The Agenda with the Missoula County Commissioners
The Missoula County commissioners host the "The Agenda" podcast, which aims to help county residents better understand how local government works and how it affects their lives. In each episode, the commissioners sit down with fellow staff, elected officials and community partners to discuss public sector projects and trending topics.
The Communications Division at Missoula County produces "The Agenda" with support from Missoula Community Access Television. If you have something you’d like to add to the conversation, let us know at missoula.co/podcast.
The Agenda with the Missoula County Commissioners
Patient-centered healthcare for every person: Partnership Health Center serving our community
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Partnership Health Center’s Executive Director Laurie Francis joins the commissioners to share how PHC addresses systemic barriers to good health and wellbeing by partnering with people most impacted by health inequalities, connecting with community organizations and incubating new programs grounded in emerging, evidence-based best practices.
She shares how PHC builds teams around patient priorities, recognizing that the patient is the expert about their needs, and the medical team is there to support and help guide them on their wellness journey.
She also highlights the new mobile Community Care Team and how everyone is welcome at PHC regardless of their ability to pay. Missoula County’s community health center provides services at seven sites offering medical, dental, integrated behavioral health, pharmacy, specialty services, housing support, legal support and social work.
With over 20 years of experience working in community health, Laurie shares how she stays positive, areas of healthcare she believes America could improve and why her team loves the work they do.
PHC won the 2021 Best of Missoula: Best Health Care Provider award and serves approximately 16,000 Missoula County residents. Learn more at https://www.partnershiphealthcenter.com/.
Text us your thoughts and comments on this episode!
Thank you to Missoula's Community Media Resource for podcast recording support!
Welcome back to Tip of the Spear with your Missoula County commissioners, Dave Strohmaier, Josh Slotnick and myself Juanita Vero. Today we have a special guest with us, Laurie Francis, the executive director for Partnership Health Center. To get started, Laurie, give us an introduction about who you are and what you do and what attracted you to public service and specifically community health centers.
Laurie Francis, PHC Executive Director:Well, thanks first for inviting me. It's great to be here with you guys. I love the energy of this group and your leadership, so thank you. What's attracted me to health centers for the last 20 years is that they attend very carefully to the disparities we see in health outcomes. We were founded on a mission of trying to reverse racism and poverty. We obviously have a little ways to go on that. But health centers focus very carefully on people who have less good health and try and make changes in within our walls and outside our walls.
Commissioner Josh Slotnick:So, Laurie, thanks for joining us, and it's really nice to see you here in person. Great to be here. So PHC is a federally qualified health center. What exactly is that and how does it different from a nonprofit health care clinic or even a for-profit health care clinic?
Laurie Francis, PHC Executive Director:So federally qualified health centers, it's a federal designation. It began in the 60s during the War on Poverty under the Johnson administration. We receive a portion of our funds from yours and my federal tax dollars, and we have some very clear guidelines. We have to adhere to differently from the private sector or other health care, including having a board that's primarily consumers of our services. So that makes us that much better. None of our services can be denied based on a person's ability to pay. And we also have to collect a lot of data around quality outcomes to ensure that we're providing great care.
Commissioner Juanita Vero:Well, can I just go back to that? So your board makeup is of patients essentially? Right, right? How big is the board?
Laurie Francis, PHC Executive Director:Our board currently is that we have a 12 member board, have up to 13 board members and we have 80% of them are consumers of our services.
Commissioner Juanita Vero:Fantastic. I don't I didn't know that.
Laurie Francis, PHC Executive Director:Yeah, it's actually a requirement that it be more than 51%. We just exceed that significantly.
Commissioner Josh Slotnick:So are there other FQHCs in Missoula and in Montana?
Laurie Francis, PHC Executive Director:No other FQHCs in Missoula. And I think you mentioned this, we are an unusual model. We are attached to the County. We are attached to you and us at the hip, which makes us that much better in Montana. There are 16 other federally qualified health centers. We are the largest
Commissioner Josh Slotnick:Not surprised.
