The roots of Legacy Community Health Services stretch back three decades, to a small Houston clinic founded in 1978 to provide testing and treatment of sexually transmitted diseases, primarily for gay men. Throughout the 1980s and ’90s, the clinic grew, adding prevention education, social services, and eventually HIV medical care for uninsured patients, funded in part by the Ryan White program and the Centers for Disease Control and Prevention.
Today, Legacy is one of the largest FQHCs in Texas, serving nearly 45,000 patients —including approximately 4,000 patients living with HIV—at 11 different clinic sites in and around Houston, providing adult primary care, pediatric care, dental, vision, and mental health services, in addition to specialized HIV care.
A key to Legacy’s success has been a willingness to embrace a service delivery model that built on its roots as a Ryan White-funded clinic and recognized a growing need in the community. In a state with a limited health care safety net for low-income and uninsured residents, it has proven to be an effective and forward-thinking approach.
Diversifying the Focus and Expanding Services
Legacy’s transformation began in the early 2000s, following a decision by its leadership to diversify the organization’s focus and funding to ensure it could sustain its ability to provide care and treatment to people with HIV in an increasingly challenging fiscal environment. Following a 2005 merger with a related community health organization in 2005, the new entity began expanding beyond HIV/AIDS services to begin its transition to a community health center and achieved its full status as an FQHC in 2007. Katy Caldwell, Legacy’s executive director of 17 years, notes that the biggest challenge HIV organizations becoming FQHCs likely face is embracing the culture and mission of serving everyone in the community without compromising their commitment to the HIV/AIDS community.
- Leadership and staff commitment to the FQHC mission
- Level of unmet medical needs in your community and your state’s health care safety net
- Systems readiness to expand billing capability and data reporting
- Ability to sustain program operations during a process that may take several years to achieve full FQHC status
- Implications of maintaining separate population-focused sites or clinics or integrating clinical programs
As an FQHC, Legacy is eligible for enhanced Medicaid payments, which with its Ryan White funding and other sources of funding, including fundraising and other grants, has enabled the organization to provide high-quality, patient-centered care to Medicaid patients and uninsured adults, including $5 million to $7 million in uncompensated care a year. Legacy’s patients receive care at a growing number of clinics the organization has acquired or developed across the Houston area in recent years.
Learning from Others
Legacy’s experience managing its Ryan White grant was beneficial as it began seeking its status as an FQHC, recalls Caldwell. She also credits helpful advice from other HIV medical provider organizations that had made similar transitions, including Fenway Health in Boston, Callen-Lorde Community Health Center in New York, and Chase Brexton Health Care in Baltimore.
Key to Legacy’s success has been its staff and leadership’s respect for the cultures of the communities and patient populations they serve, Caldwell says. Legacy’s clinics reflect their neighborhoods, from appearance to staff, to patient communication materials. “We’re here for everyone,” Caldwell says. “I think it’s important to recognize the culture of who you’re serving and make sure that you honor that.”
Ties with managed care organizations under contract with the state’s Medicaid program, other FQHCs in Houston, the public hospital system, the city’s gay and lesbian community center, and the state agency managing Texas’s federal Medicaid waiver, among other relationships formed over the years have also played an important role in the organization’s success.
Legacy also maintains relationships with its local, state, and national elected officials and is a vocal advocate on HIV-related issues and health care funding, including expanding Medicaid in Texas, which has one of the nation’s highest rates of uninsured residents.
Future, priorities include improving Legacy’s information technology infrastructure to ease compliance with data reporting requirements of both Ryan White grantees and FQHCs, in addition to federal electronic health record requirements. Helping Legacy’s low-income and uninsured HIV patients transition to insurance plans offered on the state’s federally-run marketplace will continue to be a big push. Legacy’s certified enrollment counselors helped about 5,000 people sign up for coverage in 2014.
Legacy Community Health Services
Becoming an FQHC: Making it Work
- Build relationships with all related stakeholders, other FQHCs, third-party payers (e.g., the state Medicaid agency and Medicaid Managed Care Organizations), public hospitals, and other community-based providers.
- Know and respect your community and the different cultures within it.
- Engage in local, state, and federal advocacy efforts.
- Connect with local, state, and federal political leaders.
- Invest in building IT infrastructure and set realistic expectations for implementation and the impact on staff productivity.
- Plan for a long-term transition and be prepared to overcome both internal and external obstacles, including staff and leadership turnover.
- Seek advice from other health organizations that have made similar transitions.
- Develop a public relations strategy to effectively communicate your organization’s transition and shift in focus.
This brief is part of a series developed by the HIV Medicine Association, National Association of Community Health Centers and the Ryan White Medical Providers Coalition to help build partnerships between FQHCs and Ryan White-funded providers. The project is supported with grants from MAC AIDS Fund and Janssen Pharmaceuticals.