Packard Clinic's prescription for success

The Ann Arbor News -Sunday, May 23, 2004
By Anne Rueter, News Staff Reporter

At 30, the practice is a model for providing care for the uninsured

In the late 1960s, medical student Jerry Walden bristled with idealism. A self-described "shy country boy" from Michigan's Thumb, he absorbed the social do-good spirit of his era. He had grown up with parents who always pulled for the little guy.

So during his last year at the University of Michigan, Walden went to Nigeria to work in a clinic, looking for a place where his skills could make a big difference in people's lives. That place, he soon realized, could be back in the United States, right in Ann Arbor.

In 1973, Walden founded Packard Community Clinic in southeast Ann Arbor. Energized by the civil rights movement, Waiden wanted to offer routine medical care to people of modest means he saw shut out of the health-care system then, including many African Americans. Then as now, too many people had to set aside their health problems till they ended up in emergency rooms.

Walden's idealism didn't fade. Today, he's incensed at what he considers "the indignity of having so many people left out of the health-care system" with 44 million Americans uninsured, as welt as the spiraling cost of prescriptions. "It horrifies me," he says, when he wonders why a patient's symptoms persist and the patient confesses, "I can't afford my drugs."

The clinic didn't fade either. It stands like a small greenery-edged oasis between a hair salon and an auto parts store in a commercial strip on Packard Road, a financially viable nonprofit primary care clinic that serves close to 5,000 patients.

Walden and his wife Julie Tiplady, the clinic administrator, are proud they've made his original concept work: Offer the consistent, ongoing care typical of any good private primary care clinic, but don't turn away anyone who cannot pay. To do that, the clinic relies on revenues from insured patients (85 percent of its operating budget), staff willing to work for 20 to 40 percent less than market rates, community donors, a community development block grant and low overhead.

The clinic has reached its 30th anniversary in good health in part because of Tiplady's management skills. The future holds inevitable changes, however. In a few years, Walden, 62, and Tiplady, 57, plan to turn over day-to-day management of the clinic to others, though they'll stay involved in lesser roles. Walden will probably continue seeing patients, Tiplady will work on fund raising.

They've thought a lot about the turnover "We're really co-owners of the dream," says Walden.

"Who do we give it to?" says Tiplady. "Who will care about this place as much as we do?"

Reputation for friendliness

Among a handful of other area outpatient practices that treat substantial numbers of patients with little or no insurance, Packard is a mainstay in the Ann Arbor area. About 2,000 uninsured and underin-sured patients make up about 40 percent of the clientele. The clinic serves more patients under the Washtenaw County Health Plan, which provides health insurance based on income, than any other area provider. Yet about 60 percent of Packard's patients are people with full insurance who come because they like the staff's philosophy of caring personal attention.

Mix of patients, with and without insurance

"I like the down-to-earth attitude of everyone who works here," says Ruth Diaz-Juarez, who says she has insurance and coutd go elsewhere. They 're accepting of everyone. This is a very multicultural-oriented service."

"I like it because they remember your name," says Jennifer Green, who's come to the clinic off and on for 10 years, through times when she's had health insurance or tacked it. "That didn't matter to them," she says. "I never felt I was treated any differently."

The past 30 years have shown the clinic can sustain itself while serving its mix of patients with and without insurance, Tiplady says. She has been on the clinic staff, coordinating staffing and fund raising, for the past decade. She draws on her skills as a management consultant and therapist.

Walden is the guiding force of the clinic. He revels in seeing the same families -he's treated five generations in one - and the stories people tell him. "That's why family medicine is so beautiful," he says. "You're so intimately involved in people's lives."

'My first thought is they're probably irreplaceable, but we have to train the next generation of leaders.' Kathleen Reynolds, executive director of the Washtenaw Community Health Organization speaking about Walden and Tiplady's plans to semi-retire

"He has a very unique approach. It's not just treating the physical health of a patient, but the mental health," says Kathleen Reynolds, executive director of the Washtenaw Community Health Organization. She admires the clinic's offerings to help patients maintain their health, such as nutrition counseling and diabetes management.

Walden and Tipiady are a formidable team, Reynolds says. She works closely with Tiplady on a pilot "integrated health care" program that WCHO is funding at the clinic. WCHO pays for a part-time psychiatrist and a social worker to work at the clinic, to give patients and staff prompt help with mental-health issues such as depression. Reynolds plans to present the idea to other private clinics.

Clinic in transition

"My first thought is they're probably irreplaceable, but we have to train the next generation of leaders," says Reynolds about Walden and Tiplady's plans to semi-retire, "I think they're doing a good job of training the next generation."

Tiplady says she hopes members of the current staff will want to take the reins. The clinic has asked recent hires to commit to working there five years, rather than the two-to-three-year commitment that physicians and nurse practitioners can make more easily. Staff come knowing their earnings are lower and won't rise as they would in the private sector.

Ray Rion left his job as a family physician at U-M Dexter Family Practice a year and a half ago to work at Packard Community Clinic. Deciding to work at Packard Community Clinic was not an about-face for him. "This type of work is really why I went into medicine,'" says Rion, who's in his 40s. He admires Walden not only as a humanitarian but as a doctor who keeps up in his field. "I'm really happy here. I'm not planning on doing anything different," Rion says.

Rion recently shared his thoughts about the coming transition. "If we rely on finding the next Jerry as an organization, that's not the way we need to go," he says. "It's been driven by Jerry's vision. That he'll (continue to) be involved is ' great." A minute later, Rion: adds, "I'll be honest: It's not me. I've never met anyone like Jerry in my 20 years in medicine."

Having a single guiding light may not be in the cards for the clinic as a maturing organiza* tion, he says. "Every organization needs to change what they do."

Tiplady and Walden want to spend more time in the future getting the word out to more health-care providers that their model works. A handful of Washtenaw County providers currently try to serve the county's estimated 35,000 uninsured, but there are significant gaps.

"I'm hoping some physicians will become a 501C3 (nonprofit), probably early on, or that people will take more lower-income patients as part of their practice," says Walden. Many are committed to the idea these patients need help, he thinks, but blame government for not taking care of the problem.

"Many doctors think, 'It's not really my responsibility to fix it," Walden says. "I just feel we have to fix this."