The Institute for Family Health: Providing Training, Treatment and Transformation

By Faith W. Smalls

As we prepare for gradual – and perhaps seismic – shifts in how health care is delivered in this country, the Institute for Family Health is at the center of such change, that envelops innovation, cost-effectiveness and, certainly, quality. With a focus on training clinical staff for forward-thinking models of care, their treatment of patients from a cross section of society offers promise and a broader, new way of thinking about community health care.

The Institute, headquartered in Manhattan, comprises a network of 20 sites, approximately 1,000 employees and 100,000 patients. The Institute’s key priorities are addressing complex community health concerns and health care disparities. In pursuit of this, it has garnered a number of grants and has established critical staff training programs.

“We view health care as a way of transforming the lives of people in communities, not just about good measures,” said Robert Schiller, MD, Senior Vice President for Medical Affairs at The Institute. Dr. Schiller said this goal is especially significant in providing the highest quality of care to communities that have been marginalized and victimized by discrimination.

Growth over the Years

The Institute for Family Health began in 1983 as the Institute for Urban Family Health. Their focus on training started early on with the acquisition of a grant to train family physicians at Bronx Lebanon Hospital. “Our mission is just as focused on education and training as on health care,” said Dr. Schiller.

The Bronx Lebanon grant was one of many that the Institute would receive over the years to conduct research and enhance provider capacity for dealing with complex health cases and delivering primary care more effectively. The Institute became a federally qualified health center (FQHC) in 1998. Over the years, the center continued to grow. In addition to a partnership with Beth Israel Medical Center that enabled it to train Beth Israel doctors in family medicine, the Institute experienced significant expansion through a series of mergers and acquisitions. This included a 2007 merger with the Mid-Hudson Institute for Family Health in upstate New York and the takeover of Manhattan’s North General Hospital ambulatory care unit in 2010.

Training Providers to Dig Deep

Its large primary care practice is supported by the attention to developing physicians’ clinical and critical thinking skills. The Institute has three residency programs and boasts a grassroots Family Training Program. “We look for people who have a passion for social justice and a sense of moral outrage,” said Dr. Schiller of the program’s residents. He added: “We encourage our doctors to ask, for example, ‘How did you cut yourself? Could that have been prevented?’ In other words, what’s the story behind the injury?” Dr. Schiller emphasizes the importance of medical care reaching beyond an illness’s obvious features and concerns to seek more targeted solutions. “It’s not only knowing what the medical problem is, it’s also figuring out who can help you.”

With more than 130 graduates from the Institute’s Family Medicine Training Program, the doctors at these integrative medical facilities are pleased to continue their provider educational initiatives with the help of Teaching Health Centers, a national program through the Affordable Care Act, offering funds to community health centers to train residents. The Institute was one of the first centers to be accepted into this inaugural program in 2010.

Providers trained by the Institute are poised to care for and treat a broad range of primary care issues and chronic conditions. For instance, the Institute focuses on quality reproductive health care services for women, assuring patients have access to the full spectrum of contraceptives and prenatal care. Another example of their commitment to community-based outreach and care is their work with approximately 40 local faith-based organizations to combat obesity and diabetes.

Rich Potential of Community Health Centers

Dr. Schiller insists that the Institute’s commitment to patients, staff development, collaboration with community-based entities and outside-the-box thinking demonstrates the rich and diverse solutions that community health centers can offer as health care
reform unfolds.

He said that while community health centers have traditionally been perceived as too inefficient to take on the training of residents, Dr. Schiller sees enormous potential in them as classrooms for providers’ ongoing education and research. “If we can get medical students from day one to work in community health centers, they would see this as being an attractive and rewarding career choice,” said
Dr. Schiller.

Further, Dr. Schiller believes community health centers offer a welcome and essential alternative to hospital and specialty-based medicine – a traditionally costly and often inefficient model of care. “Specialists and hospitals need to play a more diminished role,” explained Dr. Schiller. “Piecework care is still reimbursed at preferred rates. Providers should get paid for keeping people healthy, not just for what they do (e.g., run tests, exams).”

Dr. Schiller says the future of healthcare reform lies within two areas that community health centers are better suited to address: flexibility in the way health care is delivered and the capacity to explore innovative reimbursement models. Currently, the Institute offers team-based care at a few of its sites to provide prenatal, diabetic and post-discharge care. With this model, patients meet in groups for consultations. This approach both lowers medical costs and provides a support system for patients with similar conditions.

The Institute serves an ethnically and economically diverse population. “Homeless people as well as people making $150,000 a year are seen in our center,” said Dr. Schiller. “Our health care model is, if you have an appointment, you get the same level of care.” This egalitarian focus on delivering health care to the community is a value that the Institute shares with Affinity.

“The legacy of Affinity is unique as an independent health plan that has its roots in community service,” said Dr. Schiller. “We feel Affinity is a great partner. We’re working with its leadership on innovative reimbursement models and managing information to get better health results.” Dr. Schiller notes that this transitional time in health care, while challenging, offers a wonderful opportunity for the Institute, other community health organizations and, most importantly, patients. “I think it’s important to take advantage of this unique time,” he said. “While there is concern about what is going on in Albany and in D.C., I am optimistic. I think we can have a very good outcome.”