The Good Samaritan Health Center of Gwinnett

Strategic Plan: 2014-2016

Relocation and Expansion: The Keystone of Health Project The Good Samaritan Health Center of Gwinnett (the “Center”) is a non-profit medical clinic and National Committee for Quality Assurance (NCQA) recognized Patient Centered Medical Home providing low-cost primary and chronic care across the life span of uninsured residents of Gwinnett County and surrounding areas. The Center desires to relocate its operation to a larger more conveniently located facility in order to accommodate its present growth and respond to the community’s increasing unmet need for low cost and charitable medical and dental services for the poor and uninsured residents of all ages in north metropolitan Atlanta. The Keystone of Health Project is necessary because the current facility cannot physically accommodate the additional staff and volunteers needed to serve new programs and the growing number of patients seen each day, and the parking lot cannot accommodate the combined number of patients and volunteers who arrive to the clinic. The Mission of the Good Samaritan Health Center of Gwinnett (the “Center”) is to demonstrate the love of Christ in word and deed by providing affordable and accessible healthcare services to the uninsured indigent and working poor. Summary of Strategic Plan During calendar years 2014-2016, the Board of Directors of the Good Samaritan Health Center plan to increase the Center’s capacity and ability to serve the growing demand for healthcare services from those for which the Center was established to serve – the poor and uninsured of Gwinnett County and surrounding areas, such increase in capacity and ability to be accomplished by:

1. Increasing the number of paid and volunteer healthcare providers serving the Center 2. Maximizing use of the existing infrastructure through an expansion of operating hours 3. Improving efficiencies in the scheduling, delivery and cost of services 4. Relocating the Center to a larger facility to accommodate growth

The Board of Directors of the Center developed this plan in response to findings based on county and regional demographics and actual requests for services from the Center (see Evidence of Need and Stakeholder Participation). It is incumbent on the Center to pursue this Strategic Plan for the following reasons:

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1. The Strategic Plan supports the Center’s Mission. 2. The Center is Gwinnett County’s only full-time non-profit health clinic exclusively serving

the poor and uninsured; alternative venues to meet the growing need do not exist. 3. Changes in federal funding for indigent care has and will continue to have detrimental

effects on the county public healthcare delivery system, making that system less amenable to providing free and discounted healthcare to the poor and uninsured.

4. Changes in federal, state and commercial insurance reimbursements have and will continue to have detrimental effects on physicians’ income, making physician offices less amenable to providing free and discounted healthcare to the poor and uninsured.

5. Although an area (Gwinnett, Newton and Rockdale counties) public health department exists, its programs do not include medical treatment for its constituents, with the exception of immunization and certain health screening and testing services.

Mission and History of the Organization The Mission of the Center is to demonstrate the love of Christ in word and deed by providing affordable and accessible health care services to the uninsured indigent and working poor. Our Goals are to 1) provide quality low cost primary healthcare services to the uninsured, 2) decrease the demand of the uninsured for non-emergent medical services on the local hospital emergency rooms, and 3) provide a venue for medical professionals and laymen of the Christian community to serve a marginalized population. Our Purpose is to meet the general medical needs of our patients as well as their spiritual needs through prayer and biblical counseling. The Center was incorporated in December 2004 and opened its doors in June 2005 and since then has provided comprehensive healthcare services at predictable and affordable prices. Twelve-thousand patient encounters were provided during 2014, a 19% increase in demand compared to 2013. The 2014 encounters were delivered to 4,293 individuals; 2,477 were new patients. At the expense of $931,000, the Center delivered services worth more than $3.4M in the traditional fee-for-service market. Since 2005, it has provided more than 55,000 free and discounted appointments to the uninsured and underserved of our area. The Center’s current active patient count is 12,000+ unique individuals; it has served more than 20,000 since its inception. Who We Serve It is estimated 1.9 million people, 20% of all Georgians, are uninsured. Atlanta is where nearly one in four people of working age are without health insurance; the city ranked fifth in the nation for its number of uninsured residents. In Gwinnett County, population 815,000, nearly 11% are living below the poverty level, and 26.5 percent of its working population is without health insurance. In 2010, 16.5% of Georgians reported not seeing a medical doctor in the past twelve months due to a prohibitive cost of care. The Center serves the north metropolitan Atlanta area; our healthcare services are made available exclusively to the poor and uninsured who very often are unemployed or

