|Healthworks Registered Dental Hygienest Jade Bernard works on a toddler while his parents keep him calm. - Times-Mirror/Rick Wasser|
There are more than 30,000 uninsured individuals in Loudoun County – roughly 10 percent of the population.
HealthWorks, one of only two facilities in the county which specializes in providing services for those uninsured individuals, was forced recently to cut payroll almost in half and limit some of its most needed programs as a result of rapid growth and financial issues.
"We took on additional services and grew too quickly," explained CEO Carol Jameson.
The number of patients HealthWorks saw in Northern Virginia grew from 998 in 2007 to 11,356 in 2013.
The company grew so fast its expenses were putting it behind $100,000 a month.
In an April meeting, Loudoun Supervisors discussed the shortfall and what to do about it.
According to the county, Healthworks provides $1.44 million in services to Loudoun.
Because of that high figure, supervisors decided to take a look into the financial viability of HealthWorks before offering to help fund its services.
Should the supervisors decline, HealthWorks and its patients could be left in limbo.
The Loudoun Free Clinic at the Inova Leesburg campus is the only other clinic that helps the uninsured population in Loudoun, but the free clinic does not service any person over 65 or younger than 18.
As well as its primary care services, HealthWorks also runs a behavioral health clinic, a pharmaceutical service, houses a WIC program and is the only place in the county that provides dental services to the uninsured.
Its facility on Fort Evans Road in Leesburg is a Goliath glass building with all the niceties of any major healthcare facility in the area.
Jameson is quite proud of the organizations clinical outcomes, and the no-show rate for its medical and dental facilities is 11 percent or less, meaning people take their healthcare seriously. As an uninsured individual, getting quality healthcare is difficult.
The community healthcare center served almost 9,000 Loudoun residents last year.
A struggle for any community healthcare center is the inherent business challenges posed by its model.
Healthworks must figure out ways to cover the gap created by offering low cost services which are normally costly.
One initiative is to diversify their patient care mix. The formula is rather simple. For every two insured patients, the organization can serve one uninsured patient.
Last year only 10 percent of the patients the community healthcare provider treated were privately insured, and 56 percent were uninsured.
In order to close the 2-1 insured to uninsured gap HealthWorks would need to see roughly 20 percent more insured patients than they currently do.
This means that recruiting insured patients to walk through the door will be a priority going forward for the company.
It will have to figure out a way to prove to the general public it can provide a high level of service.
HealthWorks also hopes to begin to bounce back by streamlining outdated systems in an effort to more quickly process and see its patients.
"We have consolidated our services and revamped our scheduling system to see more patients in a day," said Chief Medical Officer Dr. Robin Donald.
"We are looking at each individual process and trying to make that better."
The plan is to decrease wait times and access to same day appointments.
Medicaid expansion could be a huge boost for HealthWorks as well. Almost one-third of the patients HealthWorks served last year were insured through Medicaid.
The original plan for the nonprofit when it opened in 2007 was to be the medical home for the the uninsured and limited insured population in Fairfax and Loudoun.
The idea is that people will see the same doctors every time they need care. A patient's medical history can be more easily tracked and services like primary and pharmacy care can be more integrated.
"It's the medical and dental home for children, seniors, minorities, the vulnerable population," said Dental Program Manager Jade Bernard.
When asked about what brings her into work every day Bernard said, "It's the 13 people on my schedule. We are the only dental option for uninsured people. These are the patients that can't be served anywhere else."
One of the major services HealthWorks has been forced to cut back has been behavioral health services, which mostly focuses on mental health.
Initially HealthWorks had an open door to its behavioral health clinic, but the need is great in Loudoun County and the service so costly that the company needed to cut the program back.
A total of $8.7 million in federal stimulus helped to construct the current Leesburg location.
HealthWorks is a nonprofit, but 12 percent of its annual operating budget comes from federal dollars.
One of the most integral services HealthWorks provides is its pharmaceutical care.
Recently an open heart surgery patient at the Loudoun HealthWorks location was prescribed pills which cost $31 a piece, taken three times a day.
"Yikes! A 90-day supply is $8,706," said health specialist Jeanne Roush, who works for the Northern Virginia Family Service's Loudoun Accessible Medication Program.
The patient Roush is speaking about has qualified for a program which allows for free medication for low-income individuals without insurance.
"We get expensive cancer drugs and mental health medication, but the most used medications cover diabetes and high blood pressure," said Roush.
The medicine come directly from the drug companies.
Statistically people who don't have insurance are much more likely to postpone medical treatment, and much more likely to develop diseases such as diabetes, hypertension and high cholesterol.
When asked what the center means to the community Jameson responded, "It's not just the patient who suffers, there is a ripple in the community. Ultimately we all share in those costs."