There are many different perceptions about what a free and charitable clinic is and does. We are the same in many aspects as other clinics in providing care, but uniquely different in some very distinctive ways. For 28 years, Lackey Clinic’s mission has been to provide skilled, compassionate healthcare and counseling to the medically disadvantaged in a manner that honors the name of Jesus Christ. To support our mission, we have been able to partner with many individuals and organizations to expand our capabilities and reach in a manner that is way beyond our budget and mutually beneficial to all involved. With the COVID-19 pandemic as a catalyst, we began to utilize evolving technologies to help us improve our scope and provide better access.
Our mission sets an exceedingly high standard of quality to attain, “in a manner that honors the name of Jesus Christ”. We give providers adequate time to visit with patients, many of whom have not had care in an exceptionally long time, cannot speak English, are marginalized in society, and have one or more chronic conditions. Our in-person appointments are typically 45 minutes long, and our telehealth appointments are 30 minutes long. Because we are not constrained by insurance reimbursements (which often equates to time constraints), we are free to spend the amount of time to learn about the patient as a person instead of just another face needing care. Our typical visit covers 5-6 issues, which is many more than could be covered during a 15-minute appointment.
We use multilingual staff and VOYCE (medical video translation service) when needed. A scribe does all data entry on the computer so the provider can focus 100% on the patient during the visit. And, because we screen 100% of our new patients for SDOH (Social Determinants of Health), we incorporate their impact into our care plans. What we do not do is “one-off” encounters such as school physicals and immunizations, because they fall outside of our mission of “medically disadvantaged”.
When someone becomes a new patient, we provide them with a continuity of care in-house with our integrated care model (primary and specialty medical care, dental care, eye care, free and low-cost prescriptions through our pharmacy, behavioral health services, diabetic education, and spiritual care all under one roof), and we also offer extended care through charity care agreements with local hospitals. Our eligibility process requires patients to provide financial proof that their income is between 139-300% of the Federal Poverty Level (FPL), which enables the hospitals to give our patients the care they need free of charge. It also helps the hospitals with their charity care requirements as nonprofit hospitals. 95% of our patients give our quality of care 5 stars out of 5 and we have less than a 6% no-show rate.
We define the “medically disadvantaged” who we serve as someone who has no health or dental insurance. They fall into the healthcare gap, because they do not qualify for Medicaid and cannot afford health insurance. They have often had no care, had significant gaps in their care, or used the emergency department when they needed care. The United Way describes this population as the ALICE population— an acronym for Asset Limited, Income Constrained, Employed. ALICE represents the growing number of households in our communities who do not earn enough to afford basic necessities. We estimate there are over 29,000 households in just our service area who could benefit from free and charitable healthcare through our Clinic (Virginia | UnitedForALICE). Having no insurance further defines our age group to be primarily ages 19-65 (FAMIS covers children up to age 18, and Medicare covers individuals beginning at age 65). This age group represents the population in a vocation program and in the workforce, and it is beneficial to the community to keep all our workers healthy and functioning. Sixty-seven percent of our patients are working, 40% are Hispanic (13% is the average for our region), and 30% are undocumented. 90% of our patients have at least one chronic disease, 75% have three chronic conditions, and 52% have at least five chronic conditions.
Margaret Mead wrote, “Never doubt that a small group of thoughtful, committed people can change the world. Indeed. It is the only thing that ever has.” Our team is probably the biggest reason we are different. Every one of our staff members could find a job for more compensation elsewhere, but they choose Lackey Clinic because of our mission, culture, and ability to help others. We have averaged less than a 10% turnover for the past five years (through the COVID-19 years), and most of those leaving were students who were with us for a gap year after completing undergraduate school. Our appointment length also helps protect our staff from “burn out”. Because of their excellence, we can push the envelope in exploring new processes, technologies, and innovations in our efforts to increase capacity, improve access, and achieve better health outcomes.
Our FY’24 Budget requires $2.5M of revenue. We receive funding from grants (51%), donations (42%), patient contributions and program fees (6%), and investments (1%). The Williamsburg Health Foundation is our largest grantor, followed by the Virginia Association of Free and Charitable Clinics, United Way, Sentara Healthcare, and local municipalities. Donations come through our events and appeal letters. As stated before, we take no insurances and do not charge patients a flat fee or use a sliding scale. One of the reasons we do not take any federal funding is because we do not want our mission to ever be restricted or modified.
