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Unsung Heroes Honored

— On the same Thursday morning that the U.S. Supreme Court made its momentous decision to let the Affordable Care Act stand, the Virginia Health Care Foundation was meeting in Richmond to honor heroes in health care and to celebrate the success of an effort to meet two goals of that act, to provide preventive care and primary health care to individuals who have not been able to receive it.

The work began with A New Lease on Life, a collaborative $2 million mental health initiative underwritten by the proceeds from a $1 million challenge grant awarded to the Virginia Health Care Foundation and its partners by Bob McDonnell, then attorney general. Grants were issued to partnerships of local community services board and health care safety net organizations to either establish or expand basic mental health care services in a health safety net setting or provide primary health care to uninsured CSB clients.

One honor, the Unsung Heroes Award, went to the Alexandria Neighborhood Health Services Inc. (ANHSI), the Alexandria Community Services Board and the Arlington Community Services Board who decided to come together to provide both kinds of health care. They received a $442, 823 three-year grant to increase access to primary health care for seriously mentally ill CSB clients with no insurance. The funds were used to hire two physicians and a nurse at ANHSI to provide primary care services. In addition the CSBs provided psychiatric services to patients at ANHSI. The two primary care physicians and a nurse from ANSHI would treat patients three days a week at the Arlington CSB and two days a week at the Alexandria CSB.

This was a tough task. These were individuals who had received little or no primary care for years and years except perhaps for brief visits to the emergency room. They were also people with serious mental illnesses who in many cases had been traumatized by violence or abuse. The new patients received anywhere from six to 10 diagnoses at their first visit, many of these very complex medical conditions.

The job was so daunting that the first two physicians hired for the job left shortly after starting because they were discouraged by the myriad of medical conditions of these patients. The two physicians who ultimately settled into the job were dedicated, tenacious and incredibly patient, listening to and empathizing with the patients gaining their trust and making sure they understood what they needed to do to get better.

It wasn't just the physicians and the psychiatrist, but the staff from all three organizations who made accessible, appropriate health care possible for those who had none. They developed new systems for shared record-keeping, charting and health records. They worked on reducing the number of no-shows, a typical problem with CSBs, reducing the level from 35 percent to 24 percent and are working toward lowering the rate to single digits. They meet frequently to determine the most beneficial regimen for each patient, taking into account both the extensive psychiatric and primary care treatment needed.

The lack of primary care for those with serious mental illnesses has fatal consequences with the development of chronic diseases, diseases that are often caused by the very medications that control the symptoms of their mental illnesses. The Arlington and Alexandria CSBS estimate that about 62 percent of their seriously mentally ill patients have an untreated chronic disease such a high blood pressure, diabetes or chronic lung disease. Studies have shown that individuals with serious mental illness die an average of 25 years prematurely because of these problems.

By the end of 2011, 64 percent of Alexandria CSB patients with hypertension had reached a goal of having a blood pressure reading below 140/90. In the same time frame 53 percent of the patients with diabetes had a HGBA1c of less than 7.

"After less than two years of operations, we cannot imagine the CSBs without the primary care clinic and staff. The ANHSII staff has a genuine commitment to improving the outcomes for this population and it shows in those outcomes," said Michael Gilmore, executive director of the Alexandria CSB, in his nomination of the team.

Both the Alexandria City Council and the Arlington County Board of Supervisors clearly agreed recently determining that sustaining the services provided through this partnership is of the highest priority and allocated funds to help sustain the program in the next fiscal year.

The team winners included Dr. Elizabeth Giese, Dr. Elise Morris and their team at the Alexandria Neighborhood Health Services, the case managers, psychiatrists and teams at the Alexandria Community Services Board and staff at the Arlington Community Services Board.

The city and its residents are also winners, when those who are among the most vulnerable now have health care like everyone else.