Whole Person Care
We treat living conditions as part of health care.
The Robert Wood Johnson Foundation—the nation’s largest philanthropy dedicated solely to health—has calculated that eighty percent of a person’s health is shaped by social determinants: the circumstances of everyday life, such as where people live, what they do for work, their access to health care, and whether their families are safe. So that’s where we start.
How It Works
Our team works together to take care of each patient and make our care as effective as possible. Each day starts with a team huddle, when we talk through the upcoming patients individually, by name and care plan.
The Huddle
When a patient arrives, nursing staff and volunteer clinicians, with the assistance of language interpreters, treat any immediate clinical concerns. We offer as many services possible in one visit. If a patient needs health care outside of our office, we arrange it and coordinate closely with the provider.
Wraparound Clinical Care
Individualized Care
Coordination
Each patient then sees one of our Medical Assistants who create clear, comprehensive care instructions and arrange transportation, knowing that many of our patients are new to the country or health care system. Patients learn how to retrieve prescriptions, how often they should come in for checkups, and how to manage chronic conditions.
Our Patient Service Managers and Community Health Workers then assess any additional needs—including food security, housing, employment, and childcare—and create solutions with the help of community partners.
Social Services
When a patient is referred outside of our office—from lab work to housing services—we follow up with both the patients and the referral. If it becomes clear that community systems are not accommodating our patients, we advocate for them, joining and creating committees to make change.
Community Advocacy
“The atmosphere in the clinic radiates hope and compassion. The patients sense this, that their needs are being addressed.”
— Jeff Blake, MD, VIM Founding Physician