GREENSBORO, Ga. – At TenderCare Clinic, a community health center here in rural central Georgia, medical assistant Jackie Davis plays a starring role.
Using a phone in a corner of a room reserved for minor surgical procedures, Davis calls parents who are late bringing in kids for immunizations, women behind on getting their annual Pap test and diabetics who have neglected their monthly checkups.
In a nearby office, health education coordinator Pamela Luke intercepts patients after they meet with doctors to advise them about nutrition, set exercise goals and put them through "diabetes school.’"
The reminder calls and in-house counseling are a big reason why Tendercare has some of the best quality scores in Georgia, a state where health centers rank near the bottom nationally for patient care.
At Tendercare, eight out of 10 of diabetics have their blood sugar under control and almost all children get the appropriate immunizations by age 2—rates significantly above both state and national averages for health centers. The data are from 2010, the latest available.
But Tendercare still struggles to help some of its largely poor patients get the care they need. No-show rates top 30 percent overall, and 70 percent for Medicaid clients because of lack of transportation, says CEO Lisa Brown.
Dave Ringer, a family doctor, says it's not unusual for patients to tell him they cannot keep appointments because they are unable to pay a family member for a ride.
The center also has trouble finding specialists and hospitals willing to provide surgery to its uninsured patients. In the past year, an uninsured man waited more than eight months to find a neurosurgeon to operate on a brain tumor, he says. An uninsured woman died of cervical cancer after waiting a year to find a surgeon.
While many health centers face similar challenges, Tendercare is in a more precarious spot because it is outside the areas covered by Grady Memorial, the large public hospital in Atlanta, and Medical College of Georgia in Augusta.
"The system is broken and is so frustrating," Ringer says.
The clinic's remote location also has some pluses. As one of the few health providers in town, Tendercare has been able to attract patients with Medicare and private insurance that pay higher rates than Medicaid. It privately financed a new $3 million building in 2009 and uses its former space next door for a day care center.
Tendercare is also more advanced than most rural health centers with its computerized pharmacy dispensing system to reduce errors. It also has two counselors who help patients get referrals and gain access to other community resources, such as housing aid.
But some patients still struggle. Josiette Ellison, 39, a heavyset woman from nearby Eatonville, Ga., is uninsured. On a recent visit, her blood sugar is 456, almost three times normal. Her blood pressure is also high and her vision has started to blur because of her decade-long struggle with diabetes.
"I can't avoid the sugars and sweets," she says. "I see the chocolate cake and it's hard to resist."
CEO Brown pats Ellison's leg and tells her the center's staff will work with her to get healthier. Ellison says she’s grateful. "It's my bad decisions that are to blame," she acknowledges.