In Texas, people in the uninsured and indigent population die on average 29 years sooner because they don’t have access to primary care, says Allison Greer, BBA, vice president with the Center for Health Care Services (CHCS). A San Antonio-based community mental health center that runs an opioid treatment program (OTP), and an outpatient mental health center in a different location in the county, CHCS has just added a primary care clinic right next to the OTP.
The primary care clinic, called the Dianna M. Burns Bank M.D. CenterCare Clinic, was made possible by federal 1115 waiver funding. This waiver, from the Centers for Medicare and Medicaid Services, allowed the Texas Health and Human Services Commission to expand Medicaid managed care while providing incentive payments for health care improvements for uninsured patients.
Texas did not expand Medicaid. Under managed care, health care costs are controlled by a middleman, usually a private insurance company. The waiver sent $103 million to CHCS, and one of the 11 projects it funded was the primary care clinic next to the OTP.
The clinic is the safety net—the program of last resort—for Bexar County in Texas. Seventy percent of the patients have no insurance at all—not even Medicaid. Because Texas didn’t expand Medicaid, single men who are poor, without children, and without health care coverage predominate as patients.
The CHCS received $8.3 million for the primary care clinic, which Ms. Greer describes as a “turnkey” deal. “We were able to build the clinic right next to the Restoration Center, so we didn’t need zoning, and we didn’t have any of the requirements you usually have when you build a health care facility,” she told AT Forum. Opened just this summer, the integrated care clinic is meant to lower hospital costs by discouraging treatment in the emergency department.
No Stigma, No Judgmentalism
There’s no stigma for OTP patients when they go to the primary care clinic, which is a welcome feeling for someone on methadone, said Christi Mott, spokeswoman for CHCS. The population is almost completely indigent, partly due to the lack of Medicaid expansion in the state. One of the few benefits they have is substance use disorder (SUD) treatment, and now, a primary care clinic that caters to their needs. “It’s a beautiful thing.” And because the primary care clinic is embedded in the Restoration Center, staff in both the OTP and the center know each other. Staff in primary care have worked in the Restoration Clinic, so they are non-judgmental, Ms. Mott told AT Forum. “It’s very comfortable for patients to go there.”
Physicians and caseworkers are taking the OTP patients “by the hand” to the primary care clinic, said Ms. Mott. “They’re explaining that it’s not good to over-utilize emergency departments. The main health conditions our patients experience are diabetes, cardiovascular disease, and skin cancers.”
Coordinated Pregnancy Care
For pregnant patients in the Restoration Center OTP, the focus is on getting them proper prenatal care in addition to methadone, so that the baby doesn’t have to spend months in the neonatal intensive care unit, said Ms. Greer. They can access this care at the primary care clinic, CenterCare. Women in that program don’t risk losing custody. “They can keep their babies, because they’re not addicted to opioids.” There are currently 63 women in the pregnant program, and 600 patients overall in the OTP.
CenterCare Staff and Facility
The facility has four exam rooms. In addition to primary care, the clinic provides checkups for women and babies. “We’re also talking about bringing in a pediatric specialist once a week,” Ms. Mott said. And it’s Texas, where many people—especially those without shelter—are exposed to the sun, so skin cancer is common. “If one of our doctors sees something that looks cancerous, that patient gets a referral to a specialist.”
There is also a care coordinator on staff, and a benefits coordinator who helps link patients to benefits. The majority of the patients are uninsured, but CHCS gets a combination of funding from the state, which has a generous SUD benefit, and from the county.
The Restoration Center has no waiting lists—at 600 patients a month it’s one of the smaller methadone centers in the city. “We have a little capacity,” said Ms. Greer.