The Lynn Community Health Center (LCHC) is a freestanding, nonprofit, federally qualified community health center that has served as the primary source of health care services in one of the most severely underserved communities in Massachusetts since its beginnings as a storefront mental health counseling center in 1971. LCHC has experienced significant growth and is now the largest provider of primary health care and behavioral health services in Lynn. The health center has a budget of $68 million with 154 full-time equivalent health care providers. In CY 2015, LCHC provided 252,929 medical, behavioral health and dental visits to 39,220 patients – over 40% of Lynn residents and over 40% of all Lynn children 19 and under. Our Obstetrics and Gynecology team delivered 485 babies at Salem Hospital during CY 2015.
Our goal is to positively impact the health of our community. Access to quality and comprehensive health care allows children to focus on success in school and adults to raise healthy families, pursue gainful employment, and become productive members of our society; ultimately resulting in a stronger, more vibrant community. Our target populations are those who experience the greatest barriers to care: children and their families, the poor, minorities, non-English speaking, teens, and the frail elderly. Over 90% of the health center’s patients live at or below 200% of the federal poverty level, over 80% are minorities, and over 50% are best served in a language other than English.
We accomplish our mission by providing a comprehensive array of high quality health care services, including: pediatric, family medicine, adult medicine, and OB/Gyn primary care services; specialty medical services; behavioral health and social services; health education; comprehensive HIV/AIDS services; nutrition services; a dental clinic; pharmacy; radiology; and eye care services. In addition to our main site in downtown Lynn, the health center operates two comprehensive primary care practices and behavioral health services in the West Lynn/Market Square area. The health center also manages eight School Based Health Centers in the Lynn Public Schools that provide integrated primary care and behavioral health services in three high schools, two middle schools and three elementary schools. We provide behavioral health services in four additional elementary schools. We administer the Women, Infants, and Children (WIC) nutrition program for ten North Shore cities and towns.
LCHC has been recognized by the National Committee for Quality Assurance as a Patient-Centered Medical Home Level 2. The Patient-Centered Medical Home model emphasizes enhanced access to care, patient engagement in care, coordinated care across the health system, integrated team-based care among physicians, nurses and behavioral health providers, and robust clinical information systems. LCHC is also accredited by the Joint Commission for both primary care and behavioral health since 2000, and was certified by the Joint Commission as a Primary Care Medical Home again in June 2015.
The Need in our Community
LCHC has continued to grow significantly and is now the largest provider of primary health care in Lynn. From 1994 to 2015, LCHC experienced dramatic growth in the number of total health center patient visits from 62,000 to 252,000 visits. Since 2006, LCHC has consistently seen over 400 new patients every month. LCHC believes that this unabated demand for services is due to a combination of economic conditions in our area and the significant increase in the number of individuals with health insurance through Massachusetts Health Reform and the Affordable Care Act. Lynn is a federally designated Medically Underserved Area and a Health Professional Shortage Area. In our community, providing access to primary care, behavioral health services and dental care has been a continuing challenge. A community needs assessment completed in October 2015 in collaboration with the North Shore Medical Center documented a critical need to increase primary care, substance abuse, and mental health services in Lynn.
The need for affordable community-based health services is made more acute by the continuing growth in underserved minority, immigrant, and low-income families. Lynn is an aging, densely populated former factory town, with a population of 92,137 according to 2014 Census data. Lynn’s minority population continues to grow and today comprises 62.2% of the population, compared to 26.2% statewide. Immigrant and refugee populations are also growing, with 36.0% of residents born outside the US compared to 15.7% statewide. Lynn’s per capita income is $25,412, compared to $37,288 statewide, and 17.4% of the total Lynn population lives at or below the federal poverty level, compared to 11.6% statewide.
Lynn also experiences significant health disparities. The percent of births to teens is almost twice that of the state at 10.5% for Lynn compared to 5.4% for the state (2010). Chronic disease presents a challenge for the community, with the hospitalization rate per 100,000 for diabetes at 616 for Lynn compared to 488 statewide, for asthma at 190 for Lynn compared to 156 statewide, and for cardiovascular disease at 1,633 for Lynn compared to 1,537 statewide. (2007-2009). Lynn residents experience poor outcomes related to substance abuse and mental health, with one of the highest rates of overdose deaths in the state at 40.4 per 100,000 in 2014, more than double the state rate of 18.8; and a suicide rate of 12.2 compared to 9.0 for the state (per 100,000, 2010). Source: Massachusetts Department of Public Health.
To meet the urgent health needs in our community, the Lynn Community Health Center continues to innovate and expand programming and services that are culturally and cognitively appropriate, and designed for immigrant, minority, and low literacy populations.
