Memphis health center steps in to help serve uninsured people whom the state cannot reach

A community health care program that started in Memphis, TN, 16 years ago to serve the working poor has become a model for efforts in many other places around the country. Some 15 clones of the Church Health Center have started in several states, and the center now holds monthly workshops to teach representatives from other communities how to replicate the program.

The Church Health Center was founded by Scott Morris, who is both an ordained Methodist minister and a physician.

He tells State Health Watch that its mission today is the same as it always has been — to meet the health care needs of those who work in low-wage jobs and don’t have health insurance.

Mr. Morris says the center operates on two basic beliefs:

1. The working poor don’t want handouts.

2. Medical and dental professionals will cheerfully volunteer a few hours every other month or so.

"Doctors went to medical school because they want to help people, and we give them that opportunity unencumbered by medical forms, quotas, and the numerous other things that make the practice of medicine burdensome today," he says.

Not the typical free clinic

But Church Health Center is a far cry from the typical free clinic that is open several hours a month in a church basement and makes use of volunteer health care professionals to provide limited services.

The centerpiece of the operation is a clinic that operates like any family practice physicians’ office in its own building. The clinic provides examinations, X-rays of chests and extremities, and laboratory tests. There is an on-site, full-time paid staff of six board-certified physicians and six nurses who see patients during weekdays. More than 400 volunteer physicians see patients at night and on Saturdays.

Specialty care is provided by physicians in the appropriate field who have volunteered to see patients in their own offices. There also are dental and eye clinics, pastoral counseling, and social services available.

Because more than half of the Church Health Center’s patients have medical problems that could have been prevented — the same percentage as in the general population — the Church Health Center launched a ministry to help people stay healthy in body and spirit. Hope & Healing opened a state-of-the-art facility in January 2000 that now sees 10,000 visits a month.

With an estimated 150,000 uninsured in the Memphis area, the Church Health Center realized there was no way it could meet the need solely through its clinic and so started the Memphis Plan in 1991.

The plan secures primary and specialty care, hospitalization, and other medical services for its participants. It is not health insurance.

Employers can sponsor their employees by agreeing to pay at least $10 of the $35 monthly fee, agree to remit 100% of the monthly fee to the Memphis Plan, and ensure that employees meet the eligibility requirements.

Participants are assigned to a primary care physician and a local hospital. Participants see their primary care physician for checkups and sick care. The primary care physician may refer patients to specialist physicians if needed. The physicians coordinate lab and diagnostic testing as well as hospitalization. Participants may go to their assigned hospital for emergencies and surgical care recommended by Memphis Plan physicians.

Church Health Center had a budget of $350,000 in its first year and now operates on $8.5 million. Funding comes from many area churches and other faith communities of all denominations, corporations, foundations, and individuals. Church Health Center does not rely on government funding, although it does receive some National Institutes of Health research grants.

"Either Memphis is willing to support people who are our neighbors, or we will have to let the doors close," Mr. Morris says.

He tells State Health Watch that the clinic serves those who fall through the cracks in the nation’s medical system.

Most patients are uninsured working people and their families. They don’t qualify for the state’s TennCare program and can’t afford private medical insurance. They are charged fees at Church Health Center based on a sliding income scale.

Patients include construction workers, church janitors, housekeepers, plumbers, actors, artists, musicians, day-care workers, retail workers, manicurists, landscape workers, waitresses, writers, receptionists, and middle managers who have lost their jobs.

New patients must meet these requirements:

1. aren’t covered by private medical insurance;

2. live in Shelby County, TN;

3. are employed or self-employed if older than 18 and younger than 65 (males must work at least 30 hours a week and females 20 hours a week, with some stated exceptions);

4. have proof of income brought to the office visit.

Mr. Morris tells State Health Watch that since his high school days and continuing through college, seminary, and medical school, it has made great sense to him to involve faith communities in the delivery of health care services.

"One-third of the Bible deals with healing people," he says, "and churches don’t do as much as they could. We provide a means to reconnect congregations with an effective healing ministry."

Kenneth Robinson, Tennessee health commissioner and a former Church Health Center board member, tells State Health Watch that several elements of the Church Health Center model can be replicated in other communities, although the scale at which Church Health Center operates may be difficult for many communities to replicate because of the complex relationships and associated partnerships that have developed over 16 years in Memphis.

"The care concept certainly is replicable," he explains. "There are health care professionals who are willing to donate their efforts and skills to provide services to the working poor with support from faith communities. And an organization could add salaried health care professionals."

He says that the level of participation by drug companies, hospitals, and providers in their own offices will vary considerably. A group just getting started, he says, could invite general practitioners to donate a number of their patient care slots per month.

According to the commissioner, the key success factors in starting a program such as Memphis Health Center include: 1) making the case theologically for the faith community to care for the underserved; 2) identifying health care professionals who are willing to provide services to the working poor at below market rates or for free; and 3) having a stable infrastructure. Mr. Robinson says the infrastructure does not have to be elaborate, at least at the outset, and could initially be a central location with one or two staff.

As a state government official, Mr. Robinson has no qualms about encouraging a faith-based health care program. "As a nation we should embrace the necessity of providing quality health care to all our citizens," he says. "It’s unfortunate that in this country there is such a disparity in the provision of health care based on insurance or economics. We still don’t have universal health care and it’s not the responsibility of state government to initiate universal coverage. Tennessee is closer than other states because of TennCare. But there will always be those who fall outside one or more coverage categories and need health care services. Until there is universal health care, there will always be a need for programs like Church Health Center. It’s appropriate for faith communities to live out the mandate to identify those in need and provide services to them. I think it’s appropriate and supportive of the work of government that faith communities take responsibility for providing needed services."

Mr. Morris says the role of faith communities is to care for people’s bodies as well as their spirits, and to care for the poor and the sick. "Our mission is not to solve the problem of the uninsured," he declares.

A champion is needed

For something like Church Health Center to succeed in another community, he says, there needs to be one individual who will "live and breathe it. Without such a person, it won’t work. You need more than a volunteer board of directors with people who want to do good."

He suggests organizers have a vision that is big enough to incorporate more than one faith community. There is a need, he says, to work with people who otherwise are unable to agree on anything else.

"You need to be committed to providing the best medical care that is available," he says. "That eliminates a lot of clinics that meet one night a week in a church basement. You should be committed to providing the same quality of medical care that is standard in America. You need to be willing to put resources into it and sustain what you have started. Churches often are good at starting things but not at keeping them going."

[For more information about Church Health Center, go to: Contact Mr. Morris at (901) 272-3853 and Mr. Robinson at (615) 741-3111. Mr. Morris has written a book on Church Health Center: Relief for the Body; Renewal for the Soul (Orleans, MA: Paraclete Press; 2001).]