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underemployed. Our typical patients are women (68%), Latino (62%), about 47 years old (age range: <1-95), with a median household income of $14,388. More than 50 countries are represented within our patient population. Twelve percent reside outside of Gwinnett County, 51% speak English as a primary language, 59% are unemployed, and 20% are undocumented residents. We are a faith-based organization and our services are available to all patients regardless of race, color, religion, gender, sexual orientation, national origin, veteran status, or immigration status. Although the Center is a safety net clinic, it is not a free clinic; patients pay a flat fee for the healthcare they receive, although the fee typically represents just more than half the actual cost of the services provided. We do not have an income cap above which we will not provide services because even at high levels of income the cost of healthcare services for a very sick uninsured individual can be financially crippling. We are the only full-time reduced cost health clinic in Gwinnett County exclusively serving the uninsured.

Patient Ethnic/Race Distribution Asian 4% Black 26% Non-Black Hispanic 62% White Non-Hispanic 8%

Finally, it is quite possible the patient demographic we serve will change to eventually include non-minority groups and those not living in poverty. There are increasingly less primary care options available for all healthcare consumers because fewer physicians are devoting their career to the primary care field. The United States faces a shortage of 90,000 primary care doctors by 2020 and 130,000 by 2025, says the Association of American Medical Colleges. Georgia’s population has been increasing faster than its supply of primary care doctors. Without “immediate statewide cooperation, the state may never again have an adequate supply of physicians,” according to a report by the Center for Workforce Studies. Without changes, “Georgia will rank last in the United States in physicians per capita by 2020.” Current State of the Organization As a safety net clinic, we assert that if not for the Good Samaritan Health Center of Gwinnett all or most of the individuals we treat would have gone without healthcare or sought expensive treatment in the emergency room, treatment that would have been provided at the public’s expense. A 2011 Rand Corp. study found that in the U.S. we spend $4.4 billion annually on people who use the emergency room for routine, non-urgent care. Our local hospital system reported providing nearly 64,000 inappropriate visits to its emergency rooms during 2013, with all charity care costs exceeding $66 million. Although we cannot measure it, we know we create savings for the community by being accessible to those who utilize our services. The value of services we render represents the likely uncollectable debt the hospital system would experience if not for our charity medical

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clinic. In addition to these savings, the impact of our programs extend to the improved quality of lives of our patients and their families, reduced loss of productivity in the workplace due to illness, and increased exposure and sensitivity among rising medical professionals to the needs of the poor and uninsured. In other words, while our mission specifically targets our patients, it directly and significantly benefits the larger community as well. 2011 patient encounters 3139 Estimated value $ 878,920 2012 patient encounters 5860 Estimated value $1,640,800 2013 patient encounters 10,121 Estimated value $2,833,880 2014 patient encounters 11,989 Estimated value $3,416,865 Our services include:

Women’s Health General Family Medicine Pediatric Medicine and Child Immunizations School Screenings and Sports Physicals Pharmacy Assistance Program Health Education and Disease Management Classes Individual, Marriage and Family Counseling Social Work and Resource Referral