Commissioner Dave Strohmaier:Well and one term that gets thrown around a little bit. Laurie that I believe is something that PHC has embraced is this notion of team-based health care. Can you talk a little bit about what that means in the context of PHC? Because many folks might think, well, what health care is not team based, but I guess you could just be free wheeling out there. Is it not working together? What does that mean from your perspective?
Laurie Francis, PHC Executive Director:I think a lot of health care is not team-based. Actually, what it means from my perspective is that we build teams around patient priorities, and that's still exceedingly unusual in health care, that you, as the patient Dave, are the expert in your life and in your needs. And we build a team around your priorities sharing with you our expertise, whether it's medical expertise, dental expertise, behavioral health expertise. We also have pharmacy on site, so we share with you what we know, you share with us what you know about yourself and what you want and need, and we hope to build care around your needs. That's exceedingly unusual.
Commissioner Dave Strohmaier:How does that work out in practice? Any challenges or with that?
Laurie Francis, PHC Executive Director:Well, no. We have no challenges.
Commissioner Dave Strohmaier:I don't think so. Right? Answer.
Laurie Francis, PHC Executive Director:We, you know, I think that it's a dance. It's a dance all day long. We have people who come in to Partnership either physically or by phone or video who have relatively simple lives and can afford their housing and food and have people they can call when they are lonely or need support. And we have people who don't have all those supports available to them. So partnership constructs a team that attempts to meet people on many different fronts.
Commissioner Juanita Vero:Folks also, I mean, it goes both ways because maybe as a as a patient or potential patient, you don't realize that you're worthy of the team. Because I mean, what do you expect of your health care team, Dave? Or how do you how do you approach?
Commissioner Dave Strohmaier:Well, I
Commissioner Juanita Vero:You don't think of it as a team or...
Commissioner Dave Strohmaier:No, I actually don't. I have some reason to have to go to the doctor or physical whatever. I rarely for better or for worse, think about. I hope that there's a team effort brought to bear on this. I mean, maybe in the back of your mind, you hope that there's other health professionals out there lending assistance of some sort.
Commissioner Juanita Vero:But yeah, I think that's really interesting and I want to think like more. Holistically about our health.
Laurie Francis, PHC Executive Director:I mean, I think we've all experienced the hierarchy of health care, and we are used to going in and seeing the expert and the experts as to tell us what's wrong and often that still happens and it's very it's never worked well. It definitely doesn't work well with chronic disease. And yet we continue to ascribe to this, you know, better than I about my body. So what should I do about my body? And then we wonder why patients are quote noncompliant.
Commissioner Josh Slotnick:And at PHC, it's not just physical health that's being taken care of.
Laurie Francis, PHC Executive Director:No, because we're not just physical. We have emotions. We have mouths. We have sometimes pharmaceutical needs, we have social needs, we have housing needs. So I think that's the really unique thing about health centers. And certainly PHC is there nowhere in in Missoula where you can go and get medical, dental, behavioral and pharmacy care, all in one building, all in one location. And those professionals interact all day long with the patient at the center of that. So back to the team based question so that we're not thinking about parts of bodies, but in fact, humans that reside in the society and have all sorts of opportunities and challenges,
Commissioner Juanita Vero:And even in just the physical space that a person lives in, like you wouldn't know that if you have mold or what have you going on, that's in the room that you live in or the home that you live in. It's yeah, it's easy to separate those and forget how that impacts your health or your family's health.
Laurie Francis, PHC Executive Director:And if you thought you had the right to have that ameliorated right, there's just a lot of power issues around health and health outcomes and health care that we don't typically talk about, but that are pretty important.
Commissioner Juanita Vero:So this is something that I don't really understand what's the the formal relationship between PHC and Missoula County and describe its financial independence and economic sustainability?
