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CARING ABOUT CARE

Editor’s note: Community Builders is a periodic Q & A series providing perspectives from local individuals who have been involved in significant change in Southern Oregon. Today’s interview is with Brenda Johnson, the chief executive officer of La Clinica, which provides health care to underserved people.

Q — How did you gravitate toward your work at La Clinica? What got you started in this whole field?

Brenda J. — I was fortunate to spend a year in Mexico as a foreign exchange student with University of Guanajuato and Southern Oregon University. When I came back, I went to nursing school at SOU and realized my passion for community health and serving under-served populations was part of who I am.

I did a clinical rotation at La Clinica when we had the building on Fourth Street in Phoenix, a tiny little building right on the railroad tracks. I got to see the amazing work of the clinicians there who really knew they were taking care of people who wouldn’t have access to care in any other way. And that was something that I absolutely had to be a part of.

Q — How is La Clinica serving the citizens of Jackson County?

Brenda J. — We provide primary medical services, dental services and behavioral health or mental health support. We primarily focus on people who are lower income or who have struggled to access care in the system.

Our most recent addition is our Wellness Center. We opened it late last year with the aim of showing patients how to use nutrition and exercise, for example, to improve their health. We started offering classes. Now a physician or nurse practitioner might be in the kitchen cooking with a group of people who are struggling with managing their cholesterol. And the entire conversation is about nutrition. We know that waving a finger and saying, “You better eat better,” just doesn’t work. So now we’re meeting people right where they are.

Q — How many patients do you anticipate you will serve next year?

Brenda J. — We served about 27,000 people last year. That is anticipated to grow to 31,000 over the next few years.

Q — You’ve seen a growth in the number of people served. What services have you seen grow?

Brenda J. — When we started, it was only primary medical care, and then we had an OB program where we delivered babies at Ashland Community Hospital with our primary care physicians. In 2000 we added dental services, which was an unmet need in the community. Later we offered school-based health services and realized there were kids who were sick in school and parents who couldn’t take time off work to come and get them and bring them to a traditional doctor’s office. These were kids who were going without a lot of care, and some with significant chronic health conditions that were not being managed well.

So fast forward to today. What are some of the other elements that help create a healthy community, a healthy population, that are beyond what anyone might think about normally in the traditional medical model? We have developed teams of people caring for the community in our mobile center, which goes to places like the Medford Gospel Mission and Ashland First United Methodist Church or goes and partners with our drug and alcohol treatment facilities and provides medical care and dental care on site. That is a different mode of providing services and has definitely increased over time.

Also, I think about how we coach patients or people we work with to create the kind of lives they really want for themselves. Some of them may have grown up in situations where they didn’t really know what was possible. It is exciting.

Q — Are you addressing poverty and people’s productivity by addressing their wellness concerns?

Brenda J. — Absolutely. I think we have a significant impact in that way. We believe in people, and we think there is a role and responsibility in the way that we care for people and hear them as they talk about what they dream for themselves. There are so many people in the community who miss out on the chance for other people to really believe in them. So, do I think we help get people out of poverty? Absolutely.

Q — What are the biggest issues facing medical providers, not just LaClinica, but also the bigger medical needs in the country, the state and the region?

Brenda J. — Many people are paying a lot of attention to the success or the potential pitfalls of health care reform. There is so much conversation nationally, at the state level and locally about reducing the total costs of health care services and making it much more affordable for the population as a whole. To do so we have to think collaboratively about where people’s needs are best met. So we are all, as a community, looking at lowering total costs and making the quality of care much greater.

It used to be we could and would demonstrate our success by the “did we check the box and order the labs” kind of thing. Now we are judged, our health care organizations are judged, by how well our patients do in their total health outcomes. It seems like a revolutionary idea, but truly it’s about the health of the population. How well are we managing blood sugars, for example, to improve our collective care in diabetes?

So I think about lowering costs, improving quality, and becoming more patient-centered. Many people who access health care services in any venue understand the complexity and experience of care; it isn’t always patient-centered. ... Patients feel they are kind of shuttled from place to place in the system. So there is lots of effort locally today to help reverse that story and think about ways we work together as organizations and manage the transitions of care from one part of the health care continuum to another.

Q — How could the Rogue Valley be a healthier place to live?

Brenda J. — Great question. I think our community is pretty remarkable. At our best we really care for one another, share the civic and community responsibilities for each other, and honor our differences in gender, ethnicity and income. Collectively we can create a healthy community by simply understanding one another and our broad-based community needs. I don’t mean to sound trite, but I really think caring for one another in that way is a significant forward step in creating a healthy community.

Instead of waiting until someone is incarcerated, for example, let’s deal with drug addiction early on. Let’s think about prevention much more robustly and pay for it. Because the costs of what we are paying for in the entirety through multiple systems and the destruction in communities that happen over issues like that are so severe, they are hard to dig out of.

How do we know we are creating a healthier place for people in our community to live? We don’t necessarily always have the broadest community conversations about how to measure our own success.

Q — It’s a little discouraging sometimes to read police reports and the percent of poverty in Southern Oregon ... and so to try to muster community resources to address that real need is really a challenge.

Brenda J. — I think it takes leadership from every sector and coordinated conversations and vision about what we can create. When we are at our best, we do that. And when we are not at our best, we get concerned about our own silo or turf or where’s the money going to come from and those kinds of things, which diminish our creative ways to think and partner with one another. I think it is solvable, I do. I think it takes careful consideration by many people doing this kind of thinking and working together to make a difference.

Q — Where does La Clinica go from here? Where is the future for your organization?

Brenda J. — We continue to listen really well to what the community really needs. We do our best to align our organization in a way to satisfy those needs. We are very clear in our mission and who we are serving and who we intend to serve in the future. We will continue to think about how to innovate and create our model of care that really meets people where they are.

Q — Where do you see growing or expanding from where you are right now?

Brenda J. — There are so many exciting things happening. There are a lot of promising practices that are growing up in parts of our organization that we are shining a light on. A few of them that come to mind are:

1. Our work with wellness coaches. These are individuals who have either done life coaching or have mental health backgrounds. They have an orientation to helping individuals reach their own potential. These wellness coaches are embedded in their primary care teams, so they work closely with physicians, physician assistants and nurse practitioners and create care plans for patients. They are having amazing success in motivating change or helping people actualize their desires. That is a really strong promising practice for us.

2. The work we are doing at our wellness center around mindfulness classes and group visits. It is kind of a hybrid meditation model that allows people, especially those with anxiety and depression, to think about and develop and practice skills in mindfulness.

3. We have work happening with offering Zumba and yoga classes. We’ve just added physical therapy. I mentioned our cooking classes in partnership with ACCESS and other organizations that can help us teach how to live a healthy, nutritious life on a budget.

4. We purchased a company earlier this year called Wings Seminars. It is a powerful personal and professional development organization that has had 30 years of history of knowing how to support people in the kinds of lives they want to live and helping them get out of their own way. We are thinking a lot about how to bring that resource to people who are not able to afford it and how to discount those services and make it available so they too can see their unmet potential.

We are serious about looking outside of the valley and other parts of the state and country around other “best practices” and innovative practices that we can learn from and adapt to meet this community’s needs. That keeps us on the hunt for excellence; it keeps us sharp and paying attention to where those changes and adjustments are happening in the environment. And what can we bring to Southern Oregon to strengthen our communities in ways that we previously couldn’t imagine.

Steve Boyarsky is a retired educator and longtime resident of the Rogue Valley. He continues to be involved in educational and youth programs.

Brenda Johnson