Description of Facilities and Staff The Center is located in its original space, a building constructed twenty-five year ago for use as a medical office building. It is approximately 4300 square feet in size, is located on a Gwinnett County Transit bus line and is within easy access of the Interstate 85 and Pleasant Hill Road interchange. The facility is also within seven miles of two Gwinnett Medical Center locations, both of which regard the Center as a community outreach partner, and as such, provide the Center with many specialty medical services at no or very low cost. The Center’s facility has been modified several times to subdivide rooms to accommodate additional treatment spaces as demand for services at the facility has increased over the years. The Center currently employs 12.5 full-time equivalent staff and otherwise provides its services with volunteer medical providers and administrative support, including bilingual interpreters. The Center is dual purposed; first and foremost we are a medical ministry, but secondly, we are a training site for students of the healthcare professions. Through our relationships with fifteen academic partners, we train physician, physician assistant, nurse practitioner and pharmacy students, providing them with hands on experience working with culturally diverse, medically complex and uninsured patients. Each day 20-24 people (staff, students and volunteers) man the Center to serve up to 50 patients.

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Student and Volunteer Stewardship The Center relies heavily on student interns of the health profession and volunteers to achieve its mission. In 2014, we received 18,930 hours of service donated by 470 individuals (valued at $545,571), 367 of whom were students of the healthcare profession serving the Center to fulfill clinical rotation requirements. The agreements we have with teaching institutions permits us to receive a steady stream of masters level nursing students, physician assistants students, pharmacy students and fourth year medical students to staff the Center. Additionally, clinical faculty of our academic partners periodically volunteer to mentor students and staff, and from time to time undertake research and process improvement projects for the Center. The Center provides a unique multidisciplinary learning opportunity for health profession students. None of our patients have money to spare, adding to every healthcare encounter an element of negotiation as we work together to develop a plan of care that best optimizes the patients’ limited funds. Our setting challenges students’ diagnostic and intervention skills, and is a complete immersion into a highly diverse racial and ethnic population where cultural influences have been important determinants in health status. Recognizing the barriers to healthcare uninsured patients often experience, particularly the undocumented patient, it is incumbent on the healthcare provider to offer conservative, low cost, culturally sensitive services coupled with education to effectively manage presenting medical conditions. To that end and through its relationships with its academic partners, the Center mentors future healthcare providers in the discipline of collaborating with patients, families, and other health providers to plan and provide healthcare that is both reasonable and affordable for the uninsured and impoverished patient. Not only does this objective serve to help lower the burden of healthcare costs on the poor, it benefits the larger public healthcare system as our student providers become licensed professional providers and disperse into the community with the knowledge and appreciation of a conservative approach to healthcare they acquired while completing clinical rotations at the Center. Additionally, several agency partners (Goodwill Industries and Gwinnett County Department of Family and Children Services, for example) collaborate with the Center; we receive volunteers from work readiness and employment re-entry programs that place unemployed individuals at the Center. Such volunteers “work” at the Center in order to gain industry specific experience and a professional reference to better prepare them for competitive employment elsewhere. These volunteers fill the roles of receptionist, medical assistant and bilingual interpreters. Stakeholder Participation

Board

Our board consists of seventeen voting members, including the Executive Director, representing the Christian, medical, legal, financial and academic communities. Our board is ethnically diverse and includes representation of those races and ethnicities served at the

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Center. We embrace diversity and shall continue to recruit to the board new members who are representative of the populations we serve. However, although the Center provides services to all eligible individuals regardless of race, color, religion, sex, national origin or immigration status, as a Christian ministry we do and shall continue to reserve the right to comprise our board entirely of individuals who profess the Christian faith. This Strategic Plan was developed and approved by the current Board of Directors.

Staff

The Center employs a paid and volunteer staffing model. Paid staff includes the Executive Director, select licensed medical professionals, and medical office support staff. Other staff are volunteers of varied professional backgrounds including physicians, nurses, pharmacists, medical office support staff, and English-Spanish interpreters. Volunteers are recruited from the medical community, medical training institutions and supporting churches and number more than 350 within a given calendar year. Staff and volunteers have participated in the development of this Strategic Plan through feedback and suggestions offered to the Executive Director in formal and informal contexts. Particularly, the Medical Director of the Center is and shall continue to be a key resource in the development of strategic plans for the Center.

