Accessing primary care, dental care and psychiatric services can be a challenge for people in rural communities; sometimes there simply are not enough local resources to meet demand. In response to this need, Lafayette Regional Health Center in Missouri partnered with LiveWell Community Health Center and the Health Care Collaborative of Rural Missouri and its four federally qualified health centers to find a way to meet the needs of residents while conserving scarce resources.
LRHC is a 25-bed critical access hospital. It is a part of HCA Midwest Health, a network of hospitals in the greater Kansas City area. LRHC provides 24-hour emergency services, general and orthopedic surgery, imaging, cancer care and post-acute care, and operates clinics in Higginsville, Odessa, and Lexington, Mo.
Initially, HCC was an organization that largely coordinated services for low-income individuals. However, over the past decade it has matured and grown to a point where its community-based programs include case management, counseling and assessment, health education, transportation, translation services, rural health professional recruitment, Affordable Care Act Marketplace enrollment, Medicaid and Medicare enrollment, LiveWell Connectors, a student nursing program, health care advocacy initiatives and health information technology to link services.
In 2013, two of LRHC’s clinics were struggling to maintain primary care and clinical services in and around Lexington. Ownership of two LRHC clinics in Waverly and Concordia was transferred to HCC. In 2015, HCC expanded in Carrollton and ultimately reopened a shuttered clinic in Buckner. Today, all four HCC clinics are federally qualified health centers and operate under the brand LiveWell. They offer dental, behavioral health, primary care and social-support services. In addition, the LiveWell Community Health Centers have achieved Level III Patient-Centered Medical Home recognition from the National Committee for Quality Assurance.
HCC and its LiveWell Clinics work with the LRHC emergency department to identify patients who frequently use the ED for primary care and help them to find a primary care doctor, dentist or behavioral health professional. Patients who have Medicaid are coached on the appropriate times to use the hospital ED and given a list of locations that accept Medicaid and instructions on how to contact the LiveWell Centers’ after-hours answering service prior to utilizing the ED.
The CEO of LRHC is an ex-officio member of the HCC board, and the relationship between the hospital CEO and FQHC executive director has fostered open communication, empathy and cooperation among the providers. Each knows the pressure points of the other and they collaborate to relieve stress and advance the efficient use of resources to the benefit of a patient’s experience of care. By collaborating, the providers have expanded access, improved efficiency, enhanced the health of the population and maximized resource utilization by avoiding unnecessary duplication of services while directing patients toward the appropriate site of service.