Moriah Corrigan-Mills first visited the Center for Family Health in Jackson, Mich., a month after it opened in 1992. She was expecting her first child and had no doctor. "I had just found out I was pregnant," she recalls. "The health department told me there was a new clinic that opened up."

Through two other pregnancies and a diagnosis of insulin-dependent diabetes, Corrigan-Mills has kept going back to the center, which is run by Allegiance Health. "I like the center because it's personable," she says. "They take the time to listen to what's going on with you instead of just quick in and quick out."

Recently, she lost her health insurance and figured she'd have to skip doctor visits and make do without expensive diabetes supplies. "I was panicked," Corrigan-Mills says. "But the nurse said, 'Hold on, let me go get the social worker and we'll get this taken care of.' " She was enrolled in the Access Program, an Allegiance community health program that provides medical care through donated clinicans' time.

Corrigan-Mills' children attend schools where Allegiance runs youth health clinics that provide well-child visits. That's helpful, she says, because the kids don't miss school and she doesn't have to miss work to take them to a doctor.

For more than 20 years, the Allegiance community health program has found meaningful ways to reach an economically struggling community. Because of that commitment and related innovations, Allegiance won the 2010 Foster G. McGaw Prize for Excellence in Community Service. The $100,000 prize goes to an organization that provides innovative programs to significantly improve the health and well-being of its home area. It is sponsored by the Baxter International Foundation, the American Hospital Association and the Health Research & Educational Trust.

Allegiance has a 411-bed hospital and a number of other outposts in the community, including primary care clinics, diagnostic centers, home care services, a hospice, a long-term acute care hospital, a diabetes center and a wound care center. It serves nine counties in southern Michigan with about 500,000 residents, and has a 33 percent market share. Allegiance is the sole provider for Jackson County and serves as a safety net provider for about half the region. Its Center for Family Health is a federally qualified health center.

Jackson, which is Allegiance's core service area, has a poverty rate of 20 percent. Its unemployment rate was 15.4 percent in late 2009, among the highest in the country.

These economic factors and their impact on the health of residents convinced Allegiance leaders to maintain an expansive definition of community health. "One of the fundamental issues we've faced over two decades is that the health status of the community has been very challenged for a long time," explains Georgia Fojtasek, president and CEO of Allegiance Health. "We're pretty geographically isolated. The hospital is the largest entity that has the resources and assets to provide solutions to these problems. We've increasingly realized that we really needed to move beyond the role of just responding to health problems, which is what hospitals have traditionally done."

The expansion of that role started in the late 1980s with the establishment of an outpatient clinic for pregnant women and has continued to grow by focusing on specific problems.

Community health is one of the organization's four strategic pillars. Fojtasek says Allegiance doesn't look for a specific dollar return on investment from community health. "This is an investment in the future," she says. "It's been part of our language and culture for a long time. We've been making the investments when they don't necessarily make the most financial sense. It's very hard work. We're talking about addressing long-term, ingrained health issues that have multiple resolutions."

Allegiance created a health-improvement organization to manage those projects, which was helpful in providing a structure through which it could work with other community partners, says Amy Schultz, M.D., director of Allegiance Prevention and Community Health. "Through the HIO, we can look at community health in its broadest sense: food security, parenting, emotional wellness of children."

Filling Coverage Gaps Through Donated Time

Several years ago, a community group called Health Care for All convened to discuss ways to provide care to those without insurance who do not qualify for Medicaid, Medicare or other programs. The group estimated that more than 16,000 people in Jackson County fit that description, says Brian Adamczyk, M.D., a primary care physician who spearheaded the resulting initiative called Project Access. "These are low-income individuals working at McDonald's or somewhere, not making enough money to buy health insurance," he explains. "We set out to find a program that would fill in that gap."

They ended up borrowing a model from Suzanne Landis, M.D., who created a successful volunteer-physician network in Asheville, N.C.

Largely through the persuasive powers of Adamczyk and other physician champions he recruited, primary care and specialist physicians agreed to provide free medical care to 10 additional patients each who fit the Project Access criteria. Some physicians stay with 10 Project Access patients, and others take on more. Physicians recognize the need for the services. They're not asked to work late hours in a clinic, simply to add patients to their regular practices. "We just told them, 'Look at the people who need help,'" Adamczyk says. "You can't argue with the fact that people need help, and it doesn't sound like they'll get inundated with patients."

Another key participant was Allegiance Health, which donates the use of hospital facilities and supplies. Laboratories, imaging centers and other providers also donate services, and other community nonprofits are involved. Allegiance Health has donated $4 million in unreimbursed expenses, and $1.3 million in physician services has been provided. The program operates with one employee and a $60,000 yearly budget.

There is not a significant waiting list for the program because patients' health insurance status frequently changes; when they get insurance again they leave the program. That allows others to take their places.

Allegiance also has a long-standing employee health-management program called It's Your Life, which it offers to its own staff and to other local workers. The program includes health-risk assessment screening, individual coaching sessions and individualized health plans. Over eight years, wellness scores have increased and the average number of risk factors has decreased. Allegiance credits It's Your Life with helping to keep health insurance costs to employees flat for the past two years.

The Community Medication Assistance Program provides free prescription medications to the uninsured. Since 2000, the program has filled more than 200,000 prescriptions and provided $15 million in free drugs.

Allegiance's prenatal education program has served more than 900 women since 2003. It trains recognized "natural helpers" in the community to host gatherings focused on women's health before, during and after pregnancy.

Fojtasek gets emotional when she thinks about the day when the Foster G. McGaw Prize was celebrated in Jackson, and patients came to show their support. "These are folks who are simply down on their luck," she says, stopping for a moment to grab a tissue. "They've got kids and families they care about, like we all do, but they don't have money. These people told us where they would be if it weren't for these programs. It was such a gift for us."

Jan Greene is a freelance writer in Alameda, Calif.


The Finalists

Three Foster G. McGaw Prize finalists also were recognized by their accomplishments in community service, each receiving a $10,000 prize:

Augusta Health in Fishersville, Va., for innovative leadership in developing a community health forum with more than 60 local agencies and organizations dedicated to solving key community problems. This in-cluded the creation of a 24-hour health information and referral call center and an initiative to encourage flu vaccinations.

Palmetto Health in Columbia, S.C., for establishing programs and services to reduce health disparities through increased health care access and education, including a parent-to-parent asthma support group and a school-based teen health initiative.

Wrangell (Alaska) Medical Center for successful efforts to enhance quality of life for a remote island community that the organization serves through a variety of programs, including a rural health careers training initiative and a program that cultivates leadership and civic engagement among community youth.