Eight community health centers in Boston are counting on an equal partnership with Boston City Hospital and Boston University Medical Center to gain a significant say in overall healthcare delivery.
Called Boston HealthNet, the partnership combines the resources and capital clout of a tax-supported hospital and university-sponsored teaching facility with an established but independently run network of centers with deep roots in the city's poorest neighborhoods.
Under the agreement, the eight centers would have one vote, and the two hospitals also would have one vote, said William Walczak, the partnership's new president and director of Codman Square Health Center.
Such "true power sharing" tipped the decision in favor of joining the city-sponsored network rather than one of a number of primary-care networks developing around tertiary teaching hospitals in Boston, Walczak said.
"We're being given an opportunity to set healthcare policy, which is something I only dreamed about 25 years ago when the community health centers were formed," he said. "That's really important if you're from a community that's largely poor and has particular health needs. And that is not being offered by any other network."
The city and university hospitals, located on adjacent campuses in South Boston, are working on a merger that would preserve the city hospital's mission of serving the poor and use the university hospital's not-for-profit status to make the combined hospital more competitive.
A city healthcare commission first recommended that move in March 1994 as one way to improve public health and ensure access to primary care in a changing economic climate for healthcare.
It also recommended combining the city's 25 community health centers into operations with at least 100,000 annual visits and making them part of vertically integrated networks. The eight centers in Boston HealthNet combine for 800,000 primary-care visits a year, Walczak said.
Despite the high-level encouragement, the impetus to join the partnership came mainly from the grass-roots level, he said, and the agreement involved compromises among community-center boards.
The centers popped up 20 to 30 years ago in response to a shortage of primary care in poorer neighborhoods. Most were started by community organizers wanting to take care of their own.
"As a result, they're all very fiercely independent, populist-oriented and also very small," said Walczak, who helped found the Codman center in his community 20 years ago and became its first board president.
But though the service areas usually cover only 30,000 to 50,000 people, the penetration rate into the community averages 60% to 70%. And the centers work to maintain or exceed that by hiring door-to-door representatives who try to coax wary residents, many of them immigrants, into getting care, Walczak said.
The two hospitals plan to infuse as much as $20 million to $30 million into the participating centers, Walczak said.
The centers will further the teaching program at Boston University School of Medicine by providing training opportunities in primary care to offset declining census in the teaching hospital, he said.