Clinic Transforms Care for Uninsured

But with a 4-year-old and 6-year-old to take care of, two jobs without health insurance, and no family support, the man refused surgery. With no help, he feared his children would be put in foster care, said Moore, a surgeon at Grady Memorial Hospital and Emory Healthcare.

So Moore watched the cancer grow month after month.

"It really paralyzes you," he said. "You try to offer solutions, but because of the surrounding environment, it's really out of your hands."

It was a scenario Moore, an ear, nose and throat specialist, witnessed often --- poor patients with little access to care suffering from illnesses so advanced few options were left.

So he eventually took action, loading his Subaru with plastic bins full of medical supplies and setting up "Tupperware clinics" in some of Atlanta's poorest, most dangerous neighborhoods.

Seven years later, the result of his efforts is a free health clinic called the HEALing Community Center that provides 6,000 patients a year with more than basic checkups. Located along Joseph E. Boone Boulevard on the city's west side, it focuses on preventive care with a wide range of specialty services such as foot care, mental health and cardiology, as well as helping patients make lifestyle changes.

Moore is one of a growing number of medical professionals rethinking care for the uninsured and making strides in the struggle to lower escalating health care costs. The goal: Create a medical home for patients to receive quality primary care in an effort to keep them healthy and avoid costly emergency room visits.

"If they don't get care, eventually, you're going to pay for it if you're a taxpayer," Moore said.

In recent years, Moore's cause has grown from giving cancer talks at shelters to setting up a permanent clinic in two storage rooms at the nonprofit City of Refuge, a center that offers shelter for women and children, after-school programs and other services for the needy.

And construction is now under way on a new $2.5 million, 16,000-square-foot clinic that HEAL and City of Refuge are building. The facility will include operating rooms, X-ray suites, a pharmacy and a conference room for health classes. Recuperative care beds will make it possible for hospitals such as Grady to release homeless women knowing they will receive medical care and shelter for up to six months.

The project is backed by hundreds of thousands of dollars in private donations and government grants. Meanwhile, more than 100 volunteers from Emory, Georgia Tech, Piedmont Heart Institute and other organizations volunteer to treat 500 patients a month.

Moore's vision is unique in its broad scope, said Patricia Hudgins, an Emory radiologist and clinic volunteer. "It's someone like Charles who says, 'Let's hit it from every single perspective.'"

Hudgins has helped counsel on nutrition and exercise, but it hasn't always easy. "How do you tell somebody who carries everything they own on their back to exercise?" she said.

When Moore realized the closest grocery store with fresh produce was miles away, he grew an organic garden. And a group of Emory students started a farmer's market where people could buy a head of cabbage for 25 cents.

The clinic also connects people with legal resources, job search help and other support to tackle non-medical issues that can affect health.

A person's housing and financial situation can have a huge impact on his health, said Emory student and volunteer Mitch Rostad. "What kind of food are you buying? Where are you living?"

Faced with rapidly rising numbers of uninsured patients, hospitals are taking note of Moore's comprehensive approach.

Since the recession, Grady Memorial Hospital has seen record numbers of emergency room visits, which cost around $1,500 each, CEO Michael Young said. Even if the HEALing Center keeps 1,000 patients from having to go to the hospital, that's a tremendous value, he said.

Physicians at Grady, including mental health specialists, already volunteer at the clinic. And the hospital, which spends $275 million a year on treating the uninsured, will provide lab tests at cost --- about $2 per test --- and maintenance staff to help with the new facility.

Moore's clinic is ahead of its time, Young said. "It's exactly where health care reform is going."

Hospitals have a big incentive to invest in these types of clinics, said William Custer, a Georgia State University professor and health care expert. Without access to adequate primary care, people get sicker than they normally would and end up needing the most costly services, he said.

For Moore's new clinic, medical supply company MedShare and Emory University Midtown Hospital have agreed to provide more than $60,000 in supplies and equipment.

While free clinics will need to evolve as millions more people qualify for Medicaid under the new health care law, there will still be uninsured patients to care for, Custer added. Meanwhile, hospitals will lose some of their direct funding for those who remain uninsured, such as illegal immigrants, he said. "The hospitals are going to be increasingly at risk."

Many of Grady's ER patients come from the area the free clinic serves, said Tony Johns, director of community involvement at City of Refuge. A survey by his nonprofit showed that of the 1,500-plus people it served over nine months, 63 percent were uninsured, Johns said.

Marretia Sullivan showed up at the clinic recently with a congested chest and a purse full of prescriptions.

The 58-year-old knew about her enlarged heart for years, but with intermittent insurance coverage it often went untreated. She ended up in the emergency room with congestive heart failure last April. "I ran up an enormous hospital bill," she said.

Sullivan said she comes to the clinic every few months because she feels comfortable there and volunteers show personal concern.

The trend in health care is creating a place where patients can go for all their needs, people know them by name and they have a case history, Johns said. "That's very difficult for the uninsured to have. They're just kind of piecing together their health care."

While the first phase of HEAL's new clinic is slated to open in March, Moore is also moving ahead with more ideas to expand service, recently starting an evening clinic and planning to provide OB/GYN and dental services.