City’s poor adjust to new public health model


Falling in step with a nationwide trend, the government-funded Flora Krause Casey Health Center will soon cut back on its primary health care for Alexandrias indigent population and combine forces with a clinic in the Arlandria neighborhood.
Some patients of the Casey clinic feel abandoned many will trade their longtime doctor for an unfamiliar face but state and local officials say its an efficiency tactic that will ultimately provide better care for the citys poor and chronically ailing population.
I just dont think its fair, said Patty Winters, who suffered a stroke about a year ago and depends on the clinic. My doctor is the most wonderful and caring person in the world.
Her doctor, Robert Wolverton, will be reassigned to another clinic when the transition begins November 30, she said. Winters is uncomfortable with the idea of another physician from Casey, Dr. Huy Trung, taking over her care. Hes not board certified many physicians are not but has several years working in public health and has many satisfied patients, according Alexandria Health Department Director Stephen Haering.
The Casey clinic operates with a combination of city and state funds but is considered a state entity. It is unique relative to the country and to the rest of Virginia. Only about 14 percent of Americas similarly funded clinics provide primary care to its patients, Haering said, and only a handful of Virginia districts are in step with Alexandrias public health model. 
Alexandria Neighborhood Health Services, Inc. in Arlandria, a federally backed clinic, has a better chance to serve the citys low-income sick, officials believe.
The state health department has been wanting [Casey clinic] to transition out of primary care for years, and now that ANHSI is strengthened by being a community health center they are willing and able to provide a pretty comprehensive service, said Deputy City Manager Michelle Evans.
The Arlandria health center is federally qualified, enjoying enhanced Medicaid reimbursement rates that make it easier to provide primary care for its patients, Haering said. The merge will allow the state-operated Casey clinic to focus on family planning, HIV, case management and health care policy.
You here a lot in social services about partnership what do we do best and what do our partners do best, Haering said. [ANHSI] provides primary care better than local health departments because they have a lot more assets.
But Winters sees the transition as a coup. A physician she has come to trust and depend on is leaving, while an unfamiliar doctor takes on her case and many more.

About 600 patients from the Casey clinic will now be under the auspices of one doctor, as opposed to the three physicians that comprised a little over two full-time positions.

How can they tell me Ill get the same treatment? Winters asks.
But 600 to one ratio is more than sustainable, Haering said. Many primary care physicians have upwards of 1,000 and he claimed waiting lists would not suffer majorly.
The city government has defended the Casey clinics services before and it funds more than the amount required by the state. The city council spoke out against state cuts to the health centers pharmacy last year when medicine for patients became more expensive and harder to receive. The last thing officials want to see is an end to public health benefits altogether, hence the transition, Evans said.
We do, absolutely [want to continue providing health care], she said. That is why were working closely with health department to ensure that the resources are available to make this happen. What well be doing is analyzing what is needed to continue to do provide for indigent Alexandrians.