Q&A: Using PFS to scale Clinica Esperanza’s Bridging the Gap program in Providence, Rhode Island

Clínica Esperanza/Hope Clinic (CEHC) is a free clinic in Providence, Rhode Island, that aims to provide culturally-attuned and linguistically-appropriate health care to uninsured patients. Located in a neighborhood primarily comprised of immigrants from Central and South American countries, CEHC serves a patient population that is more than 70 percent Spanish-speaking.

We spoke with Katie Barry, Senior Project Manager at CEHC, about their interest in pay for success (PFS) as a way of financing some of their services.

PFSI: What is Clinica Esperanza’s mission, who does it serve, and what services does it provide?

Barry: We aim to provide high-quality primary care and health education services to our uninsured, Spanish-speaking patients. In addition to our Continuity of Care Clinic (CCC), patients can also be scheduled with the Physician Assistant-run Diabetes Clinic, Psychology Clinic, or the Women’s Clinic, as needed. To address unnecessary emergency room usage by uninsured patients, CEHC opened the CHEER walk-in clinic in 2012. Here, patients can get same-day care for their acute but non-emergent needs and can also be connected to CCC for their primary care needs.

In addition to medical care, we offer lifestyle change programs, including Vida Sana, an 8-session class that teaches patients to eat well and be active. We also offer this class in four ‘One-on-One’ sessions with one of our Navegantes (Community Health Workers) to accommodate patients who are unable to attend Vida Sana.

Patients with one or more chronic diseases are enrolled in the Bridging the Gap (BTG) program, which keeps them continuously engaged in care with quarterly follow-up appointments, blood tests, and yearly enrollment in a lifestyle class.

PFSI: What benefits do you see your services delivering, not just to individual patients but to the broader health care system in Rhode Island?

Barry: The benefits to our patients are clear: we have shown that CEHC (and our BTG program in particular) helps patients improve their health knowledge and their clinical indicators, such as blood pressure, blood glucose, and total cholesterol. These patients who otherwise would likely have no source of primary care services are able to get their acute and chronic conditions under control - before they become emergent and create lasting damage and high costs.

Our services also prevent unnecessary health care spending at Rhode Island hospitals and medical centers. Last year, an analysis of our CHEER emergency room-diversion clinic data showed that our walk-in services prevent approximately $500,000 per year in unnecessary emergency room visits. This figure does not take into account all of the future health care spending that is avoided by identifying and treating chronic diseases such as diabetes, hypertension, and hyperlipidemia.

We know that it is better to provide care to our patients before their conditions become emergent or incurable, because it improves their quality of life and lessens the burden on local hospitals and emergency rooms. Through our collaboration with Urban, we hope to develop a method of demonstrating the monetary value of these health care improvements.

PFSI: What attracted you to the PFS model?

Barry: We are always in search of sustainable ways to fund the work that we do. While we have been fortunate to receive nearly $2.5 million in grant funding and private donations over the past ten years, it is becoming increasingly difficult to maintain and expand the services that we provide. For this reason, we decided to investigate the possibility of receiving state or federal funding, as part of a PFS arrangement, in exchange for the improvements in health that we are able to document.

We believe that many of our patients will eventually transfer to insured care, likely through Medicare or Medicaid, and we want to show that their cost to the insurer will be decreased by the care that we provide while they are uninsured. By stabilizing and treating our patients’ conditions and teaching them to better manage their own health, we are preventing future costs for the state and federal governments. However, since only a small number of our patients have transferred to insured care thus far, we hope to work with Urban to also demonstrate the potential savings by decreasing the rate at which our patients visit the emergency room.

We have already seen that our work makes significant improvements in the health of our patients, and with the help of Urban, we hope to make the case with evidence for continuous funding to continue our work.

PFSI: What data-related barriers does Clinica Esperanza face, and what benefits do you hope to derive from the TA partnership with Urban?

Barry: The biggest barrier to success with our BTG program is obtaining access to comparable data from our state. We’d like to show that our clinic improves health and lowers health costs for our population of patients, who are uninsured, low-income, and primarily Latino. But we have had difficulty obtaining this information from the local health authorities. We’d also like to track our patients after they become insured, but building the relationships and getting agreements signed has been time- and resource-intensive.

Due to budget constraints, we are not able to employ staff who are specifically focused on data analysis, and therefore, we rely on volunteers as they are available. We hope Urban can use their expertise in this field to help us connect with data sources, create a framework for working with collaborators, and find resources for managing the clinic’s future data collection. Above all, we hope Urban can help us understand what data we should be focusing on and how to best showcase our work.

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