City's Network of Clinics a Model for National Health Reform

A Guest Column by Mitch Landrieu and Kathleen Sebelius

Five years ago, Charity Hospital, a teaching hospital in Louisiana, had one of the busiest emergency rooms in the country. But when Hurricane Katrina struck in 2005, rising flood waters rendered it—and many other health care facilities in New Orleans—useless.

Health leaders, including Karen DeSalvo, M.D., M.P.H., M.Sc., who at the time was a fellow in the Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholar program (2002 – 2007), rushed to set up a new system of clinics to fill the void left by the city’s flooded health care facilities and serve the countless hurricane victims who were in dire need of medical attention after the storm.

Five years later, this system is firmly established in New Orleans—and winning national plaudits for its accessibility, comprehensive services and high quality of care.

Health and Human Services Secretary Kathleen Sebelius and New Orleans Mayor Mitch Landrieu have called the system, “a model for the entire country as we reform our health care system.” They wrote in an op-ed that ran September 23 in the New Orleans Times-Picayune: “It seems fitting that New Orleans and its people, who have shown the nation how to survive unthinkable tragedy, can now set an example for strengthening the nation’s health care system into the future.”

The network of 93 clinics and mobile health units in the greater New Orleans area has also received widespread attention from the national news media. The PBS NewsHour and NBC Nightly News recently aired feature stories about the clinics.

“We had a clean slate. And, you know, Katrina, the storm, the flooding was horrific, but it really was an opportunity for us to try something new and better for our patients,” DeSalvo said on the NewsHour. “So, when we had that chance and could go out in neighborhoods and begin building from scratch, that is what we sought to do.”

Generalist Physician Faculty Scholar Founds Clinic in Wake of Hurricane Katrina

DeSalvo founded one of the new clinics when the storm hit. Sensing the immense need for immediate health care services in the wake of the storm, her fellow Generalist Physician Faculty Scholars and program staff at the Robert Wood Johnson Foundation reached out to her and volunteered resources. DeSalvo was able to open a community health center clinic at Tulane University with their help.

The clinic proved invaluable to area residents and is now one of eight clinics and mobile health units run by Tulane. Together, these clinics serve some 8,000 people and provide workforce training for doctors and health care professionals at Tulane University’s School of Medicine.

“We got the idea very quickly that this system should be permanent,” said DeSalvo, who is Tulane University’s vice dean for community affairs and health policy.

That’s because the new clinic represented a considerable improvement over the old system, which was centralized in the downtown area and difficult to access for farther-flung residents, DeSalvo says. In addition, health facilities in the old system often offered a limited range of services to patients.

The new clinics, however, are spread out across the city and provide greater accessibility to residents. Known as “medical homes,” the clinics also provide a broad array of services under a single roof. In addition to primary care, many provide mental health services and specialized care. As such, they offer continuous, personalized care for residents who would otherwise have to rely on emergency rooms or multiple providers for services.

Additionally, clinic officials have won the respect of the community because they go above and beyond traditional medical care, DeSalvo says.

Tulane’s clinic officials, for example, reached out to churches after the storm to create community registries so they could recruit and keep patients in the system rather than waiting for them to come in on their own.

Other clinics, meanwhile, have held weekend farmers’ markets in their parking lots to provide fresh, healthy produce to area residents. Still others have trained staff to provide residents with helpful information such as which farmers’ markets accept food stamps; which are easily accessible by bus; and how patients can grow their own food in a public garden network.

“We were rebuilding our entire society, so we had to think about the social determinants of health,” DeSalvo said. “You can’t tell a diabetic they should be eating more vegetables if every grocery store within 10 miles of their house is gone. We believe health is more than getting someone to a doctor, and we have integrated that in our daily practice.”

These actions have enabled clinic officials to forge strong bonds with the community, and those bonds have helped them survive and thrive in a difficult post-hurricane environment.

The future of the clinics appears more secure than ever.

In September, the state of Louisiana and the city of New Orleans entered into a partnership with the U.S. Department of Health and Human Services that will bring nearly $100 million in funds to the network of clinics over the next three years. The state will be able to redirect a portion of its Medicaid budget from hospitals to the clinics, sustaining them until at least 2014, when the new health care reform law will be fully implemented and a greater number of uninsured patients will be eligible for health insurance.

“We were literally under water five years ago,” DeSalvo says. “In five short years we’ve built this system and proved that this model works in structure and in quality.”

DeSalvo is sharing her expertise and experiences as a member of the Alumni Network Roundtable on Health and Health Care, a project of the RWJF Alumni Network in which members gather for a rigorous examination of the complex issues facing the nation’s health care system—and how alumni can use their passion, talent and real-world experience to strengthen the national discussion.