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Creative Juices Flow in Alameda County: Converting Fire Stations to Health Portals

Creative ideas from participants are always intriguing during our regional workgroups. Participants often propose unique strategies to improve health and health care delivery. For example, one participant proposed partnering with the Department of Justice to keep parks open later to reduce crime and increase physical activity. Another told us of a new plan to e-mail skin images from underserved areas to dermatologists in urban areas for diagnosis to reduce costs and increase access. The list goes on.

I was especially pleased to hear that Alex Briscoe, Alameda County Health Care Services Agency (HCSA) Director, recently put his creative idea to work. He first mentioned the idea to Lucien and me after our Bay Area Regional Workgroup in 2009. The idea was simple: We have a shortage of primary care services. We also have firefighters and paramedics who are trained in basic medical procedures located at large, equipped fire stations. Why not tap into these underused resources to help mitigate the shortage of services? He had our attention….

The Problem

Briscoe explained the issue with access to care in Alameda County, including that health coverage is unaffordable for more than 200,000 County residents, 1 in 4 bankruptcies in the County are from medical debt, there are inadequate reimbursements for safety net hospitals, and there is a lack of support for patients to manage their own care. Primary care wait times can be as long as 3 months for new patients and specialty care wait times can be as long as 6 months for new patients. In addition, the County is driving episodic care to the highest cost settings.

The Vision

Briscoe envisioned circles of care; the outermost circle being prevention, and the innermost circle being a General Acute Care Hospital (GACH). Health care starts with the outer circle, preventive services, then goes through emergency medical services, health portals (in community colleges, school-based health centers, and fire stations), primary care doctors, urgent care, and in the center of the circle, a General Acute Care Hospital.

Figure 1: Briscoe’s circles of care.

The Plan

We recently found out that Briscoe partnered with Sheldon Gilbert, the Alameda County Fire Chief, and the Fire Station Health Care Portal pilot program was born. The program will offer free primary and preventive care at five fire stations in Alameda County, in Oakland, Newark, Hayward, San Leandro, Union City, San Lorenzo and/or Ashland. It will specifically target uninsured and underinsured individuals and stations will be selected based on size, proximity to public transportation, number of patients in the surrounding area, and neighborhoods with high numbers of avoidable ED visits.

The collaboration is between fire departments, acute care hospitals, FQHCs and the HCSA EMS division. Each station will be staffed with a firefighter-paramedic, a care coordinator and a nurse practitioner from the FQHC. They will provide primary and nonemergency care to patients in the surrounding area, respond to nonemergency 911 calls, provide follow-up care for residents 48 hours after an ER visit and take direct referrals from 211 calls for medical advice. Ten clinical problems will be addressed, which encompass more than 90% of retail clinic visits, 15% of PCP visits, and 20% of ED visits.  Most problems do not require physician services.

Examples of services offered include:

  • Sinusitis;
  • Tuberculosis Tests;
  • Blood Pressure Checks;
  • Wound Care;
  • Monitoring Weight Gain;
  • Immunization;
  • School Physicals;
  • Disease Management;
  • Occupational Health (such as urine test for probation); and
  • Prescription Refills.

The goal is to have the first station operating as a health care portal by fall 2012. The three-year pilot program needs $9-$10 million for one-time renovation costs. Briscoe and Gilbert have already raised $6M.

For more information, read this article in the Contra Costa Times

Note: Is your county working on similarly creative health care improvement strategies? If so, please e-mail information and updates to me at ashley@itup.org!

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