The problems identified here aren’t new, but publicly naming them is. Among the five new measures reported for FY24, the report links three of them to existing resource gaps:

• Retinal screening for patients with diabetes has been discussed as a problem for years. PCC even applied for foundation funding in FY19 and FY20 to purchase retinal cameras as a bid to provide a low-cost, on-site screening mechanism within primary care. But the cameras were not funded, and the problem has remained. It is an important health maintenance measure that does not happen because our primary care partners lack a viable routine way to provide it. 
• Foot exams for patients with diabetes are possible in a primary care setting, though they may be hard to include among multiple competing concerns in a single visit. Additional specialty care funding for podiatry visits would help ensure higher exam coverage.
• Pneumococcal vaccine coverage can help prevent serious--possibly fatal—infections, but insufficient funding to purchase and administer these vaccines has led to very uneven vaccine coverage across the MCares partner network.  

The consequences of these gaps are significant, and they cannot be bridged by health centers alone.

by Stephanie Narayanan, Director of Development and External Relations

My favorite part of Alabama history* is an elegant marble monument honoring…a bug. It’s not (just) the idea of memorializing a beetle that appeals to my inner storyteller; it’s also the quirky reminder of a timely lesson.

The boll weevil was not just an Enterprise, Alabama problem, but an environmental change that threatened US cotton production for the better part of a century, according to Smithsonian Magazine. What was different about Enterprise, though, was its response: Instead of focusing their energies on preserving cotton fields, farmers pivoted—first to peanuts, then to a range of crops that diversified local growing.

Hence, the boll weevil’s marble monument, which reads: "In profound appreciation of the Boll Weevil and what it has done as the Herald of Prosperity."

I’m not suggesting we celebrate the very real crises that are likely coming, but I am suggesting we focus on where there are opportunities.

In an ideal world, we’d be building up new models out of abundant resources—a strategy PCC has been working on steadily since before the federal funding cliff. Things are not ideal. We continue the work anyway. 

We cannot keep underfunding nonprofit operations—the “Nonprofit Starvation Cycle”—but we can think hard about where strategic partnerships benefit both an organization’s operating capacities and its beneficiaries. We need to get to a place of doing more with more. We can start by finding ways to leverage the resources—including backbones—we  already have.

Community-building is an ecosystem effort. Diversification is not just a funding necessity but an operating imperative. We all need to be clear about the strengths we bring and the gaps others can fill. PCC has built trust by our insistence that we don’t try to replicate the work other organizations are doing. It’s a waste of energy on unnecessary competition when we could be building out balanced efforts. At PCC, we are focused on the value we can add. We are focused on the long-term health of a thriving community. 

 
*Being Alabama-born and raised, having a favorite Alabama history moment is not as random as it sounds.

by Annice Cody, President and CEO
With all due respect and apologies to Commanders fans, I was intrigued by Binyamin Applebaum’s contention that sports stadiums have become “monuments to the poverty of our civic ambitions.” He argues that glossy projects like stadiums are decoys for the real work of building communities. I believe PCC offers the opposite: An abundance of civic ambition to build a lasting infrastructure that supports our shared desire for a stronger, healthier community.

As the County Council’s budget decisions were wrapping up in May, and even as he warned of a tough budget year ahead, Councilmember Gabe Albornoz said something that has stuck with me: “There’s nothing wrong with Montgomery County that can’t be fixed by what’s right with Montgomery County.”

That’s the spirit PCC was founded on. When our founders looked for ways to serve uninsured neighbors, they didn’t start with what was missing. They started with what we already had—and asked how we could use it to help more people.
It’s the PCC version of the "abundance mindset": a deep respect for the community we have, and an unfailing belief that it can be big enough, strong enough, and generous enough to serve us all.

But that doesn’t mean this work is easy.

When Leslie Graham stepped into this role in 2014, she was concerned about environmental uncertainty. As I step into this role today, uncertainty still exists.
We’re navigating a time of deep political strife, uncertain healthcare funding, dramatic shifts in immigration policy, and a broader climate of retrenchment and protectionism. Naturally, I’ve asked myself: What does this mean for PCC and how should we respond?

When the world feels chaotic, I try to simplify my response: How can I help? And I often find guidance in the wisdom of the Jewish prophets in the Talmud: “Do not be daunted by the enormity of the world’s grief. Do justly, now. Love mercy, now. Walk humbly, now. You are not obligated to complete the work, but neither are you free to abandon it.”
Pretty good advice, right? So, what can you expect from the Primary Care Coalition as we move forward?