Laurie Francis, PHC Executive Director:Yeah, that's a great question. I think we have a pretty good understanding by now. It's called a co-op applicant, the history of Partnership Health Center. Some of you may know I'm newer to it and had to learn it from from the reading that I did and from people like you guys, the county applied. The health department applied for this funding many years ago. Our current budget is $44 million a year. Approximately $5 million comes from the federal government directly in the form of a grant. We take no county tax dollars or city tax dollars. It comes from patient revenue. We bill all insurance companies. That's a sort of misconception in this community that you have to be uninsured. We see Blue Cross Blue Shield, we see PacificSourc Co-Op, Medicaid and Medicare, and that's the preponderance of our funding.
Commissioner Josh Slotnick:But if people roll in who have nothing,
Laurie Francis, PHC Executive Director:We see them.
Commissioner Josh Slotnick:It's fantastic.
Laurie Francis, PHC Executive Director:We see them. Yeah, we we love seeing people whose lives are difficult and we love seeing people whose lives are a little bit easier. And Juanita, back to your question about co-applicants. So we we are county employees. We just don't use county tax dollars to pay our employees and we have a 501c3 board. So a nonprofit board and then also the county commissioners provide oversight to our hiring practices. They sign off on the budget ultimately, but our board has to have complete control over hiring and firing the executive director.
Commissioner Juanita Vero:Right? Ok, thank you.
Commissioner Dave Strohmaier:Let's talk a little bit about the geographic breadth of of PHC. So many folks are familiar with your location right downtown at the Creamery Building, but you also have clinics and Seeley Lake, the Food Bank over at Lowell School. What's the thought of of being dispersed in that way? Are you reaching different? I'm assuming trying to make it convenient for folks who might be needing partnership health services.
Laurie Francis, PHC Executive Director:Exactly. So we've set up sites in Seeley, as you mentioned that we're the only health care in Seeley. We see one 105% of that population, which I think is because of the summer visitors. Wow. So everybody who needs health care and it looks like we're seeing,
Commissioner Dave Strohmaier:Oh, OK.
Laurie Francis, PHC Executive Director:I'm sure there are people who come and go. But but when you do the counts and then we have the clinic at Lowell, as you mentioned, that was originally a school-based, school-focus. Now we make sure that the kids and teachers are taken care of, but we're facing in the community. And it is, as you suggest, Dave to be easier to access because it's more proximate to where people have needs. Same thing with the food bank. People come in to get food, but they can come upstairs and be seen for medical or dental reasons. We're also at Willard School with behavioral health, and we have a great and very popular presence there. Some of those kids have tough lives and families have tough lives, and we want to make it very easy for them to get extra help.
Commissioner Dave Strohmaier:Well, something that I'm super excited about and I bet our listeners may or may not have heard of. This is the Community Care Team and just what that provides by way of additional outreach to members of our community who might otherwise find it difficult or in some respects, maybe impossible to to get the sort of services that he has.
Laurie Francis, PHC Executive Director:Mm hmm. That was a brainchild of a number of us, not just Partnership, but also the County and City came together as we realized that the numbers of homeless people were climbing in the area and I think were uniformly concerned about their mental and physical health and well-being. And so the community care team arose out of that conversation and to ensure that people who are living out of doors have easy access to nursing care. We have a residency program at Partnership called Family Medicine Residency of Western Montana, and we have residents going out who are physicians to make sure there's medical care available. We also are working to get all of those folks housed. So it's not just about health care, which is so critical, but also about moving people on the continuum to become fully housed. The Community Care Team is funded through ARPA dollars. We're using that to help people who've been poorly affected by COVID and many other barriers.
Commissioner Dave Strohmaier:And for those of you who have not been following the COVID pandemic for the past two years, ARPA means American Rescue Plan. This was a lot of dollars the federal government has disbursed to states and local governments across the nation. So I guess on any given day, what is the what is the deployment of the community care team look like? Are folks certain days of the week going out into to the community to engage folks or?
