Metro Community Health Centers aim for prevention in patient-centered care

“If we’re doing our job right, patients won’t need us,” says Rita Bilello, DDS, Chief Executive Officer at Metro Community Health Centers (MCHC), who established a partnership with Yuvo Health in 2022. Her goal, she says, is to introduce patients to care and build an environment where people feel safe and secure, so they feel comfortable reaching out when they have an issue.

“We want to improve the quality of care and reduce the visits,” says Dr. Bilello, when discussing the health and wellness of patients.

On a mission to enable access to and provide high-quality, well-coordinated, primary and specialty medical, dental, behavioral, rehabilitation, and ancillary health services to patients who are underserved, MCHC is a federally qualified health center (FQHC) with four locations in New York City serving more than 7,000 patients annually, including children, adolescents, and adults.

Related: Hear from more FQHCs like Metro in our latest Annual Report.  

Serving the underserved

While MCHC has an open door policy for community members, patients with intellectual and physical disabilities comprise the majority of MCHC’s patient population. Many are underinsured, don’t have access to healthcare, or need help navigating the health system. MCHC providers are well-equipped to work with caregivers, as well as address language barriers, health literacy, and other factors to provide the highest quality care and create the most meaningful impact.

“The disabled population can’t find providers who can treat them,” says Dr. Bilello, and very often patients are battling comorbidities, such as physical disabilities and mental health disorders, which can hinder life skills and create challenges around their ability to set goals and achieve them.

While primary care is a necessary service, it’s not usually the first need of a patient, as many underserved community members are hopping to different urgent care centers and emergency departments, Dr. Bilello explains. “Many people are in a state of crisis,” and have urgent health or mental health concerns that need immediate attention. This is why MCHC has a robust intake process and assesses a patient’s acute needs before providing treatment and connecting them to primary care.

Rising above the strains

Since the pandemic, MCHC has experienced workforce changes, administrative burdens, financial burdens, and ongoing regulatory responsibilities, among other hardships. When lockdowns began in March 2020, MCHC immediately shifted their attention to telehealth services, which meant buying a platform and learning a new technology. In the process, the organization learned that a lot of patients, regardless of their living situation, had trouble accessing care.

How can we think outside of the box to reach out to patients and accommodate them? How do we transition our call center and staff, with roles changing every day, to better address patient needs? These are just some of the questions Dr. Bilello has asked in an effort to improve quality care and delivery in a time of high stress.

“We’ve all taken it to the next level,” says Dr. Bilello. “Adaptability is where FQHCs have shined. We’ve mastered changing the game plan at a moment’s notice.”

MCHC has delivered more than 13,000 COVID-19 vaccines. The organization also has battled financial burdens, while still finding ways to retain providers through creative incentives, flexible working options, and more self-protective measures.

With a rise in demand for mental health, psychiatry, behavioral health services, as well as healthcare and supportive services like home healthcare and transportation, MCHC has pivoted its efforts – and found new ways to meet the needs of patients while protecting the health of providers. “Even if we have to ask a provider to stay on and even if a patient is new, a crisis gets handled at the moment,” says Dr. Bilello. Understanding the strain on providers, Dr. Bilello is dedicated to making small improvements every day to make their jobs easier.

“What keeps me motivated are the small wins,” she says.

Dr. Billelo has witnessed many life-changing moments, especially around behavioral health. The organization has received countless urgent calls from loved ones of patients in crisis who may be acting out because they’re overwrought by life or by changes in their routine. Deescalating the situation and connecting patients in crisis to urgent services is a success. To see a patient smiling, after going through this, is a small but mighty win. They smile, not because life is great, Dr. Bilello says, but because they can suddenly take a breath without worrying.

The work may be grueling, on a day-to-day basis, but it’s also equally rewarding.

Building a path to prevention

Dr. Bilello wants to connect patients to primary care and establish a continuity of care, but far too many people are battling unaddressed needs and those take precedence. Oral care, for instance, is a well-documented unmet medical need among the disabled population, Dr. Bilello explains. In the greater community health world, dental insurance is not insurance in the true sense of insurance, but an FQHC has the ability to offer services at a discounted rate. This can be monumental for patients. Imagine a diabetic patient who can’t chew due to an untreated oral condition or a patient on psychiatric medication who acts up during meal time because they have an untreated toothache, Dr. Bilello says. “When patients get oral care, their nutrition improves, their medications work more effectively, and they’re better able to manage their condition.”

Looking toward the future, Dr. Bilello says her goal is to not only improve clinical and organizational operations, but to continue offering a space where patients feel safe and secure. That way, patients can reach out when there’s an issue – and when there’s not, the center will still be there to offer preventative care.

Here at Yuvo, we’re thrilled to join in partnership with MCHC and hope to equip the organization with more resources to expand their offerings and change more lives. You can learn more about how Yuvo Health supports FQHCs here.

If you'd like more resources on value-based care for your FQHC, download our free guide.

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