As complexity increases, I focus on “no-regrets” priorities--initiatives that will serve us well no matter what the future holds. Let me highlight four of them:

We may not know exactly what lies ahead, but we can be fairly certain that funding for health and social services will tighten. That makes stewardship of resources more important than ever. To make the most of our resources, we will seek opportunities to improve performance, to share best practices, and to take advantage of economies of scale to be effective stewards of our community’s resources.

by Annice Cody, President and CEO

I’m still figuring out how to tell people what I do now as CEO of Primary Care Coalition. By that I mean the challenge of explaining the organization I’m leading. A broad scope of partnership work makes it difficult to be both accurate and concise. How much narrative weight do I give legacy programs that focus on the uninsured, versus emerging work that looks more comprehensively at vulnerability?

Maybe it’s best to start the conversation with the purpose of our work, rather than the details of it. Perhaps that’s the sweet spot for engaging people in its importance.  

So what is that purpose? Our vision is a vibrant community that supports all people in living healthy lives. It would be easy to focus on the health part of that vision, particularly in light of the day-to-day work we do, but I wonder if that isn’t somehow missing the point. Our lens is health and health care, certainly, but our vision is one of community.

The thing I like about health as a scaffolding for community is that it’s relatable. Not everyone knows the strain of housing insecurity, even if we all recognize the importance of home. But I can’t think of a single person who hasn’t needed health care. And in our American system, I’m hard-pressed to think of anyone who hasn’t struggled at some point to get the healing they need.

For as broad and wily as the notion of community can be, it’s always built around something shared: geography, history, values. Pursuing health is a shared experience, and most of us realize we’re all only one bad-luck diagnosis away from leaning heavily on healthcare.

A former board member would talk about his emotional connection to PCC in terms of Care for Kids. He realized that parents and guardians with limited resources still wanted the same healthy futures he had wanted for his children. Whatever the difference in their material circumstances, their visions and motivations were shared.

As we watch systems crumble all around us, it is tempting to despair. In the same way that watching cancer cells metastasize could feel like an inexorable march toward doom. But the antidote to that despair already exists: community. Our ability to lean on connection is the breakthrough immunotherapy for this moment.

We are each other’s answer. PCC’s role is to remind us of that.

In last month’s brainwaves we talked about PCC as a backbone, and that’s certainly true. But the piece that resonates most deeply for me is this: PCC is a connector. Whether it’s elbow to femur or grassroots to treetops, we specialize in bringing together a whole that eclipses its parts.

Consider the evidence around collaborative care as suicide prevention publicized by Shatterproof and the Bowman Family Foundation: in addition to prior research on cost savings, a study by Kaiser Permanente found a 25% lower rate of suicide attempts among patients who had received a collaborative care-style intervention than those who had not. Collaborative care, which PCC has adapted for our local safety net, is not an elaborate model. At its core, it is a care delivery model focused on primary care and mental health providers working together to leverage modest resources effectively.  

Community is the ultimate multiplier. As uncertainty becomes the standard operating environment, PCC will be focused on combining the work we do best—connection—with an eye toward innovative collaboration. We’ll be focused on transforming our collective resources into the community we want to be.

The safety net is our community’s herd immunity, and we don't necessarily notice when it starts to thin. Slowly, vaccine hesitancy goes up, and coverage goes down. Experts warn we’re below the threshold, but everything feels mostly fine. Things hum along, until they don't. In a matter of days, our first detected case can explode into an outbreak.

We are seeing the safety net thin. A sudden surge in newly uninsured residents dropped from Medicaid rolls is not a challenge they can absorb. We are hearing clinics say privately that they're struggling—not all of them, but some. We've seen even large FQHCs undergo strategic reorganization to get ahead of possible Medicaid reductions.  These are all signs we may be losing the herd. The system as we’ve known it cannot hold much longer, and the emergency is now.

We know there are many emergencies out there. The good news is, we are an incredible community, and we can do this. But we have to do it together.

Our partner health centers know this is a tough budget year and fiscal prudency is essential, but it cannot be a flat year either. (As anyone reliant on cost-of-living adjustments knows, flat is actually another loss.) They need enough of an increase to keep going. They need a promise they're not forgotten: that they are working in partnership, not alone.

This article has not been reviewed or approved by the Montgomery County Department of Health and Human Services.