To maintain their tax-exempt status, nonprofit hospitals in Virginia must demonstrate they provide a substantial community benefit. This benefit can include services such as charity care, medical education, research, and other programs that directly benefit the community's health. Lackey Clinic has these agreements with the three major hospital systems in the region, Riverside (95% of all referrals), Sentara (mammograms), and Bon Secours (pathology and cytology labs) for patients meeting our eligibility requirements (income up to 300% FPL). Because of our robust eligibility screening, our patients do not need to pay or apply for financial aid. For specialty care beyond what our volunteers can provide, we rely on these hospital systems. In addition, our patients can get labs, x-rays, imaging, and in-hospital care for free.
We have a remarkably effective volunteer model that complements our staff of 35 with an average of 8-10 volunteers/day. In FY’23, we had a total of 346 volunteers providing 14,886 hours of service for a value of $538,671. We had 23 providers, many of whom offer specialty care at the Clinic, eight dentists, and seven pharmacists. Providers can practice the way they used to by spending adequate time with our patients and letting scribes record visit notes on laptops. We currently have 24 pre-med students from William and Mary, CNU, and UVA who fill the role of scribes and patient partners, eight hygiene students from VPCC, and two behavioral counselor residents. It is a wonderfully symbiotic relationship where our volunteers contribute free care to our patients and in return they learn from “hands-on care” and accumulate required hours needed for their programs. Most of our scribes have successfully been admitted to med school and so the competition for these positions at our Clinic is fierce.
Collocated services mean services that are all in one location. Chat GTP did a wonderful job below in explaining the beneficial aspects of collocated services.
Lackey Clinic has two part-time chaplains on staff, a volunteer Spiritual Care Team, and a Spiritual Health Committee led by our Board members. According to an article published in The Harvard Gazette, Spirituality linked with better health outcomes, patient care – Harvard Gazette , “They noted that for healthy people, spiritual community participation — as exemplified by religious service attendance — is associated with healthier lives, including greater longevity, less depression and suicide, and less substance use. For many patients, spirituality is important and influences key outcomes in illness, such as quality of life and medical care decisions. Consensus implications included incorporating considerations of spirituality as part of patient-centered health care and increasing awareness among clinicians and health professionals about the protective benefits of spiritual community participation.” We offer spiritual care to our patients, volunteers, and staff. We begin each morning with prayer and hold weekly Bible studies during lunchtime. Many of our patients who do connect with our Spiritual Care Team often end up not needing behavioral health counseling.
In The secret to great health according to data | McKinsey the authors write, “We also recognize that a large and growing body of evidence suggests that at least 19 of the 23 drivers of our health sit outside conventional healthcare systems. Each of these drivers appears to have an independent, direct, material, and causal impact on our health. These drivers include what we put into our bodies, how we spend our time, when and how we move, what our minds and bodies are exposed to, and what we believe about the nature of reality, ourselves, and other people”. Our Clinic decided to incorporate as many of the 19 drivers of health outside the conventional care system into a more comprehensive care model. In 2022, we piloted a Connected Care Weight Loss Program using technology, patient partners, and medical staff to educate, motivate, and empower our patients. The goal was to help patients lose weight and lead a healthier lifestyle through better health literacy, a healthy food prescription program, accountability coaches, and technology. After eight months, over 75% of the patients lost weight. Due to the pilot program's success, we expanded the program for hypertensive patients in February 2023. The benefits of telehealth and remote patient monitors (RPM) for chronic disease management include a better patient experience, better health outcomes, and reduce barriers for patients to access healthcare. It also has been shown to improve patient health literacy and provide social support, especially for older patients. Lackey Clinic’s Connected Care Program uses RPM to empower and educate patients to manage their health and actively participate in their healthcare. RPM can give clinicians a holistic view of a patient's health over time, increase visibility into a patient's adherence to treatment, and enable timely intervention before a costly care episode. To address the prevalence of low health literacy in our patients, we utilize technology to text, email or video conference patients with personalized education based on their diagnosis. This education can range from hypertension, medication, and stress management to healthy eating habits and smoking cessation. We utilize patient partners (William and Mary pre-med students) to serve as patient coaches to provide social support and encourage our patients. Because the patient is at the center of all interactions and communication, understanding a patient’s beliefs is essential. Our goal in the next few years is to move from the pilot stage to full scale adoption for all our diabetes and hypertension patients.
Lackey supports the overall community in many intangible ways. For example, the Mayo Clinic cites three health benefits of volunteering, especially for older adults. It improves physical and mental health, provides a sense of purpose, teaches valuable skills, and it nurtures new and existing relationships. We have 56 people between the ages of 41-65 and 60 people age 66+ who volunteer for the same reasons. We provide a bridge for healthcare professionals from other countries to meet the requirements of becoming a provider in the USA. Many were practicing as a doctor or dentist and now must redo some of their certification and licensing because of US requirements. Recently, we had a doctor from Bangladesh and a dentist from Nepal who volunteered at our Clinic, and they have now been accepted into medical and dental school. We help many small businesses with health and dental coverage for their employees. These businesses are too small to afford any type of health or dental insurance; therefore, the talent pool from which they can employ is restricted. By partnering with these businesses, we can often offer health and dental care if their employees meet our eligibility requirements. We also partner with dozens of community organizations who can help address our patients’ Social Determinants of Health (SDOH) needs (see Partnerships).
