When Dr. Tonya Adkins, MD, advanced from Chief Medical Officer into the CEO role at HealthWorks for Northern Virginia last summer, she had big shoes to fill. The retiring CEO, Carol Jameson, named the County’s top non-profit executive in 2019, had helped to create the health service by merging the Jeanie Schmidt Free Clinic in Herndon with the Loudoun Community Health Center in 2012. More than a decade later, HealthWorks now serves more than 15,000 patients from Ft. Evans Rd. in Leesburg, two sites in Herndon, one in Reston and – as of the end of March – from Ridgetop Circle in Sterling.
But Dr. Adkins, a Navy veteran with more than 20 years in both community health and private practice as an OB-GYN, has never shirked a challenge. Her commitment to exceptional patient care seems exactly the right focus for helping HealthWorks to grow beyond its perception as a “free clinic” to the kind of personalized practice that can serve everyone in the community.
HealthWorks functions as a nonprofit, Federally Qualified Health Center or FQHC, meaning that it is partially federally funded and doesn’t turn away any patients who are either uninsured or can’t afford health care. To meet the stringent federal requirements for federal funding, its offerings include preventative care and medical, dental and behavioral health services to medically underserved and vulnerable populations living below the poverty level. It boasts a Patient-Centered Medical Home philosophy, meaning that it aspires to serve as a kind of primary care practice for families who work with their doctors to make health care more effective and affordable.
Currently, only 17% of HealthWorks’ funding comes from federal grants and another 17% comes from both Fairfax and Loudoun County. The remaining 50% comes from patient revenue, community grants and donations, Dr. Adkins says HealthWorks needs to improve the payor mix and to have larger donor participation and grants to offer its brand of high-quality patient-centric healthcare to everyone in its community. Because almost 60% of its patients are uninsured – and some 88% of them live 200% below the federal poverty line – that means that for uninsured patients the practice is operating at a deficit of more than $200 per patient visit. “We rely on grants to help cover that cost,” Dr. Adkins says frankly. “There was plenty of federal funding during the pandemic, but most of that expires May 11th with the end of the Public Health Emergency.”
HealthWorks also takes Medicaid and Medicare and commercial insurance but sees uninsured patients on a sliding scale and won’t let anyone’s inability to pay create a barrier to excellent care. “There just isn’t any other practice out there that can say they don’t turn anyone away. Our goal is open access to everyone. On top of that, we give high-quality health care.”
Speaking of the pandemic, Dr. Adkins believes the last two years were among HealthWorks’ finest. Having already served as a part-time OB-GYN, and then Associate Medical Director, she became Chief Medical Officer one day before the service saw its first COVID patient. “I got us through COVID and It was the best two years of my medical career because I saw a very kind country and everyone was working together for the good of everyone else. Here, we worked as a team as we have never worked before... we just made things happen.”
Providing everything patients need under one roof is a high priority for Dr. Adkins. “We have dental. We have behavioral health. We have pediatrics and we have adult care.” As a two-decade veteran of women’s health medicine, her current passion project is to provide a radiology suite to make mammograms for women and ultrasounds for all more accessible. This focus clearly stems from the fact that she continues to see patients two mornings a week, and has heard on more than one occasion from women who told her they would have to wait more than two months for a mammogram – time obviously better spent in delivering an accurate and timely diagnosis and treatment of potential breast cancers.
She plans to appropriate HealthWorks’ first-floor acute care suite for the radiology department which she anticipates will cost around $1 million to equip and staff. She already has applied for one federal grant for about a third of that cost and looks to raise the rest in grants and donations to realize her dream that no woman has to wait for critical preventive screening. She adds, “People love to give to end hunger and homelessness, but they don’t really think about health care, because most of us have it. That makes me sad because too often we see patients who have cancer and but by the time they find us, it’s in a late stage.”
She says, “I love taking care of my patients – just the joy of being able to explain to them what's wrong with them, versus saying, ‘Take this pill and you'll get better.’ I love to teach. I just love my patients and they know I love them. And, I know everything about them – I know about their children and I know about their lives and I know what's going on with their sister who just had a baby. So even though there's a language barrier, I still get to know them before I get to know their medical problem. And that way I can put it all together.”
The language barrier comes from the fact that some 73% of HealthWorks’ patients are Spanish speaking with a total of 78% having a primary language other than English. Providers and staff make use of a live translation service that not only provides real-time translations in over 100 languages but also keeps a log of each encounter.
Watching Dr. Adkins in action with patients, it’s clear there’s no loss of communication when it comes to expressing empathy or in addressing concerns that may have languished, undiagnosed or misdiagnosed from previous acute care treatment. She says HealthWorks behaves much more like a private practice in this regard, taking ownership of whole patient care, “not just the symptoms that brought them in the door.”
“We’ll never turn a patient away,” she explained. “We just want to make it clear that we’re here to serve the whole community.”
Being an administrator means that she also meets with legislators to make sure that federal funding for community health centers doesn’t “fall off the budget cliff” or that support for using 340B pharmaceutical industry funding for prescription drugs HealthWorks’ patients need isn’t cut.
As for where she finds the strength to cover all those bases, she says, “I'm a Christian. It comes from above. I work for an audience of one every day. If I can say, Have I done the right thing? I'm good. God's got me. He wouldn't have put me in this position if he didn't have my back. There are going to be days when I don’t please anybody, but I have learned if I can please Him, I'm okay with that.”
