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NEW ORLEANS — The groundbreaking in August on an expanded replacement clinic in the Algiers neighborhood of New Orleans is just the latest example of the growth of DePaul Community Health Centers.

The new clinic is being built at an estimated cost of $14.4 million and is planned to open in September 2024. It will have 20,000 square feet of space, five times as much as the current site. The new facility will offer more on-site services, including optometry and urgent care.

The groundbreaking came four months after the opening of a DePaul clinic in Harvey, another economically challenged neighborhood that is just across the Mississippi River from New Orleans' famous French Quarter. The Harvey clinic has more than double the space of the one it replaced that was next door in Gretna, Louisiana.

Meanwhile, a clinic that will be part of a 192-unit affordable housing development that is under construction is set to open in January in the Central City neighborhood. With that clinic's opening, DePaul is closing a smaller nearby one.

Since the first clinic of what would become DePaul Community Health Centers opened in 1997, the network has grown to 11 standing clinics plus two mobile ones that it sets up across the city.

President and CEO Michael Griffin sees the expansion of space and access to services as evidence that DePaul is succeeding in its mission. "Our goal is to improve the health status of the entire community," Griffin says.

From acute to community care
DePaul is part of St. Louis-based Ascension. DePaul's roots go back to the Daughters of Charity congregation that began providing health care in New Orleans in 1834. When the congregation sold its Hotel Dieu Hospital in New Orleans in 1992, it shifted its focus from acute care to community care. Five years later, the congregation opened its first community clinic under the Daughters of Charity Services of New Orleans brand, later renamed to Ascension DePaul Services of New Orleans.

DePaul Community Health Centers, which is under the umbrella of Ascension DePaul Services, is a federally qualified health center. As such, it operates under specific guidelines, including taking direction from a board with a majority of members who are users of its services. Like all FQHCs, DePaul gets enhanced reimbursements for its services from Medicaid and Medicare. That extra funding is meant to offset the cost of a requirement that the clinics serve all patients, including those who are uninsured.

"We have a sliding fee scale for all of our clinics on all our services," Griffin explains. "Individuals who don't have any coverage or insurance can have a discount on services based on their household income."

Jennifer Frizzell, vice president of population health and quality management, says DePaul counted about 50,000 unique patients — including 13,000 children — in 2022, about double the number from 2012. Of its patient population, 97% meet federal guidelines for low income and 87% identify as part of a racial or ethnic minority. Most of the patients qualify for Medicaid, Medicare or one of the low- or no-cost insurance programs on the federal marketplace.

Paul Bryant is among DePaul's patients. Bryant, 57, drives about an hour from his home in Donaldsonville, Louisiana, to a clinic to see his primary care doctor. He credits that doctor for helping to move him from a lethargic state in 2020 that left him weighing in at 350 pounds and dealing with hypertension and diabetes.

He since has begun to focus keenly on his health, including switching to a no-sugar, plant-based diet and upping his exercise regimen. The changes have brought the weight on his 6-foot-2 frame down to 270. He's also able to control his diabetes without medication.

Of the medical care he gets from DePaul, Bryant says: "I'm very comfortable and pleased with it."

Team empowerment
DePaul offers a medical home to all its patients. In addition to primary care, its services include pediatrics, podiatry, dental, eye care and pharmacy services. The clinics have integrated behavioral health into primary care. New patients are screened for behavioral and mental health issues such as substance misuse and depression. All of the clinics have therapists on staff who can address mental and behavioral needs.

Dr. Robert Post, DePaul's chief medical officer, has been with Daughters of Charity's health ministry since the days of Hotel Dieu Hospital. He says that after Hurricane Katrina devastated New Orleans in 2005, the ministry rethought its care model and adopted one based on the Nuka System of Care developed in Alaska.

The model allows the various members of the care team — nurse care managers, community health navigators, behavioral health specialists and others — to use their unique roles and skill sets to meet patient needs without a direct order from someone else.

"It's basically empowering every member of the care team to serve the patients directly without having to go through specific providers," Post explains. "It's made a huge difference, I think, in our outcomes."

Needs beyond medical care
In addition to medical and behavioral health care, DePaul providers screen patients for social determinants of health needs, such as food insecurity and housing. Frizzell says the findings show the breadth of need in the New Orleans neighborhoods the clinics serve.

"The average patient here at DePaul Community Health Centers doesn't have just one social determinant they're trying to overcome," she notes. "The average is actually seven, seven things in their life that are preventing them from putting themselves and or their health care as a priority."

Patrice Paisley is part of the team of community health navigators that DePaul employs to help patients meet those social needs. When care providers identify a need for nonmedical help, they flag Paisley's team through the patient's electronic medical record.

The team uses the Findhelp platform, formerly Aunt Bertha, to directly link patients to partner organizations that can assist with a myriad of services, including transportation, child care, utility assistance and access to healthy food. She has helped domestic violence victims find emergency shelter, a cancer patient get rental assistance and a teenage mother find a stroller for her newborn.

"We message the provider back and say 'Hey, we got the flag. We provided this, this and this to the patient. Need anything else, let us know,'" Paisley says.

Paisley assists at the food giveaway that DePaul hosts the second Friday of every month in conjunction with the Second Harvest Community Food Bank. Anyone can come and get a box with fresh and shelf-stable foods. The line for the giveaway typically stretches around the block. "I think we started with about 500 people and at our last pantry it was like 2,432 people," Paisley says.

Caring for newcomers
To reach new patient populations, DePaul does continual community outreach. It sets up information tables about its services at health fairs and other community events.

Sr. Irma Vargas, DC, is one of DePaul's patient and community engagement specialists. She keeps an office at the Society of St. Vincent de Paul New Orleans, which offers social services to those in need in the community, including newly arrived immigrants. Sr. Vargas informs St. Vincent's clients of the health services available at DePaul and helps them enroll in insurance programs.

Often the immigrants are traumatized from their journey and in need of mental health care, Sr. Vargas says. It also is not uncommon for newcomers to be pregnant, infected with a sexually transmitted disease or in severe need of dental care.

Many of those she assists have come from Mexico and other Spanish-speaking countries. Spanish is her second language. But she also has assisted immigrants from Haiti, Korea, Vietnam and elsewhere. Among these newcomers, she says, are "the poorest of the poor," or people with no resources or family support.

Sr. Vargas coordinates culturally informed care from DePaul Community Health Centers for anyone in need. "Jesus did not leave anybody behind and that's our thing, too," she says.

Training providers
Griffin says DePaul considers as part of its mission to train the next generation of community health care providers. It long has had relationships with medical, nursing and pharmacy schools in New Orleans to bring students into its clinics as part of their training. In more recent years, it has started its own residency program for physician assistants. It is in the process of adding family medicine and dental residencies.

Griffin is hopeful that the exposure to a community health care setting will convince some of the practitioners to stay. "There's only a small percentage that do, because the bigger money in medicine is in cardiology and in all of these other types of specialties," he notes.

Post says his support for the Daughters of Charity's mission to improve the health of underserved communities has kept him in community health care. In his more than three decades with DePaul and its predecessor organizations, he's been heartened by the dramatic expansion in services and patient population he has helped oversee.

"There's a lot of people, a lot of communities that really depend on us to help manage their care," he says.