Eastern Iowa Health Center, marking 10 years, copes with ACA, managed care

CEDAR RAPIDS — On Friday, Mary Lawshea visited her primary care provider. The arthritis in Lawshea's knees were bothering her and she had been having trouble sleeping.

Nurse Practitioner Amy Wilson checked her knees and ordered blood drawn to check for other potential health issues. They also discussed arranging transportation for her next visit through her insurance.

Lawshea of Cedar Rapids loves the care she gets at the Eastern Iowa Health Center, saying Wilson always 'makes sure everything is good.'

But for Wilson, working at the clinic where she started nearly four years ago has been an eye-opening experience.

'You don't realize the amount of barriers faced by our community,' Wilson said.

Lawshea is one of thousands of patients who have received care at the Eastern Iowa Health Center, a Cedar Rapids provider that offers health care for an underserved population across Eastern Iowa. The center celebrated its 10-year anniversary in November.

It's a trend across the country — those who do not have insurance often end up in an emergency room. Even those who receive Medicaid or Medicare coverage struggle to find a health care provider.

A decade ago, these individuals would come to the Community Health Free Clinic, said Darlene Schmidt, the clinic's chief executive officer.

'There was such a need for chronic disease management,' she said. 'It was beyond the scope of all our volunteer doctors.'

Federally Qualified Health Centers is a designation given by the federal Centers for Medicare and Medicaid Services to facilities that serve as a 'safety net provider' for an underserved population, such as those on Medicaid. The facilities are eligible for higher reimbursement rates from CMS.

It was through the efforts of Schmidt and several other local health care leaders that the Eastern Iowa Health Center in Cedar Rapids opened in 2007 as one of 14 federally qualified centers in Iowa and of about 1,300 nationwide.

'Its where the most socio-economic disadvantaged people come for medical services because we will treat them regardless of their ability to pay because that is part of our federal charter,' said Joe Lock, president and chief executive officer of the center.

Today, the health center — with a budget of $12.5 million — has five locations that offer acute care, dental, family medicine, obstetrics and gynecology and pediatrics. Social workers at the clinics also provide behavioral health assistance, Lock said.

'We're really able to treat the whole family, from prenatal to newborns to geriatric care,' he explained.

The ACA effect

The passage of the Affordable Care Act and the switch to managed care for the state's Medicaid system had the largest impacts on the center over the past 10 years, Lock said.

Lock said the center saw an influx of patients after the ACA was implemented, as more people obtained insurance and could have regular doctor's appointments.

The switch to private managed-care organizations for Iowa's Medicaid program 'had a huge impact' financially, Lock said.

Since the rollout in April 2016, many providers across Iowa have complained of late or miscoded payments from the managed-care organizations.

In April of this year, the three insurers owed the Eastern Iowa Health Center $1.4 million, Lock said. As of this month and after some recent payments, that amount is down to some $200,000, Lock said.

Lock added that the state of Iowa's Medicaid is one of his biggest concern for the future.

'We don't know what's going to happen,' Lock said. 'What if something happens with one of the existing two (managed-care organizations)? There's a lot of uncertainty, and that's tough.'

Since Lock was named president and chief executive officer in 2015, the health center has seen a boom in growth.

The center's more recent expansions including construction of a $1 million Dental Center at 1225 Third Ave. SE and a renovation and expansion project on its primary care clinic at 1201 Third Ave. SE. Both were in 2016.

The center employs dozens of physicians and nurses. Lock said they recently hired an oral surgeon who will start in January — a service rarely offered at other Federally Qualified Health Centers, he said.

It also has instituted new services, such a partnership with the not-for-profit Young Parents Network to launch the Eastern Iowa Diaper Bank, which provides diapers and wipes for families.

The five locations see about 50,000 visits per year, said Erin Langdon, the center's chief development officer. Of those, Langdon said about 10,200 so far this year are unique patients.

Ninety-six percent of the center's patients live up to 200 percent below the federal poverty level, Langdon said, adding that the vast majority of their patients are on Medicaid.

Even then, Lock said officials estimate the center serve only about 16 percent of the total Cedar Rapids population living between zero to 100 percent below the federal poverty level.

'The need is there,' Lock said. 'We're not done growing.'

Looking ahead to the next 10 years, center officials hope to continue expanding its reach — such as a new clinic in Iowa City to provide care for the impoverished populations there, Lock said.

'EIHC is poised for growth under (Lock's) leadership and we're excited to continue to serve that safety net and work in conjunction with (the Free Health Clinic) and the hospitals and all the family practice doctors in town just to make sure that no one goes without medical care,' Langdon said.

'It's such an inherent right.'

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