Patient assistance programs (PAPs) are usually sponsored by pharmaceutical manufacturers and are promoted as a safety net for Americans who have no health insurance or are underinsured. The goal of these programs is to provide financial assistance to help these patients access medications for little or no cost. Our patients receive over $9 million worth of brand-name protected drugs for free, whereas most insurances will only cover generics or not cover the cost at all. Such examples are Ozempic (diabetes), Emgality (migraine), and Ranexa (chest pain).
In the past 23 months, we have provided free healthcare access through over 580 Virtual Urgent Care (VUC) appointments to Virginians who were not our patients but had barriers to accessing healthcare. They can book appointments online (Free Urgent Virtual Doctor and Dentist in VA - Lackey Clinic) and see our certified doctors virtually in lieu of going to an Urgent Care facility and paying $90-$100/visit. Our doctors are volunteers who have a Virginia license and can work from anywhere they have access to the internet. Because these visits are done virtually, anyone in Virginia can book an appointment. Thirty percent of the people who get seen in our VUC appointments become regular Lackey Clinic patients—helping them receive routine care instead of just urgent care. We support the Four Oaks Day Service Center (a homeless shelter in Newport News) every Thursday morning. Newport News EMS calls to this facility were greatly reduced on Thursday mornings, and there were zero calls in November of 2022.
Because of our long history and holistic approach to patient care, we collaborate with many agencies to help fulfill our mission: OneStop and Workforce Development (job placement/training); United Way (disconnect notices, rent assistance); Thrive Peninsula and Grove Christian Outreach (fresh produce for food prescription program/food insecurity); Peninsula Agency on Aging, A&T transportation, and Lyft Medical (free patient transportation); City of Newport News, City of Williamsburg, James City County, and York County (Community Paramedicine); William and Mary, CNU, and UVA premed students and VPCC students (patient partners for our Connected Care program, Medical Scribe Program, and Dental Program); Iglesia Vida Abundante Virginia “Abundant Life Church” (spiritual counseling and care to Spanish-speaking patients); Liberty University College of Osteopathic Medicine (for medical student support); Colonial Behavioral Health and Genesis Counseling Center (behavioral health); Every Woman’s Life (breast and cervical cancer screening); and Four Oaks Day Service Center (homeless shelter care).
Lackey Clinic has embraced technology to improve capacity and patient care. Beginning in 2020, we started using telehealth to provide more access to care, and today we continue to do 30% of our visits virtually. As previously highlighted in the Connect Care section, we provide our patients with remote patient monitoring (RPM) devices to measure weight, blood pressure, blood glucose, and activity tracking (Fitbit). Seeing real-time data on their own health metrics empowers patients to make timely lifestyle decisions. To scale our data collection to all patients in the future, we partnering with Florence, an intelligent messaging program from Generated Health. We use online applications for eligibility and our Virtual Urgent Care appointments. Lastly, we benefit from the generosity of Riverside Health System, which provides us with Epic Electronic Medical Records and allows us to track patient care across time and care givers.
Lackey Clinic is a modern, well-kept 10,000 square foot facility which is totally owned and operated by our LLC. We have been blessed to have funding to support excellent equipment, furniture, and supplies. For example, during COVID-19, we were able to quickly buy and install UV lights and electronic filters in our HVAC system, UV light at workstations, and portable UV disinfectors. Our dental office is equipped with the latest equipment for general dentistry to include x-ray, panoramic x-ray, and intra-oral scanners for 3D printing. Patients with diabetes and hypertension receive monitors to be able to read their blood glucose or blood pressure, Fitbits, and weight scales.
The Neighborhood Assistance Program (NAP) in Virginia encourages businesses, trusts, and individuals to make donations to approved 501(c)(3) organizations for the benefit of low-income persons. Businesses, trusts, and individuals may receive tax credits equal to 65% of the donation that may be applied against their state income tax liability in return for their contributions. Lackey Clinic received over $167k in FY’24 to use to attract volunteer providers and large donations.
