In five decades of providing behavioral health services, Wheeler Clinic has served hundreds of thousands of Connecticut residents, many with serious mental illness and addiction disorders.
But many of those clients had other needs that weren’t being met.
Nearly 70 percent said they had no access to primary care. Many also reported having hypertension, diabetes, or other health conditions that could be prevented or controlled with access to regular primary care. Clinic staff would attempt to refer clients to primary care providers, but often with little success.
“We said, ‘We need to start thinking about how we can do this differently,’” said Susan Walkama, Wheeler’s president and CEO. “We began to say, ‘Is holistic care the better way to provide care, and to really impact all aspects of an individual’s life?’”
Wheeler Clinic’s transformation coincided with a shift in the health care system, which has in recent years begun to place more emphasis on care quality, cost, patient satisfaction, and outcomes. Wheeler began providing medical care by bringing on nurse practitioners, with clinical oversight provided by local hospital physicians. Within a few years, the clinic achieved designation as a federally qualified health center, offering primary care, behavioral health services, and dental care. The federal designation allows it to receive higher Medicaid payment rates than other clinics, making its business model more sustainable.
Walkama approached the Connecticut Health Foundation about collaborating to reduce disparities in access to health care. President and CEO Patricia Baker noted that the foundation does not fund direct medical services, so it couldn’t pay for doctors to staff the clinics or sponsor a facility. But she had another idea.
The result was a grant from the foundation for data collection and analytics that allowed Wheeler to examine the needs of its patients, to understand the barriers they faced in taking care of their health, and to examine cultural, racial, or gender differences that affect patients’ well-being.
The process made a big difference.
“The data collection and the analytics on the data really helped to begin to drive the way we have developed our health centers,” Walkama said.
Wheeler learned that many patients didn’t go to a doctor unless they felt sick. For some, that reflected how health was approached in their cultures.
“A preventative approach is not culturally consistent with how many people in different areas of the world think about their health care,” Walkama said. “So we had to begin thinking about how do we begin talking to our patients about some of this information and data we were receiving, in a way that would resonate with them in terms of their culture?”
Wheeler began working with faith-based organizations – which are often the most trusted parts of a community. Clinic staff recently taught a program on heart health at a local church. That approach is likely to be far more effective than handing out flyers urging people to come to the clinic, Walkama noted.
“If the church says it’s ok, then the door is going to open more widely than if it’s offered in our center,” she said.
Other aspects of Wheeler’s operations also reflect a deeper understanding of patients’ lives outside the clinic. Many patients live in poverty and face stressors including physical health problems, behavioral health issues, or addiction.
“Thinking ahead and planning ahead is not necessarily always a top priority when they’re just trying to survive day to day,” Walkama said. “So a lot of their health care then becomes somewhat reactive.”
To better meet patients’ needs, Wheeler tries to make sure patients can get all the services they need in one visit – including seeing a primary care doctor, a behavioral health clinician, and a psychiatrist if necessary – rather than having to come back several times in a short period for separate appointments.
Because many patients rely on public transportation, Wheeler has “open scheduling” for initial visits, so a patient who arrives at 9 a.m. because that’s when the bus comes can be seen soon after arriving, rather than having to wait until a scheduled appointment time that could be much later in the day.
The Connecticut Health Foundation grant helped Wheeler Clinic at a time of transformation, reshaping the way it serves thousands of people.