Putting Nurses in Charge: How One Clinic is Serving More Low-Income Patients

Between 1996 and 1999, Rutgers University Foundation, New Brunswick, N.J., carried out a project to help define the financial and operational structure necessary for the long-term viability of a nurse-managed primary health care center in Elizabeth, N.J.

Preliminary data from several health maintenance organizations (HMOs) indicate that nurse-managed community health centers reduce hospitalization costs by 50 percent compared to the sum total of family practice groups in the HMO.

The Elizabeth-Port Community Health Center opened in a federally designated Health Professional Shortage Area in February 1996 as a collaborative effort of the City of Elizabeth, Rutgers University College of Nursing (College of Nursing), and the Visiting Nurse and Health Services.

Key Results

  • The Elizabeth-Port Community Health Center developed a business plan detailing its strategies for operating after a five-year federal grant period ended, including issues of:

    • Workflow and information systems.
    • Practice management.
    • Procuring health services contracts with community businesses, schools, daycare centers, and municipal programs that require physical examinations and other health services.
  • To increase referrals, the community health center forged a connection with the Newark Center for Families and Communities, which includes Rutgers faculty and students from legal, educational and social fields participating in outreach programs.

  • The community health center also established collaborative agreements with two nearby hospitals (which later merged into one entity, Trinitas Hospital) for medical referrals and radiological services, and at the end of the grant period was pursuing a contractual affiliation with Trinitas.

  • In July 1999, the community health center contracted with Health Care Network of New Jersey, LLC (a network of private physicians working in partnership with Trinitas Hospital) for technical assistance to position itself to assume managed care contracts.

    As a result, the community health center completed the process for becoming credentialed with three managed care companies: Mercy Health Plan, Managed Healthcare Systems of N.J., and Americaid Community Care.

    In March 2000, the health center signed contracts with each of these companies, which activated its provider status, and soon began receiving capitated payments for patients.

  • The health center also developed community partnerships at the local and state levels.

    • The City of Elizabeth spent $80,000 to renovate a larger space for the health care center.
    • The Elizabeth Development Agency has given priority to assisting in the efforts to sustain the health center after the end of federal funding, according to the project director.