the company would not take him back when he tried to renew his coverage. No insurance company would enroll him.
If Arriola or anyone in his family needs to see a doctor, he pays full price, about $75 before lab tests and other fees. "It's $75 if they don't touch me," he says. "If they touch me, it's more."
The range on NOFHA's sliding scale in New Orleans isn't set yet, but the average price for a visit at the Memphis clinic is about $25.
"It's not insurance, but it's a big, big help," Arriola says.
In its first year of operation, NOFHA is expected to enroll about 500 working, uninsured patients. As it scales up, it will receive intellectual and financial support from Kaiser Permanente (not associated with Kaiser Family Foundation), a nonprofit California-based health system and one of America's largest HMOs. Kaiser Permanente has donated consultants to help NOFHA plan patient flow and management, and the group's architects will visit this month to draft a redesign of the space at First Grace, where NOFHA is signing a three-year lease.
Kaiser got involved in February 2007. Around the same time Wade was getting people in New Orleans excited about the clinic, Dinah Dittman, national director of community relations for Kaiser, was sitting at a conference in New Orleans, listening to a representative from Catholic Charities talk about the need for primary care. After Katrina, Kaiser pledged $3 million to rebuilding and expanding health care on the Gulf Coast. Two million of those dollars went to the Centers for Disease Control and Prevention to help with stabilization, and Dittman was looking for places to invest the rest.
After the conference, Fournier asked Dittman if her organization could assist NOFHA by sharing intellectual resources such as help in laying out the clinic and information about managing records. Dittman was happy to make the resources available, and later made a counteroffer: $300,000 over three years to develop the clinic. "This is a humanitarian effort for us," Dittman says. "It's about sharing the things we know work well in our clinic settings."
Kaiser will monitor NOFHA's progress closely. Serving 8.6 million people, the organization is always looking for the best practice models. "There's more than one way to operate a health clinic," Dittman says.
Kaiser's financial support has been a welcome surprise for NOFHA, which estimates its first year of operation costs will exceed a million dollars. The patient copays are expected to cover only about 20 percent of the annual cost.
Making up the difference is a challenge. NOFHA will operate with exclusionary criteria for patients: They must be employed but not have insurance. Patients will sign a contract as partners in their own health. They'll be set up with resources to help them follow through with disease management and lifestyle changes, but if they are habitually noncompliant, they may be asked to seek treatment elsewhere. As a result, the clinic is not eligible for federal funding.
"You have to be doing everything you can to have as broad a funding base as possible," says Dr. Scott Morris, founder of the Memphis Church Health Center. "You have to have literally thousands of people who care about what you're doing."
Because the Memphis center gets so many requests for help, the replication seminars are usually the biggest support Morris offers, but he did visit New Orleans last fall to help NOFHA hash out some of its plans.
"I'm like the rest of the country," Morris says. "New Orleans is a special case after the hurricane." He suggests NOFHA take advantage of that. "There are still a lot of people around the country who still care," he says. "A project like this, it makes people's hearts soar."
Not accepting federal dollars also means NOFHA is not beholden to the strings attached. For example, it will not be required to ask for patients' Social Security numbers. This means the clinic is in a position to become a care provider to the undocumented, largely Hispanic labor pool that arrived in New Orleans to rebuild. Emergency rooms are required to accept patients regardless of documentation status, but for these laborers, access to primary and preventative care is extremely limited. First Grace actively ministers to this population with bilingual services, and NOFHA is prepared to have Spanish speakers available.
"They don't just want to be our landlord, they want to be our partner," Fournier says. He sees these connections as part of the integration of faith into the project, although patients are not required to declare faith to be treated. If it's already part of their lives, however, he says spirituality can be one more resource clinicians use.
Morris applauds NOFHA's dedication to keeping the clinic interdenominational and for reaching out to Kaiser. "It's more than any one church can do," Morris says. "It's more than any one hospital can do."