Community Partners

The following are a sampling of our community partners. Partners have variously and indirectly contributed to the development of this Strategic Plan through their referral of patients with specific needs and of various life circumstances, requests for particular healthcare and supportive services, and general discussions about the state of the area medical and social services systems and resources available to those of poor health and limited means.

Academic Community

Foothills Area Health Education Center Georgia Gwinnett College Georgia State University Gwinnett Technical College Medical University of South Carolina Mercer University Philadelphia College of Osteopathic Medicine University of North Georgia Vanderbilt University Faith Community Christian Community Health Fellowship Christian Medical and Dental Association – Atlanta Cross Pointe Church

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Gwinnett Church Norcross Cooperative Ministry Norcross First United Methodist Church North Point Church Perimeter Church Simpsonwood United Methodist Church Victory World Church

Business Community

Georgia Charitable Care Network Gwinnett Coalition for Health and Human Services Gwinnett Hospital System Gwinnett, Newton, Rockdale County Health Departments Northside Hospital (FASP Program) United Way of Greater Atlanta (GRIP: Gwinnett Re-Entry Intervention Program) Vaccines for Children, Georgia Department of Public Health

Consumers

Our consumers provide general feedback to the organization in their interaction with healthcare providers and support staff, and specific feedback to the Executive Director when the opportunity is requested from time to time. We encourage and openly receive consumer feedback and act on reasonable recommendations and mutually identified problems which are within our ability and means to address. Consumer feedback is generally about telephone access to the office (consumers desire real time response rather than delayed response to voicemail messages), hours of operation (consumers desire evening and weekend hours), fees (consumers desire free healthcare) availability and cost of medical specialty services (consumers desire a broader array of specialty services within our referral partners and free or less expensive fees for specialty services) and dental care (consumers desire access to free or charity dental care). The Board of Directors has determined the method of soliciting stakeholder participation from consumers described above is sufficient for the organization’s strategic planning purposes, and this plan includes objectives that respond to appropriate issues of our customers’ concern.

Contributors

Our contributors have indirectly participated in the development of this strategic plan through their delineation of funding priorities, specifically, providing low cost quality healthcare to the poor and uninsured, serving the underserved and disadvantaged, and achieving non-profit sustainability. In response to these priorities, this strategic plan endeavors to strike a balance between providing the widest range of services at the lowest price and controlling costs through operating the organization within a clearly defined scope of services at a price that assumes a reasonable level of patient financial responsibility.

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Important Initiatives Limited by Our Current Location Pediatric Services

Georgia, with its 9.2 percent uninsured rate among children, the second-highest in the South, ranks No. 43 in an annual survey of the overall well-being of the nation’s children. According to the 2013 Kids Count study, released by The Annie E. Casey Foundation, one in five Georgia children lives in poverty, while the number of children living in households where their parents lack a full-time job is now 866,000 -- nearly 25 percent higher than four years ago.

Title XXI of the Social Security Act provides healthcare for uninsured children in the United States. This legislation gave states the opportunity to create State Children’s Health Insurance Programs (S-CHIP) to increase access to affordable health insurance. In Georgia, this comprehensive healthcare program is known as PeachCare for Kids. To be eligible for PeachCare for Kids, the child(ren) must be under the age of nineteen (19), living in families with incomes less than or equal to 235 percent of the federal poverty limit, and be a U.S. Citizen (or fall within an eligible legal immigrant category). It is this last criterion that leaves many children in Georgia, particularly Gwinnett County, uninsured. Latino children represent more than one-third of the total Latino population in Georgia, and approximately 16% of those children are not U.S. citizens. Georgia has an estimated Latino child population of 325,000; we can conservatively estimate there are 52,000 uninsured Latino children in the state. We can also safely assume this number underestimates the real size of Georgia’s uninsured population of illegal Latino children, understanding the reluctance of the illegal immigrant to voluntarily be counted in any census. Gwinnett County Public Schools System has 124 schools serving 148,872 students, 25% of which are Latino. Across all county schools, the percentage of students living at the poverty level ranges 13-51%. More than 87,000 students, 54% of all students, are enrolled in the free and reduced lunch program. The Good Samaritan Health Center of Gwinnett operates in the Berkmar Cluster; 88% of all students attending school within that cluster are enrolled in the free and reduced lunch program. Clearly poverty is prevalent in our service area. Further, 26.5 percent of Gwinnett County’s nonelderly adults have no health insurance. It is likely their children, at least those living above the poverty criterion for PeachCare for Kids, also do not have health insurance, irrespective of their immigration status. We know that poverty and immigration status are highly correlated, thus we believe there are a great many illegal children in Gwinnett County who are not eligible for PeachCare for Kids and, due to poverty, are not otherwise receiving adequate healthcare services. We desire to address this disparity in access to healthcare by developing and offering a reduced cost Pediatric Clinic at the Good Samaritan Health Center of Gwinnett.