Laurie Francis, PHC Executive Director:And again, that that was a community effort. So at its inception, it was meant to coordinate a number of different groups. So there's the hot team out of the Poverello Center. The Open AIDS Alliance has a team. There are a number of people who are trying to help people living out of doors, and the the impetus behind the Community Care Team is to rally all of those forces, bring them together, use ARPA funding and really provide better, seamless continuous care. So daily there are people making contact with folks who are living in safe outdoor spaces to ensure that they know we're here. If they need more care, they can come to Partnership, they can go to the emergency room.
Commissioner Juanita Vero:So is the Community Care Team, like a larger umbrella and the Homeless Outreach Team, is on the ground engaging with folks who are experiencing homelessness or need help. And if someone needs medical assistance, then they go find the Community Care Team member. I don't quite understand like how it
Laurie Francis, PHC Executive Director:Well and the Community Care Team, by the way, just got started about two weeks ago.
Commissioner Juanita Vero:Oh, OK, OK,
Laurie Francis, PHC Executive Director:It's just just beginning. And I think if you ask me these questions in about three months and six months, we'll have different answers. But its intention was to coordinate. It wasn't to supplant any of the good work that was happening, but rather create a systematic way of ensuring that every single day people who are living out of doors have access to conversations, health care, medical care, social care as needed.
Commissioner Josh Slotnick:So I think we're, speaking for all of us, I think we're really proud of some of the steps we've been able to take in terms of helping people who are living out of doors. Two really big ones. We created the Temporary Safe Outdoor Space, right, and we partnered with the City and the alternative campsite. So instead of people being completely off the grid, they're in safe spots with things that all humans need, the Community Care Team are they going to visit the Temporary Safe Outdoor Space and the alternative campsite?
Laurie Francis, PHC Executive Director:Both of those, yes.
Commissioner Josh Slotnick:Great
Laurie Francis, PHC Executive Director:Yeah, they're visiting both of those on a very regular basis again, along with our partners in the community and also working with MSU School of Nursing. There's a lot of people involved who want to make a difference, and we didn't want it to be uncoordinated so that some days there'd be five different groups showing up and on Tuesday there'd be nobody.
Commissioner Dave Strohmaier:Yeah, that's great.
Laurie Francis, PHC Executive Director:Well, Laurie, I have a question for you. I've been longing to ask someone who really understands how health care works. So reportedly we in the United States pay more for our health care than any other group of people on the Earth. And even so, we are not at the on the top in terms of outcomes where our life expectancy rate isn't good. Infant mortality isn't good. Our rates of chronic disease are terrible, and yet we pay so much money. So if you got to be the boss of it all, if you got to figure out what our health care was going to look like in the United States, so we had better outcomes and paid less money. What would that health care system look like? Great question. Asked by many. My answer, and I think well supported by evidence, is that the investments in this country are misdirected. So we spend money in health care, on imaging, on expensive surgeries, on all sorts of elective types of issues rather than taking the health. Dollars and investing them in social care. So if you look across Western Europe, if you look at Canada, if you look at all countries that have chosen to invest in both social and health services significantly, approximately 35 to 40%t of our gross domestic product in any of those countries develop is equal. What we do in the United States is we take all the money that would have gone into early childhood would have gone into social services, and we use it for high end health care costs. So we get very little out of it. So those maternal
Commissioner Juanita Vero:Because we're hitting the problem so much later, too late in the game,
Laurie Francis, PHC Executive Director:Way downstream where it's so expensive and irreversible, really. So you're treating people after they've had years and generations of poverty, racism, lack of housing weren't able to graduate from high school because the things going on in their families and we understand very well, it's not the data is there. We just have to make different policies. If we invest in early childhood education, kids arrive ready to learn at kindergarten. If they're ready to learn at kindergarten, they graduate from high school. If they graduate from high school, they have better health outcomes. It's very simple. It's a really we just don't do that. And I don't know if it's because of lobbies in the country around hospital, the imaging, folks.
