Chapa –De Indian Health
Compassionate Care for those in need
March 7, 2018
The motto of Chapa-De Indian Health is "Passionate People. Compassionate Care." More than just an empty slogan, Chapa De's leadership and staff truly embrace those words and strive to ensure that every patient receives the best possible care in a way that is convenient, caring, and thorough.
Chapa-De serves over 22,000 active patients in two beautifully designed campuses located in Auburn and Grass Valley, and continues to expand services based on the needs of the community. Both nonprofit health centers offer adult and pediatric primary medical care, nutrition and health education, women's health services, dental care, orthodontia, mental health counseling, psychiatry, optometry, and pharmacy services. Chapa-De is committed to providing quality, integrated and patient-centered care to all people regardless of their financial situation or ethnicity.
Chapa-De was founded in 1974 after a study showed American Indians in California suffered from a higher incidence of diabetes, depression, and substance abuse than other ethnic groups. American Indians were also found to suffer from higher rates of infant mortality and have drastically shorter life expectancy rates. American Indians had been displaced from their native land into Rancherias over a century before, which were generally pieces of land that had no value to the white man and were far from urban areas. The study found that as a result, American Indians had not had regular access to healthcare services, including basic dental care, since the 1950s. "In the 1700s, treaties were signed and promises were made that the Federal Government would take care of Indian people's health and wellbeing," said Lisa Davies, CEO. These findings compelled a group of local American Indians to open Northern Sierra Indian Health, later to be renamed Chapa-De Indian Health. "Chapa-De" originates from a Niesenan phrase that means "where the valley meets the foothills." When it first opened, Chapa-De had one dental chair in a rented office space with the sole purpose of providing care to the local American Indians in Placer, Nevada and Sierra counties. That small office has now grown to encompass two full-service health clinics that serve the native and low-income populations in their communities.
These nonprofit community health centers are governed by an American Indian Board of Directors. The Board of Directors includes members of the United Auburn Indian Community, which is Chapa-De's supporting Tribe. Under UAIC's authority, Chapa-De contracts with Indian Health Services (IHS) to provide no-cost or low-cost services and medications to verified American Indians and Alaska Natives from federally recognized and California tribes. In the 1990s, the board recognized that the communities that Chapa-De serves held many low income people that also needed care and opened up the facility to them, as well. Currently, the patients that come to the two centers are 30% American Indian and 70% Non-Indian, but everyone who comes to Chapa-De receives the same high level of quality care.
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It was important to those who established Chapa-De that the facilities and grounds themselves promote healing. Former CEO Carol Ervin had a strong conviction that just because people are poor, that does not mean that they deserve inferior clinics or care. This is because as a native herself, Ervin had grown up on a Rancheria receiving her health care in a tent, even when it was snowing. "She wanted people to start feeling the healing as soon as they pulled into the parking lot," said Davies of her predecessor. "This is one of her great legacies."
But that sense of compassion does not end with the intentionally designed building, which is done in the traditional California Roundhouse style and oriented toward the east so that the sun comes through the door in the mornings as a nod to native beliefs and traditions. Every person hired to work at Chapa-De is screened not only for their work experience, but also their personal dedication to healing and their disposition. Chapa-De's Managers take their time in the hiring process, often doing a nationwide search and ensuring that whoever they hire is aligned with the values and mission of Chapa-De.
One example of this is Medical Director Dr. Tracy Thompson, DO. He came to Chapa-De after a 21-year career as the Medical Director of the Cherokee Nation in Oklahoma. He made the change because he felt compelled to be of service in a new way. "I came here for something different," he said. "We all need to keep striving and moving toward our purpose. I asked myself "Can I do more?" and I determined that I could and that working with Chapa-De was the way to do that."
As Medical Director, Dr. Thompson is in charge of hiring people and brings that same philosophy to his decisions about who will be the best fit for the team. "A lot of the employees here live in the community and really care about this place and their neighbors they serve here, and you see them out at the grocery store or at events," he explained. "There's a certain something we look for in people that we recognize when we find it. Call it heart, compassion, or whatever you wish; that spark is what makes someone a good fit for Chapa-De."
Chapa-De has a healthcare model that is both patient-centered and integrated. The patient is the central focus of all services and processes, and they receive care from a highly skilled team of healthcare professionals. Chapa-De does not contract with conventional HMOs or PPOs, because its leadership feels that there are enough facilities where those with traditional insurance can be seen, and their goal is to fill the gaps in care in the communities where they operate.
As such, Chapa-De is open to everyone; those on Medi-Cal, those without insurance, and even those with insurance who want to go outside of their network to receive care at the location of their choice. For those who wish to pay directly for their services, Chapa-De offers a sliding scale of up to 50% off of services determined by the patient's income. They also attempt to accommodate patients as quickly as possible, although there can be a wait of an average of two weeks if it is not an urgent matter.
The staff also coordinates to make sure that care is integrated and as convenient as possible for a patient. "We are very conscious of the fact that some of our patients don't have transportation, and that it is difficult to take off of work for medical or dental appointments, so we try to schedule as many services into each appointment as possible to make the visit as productive as we possibly can," explained Chapa-De Dental Director, Dr. Pauline Karunakaran, DDS. "Having all of our services under one roof is convenient for our patients and we always think about what is best for them."
Seeking gaps in community care, Chapa-De leadership is developing their capabilities in population health, which is using data from electronic health records to assess how well we they are taking care of the entire population that they serve, and look for opportunities to fill gaps in care. "Chapa De is trying to transform how we deliver care," emphasized Chapa-De Strategic project Director, Dr. Michael Mulligan, MD. "We are actively developing team-based healthcare which is a relatively new concept and involves many different pieces of the organization working in a coordinated fashion to deliver care to the patient. What we are trying to do by looking at the aggregate population is to tackle disease upstream; we are looking at prevention, not just dealing with people once they become sick."
A couple of programs that have been started through this review of existing gaps in care are the diabetes management program and Medication Assisted Treatment (MAT). MAT is a way to help patients beat an opioid addiction, and Chapa-De is also very cautious about prescribing opioid medications to any patients except in rare and extreme situations where they are absolutely critical for pain management.
There is a huge burden of diabetes in the U.S., and so Chapa-De has a huge diabetes department that works with general care providers to coordinate the necessary screenings specific to diabetics. They get one-on-one nurse case management to optimize their care, and the can attend classes to learn more about self care.
"We try very hard to help people understand what healthy lifestyles are, get them screenings and immunizations that they're due for and any counseling they might need around unhealthy lifestyles that we can help to intervene on," Dr. Mulligan said.
To learn more about Chapa-De's mission, philosophy, services, and programs, visit chapa-de.org, or to make an appointment call (530) 887-2800 for the Auburn campus or (530)477-8545 for the Grass Valley location.
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