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With the Keystone of Health Project we seek facilities adequate to provide a segregated pediatric treatment space, store pediatric medical supplies, vision and hearing testing equipment, point of care test kits (strep swabs) and host child health awareness programs for uninsured children of all ages. Evenings and Weekends We know that due to general poverty and high unemployment rates (8.0%) there are many residents of all ages of Gwinnett County who are uninsured and not receiving adequate healthcare services. Further, we know that many other individuals are underemployed, often working for per day cash wages and without benefits, making it difficult to leave work for healthcare purposes. We desire to address this disparity in access to healthcare by increasing the hours of operation of the Center to include nonstandard hours of care (evenings and weekends). Although women and children of all ages will benefit from the proposed expansion of hours, we expect a larger percentage of new patients who enter the Center through this project to be working men of the unskilled trades.

A survey of our patients led to the following conclusions about why many do not regularly come to the Center to see a healthcare practitioner:

1. Our current available appointment hours (M-F, 8:00AM-4:00PM) are in conflict with most blue-collar work schedules.

2. Time off from work to attend a medical appointment would be without pay. 3. Fear of consequences in the work place if it were to become known to an employer that

the employee was not healthy and in need of medical treatment. In May 2013 we began a phased approach to increase our hours of operation to eventually include a weekly Thursday evening clinic (4:00PM-8:00PM) and weekly Saturday morning clinic (8:00AM-12:00PM). We expect to serve an additional 250 patients per month when this program is fully developed; that development is hampered in part by the parking space limitations of the current facility (extended hours create the need for additional staff and volunteers).

Dental Services Oral diseases ranging from dental cavities to oral cancers cause pain and disability for millions of Americans. The impact of these diseases does not stop at the mouth and teeth. A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke. In pregnant women, poor oral health has also been associated with premature births and low birth weight. These conditions may be prevented in part with regular visits to the dentist. A State of Decay, a 2013 report by Oral Health America, describes a shortage of oral health coverage, a strained dental health workforce, and deficiencies in prevention programs across