Commissioner Juanita Vero:Is that just uniquely American, though? If you think about like the history of our country and culture, rugged individualists? Yeah, I don't know. We like playing blame. The problem?
Commissioner Josh Slotnick:I'll pull myself up my own bootstraps and fix my own torn meniscus.
Laurie Francis, PHC Executive Director:Exactly.
Commissioner Juanita Vero:It's like a story we like to tell ourselves. But it's not true.
Laurie Francis, PHC Executive Director:I don't actually. I think that's why. I mean, again, if you look at countries who are making better decisions, they're still investing the same amount of dollars. They're just investing them differently.
Commissioner Josh Slotnick:The same amount of dollars,
Laurie Francis, PHC Executive Director:The same amount of dollars per capita. Yeah, yeah. So we're yeah, we're spending a lot of money on health care. We're spending not a lot of money on social care.
Commissioner Juanita Vero:So what are some of the things you wish the community knew about PHC?
Laurie Francis, PHC Executive Director:There's so many things I think that back to Josh's question that we somehow have been taught that we are mouths, bodies, emotions, all living independently. And yet we all know in our own lives that our happiness, our well-being, is very affected by all those factors. So the fact that PHC is an integrated health system with medical, dental, behavioral and pharmacy is critical and we take care of sixteen thousand patients. That's greater than 10 percent of the county. While a high percentage of our patients have live on limited means, a significant portion, have lots of resources and choose to come to the best health care in Missoula.
Commissioner Juanita Vero:And it's the best health care because of this team approach.
Laurie Francis, PHC Executive Director:I think it's team we hire really well. We with support of the County, we pay fairly. We create a really inviting culture where employees get to express their opinions and make changes in their workflows because they know how to do them. And we and leadership don't necessarily
Commissioner Josh Slotnick:Just sort of throw this out. I think the presence of residents when I've been there, there's this very active, I would say youthful, but there's a there's an energy there that isn't you don't run into that and I've never run into it in any other health care context in Missoula.
Laurie Francis, PHC Executive Director:Yeah, I'm glad you pointed that out. I mean, it's a very vibrant culture. Some would say chaotic, but I don't think it's that. It's really energetic. It's very learning oriented. There's constant or do a lot of education. The residents do a lot of education. The residents provide about 45% of our visits now at this point. And again, those are physicians. They're physicians who are specializing in family medicine. So they're at the top of their game. Two or three physicians are often involved in a visit, so it makes it very invigorating to be there.
Commissioner Josh Slotnick:I also really like the aesthetic too.
Commissioner Juanita Vero:Beautiful space.
Commissioner Josh Slotnick:Yeah, it's a really nice space.
Commissioner Dave Strohmaier:Almost as nice as this conference room.
Commissioner Josh Slotnick:Almost as nice as 199 West Pine.
Commissioner Juanita Vero:Almost almost.
Commissioner Dave Strohmaier:Yeah. So Josh, why don't we tag team this next one? I'm going to default to something that I know very well and that is having a glass half empty. And then you can you can follow up with the the opposite of that here. So, Laurie, what what are some of the things that most frustrate you in the work, the important work that you do? And are there any solutions maybe that you see as addressing some of those basic frustrations in your work?
Laurie Francis, PHC Executive Director:The things that frustrate me most are the payment system for health care in this country. That's a hard one to change, but I will say we are not paying for the right things. As I said before, we need to put more money into primary care, which is what we provide and less money into the very expensive services that, you know, don't prolong the life significantly, don't improve health outcomes for babies and moms. You know, there isn't a lot that frustrates. To me, beyond that, I love working with the county, I think our county partnership is wonderful. I think working with the health department, which is public health and Partnership, which is community health, working with the residency, those those are all really good things. They make our work life more complicated but much more fruitful. So I don't get very frustrated.
