Caring for all women

On the morning of May 2, the day Northern Valley Indian Health’s Women’s Health Center started treating patients, an expectant mother who’d driven an hour entered the reception area. She hadn’t made an appointment. She had no insurance. She had no idea how to proceed. She just knew she needed health care.

Within an hour, she had a Medi-Cal application submitted (she was immediately covered via “presumptive eligibility”), received prenatal counseling through the Better Babies program and began her comprehensive exam with Certified Nurse Midwife Ann Wright—all on-site.

She’d found her medical home.

Dr. Andy Miller, medical director of NVIH, said he came into the day thinking that the first scheduled patient, a young Native woman who had made an appointment, would be the success story. Instead, he and the staff found an even greater sense of satisfaction from helping the woman who showed up unexpectedly.

“That couldn’t have happened before—not all that happening,” he said.

No private physician’s office can give presumptive eligibility, which is determination under the Affordable Care Act that a patient qualifies for Medi-Cal benefits and can receive immediate care. Only hospitals and designated clinics make that call.

Plus, he added, “there’s a hard time getting seen for prenatal care in Chico.” Anywhere else, she wouldn’t have been seen that day.

These aspects, plus all the support services, made Miller think, “That’s the reason.” That’s why NVIH opened the Women’s Health Center.

Filling a need, as well as the missing piece of NVIH’s cradle-to-grave quilt, the tribal nonprofit has been contemplating this venture for years—roughly since 2012, when it took over the Chico Children’s Health Center from Enloe Medical Center. Not coincidentally, the Women’s Health Center and Children’s Health Center are located right across from each other on Cohasset Road.

Prenatal Services Director Betsy Mott has worked at both facilities. She says NVIH hopes women’s clinic moms with newborns will find a smooth transition into the children’s clinic.

“Those moms go oversupported,” Mott added, “and that same support continues when they go across the street with their babies.”

The Women’s Health Center has taken form of the children’s center in its Enloe days. Back then, local pediatricians took turns away from their private practices seeing patients during afternoon clinic shifts; nurse practitioners and/or physician assistants served as the clinic’s full-time primary caregivers. (The children’s center now has staff pediatricians alongside midlevel providers.)

Wright is the Women’s Health Center’s regular practitioner, and NVIH has one Chico obstetrician—Dr. Maurice Valcarenghi—working a half-day a week. Miller expects to sign two other local OB-GYNs soon.

Physicians were, and are, key. Indian Health and Enloe collaborate, as obstetric care culminates in deliveries at the Nettleton Mother & Baby Care Center. The hospital’s medical staff had to play an active role, not only by seeing patients but also by ensuring the standards of practice coincide.

Pragmatic realities offer obstetricians the incentive to participate. Medi-Cal reimburses entities such as NVIH at higher rates than individual offices; with demand for services already greater than the number of OB-GYNs, North State women with publicly funded insurance tend to wind up on waiting lists. The center resolves both issues.

“It wasn’t our board coming to us saying, ‘We want a prenatal clinic,’” Miller said. “It was the community coming to us and saying, ‘We need this.’ So it really was, from the beginning, a partnership with the community to try to protect services and try to help.”

The Women’s Health Center, once operating at full capacity, will have approximately 35 employees for the 10 exam rooms, three Better Babies counseling rooms and in-house lab. A new ultrasound machine is due.

All women are welcome. Native or not, private insurance or public—the clinic accepts all new patients. Those without insurance can meet with a staff member to ascertain eligibility.

Medi-Cal comprises much of NVIH’s insurance base. Mott hastens to point out that all expectant mothers face challenges; those coming to NVIH facilities just have their share in a seemingly larger portion and proportion.

“It’s socioeconomic, it’s educational, it’s not having the same family support,” she explained. “It is, of course, substance-abuse problems. These are well-meaning, wonderful women who want to have healthy babies. The right support can make a huge difference.”

Better Babies is a major component. Offered through the Chico-based Comprehensive Perinatal Services Program (CPSP), the counseling educates mothers on health and nutrition, plus provides social and other support. CPSP’s Gwin Richter—longtime nurse, Chico State professor and Better Babies educator—works at the Women’s Health Center.

Medi-Cal covers the Better Baby program as part of prenatal care; Mott hopes other insurers will follow suit. A study commissioned after the 1987 launch found women who received Better Baby services had a reduced risk of a child with lower birth weight.

“I’ve had OBs say, ‘How come my private patients don’t get those services?’” Miller added. “Medi-Cal has made that decision for cost-saving and patient-care reasons.”

While serving expectant mothers may have been the impetus, the center offers a range of women’s health care, as its name implies. Staff do provide the gynecological aspect of OB-GYN—though Miller admits he needed some convincing.

“It was really just to keep the scope small; bit off a small chunk and try to do it well,” he said of initial thoughts of an OB-centered clinic. “As it got closer, many people pointed out that that’s kind of a false distinction; even at your post-partum visit, you’re already doing gynecology….

“We’ve ordered most of the equipment, most of the providers want to do both, so we’ll do them both. We need them both.”