Spiritual Care. A.R. is a 50-year-old woman from Honduras referred to the diabetic educator for lifestyle management of pre-diabetes and obesity. Within minutes of the appointment, the patient dissolved into tears and haltingly described being recently divorced. In addition, her 18-year-old son who had been raised by her mother in Honduras had come to live with her. She was using food for emotional comfort, had distanced herself from church out of shame and embarrassment, and was resistant to seeing a counselor. One of the spiritual caregivers from Abundant Life Church was present in the Clinic, and A.R. agreed to meet with her. Their relationship continued at clinic appointments and by phone and text. With the support of the caregiver, A.R. returned to church, which strengthened her network of friends. At her two-month follow-up appointment, A.R. presented herself as an entirely different person: smiling, bright-eyed, neatly groomed and dressed. She described “feeling good” with increased energy and was no longer isolating out of shame. She had lost four pounds. She was also able to share what she has been learning about making healthier lifestyle choices with her son who had gained weight since coming to the U.S.
This encounter is characteristic of the Clinic’s capacity to care for the whole patient. The patient’s distress was identified not only as an emotional reaction to a stressful life event but also as a barrier to her ability to learn and apply information to manage her pre-diabetes and weight successfully. The access and availability of the caregiver in the moment was critical to meeting the patient where she was in the moment.
Quality Care. At the end of April 2023, we began caring for a new patient in her mid-50s who presented with a history of high cholesterol, anxiety, mitral valve prolapse, dental pain, and chronic right shoulder pain. As part of the initial workup, the provider ordered x-rays of the patient’s right arm and shoulder to further evaluate her pain. Expecting the x-rays to return with arthritic changes or a subacute shoulder injury, the provider was shocked to see that the patient’s shoulder was fine, but the x-ray revealed evidence of multiple lung nodules. Two days after her shoulder x-rays, the patient was seen for a CT scan of her chest, which revealed too numerous lung nodules compatible with a metastatic disease process (cancer in another area of the body that spread to the lungs). She subsequently had a CT of her abdomen and pelvis and a biopsy of the lung nodules, revealing metastatic adenocarcinoma of endometrial origin. Within four weeks of her biopsy, the patient was seen by Riverside Peninsula Cancer Institute as well as Riverside Partners In Women’s Health Oncology. At these visits, the patient was scheduled for port placement, had a chemotherapy plan formulated, and more biopsies were completed to confirm and stage the endometrial cancer. Throughout this very short eight-week process, the patient was also cared for by the Lackey Dental Team to receive needed dental care and extractions, had several visits with her new Lackey PCP to address her anxiety and depression related to her new cancer diagnoses, and met with the Lackey Chaplain for brief counseling. Without Lackey Clinic, this patient would not have received fast, effective care, and without our charity care partnership with Riverside Health System, our patient would not be receiving the state-of-the-art treatment that she so desperately needs.
We are grateful to be a part of the “solution” to the healthcare needs of so many in our community who would otherwise go without.
Connected Care Program. One of our William and Mary Patient Partners has been partnering with a female “Connected Care” hypertension patient in her early 60s for several months. During that time, the patient partner noted that the patient showed great strength and commitment in making positive changes to manage her hypertension. With each conversation, the patient partner learned more about her, her family, and her interests. The connection that was built was valuable, and it was clear that both the patient partner and the patient truly enjoyed the calls. Through their discussions, the patient partner provided motivation and guidance, supporting the patient through a challenging process. However, one morning in late May, the conversation took a different turn. The patient partner reached out to the patient at their regular time, only to find the patient expressing frustration and resignation. Despite her diligent efforts in implementing life-altering changes, the patient had noticed no significant improvement in her daily blood pressure numbers. She had even packed up her machine and planned to return it that same afternoon, ready to give up on the program entirely.”
Upon hearing this, the patient partner was initially taken aback. As an outsider, it was easy for the patient partner to judge her decision to quit. Instead, the patient partner chose to listen attentively to the patient’s frustrations, putting herself in the patient’s shoes and empathizing with the difficulty and emotions she must have been experiencing. Taking the patient’s concerns seriously, the patient partner validated her feelings and reassured her that her reaction was completely understandable, emphasizing that it did not diminish her worth as a person or patient Gradually, the patient partner began to remind her of the breakthroughs she had achieved during the past few months. The patient partner highlighted the mental hurdles she had overcome, the behavioral and emotional challenges she had conquered, and the progress she had made. Recognizing and appreciating her accomplishments, the patient partner explained how impressive they were and reminded her of her initial motivation for joining the program. Together, the patient partner and patient acknowledged her commitment to improving her health for herself and her family.
By reframing her mindset and reorienting herself within the program, the patient decided not to return the machine that day. Instead, she agreed to take her blood pressure immediately after the call and continue her journey. United, the patient and patient partner worked through the barriers she faced and made meaningful changes. Although the patient may not be increasing her goals at this time, she is adapting and modifying her life and behaviors in a sustainable and personally helpful way. It is important to recognize that this program extends beyond the specific goals we set with our patients. It is about transforming lives and acquiring new knowledge along the way.