Transition Plan: From HIV Service Provider To Community Health Center
Founded in 1978, Whitman-Walker Health’s roots are in serving individuals who face barriers to accessing care, starting as the Gay Men's VD Clinic and evolving to become Washington, D.C.’s primary HIV clinic.
But as the healthcare marketplace has shifted over the years, the organization has had to adapt, reorganize, and reinvent itself to stay nimble, profitable, and, ultimately, able to carry on its present-day mission as a nonprofit committed to serving the gay, lesbian, bisexual, and transgender (LGBT) community and people living with HIV and AIDS.
In 2006, Don Blanchon was hired as executive director to lead Whitman-Walker’s transition from a service organization to a community health center model.
To start, Whitman-Walker brought in physicians through the Washington Free Clinic to provide primary care services. Its northern Virginia clinic was closed, leaving it with two Washington, D.C.-based sites: the Elizabeth Taylor Medical Center and the Max Robinson Center.
With the passing of the Affordable Care Act (ACA), Whitman-Walker had to address another challenge: what would its organization look like post-ACA? “We spent a lot of time on what that meant to Whitman-Walker and who we are, who we serve, and what we’re trying to do in service to our community,” Blanchon says.
Part of that plan identified the need for a new, modern healthcare facility that would enable it to expand care, meet the needs of its growing population base, and offer greater financial diversity to ensure long-term viability.
The new 43,000-square foot building is expected to open in late spring 2015.
Healthcare Design recently talked with Blanchon about the organization’s transition, the challenges it faces, and its strategy for remaining a viable member of its community.
Healthcare Design: Why was it important for Whitman-Walker Health’s future to transition from an AIDS service organization to a community health center model?
Don Blanchon: First and foremost, it was about the people we cared for. People with HIV were living longer because of the antiretroviral and they were dealing with other health issues, like hypertension and diabetes, and had other kinds of primary and preventive care needs.
We had patients getting their primary medical care somewhere else and their HIV care and other related services here, which led to a fair amount of fragmentation and poor outcomes. We wanted to make sure that we could do an integrated primary/HIV model so that we can take care of those individuals on a community basis here.
The second reason is the community role that Whitman-Walker has had over four decades. We were first a gay and lesbian center and, before the epidemic, our services were largely geared around gay men and lesbians and some direct care, mental health counseling services, and sexually transmitted disease or sexually transmitted infection testing. The board felt pretty strongly that in making the move back to a community health center model, it wanted to make sure that this was a place where the metro D.C. LGBT community could come and get care.
That was important because it reaffirmed who we were but it also helped destigmatize getting care here. If you are mainly providing HIV-only services and then you expand, you still have to have somebody cross the threshold and, in this day and age, there’s still stigma associated with a diagnosis. The organization felt very strongly that the best way to help destigmatize HIV and AIDS was to become a community center and then allow people to come here whether they’re positive or negative.
What’s your population base?
We served a total of 14,184 individuals in 2013. Seventy percent of them were from the District of Columbia, 16 percent were from Maryland, 11 percent from Virginia, and 3 percent from other jurisdictions.
On gender identity, and this is self reported, 68 percent of our patients are male, 27 percent are female, and 5 percent are transgender. In terms of orientation—again, self reported—it’s 52 percent gay, lesbian, or bisexual; 3 percent other; and then 45 percent heterosexual. About one-half of our medical visits are related to HIV care.
How has that number changed since you joined the staff?
We have what’s known as an “all-boats rise” phenomenon. We’re gaining about 500 to 750 net patients a year. We currently treat about 3,000 of the 16,000 people in D.C. who are living with HIV. We have another 3,000 who are in primary care that are HIV-negative.
The fastest growing group is the LGBT community who is using us for primary care. Then we have a host of other services that people access outside of primary, including a dental program and mental health, so people can come in from multiple points of entry.
I suspect what’s going to happen over time is that HIV visits as a percentage of total work will come down, but that HIV work will still be a considerable portion of what we do until there’s a cure. It’s about 50/50 right now; seven or eight years ago it was probably 90/10 HIV to other.
You’re starting off the new year with the opening of a new facility. Tell us about it.
We’re opening a modern neighborhood health center at 1525 14th Street. It’s going to have a pharmacy available to the neighborhood, an expanded dental suite, complementary therapies, physical therapy, three floors of direct medical care, and a big component for behavioral health.
We needed to expand, one, to serve our current needs and, two, our patients—particularly the long-term patients—deserve our respect and dignity for hanging with us all these years. We owe them something more than just a renovated old building; we owe them a higher level of patient experience that’s commensurate with the expectations of the Affordable Care Act.
How is that goal reflected in the environment of the new building?
There are several things. First, at our existing Elizabeth Taylor Medical Center, we have one large waiting room. But patients thought the larger waiting area feels too much like the DMV, so the [new facility] will have individual waiting spaces and reception areas on each floor, with the exception of the ground floor.
Restrooms are a sensitive issue for the LGBT community. There’s an ongoing debate in public discourse around how to deal with people who don’t identify as male or female, or who are transgender or questioning [their gender identity]. Instead of having gender-identified restrooms, we decided to invest in individual restrooms to create an area where it’s an affirming place.
We’ve also adopted a team model of care, so there’s no executive suite in the building. We have shared space on each individual medical floor, and then on our sixth floor is an employee area where we have an open footprint plus some team rooms. We made a concerted effort to integrate people into the team model and then have the building reinforce that with shared space.
What do you think Whitman-Walker Health will look like five years from now?
I don’t know if we’re markedly different from this. We’ll change in size and scale a little bit, but I suspect we won’t move in mission, given who we are and our place in the community.
If you go further out than five years, you start having to ask questions about the service delivery model, because for the last 10 to
15 years for health centers, it’s been about charting visits and getting revenue by being efficient and having more productivity. The reality is that’s not where the ACA is headed.
ACA is headed toward a realignment of where dollars are spent, whether it’s close to the community, on housing that supports people, or whatever can help reduce some of the inpatient cost burden. That may be a health center like us, or maybe 20 to 30 years from now, we could be a home health agency.
What’s the biggest challenge you face?
At the end of the day, it comes down to providing the highest quality care we can to the patients that we serve now and in the future. I think that in order to do that, you have to be willing to learn and get better every day.
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.