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Case Study: St. Frances Cabrini Clinic

Location: Detroit, Michigan
Budget: $350,000
Patient Visits in 2012: 5000

Abstract

St. Frances Cabrini Clinic has been serving the uninsured residents of Detroit since 1950, and is the oldest free medical clinic in the nation.  With a small operating budget, Cabrini Clinic has leveraged successful partnerships with local hospitals and universities to bring primary and specialty care services to uninsured Detroit residents, including prescription assistance, podiatry, optometry, dermatology, social services, dental care, and mental health.  Located in the poorest large city in the United States, the demand for mental health services is unprecedented.  With an unemployment rate of 18 percent, the number of patients seeking services for mental health has tripled in the last several years.  Through a partnership with Henry Ford Hospital, third year psychiatric residents treat patients for acute and chronic mental health needs.  The clinic has a Prescription Assistance Program (PAP) which utilizes the indigent drug programs of the pharmaceutical companies, and makes it possible to provide the psychotropic and other medications needed by patients.  A software program developed for patient registration and to track these PAP orders has proven cost effective, and is being shared with several free clinics across Michigan.  

Mental Health in Detroit

The U.S.economic downturn hit Detroit first.  The Census Bureau reports the rate of poverty was 34.5% between 2006-2010, one of the worst in the nation.  With the economic downturn and the auto industry decline, Detroit has seen an increase in the number of unemployed and uninsured.  This has led to an increase in the need for mental health providers and programs.  Governor Engler (1996-2003) shut down the state hospital system, in favor of treating the mentally ill “in the least restrictive environment.”  Unfortunately, in many cases, this turned out to be the streets.  Community Mental Health (CMH) has very restrictive eligibility criteria, i.e., severely and persistently mentally ill, and is unable to meet the need in Detroit.   There are countless people in need of mental health services who cannot access psychiatric care because their illness, while impairing, is not extreme enough to meet CMH’s limited eligibility criteria.  Cabrini Clinic is the only place in Detroit serving uninsured mental health patients who do not meet the criteria for Community Mental Health.  In fact, local CMH clinics are the main source of referrals to Cabrini Clinic’s Mental Health Program. 

Increasing access to mental health services

In 2005, the Henry Ford Health System was looking for placements for its psychiatric residents, and approached the St. Frances Cabrini Clinic. The clinic has a long history of working with the Ford Medical Group.  Simultaneously, the clinic was having trouble finding resources in the community to refer medical patients who needed mental health care.  Two 4th year psychiatric residents were assigned to the Cabrini Clinic for a 4-month rotation.   During the mental health clinic hours, the psychiatric residents would complete intake assessments, evaluations and review medication needs of the patients.  When continued long-term care was required, they would refer the patients to one of the two PhD psychologists who volunteer at the Cabrini Clinic on an ongoing basis.  These psychologists are not associated with the Henry Ford residency program, and provide continuity to the mental health clinic. The Henry Ford residency program supervised the residents and, at the end of 4 months, two new residents took over.  The successful program continues.  According to Sister Mary Ellen Howard, the Executive Director of St. Frances Cabrini Clinic, the psychiatric residents enjoy their time at the clinic because they can see the progress patients make on a week-to-week basis, and the patients express their gratitude for the care received. 

Henry Ford is not able to increase the number of residents assigned to St. Frances Cabrini Clinic, so the program has remained stable, offering one clinic per week, treating about 30 patients per clinic.  There continues to be a waiting list for appointments, with two to three new patients added each week.

This residency program has continued to be a beneficial relationship to both the Henry Ford Health System and the St. Frances Cabrini Clinic, and thus has allowed the clinic to provide much needed mental health services to its patient population.

Increasing access to pharmaceuticals

In 2009, the St. Frances Cabrini Clinic began searching for software to meet its need for an electronic patient registration system.  A thorough search was completed but no systems were found to fit the clinic’s needs or price point.  Most commercial programs are geared toward billing, are expensive to purchase, and charge a monthly subscription fee for updates.  The few freeware systems available did not allow for any personalization.  It was decided that they would hire a developer to build a program specific to their needs.  When pressed to define exactly what functionalities were needed, the clinic wanted to combine patient registration with the ability to track PAP applications, thus entering patient demographic data only once, and not having to maintain two separate software programs.     The clinic paid for the original program to be created, and for installation and technical support.  The program was developed using MS Access and requires that Access is installed on the computers using it.  Updates and changes are contracted on an hourly basis when needed.   Since the implementation of their registration and PAP tracking system, the clinic has realized increased efficiencies and is able to produce data for planning and fundraising purposes.  The PAP component allows staff to track when orders were placed, received, and need to be re-ordered.

Spreading access to pharmaceuticals

The St. Frances Cabrini Clinic knew that other free and charitable clinics had the same need for a simple, cost-effective program to register patients and to track their PAP orders.  Therefore, at a Free Clinics of Michigan meeting, they demonstrated their home-grown software, and offered it to interested clinics.  For $150 (which is split between the St. Frances Cabrini Clinic and the software developer), clinics receive a CD and instruction manual for the program.  Since this program was first offered to Michigan clinics, more than ten have purchased it for their own facilities. This has helped the St. Frances Cabrini Clinic recoup the cost for developing the program, and has brought greater efficiency to the recipients.

Lessons Learned   

  • When providing primary medical care to an uninsured population in poverty, you will find that many of the patients have mental health issues.  If you cannot find resources in your community to address these, it is possible to build your own program.
  • Build strong relationships with providers in your community.  When Henry Ford Health System needed a partner in Mental Health services, they looked to Cabrini Clinic.  Out of this collaboration has come a strong program which serves a great need in Detroit.
  • Homegrown patient registration software can be cost-effective and meet the needs of free clinics.  Be sure to hire a pro to help you develop it.
  • Share your successes.  Other free clinics benefitted from our software program, and we were able to recoup our original investment in its development.