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the U.S. Georgia, which has no dentist in 24 of its 159 counties, scored 62 out of 100 on a scale measuring adequacy of access to dental care. WorldDental.org reports 50 percent of Americans do not have dental insurance, further highlighting the need for more affordable care. Georgia’s dental care safety net system is fragile and vastly smaller than in previous years. Georgia’s dental Medicaid program is essentially a children’s program with extremely limited emergency services available to adults. In Gwinnett County, one charity dental program is in operation and provides serves only three days per month. The Ben Massell Dental Clinic, Georgia’s largest and most established charity dental clinic, accepts twenty-five new patients per week yet reports receiving hundreds of requests for services per week. For non-emergent cases, the wait for an appointment can be 4-12 months depending on the dental issue needing attention. In June 2013, the Georgia Dental Association hosted a two day free dental clinic known as Georgia Mission of Mercy (GMOM) in Gwinnett County. The GMOM volunteer dentists provided routine and complicated dental care to more than 1600 individuals during the event, and as many more were turned away due to lack of time and resources to serve everyone. All too often we receive requests for dental care that we are unable to provide and must refer our patients to distant charity dental clinics, knowing they will be among many on a long waiting list. Our health clinic was founded to relieve the pain and suffering of those without convenient access to affordable healthcare; it grieves us to recognize the need for affordable dentistry for the uninsured and be unable to meet that need. We desire to expand our offerings to include a full-scale full-time low cost dental practice to serve those of Gwinnett County who are without any form of dental insurance. Our current facility has no space available, in the building and parking lot, to accommodate such an expansion. Our Present Challenge We envision a new Good Samaritan Health Center of Gwinnett located within a 15,000+ square foot space, one large enough to accommodate ten medical exam rooms, eight dental treatment areas plus dental x-ray equipment and space to fabricate and repair partials and dentures, nursing stations, phlebotomy stations, laboratory, pharmacy, counseling offices, classroom space, a waiting area to comfortably seat fifty, prayer chapel, and storage. In such a facility, we project to offer 18,000 –20,000 encounters per year. Our fundraising goal of $7,000,000 for this important project is explained as follows: I. Relocate the Good Samaritan Health Center of Gwinnett

Acquire a New Facility: Relocation to a minimum 15,000 square foot space with at least 100 parking spaces will address limitations that now constrain GSG’s ability to accept new patients and volunteers.

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Update Facility for Medical Use: Build out and equipping of the newly acquired building will be necessary to ensure proper function for GSG’s needs.

Goals:

o Goal 1: Provide 14,000 medical appointments in the first year of occupancy. o Goal 2: Increase medical appointment by 15% annually.

Year 1 Cost: $3,600,000 Acquisition of Building: $2,000,000 Renovation, & Equipping of facility: $1,600,000

II. Expand Services Offered

Establish a Pediatric Clinic: The percentage of children under the age of 18 served by GSG is increasing; GSG needs staff and facilities dedicated to pediatric care.

Establish a Dental Clinic: Currently in Gwinnett, there are only part-time charity dental services available. GSG must provide low cost dental care to those who are without dental insurance.

Establish a Pharmacy / Dispensary: If patients are to have the necessary medications for prescribed treatment, GSG must obtain staff, facilities and funding to operate a low-cost pharmacy for patients needing prescription medications.

Increase Evening and Weekend Hours: GSG will provide services on additional weekday evenings and every Saturday to better serve the working poor.

Increase Mental Health Services: GSG will establish an in-house counseling program to work with patients who are in need this service.

Goals:

o Goal 1: Increase hours of operation from 54 per week to 60 per week. o Goal 2: Provide 500 pediatric appointments per year. o Goal 3: Provide 3000 dental appointments in the first year. o Goal 4: Increase number of dental appointments by 10% annually. o Goal 5: Provide 1500 counseling appointments per year. o Goal 6: Provide just-in-time samples for 90% of patients needing prescription

medication at the time of an appointment. o Goal 7: Establish five partnerships with pharmaceutical companies within the

first year.

Annual Cost: $200,000 Five Year Cost: $1,000,000

III. Expand Current Services Additional space and programming mandates the expansion of GSG’s staffing team. In order to effectively execute the preceding areas of service expansion and to sustainably operate a larger facility, retaining the proper qualified human capital is essential. This

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strategic plan will allow GSG to meet the demand for affordable healthcare services in Gwinnett as well as ensure stable and sustainable operations processes:

Increase Staff: As patient volume continues to increase, GSG must hire additional healthcare professionals.

Goals:

o Goal 1: Transition part-time medical professionals to full-time status to ensure better continuity of care for clients.

o Goal 2: Hire a full-time medical director. o Goal 3: Hire a Director of Operations and Development Officer to provide vital

infrastructure to sustain and grow GSG in future years. o Goal 4: Hire a staff to operate the Dental Clinic. o Goal 5: Hire a licensed mental health professional.

Annual Cost: $480,000 Five Year Cost: $2,400,000

Keystone of Health Fundraising Goal: $7,000,000