Salud on the Move!
Big Success, Bigger PlansRobert | Family Medicine May 1, 2019
Tell us who you are and what you do.
I am Tillman Farley, MD board certified in Family Medicine, Chief medical officer, Salud Family Health Centers, and Associate Professor of Family Medicine, CU School of Medicine.
Although I am employed by the University, Salud buys back all my time so it ends up that I look exactly like an employee of Salud. This arrangement works out because Salud and the University both have interests in a close connection.
The purpose of the relationship from the University perspective is to offer abundant opportunities for students to train in a high quality clinic system serving low income and vulnerable populations with limited access to care.
Salud benefits from this relationship by having a never ending stream of potential employee providers do their training here. In addition, our providers like to teach, so the relationship helps us with retention.
You are the son of Eugene Farley, former chair of the department and the name sake of the Farley Health Policy Center. What was it like growing up with such a passionate doctor in the family and how did he inspire you to follow his lead?
I just got back from giving a talk at the 50th anniversary celebration of the Rochester Family Medicine Residency, which my dad founded in 1968, the 3rd Family Medicine residency in the country. They asked me to speak about what it was like growing up in his house. Click here to read my remarks.
The idea of the Salud Clinics goes back to the late 1960’s. Tell us, briefly, what is the concept and how is it being realized to this day?
Salud is a result of the Community Health Center Act, passed by Congress in 1963. The idea behind community health centers was to provide appropriate and affordable health care to low income and uninsured populations via high quality clinics run by a patient majority board of directors.
Salud, itself, responding to the need for health care among the farmworker population of Weld county, started operations in 1970 as a migrant health center. The formation of Salud in Fort Lupton was a tumultuous and at times violent process. The whole process was the subject of New England Journal of Medicine article published in 1973.
In 1972, Salud added community health center status, becoming a migrant/community health center. We have expanded constantly since then, from a single clinic in an abandoned onion warehouse to our current operation of 15 full scope primary care/dental/behavioral health clinics plus a mobile unit and close to 100 school-based dental clinics.
We serve most of northeastern Colorado, as well as Trinidad, Colorado. We offer services to anyone, regardless of ability to pay, with a particular focus on low income, uninsured, immigrant, and farmworker populations in our catchment areas.
Over the years we have expanded our care teams significantly. Besides physicians, physician assistants, advanced practice nurses, dentists, and dental hygienists, our teams now also include most types of behavioral health providers (LCSWs, LPCs, LMFTs, psychologists, and psychiatrists), clinical pharmacists, transition of care workers, patient navigators, patient educators, and even lawyers for patients with legal needs.
We work closely with all the schools at the University to expose students to the satisfaction of working in primary care, generally, and community health centers, in particular. We have collaborated with the Department to open a rural residency track, with residents spending their first year of training on the Anschutz campus and their second and third years in Fort Morgan.
Over the years, Salud has also been an integral part of the Colorado Research Network (CaReNet) and the Statewide Network of Ambulatory Practices (SNOCAP).
The idea of whole health and the fact that Salud offers so many diverse services is unique in today’s health care world. Can you give us the lowdown on the list of services available for individuals and families when they walk into a Salud Clinic?
Salud prides itself on our fully integrated model of comprehensive primary health care provided by a large team of professionals, each member of which takes responsibility for every patient.
Our behavioral health providers work in the same space on the same patients at the same time as our medical providers. New patients to Salud, no matter the reason for visit, will see a behavioral health provider as well as a medical provider. Our behavioral health providers try to meet with at least 80% of established patients at least once a year, regardless of whether the patient or the medical providers ask for them. We believe that everyone deserves behavioral health care as well as medical care.
All children coming in to Salud for any reason, even if they don’t have an appointment and are just tagging along with a parent or sibling, will see a dental hygienist and receive oral health education, a fluoride varnish (if due for one), and a toothbrush.
Clinical pharmacists, also working in the same space and on the same patients as our medical and behavioral health providers, take responsibility for patients with chronic diseases, and also serve as consultants to our medical providers on any number of patients, for example those with polypharmacy, or needing an adjustment in psychotropic meds.
Patients are also screened for legal needs, and are referred to the lawyers working on site as part of our medical-legal partnership (the only one in Colorado) as necessary.
All patients are also screened for food insecurity and referred to Hunger Free Colorado if they score positive.
Our dentists offer full service primary care dentistry, with a focus on prevention and restoration, and provide services such as crowns and root canals, that many private general dentists are sending out to endodontists. Our dentists working on patients in the dental department have ready access to medical providers to consult with as necessary, and medical providers will often walk patients with significant tooth problems over to the dental department for an immediate appointment. It truly is one stop shopping.
There is some exciting work underway to bring a Salud Clinic to Aurora, close to the Anschutz Medical Campus. But, it is really more than just a clinic. Can you please share what is happening and the vision for this big move?
This is an exciting project that gives us the opportunity not only to expand our services to a very underserved area, but also to expand our care model. We want to develop the most innovative residency training program in the country while at the same time providing some of the most innovative programs to enhance overall health.
We plan to have 16 residents divided among internal medicine, family medicine, and med-peds. The mission is to train residents in such a way that they are motivated and competent to provide comprehensive primary care services to low income populations.
We hope this will help provide a workforce pipeline to community health centers across the state. We also see this as an opportunity to create more than just a high functioning medical clinic. We really want to create a health campus, addressing as many of the social determinants of health as possible.
Needless to say, we will bring a large health care team to that site, but we also want to expand, if possible, into other health related programs such as community gardens, and even perhaps low income housing. Right now a lot of these ideas are in the arm waving stage, but we hope to realize as many of them as we can find funding for.
Stay tuned for updates!