Commissioner Dave Strohmaier:Ok.
Commissioner Josh Slotnick:That's great. So in your time at PHC, what do you what are you really proud of?
Laurie Francis, PHC Executive Director:I am proud of being part of a group of people that are very much driven by the mission of health equity. You feel that all the time we do staff surveys fairly regularly to find out where our staff is in terms of its engagement, and that's always the number one reason people are there. I feel very proud of the integrated care we talked about. I feel proud that we talk about racism and poverty on a very regular basis and look at data through that lens. The two things I'm really proud of two of our staff, is that we use data increasingly well, and so we look at data to see how we're doing on any number of health outcomes diabetes, hypertension, depression, smoking cessation, body size, immunizations for little little kids and for adults. And we have been increasingly known both in the community, regionally and nationally for how we disaggregate data and look at how different subpopulations are doing, whether it's trans members of our society, whether it's Native Americans and looking at how their health outcomes differ in what we can do about that. So we have created a patient family advisory council of transgender patients and also one of Native American patients. That's still really unusual. It's sort of shockingly unusual because those subpopulations, while comprised of individuals, have a very different ask of us that we don't know how to meet unless we listen. So I'm really proud of that. And, yeah, proud that we're developing national recognition as a very innovative, progressive health center. I'm really proud of this community. Talking about race equity issues of equity, the city, the county partnership, a number of other entities are meeting on a very regular basis to look at what's in the way of all people experiencing high levels of health and well-being. And we're really unusual as a community, so I feel really proud to be part of that. I'm proud to work with you guys. Quite honestly, I truly am proud to work with the county. It's the county. I imagine the county co applicant health centers tend to have a tough time and we don't because we have this very collaborative relationship with the county. And I think the County, the Health Department, Partnership and the residency are all very committed to improved health for all, and that's a rarity. So really appreciate that.
Commissioner Juanita Vero:Thanks for saying that.
Commissioner Josh Slotnick:We are really proud PHC is part of the County.
Laurie Francis, PHC Executive Director:Yeah, we feel lucky. It's a it's a really wonderful partnership and I think it works well for us in both directions.
Commissioner Juanita Vero:It's fantastic. So how does PHC work with all Nations Health Center?
Laurie Francis, PHC Executive Director:Like we do with other health entities? We work very closely with St. Pat's and All Nations. So Skye McGinty, their executive director, CEO, is wonderful. We talk on a really regular basis on what they're up to, what we're up to. We both are hiring community health workers, as is st. paths. We're working on that concept. We are looking at community organizers. We've had community organizers together to look at empowering people so that they're able to make changes in their lives. So it's really back and forth all the time. We check in with each other.
Commissioner Juanita Vero:It's great to hear. So, yeah, before we wrap up, give us a a great book recommendation or nugget of wisdom that you'd like to share with us and our listeners.
Laurie Francis, PHC Executive Director:I'm rereading two books for a second time. One is The Overstory. I don't know. Oh yeah. And the other one. We now have an internal book club, so I'm rereading that and it's Cutting for Stone.
Commissioner Juanita Vero:Yep, that was that was like 15 years ago. It's early 2000.
Laurie Francis, PHC Executive Director:It's a beautiful book that looks at the impact of society and medicine and the interaction of the two. Most of it takes place outside of the United States, but some of it's here and it's really compelling. Page turner.
Commissioner Josh Slotnick:Wow.
Commissioner Dave Strohmaier:Ok, great.
Commissioner Josh Slotnick:Thanks for that.
Laurie Francis, PHC Executive Director:Thank you. Thanks for joining us, Laurie.
Commissioner Juanita Vero:Yes, yes. So it's such an honor and pleasure to have you with us.
Laurie Francis, PHC Executive Director:Thank you. Thanks for having me. It's great working with all of you.