This article first appeared in the St. Louis Beacon, April 15, 2011 - A Hispanic male in his 30s showed up recently at Casa de Salud, a health center on the south side, feeling ill, distrusting hospitals and lacking health insurance to cover whatever care was needed.
Providers at Casa de Salud, Spanish for House of Health, were grateful that he dropped in. He turned out to have an active case of TB, and the care he got meant he wouldn't spread the disease to others.
On this week's first anniversary of Casa de Salud, board chair Bob Fox and executive director Jorge Riopedre cite this case as one example of the good the center has done during its first year of operation.
Casa de Salud, at the corner of Chouteau and Compton avenues, caters mainly to new Hispanic immigrants, providing them with care that isn't duplicated by other health-care providers in the region. The center is unique in the St. Louis area, staffed by about 100 volunteers, including 26 doctors. Most of its volunteers come from Saint Louis University, Washington University, the University of Missouri-St. Louis and Webster University.
Fox, owner of NewSpace Inc., got involved in setting up the center after the earlier La Clinica folded due to dwindling funding and board turmoil. From the start, his goal was to find a niche that wasn't being served by other health facilities. For example, he says, no pediatric services are provided because numerous health centers already offer those services and can bill Medicaid for them.
Casa de Salud works this way: Hispanics hear about the facility, usually by word of mouth, as a place where they can get compassionate care. The average cost of the care is roughly $100 a patient. Patients are expected to pay $25 of that amount if they can afford it.
Fox describes the center as an efficient model because of the volunteer staff and low overhead. There's no large office to handle insurance, Medicaid or Medicare billings because the center doesn't seek reimbursements. Instead it relies on a $1 million budget, half of it coming from in-kind assistance and the other $500,000 from funds raised by the center, including about $100,000 generated from the $25 patient payments.
"We're a kind of conduit, a gateway to health and wellness services for new Hispanic immigrants," Fox says. "It's a place where they come for episodic care instead of going to the emergency room."
This means that many of the 6,000 patients served by Casa de Salud don't end up in emergency rooms, he says, noting that the average ER visit costs $1,300. At that rate, if just half of the center's patients had gone to the emergency room instead, those visits would have added nearly $4 million to ER costs in the region.
Fox says the center's patients are about equally divided between men and women, mostly between 17 and 35. He says the center had expected to serve more women but that many men come in for work-related injuries.
Riopedre points to public health as an important value of the center. He says he often hears people explain that they are not Hispanic, have good insurance so why should they care about the center..
"Imagine that the person with active TB had not come in and received treatment," he says. "TB is extremely contagious. If you came in contact with that person at any time that he was in the public, you were likely to get sick. This is one way Casa is able to protect the health of the public in the region."
Casa de Salud also helps other health-care facilities and providers offer better service to non-English-speaking Hispanics, he says. The center does this by offering what's called volunteer navigators who accompany and advocate for Spanish-speaking patients at other facilities.
Fox stresses that the center is open to everyone, but Hispanics make up about 90 percent of the patient population.
"Most people who come here are workers, family oriented. Aboout 95 percent are able to pay. Some come back the next day if they don't have the money right away. It's a little bit of pride in the fact that they get to contribute to the cost of their care."
In spite of serving everyone who comes in the door, Fox says the center is "branded Latino" because "they're the people most afraid to go for health services because they have cultural, language and discrimination issues and other concerns. They don't want to go where they're not wanted or looked down on."
As Casa de Salud starts its second year, Fox says plans are in the works for additional services. They include: hiring a clinical social worker to focus on mental health; a health literacy program; a community garden; and dietary programs to address obesity, hypertension and other problems.
The center is operating at capacity, adds Fox, and is raising money to increase the number of exam rooms to six from two, and add rooms for mental health services, social services, and group and occupational therapy.
Fox says the center helps young Hispanics cope with feeling isolated and alone. For many, it's the first time they've been unable to turn to mothers, grandmothers and others they relied on for advice back home.
"What we're trying to do at Case de Salud is bring Hispanics out of that isolation and into care to avoid those problems that go along with being away from home."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