In 2012, the Lynn Community Health Center completed construction on an $18.8 million, 55,300 square foot addition to our main site. The facility includes a large Urgent Care Center on the first floor. The second floor was designed to support an innovative Integrated Health Care Team of medical and behavioral health providers. The second floor also houses a Dental Clinic with twelve dental operatories. The lower level includes additional office space as well as a teaching kitchen and multi-purpose room for health education programs promoting prevention, wellness, nutrition, and physical activity. We have also been able to expand our space for specialty Behavioral Health Services and Eye Care at 20 Central Avenue. These expansion efforts have significantly increased our ability to carry out the health center’s mission by providing the space we need to meet the most pressing primary medical, dental, behavioral health, and health education needs of a severely underserved community.
The additional space has allowed for the development and implementation of a fully Integrated Primary Care and Behavioral Health model with (1) co-location of primary care and behavioral health services, (2) co-management of patients by medical and behavioral health providers through a “Shared Care” model, and (3) utilization of a shared electronic health record (EHR). LCHC’s Integrated Health Care model has improved access to needed behavioral health care, reduced stigma, and greatly increased demand for additional behavioral health services. In 2015, LCHC provided 86,236 behavioral health visits for 7,315 patients, more than doubling our visit volume since 2010.
LCHC has developed five fully Integrated Primary Health Care Teams; each with five to nine Primary Care Providers (family medicine, internal medicine and pediatric physicians, nurse practitioners, and physician assistants) and two to three licensed Behavioral Health Therapists (psychologists, social workers, mental health counselors). The integrated teams also include a psychiatrist or an advanced practice psychiatric nurse practitioner, nurses, clinical assistants, community health workers, and nurse care managers. LCHC has designed our integrated model to align with our target populations, with eight of our school based health centers (SBHC) staffed by integrated provider teams. LCHC has developed an Integrated Addictions Team to provide primary care and behavioral health for patients with substance abuse disorders, including medication-assisted therapy to treat opiate addiction. LCHC has also co-located primary care within our specialty Behavioral Health Department at 20 Central Avenue to reach out to patients with serious mental illness who are not receiving optimal primary care.
Board of Directors and Leadership
LCHC is a nonprofit 501(c) (3) organization, with a 21-member Board of Directors, representing a cross-section of the population served by the health center. Over 50% of the board members are active patients of the health center. Board members have a diversity of experience and expertise. We have, for example, members with expertise in banking, law, finance, long term care, public health, employees of other community agencies, a Lynn Episcopal priest, a high school student (patient of our SBHC at Classical High School), and several retirees. 12 of the current 21 members are Latino, African American, or Asian. 13 are women.
The Board of Directors has responsibility for setting the policies of the corporation, managing and controlling all property of the corporation, and assuring the financial viability of the organization and the quality of its services. The Board has the responsibility for recruiting, hiring, and regularly evaluating the Executive Director, who is responsible to the Board for carrying out strategic and operational goals. The Senior Management team reports to the Executive Director. The Chief Executive Officer, Lori Abrams Berry, MSW, MPH has been at the health center since 1996 and has over 40 years of experience leading community health programs. Kiame Mahaniah, MD, a licensed family medicine physician, is our Chief Medical Officer and has over two decades of community health center experience. Mark Alexakos, MD, MPP, is a licensed psychiatrist board-certified in both child/adolescent psychiatry and adult psychiatry, and serves as our Chief Behavioral Health Officer. We recently hired a new Chief Operating Officer, Bernadette Thomas, APRN, DNP, MPH, who has many years of health center clinical and operational experience at Community Health Center, Inc in Connecticut and the East Boston Neighborhood Health Center. Our medical staff members are all board eligible or board certified in their specialty areas and we have extensive credentialing and privileging procedures for all licensed clinical staff.
LCHC makes every effort to meet the diverse multicultural needs of its target populations with significant numbers of bilingual and bicultural staff. Of current employees, 55% are non-white. Staff members who are bilingual or multilingual make up 55% of our staff. Languages spoken at the health center include Spanish, Khmer, Russian, French, Kreol, Portuguese, Albanian, Vietnamese, Thai, Pashtun, Armenian, Somali, and Arabic. The health center serves many Latino, Cambodian and Russian families and individuals. As the Massachusetts Refugee and Immigrant Health Program’s health assessment service for the North Shore, LCHC has also attracted patients from Iraq, Burma, Bhutan, Somalia, Liberia, Burundi, and many other countries.
The health center has made an ongoing commitment to improve organizational cultural competence and to assure the delivery of effective care that incorporates the cultural values and beliefs of the patients that are served. The health center has developed a variety of organizational systems to improve cultural and linguistic competency, including the addition of cultural sensitivity and awareness expectations to job descriptions and annual performance evaluations for all staff.