Diabetes Clinic Expansion Promises To Extend Health Outcomes To Wider Community

Dar Salud runs a busy pharmacy, among other services it provides in house, as part of a model that makes it easy for patients to get the care they need in one place. (Memphis, Tennessee)

Caring for the Community that Cures

Dr. Pedro Velasquez-Mieyer never planned to stay in the U.S. after completing his fellowship at Harvard and returning home to Venezuela. But when his son Pedro developed a rare form of leukemia, they turned to St. Jude Children’s Research Hospital and in the years of treatment that ultimately cured his son, Memphis became home. Twenty years later, Dr. Velazquez oversees a thriving medical practice he established called Dar Salud that has pioneered new approaches in coordinated, holistic care for diabetes and metabolic disorders and delivered dramatic health improvements for the families it serves.

During his first few years practicing in Memphis, Dr. Velasquez was struck by the high numbers of young children he saw who presented the same heart disease, obesity, diabetes or related risk factors as their parents, particularly among the city’s most vulnerable populations. Moved by a desire to give something back to the city that cured his son, Dr. Velasquez established Dar Salud in 2005 and put his endocrinology training to work developing new approaches to treat them.

Today, the standard of care and cost-effectiveness Dar Salud has achieved with its innovative multi-specialty, family-centered clinical model has earned distinctions including NCQA’s Diabetes Recognition Program and a Cardiovascular Center of Excellence, among others. With its focus on predicting and preventing disease or complications in at-risk patients, Dar Salud is succeeding at tackling tough challenges that come with serving its patients, including high rates of hospitalization or emergency room visits and non-compliance with providers’ appointments, medications or other advice.

“With such high non-compliance rates in the uninsured and Medicaid patient population we serve, we work to make visits engaging and to create incentives that bring our patients into the clinic. The more regularly we see them, the better the chances we can quickly identify and prevent illness or complications,” said Pedro Velasquez Jr., operations director and Dr. Velasquez’s son.

A New Standard of Care

Dar Salud’s model addresses patients’ life circumstances that make it difficult to keep up with appointments or medications such as the need to miss work or make multiple bus trips to a pharmacy. In practical terms that means Dar Salud’s patients can see providers with their families, and in a given visit, they may see a primary care provider, cardiac specialist and nutritionist; attend a group workout class and visit with the therapy dog Thor; and leave the clinic with the prescription eyeglasses and medicines they need.

Dar Salud’s data shows its model is working. Dar Salud outperforms other Medicaid clinics on no-show rates at two in 10 patients compared to 4 in ten in other clinics, according to Velasquez Jr. He adds that for patients who seek care for blood sugar or blood pressure crises from Dar Salud instead of an ER, the clinic sees a 90 percent reduction in subsequent ER visits. In 2017, hospital costs incurred for Dar Salud patients by insurance companies were 45 percent lower than other Memphis-area practices.

“Traditional clinical approaches begin treating patients when disease develops because that’s when insurance starts to pay. But we know that managing risk is less expensive and more efficient than managing disease and produces better health. And that’s why we’re here, so when we see what may happen based on a patient’s risks, that’s when our clinic starts to treat the patient,” said Dr. Velasquez.

Pathway Opens the Door to Community Scale

Since opening, Dar Salud has been able to sustain its own growth, carefully adding areas of practice only as it identifies a need among its patients. Now in its fifteenth year of practice showing its model works, the clinic is ready to pursue projects that will benefit the community at a larger scale. But that requires bigger investments than it can support on its own, so the clinic turned to Pathway Lending for a microloan and line of credit and will work with Pathway Business Advisory Services on new financial models to support its new initiatives.

“This is the first time we’ve sought outside funding, but it’s not easy to get traditional bank funding when you work with people of limited means. We’ve been proving our model and sustaining it with no outside support for 15 years. Pathway is giving us the chance to bring those outcomes to the wider community.”

Among Dar Salud’s new initiatives is a community engagement strategy where it will partner with Shelby County and charter schools to reach students, families and staff in a given zip code where the clinic has collected ample behavioral baseline data it needs to track outcomes and compare them to the clinic setting. The project will inform Dar Salud efforts to replicate its model in the wider Memphis area.

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