Health Care for the Homeless
In 1985, Care Alliance Health Center (CAHC) first emerged as Cleveland Health Care for the Homeless as part of a demonstration project funded by the Robert Wood Johnson Foundation and Pew Charitable Trust in response to the growing homeless population nationwide. CAHC began conducting homeless outreach to build trusting relationships in the Cleveland community that would ultimately connect patients to health care. Given the history of trauma and distrust by many homeless individuals, relationship building and support is essential before patients will trust primary care teams.
Care Alliance Health Center Emerges
Initially under the auspices of The Federation for Community Planning, Care Alliance Health Center became an independent 501(c)3 organization in 1993. Its first location was in the basement of the Sidney Hillman Memorial Building on Payne Avenue.
Care Alliance Health Center expanded to provide public housing primary care (PHPC) in 1993 in an effort to follow homeless patients as they became housed. In 1998, at the invitation of the Health Resources and Services Administration (HRSA), CAHC assumed responsibility for providing health care in the community’s public housing estates, becoming the local grantee for the Department of Health & Human Services’ Public Housing Primary Care Project in Cleveland, Ohio. Extending its target population from those who experience homelessness to also include those living in public housing, allowed Care Alliance to follow patients as they move along the housing continuum.
Services to People Living with HIV/AIDS
In 2000, the Bureau of Primary Health Care awarded Care Alliance Health Center a Ryan White Title III grant for primary health care and case management services to persons living with HIV/AIDS. CAHC was able to provide care to individuals living with HIV/AIDS through comprehensive medical and dental care, medical case management, access to Ohio HIV Drug Assistance Program and all other Ryan White services.
Oral Health Services
To begin addressing one of the greatest health care needs in the state of Ohio, Care Alliance Health Center began its comprehensive dental program in 2002, servicing people who are homeless and persons living in and around public housing. The Dental Department provides comprehensive and affordable oral health services, including dental cleanings, extractions, x-rays, oral cancer screenings, oral surgery and restores smiles through partial dentures.
Warehouse to State-of-the-Art Medical Care Facility
The receipt of an Expanded Medical Capacity (EMC) Grant award in June 2005 enabled Care Alliance to increase clinic hours to five full days per week. Previously, the homeless health center was open half days only. Additionally, service hours were expanded to include two morning sessions at the Public Housing Clinic located in the Carl B. Stokes Human Services Mall and Riverview Tower Clinic.
On July 11, 2006, Care Alliance’s Board of Directors, staff and community partners celebrated the grand opening of its newly renovated former warehouse as a beautiful, state-of-the-art medical and dental facility for homeless clients. On bus lines and within walking distance of both the men’s and women’s emergency shelters, the St. Clair clinic increased the opportunity for more Clevelanders who are homeless to access appropriate health care.
Electronic Medical Records
In 2011, Care Alliance took a giant step toward organizational efficiency by implementing the Electronic Medical Record (EMR) system, EPIC. In 2013 Care Alliance transitioned completely to the electronic health records by adding Dentrix as the Electronic Dental Record (EDR) system.
Patient-Centered Medical Care
Since its inception, Care Alliance has been committed to providing care that not only addresses health care needs, but also other socioeconomic barriers that make it difficult for prioritize health care. In 2013, Care Alliance’s vision for care was affirmed through recognition by the National Committee for Quality Assurance as a Level III Patient-Centered Medical Home (PCMH), the highest level of recognition. In 2014, Care Alliance adopted the physical-behavioral health integration (PBHI) model, integrating behavioral health into primary care.
Central Neighborhood Clinic
Opened in April 2015, Care Alliance’s Central Neighborhood Clinic is a new, modern health clinic located on the corner of East 30th and Central Avenue. The two-story, 30,000 square foot facility includes 10 dental chairs; 16 medical exam rooms with women’s health, pediatric and family medicine areas; separate podiatry and optometry areas; 5 consultation rooms for behavioral health care; and a large patient pharmacy. The lower level of the building houses a cafeteria, conference room, and training room, supplementing existing administration space. The building is designed to follow the American Institute of Architect’s Guidelines for Health Care and is certified by the Green Building Council as LEED Gold.
To improve accessibility of primary care services and to support coordination of primary and behavioral health care for residents of permanent supportive housing, in 2015, Care Alliance Health Center launched its Mobile Clinic. The intention of this initiative was to create a health home for every Housing First resident and extend medical services to the community beyond its stationary clinics.
On May 2, 2016, Care Alliance opened an on-site full service pharmacy in the Central Neighborhood Clinic, allowing prescribers immediate consultation with a Pharmacist, increasing patient education on medication management and adherence, and ensuring ease of access for patients. The pharmacy is 340B certified and offers outpatient drugs at discounted prices to uninsured and low-income patients on a sliding fee scale.
Care for Families & Children
After the opening of the Central Neighborhood Clinic, Care Alliance began offering more comprehensive family-based services in response to the overwhelming need in the community. To support prenatal and infant care, CAHC launched CenteringPregnancy in June 2017. CenteringPregnancy is group-based prenatal care wherein women with similar gestational ages meet for 10 sessions throughout their pregnancy. CAHC also began offering optional family planning services to all female patients, and provides same day access to long-acting reversible contraceptives (LARC) for interested women. In addition to clinic based services, in Spring 2016, Care Alliance began a partnership with the Cleveland Municipal School District to bring onsite care to various schools in the Cleveland community using the Mobile Clinic unit and space inside the school buildings.
Increasing Access to Care
Despite the myriad of new services provided by Care Alliance, patients were still experiencing trouble making it to appointments. To address these issues, Care Alliance began implemented several initiatives. In 2017 Care Alliance launched an Uber-based transportation program using HIPPA-compliant Circulation software. CAHC was provides shuttle service between all of its clinics to transport patients to and from clinic appointments. In 2019, CAHC launched telepsychiatry will provides yet another way for patients to access care remote to providers.