Sonoma Valley Community Health Center thrives

It is the biggest little secret in Sonoma Valley healthcare circles and it has been hiding in plain sight on West Napa Street since 1992.

And unless you’re one of the 7,000 Sonoma Valley residents who use it every year, there’s a good chance you don’t even know that the Sonoma Valley Community Health Center is a comprehensive, primary care clinic with a federal mandate to treat everyone who walks (or is carried) through the door, from cradle to grave.

"We are," said Marc Schwager, a member of the health center’s board of directors, “a family practice clinic on steroids.”

Added Kathleen Bianchi-Rossi, development director for the center, “Imagine the Hulk, dressed in a lab coat.”

If that image is a reach, try to picture 30,000 patient visits a year, translating into more than 80 visits a day.

Until July, that patient load was funneled through a cramped and crowded complex of less than 9,000 square feet with all of 20 parking spaces. Room at the old health center was so maxed out that the medical lab and the baby scales were in a hallway, patients were seen in administrative offices, and a laundry room was turned into computer workspace.

In the evening, a reception area was used for group therapy, with the outside glass wall partially frosted to block the view from pedestrians passing on the sidewalk.

Now all that has changed. Since moving out of the cramped confines at 430 W. Napa St., the health center has expanded like an accordion puppet into a freshly renovated, 18,621-square-foot building at 19270 Sonoma Highway.

The new facility has 15 exam rooms for family practice, instead of eight, each identical in size and configuration, so that medical team members can move between similar environments. Design elements are impressive.

A new Behavioral Health Services Center has three consulting rooms with a staff member available to intercept new behavioral patients with a “warm hand-off” for people with psychiatric conditions.

There is finally a bona fide medical lab licensed to draw blood, a community education center with two classrooms and, perhaps most notably, given the enormous unmet need, a complete dental clinic with six operatories set to open in September.

But despite the dramatic improvement in healthcare resources, some aspects of the center’s role in healthcare delivery remain a mystery to many Sonomans.

Perhaps the leading issue most often misunderstood is the question of who can access the center. The answer is simple: everyone. While 45 percent of the health center’s patients live at or below the poverty line, that means that more than half don’t. Marc Schwager, the board member, is a patient, and so is Cheryl Mariscal Hergert, a relatively new arrival who desperately needed a doctor last January and couldn’t find one.

As she wrote to the Index-Tribune, “I figured the best last-minute option was SVCHC. I showed up at the Health Center without an appointment. Amazingly, I was able to see a physician within 30 minutes.”

Part of what makes the community health center model work is the fact that health centers are reimbursed by Medicare and Medi-Cal at a higher rate than hospitals. But in exchange, they are required to accept every patient who arrives seeking health care, and they must care for those patients for, essentially, as long as they live.

Treatment isn’t free – it never is – but services are billed on a sliding scale depending on ability to pay.

The average annual per-patient cost at the health center is about $764. To put that in perspective, Schwager pointed out, “For half the cost of one ER visit, we can take care of someone for a year.”

But if a patient shows up at the center and is in need of emergency treatment, the center is obligated to transport the patient to a hospital ER and cover the unpaid cost of emergency treatment.

But emergency medicine isn’t what the health center is primarily about. The full range of services provided would fill a page. It includes a variety of primary and preventative services, including children’s health and school-based mobile medical van services; immunizations; confidential teen services through a Teen Clinic; pre- and post-natal care; adult and geriatric services; women’s health and family planning; behavioral health; limited pharmacy services; diabetic and health education; nutritional and social services; outreach education and insurance application assistance.

There is a likelihood that demand for these service will rapidly increase as the Affordable Care Act pushes healthcare further in the direction of community health clinics.

Indeed, Health Center CEO Cheryl Johnson insisted at a recent walk-through of the new facility, “Without the Affordable Care Act we would not have this building.” The facility was partially paid for by a $5 million grant secured under provisions of the ACA.

Looking at the big picture of health care in Sonoma Valley, it becomes clear that the two primary healthcare facilities – Sonoma Valley Hospital and the Sonoma Valley Community Health Center – have a symbiotic and mutually dependent relationship. The hospital provides an ER, a birthing place, a surgery center, medical imaging, a skilled nursing facility, a women’s health services lab and various rehabilitation services. The Health Center provides virtually everything else.

But there remain at least two expanding holes in healthcare in Sonoma Valley: the challenge of finding enough doctors, and the further challenge of finding available doctors who will accept either Medicare or Medi-Cal.

Those are two medical conundrums neither the Health Center nor the hospital have yet been able to solve.

And they will be part of the focus of an ongoing, Index-Tribune examination of health care in the Valley.