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Community Impact Report Mosaic Medical 2020 -2021

Power of partnership

Every year—but especially this one—I am in awe of the power of partnership. How partnership can transform lives, inspire change and enable communities to overcome great challenges.

In the pages that follow, we detail how a partnership between a provider and patient led to a greater understanding and control of diabetes. How a partnership between colleagues connected a young patient with her care team. And how our Mobile Clinic team partners with peer organizations to go above and beyond for patients.

We also celebrate how our partnerships with school districts, government entities, businesses, volunteers, and others helped Mosaic achieve one of the greatest accomplishments in our history: administering over 16,000 doses of COVID-19 vaccine in Central Oregon.

Next year, Mosaic will celebrate our 20th Anniversary. Of all the notable successes along the way, I am most appreciative of the partnerships we’ve built. With patients, peer organizations, and all others who share in our vision of quality care for all.

As we look forward to our anniversary, we also look forward to growth. We are opening a new health center with retail pharmacy and affordable housing in Bend this fall and a comprehensive health center in Madras in the spring of 2022. Both projects made possible through the power of partnership.

Thank you for being with us on this journey, for sharing this report with your networks, and for helping us honor another year of service.

Pictured: Vaccination team outside of the Redmond Clinic in February of 2021.

Year in review

Mosaic continued to adapt to COVID-19 last year, serving our patient base in new ways. Below, we provide a summary of our patient demographics, service offerings and financials from July 2020 through June 2021.

Patient Stories - Joseph and Taylor

Empowering through education

The thing about Type 2 diabetes that’s often overlooked is that it’s complicated. Really complicated, especially if no one ever explained how the things you eat affect your blood sugar.

This was the case for Joseph, whose A1C (average blood sugar levels) had flared to a severely uncontrolled level of 10.7 in October of 2020.

Joseph’s chart was flagged during an expansion of Mosaic’s nurse case management program. The program matches nurses with Medicare patients who have chronic illness that could be improved through coaching.

Soon, Joseph was connected with Taylor, a nurse case manager in Mosaic’s Redmond Clinic. They began meeting monthly over the phone to discuss his diabetes.

“It was clear from the very beginning that motivation was not the problem behind Joseph’s A1C,” said Taylor. “It was a lack of information about how diabetes actually worked and how to control it.”

During their check-ins, they began to break it down together. They talked about carbohydrates and how they influence blood sugar. They decided on tweaks that Joseph could make to his diet to get his A1C down. Taylor made handouts with pictures of carbohydrates to avoid and those to embrace.

“I quit my ice cream,” said Joseph. “And potatoes and other things with lots of sugar.”

Joseph also connected with a clinical pharmacist at Mosaic to dial in his medication and learn more about how it helped control his condition.

By April, Joseph had gotten his A1C down to a 6.3, an incredible accomplishment directly tied to his hard work.

“I’m feeling better,” said Joseph. “Feeling really good.”

Taylor was amazed to see this kind of progress in such a short period of time.

“I really feel like regular check-ins were crucial,” she said. “I’m so glad I could help give Joseph the information he needed to succeed.”

Nurse case manager, Taylor.

Zoe, Gladys, Abby and Jacquie

Creating connections

En Español

Like so many other experiences in her life, Zoe’s medical appointments were isolating. Her mother was able to communicate through a Spanish interpreter, but nine-year-old Zoe—who is deaf—didn’t have anyone who was fluent in the language she recently learned: American Sign Language (ASL).

“She had a hard time sitting through appointments and would try to run out,” said Zoe’s mother, Gladys.

Gladys knows some ASL and is in classes to learn more, but she was unable to relay everything to her daughter during appointments.

“I discovered Zoe’s language requirements when I reviewed her chart before our first meeting,” said Dr. Abby Hendricks. “I felt it was critical to get an ASL interpreter so Zoe could experience her appointment as fully as any other child.”

Dr. Hendricks consulted her colleague Jacquie, a Language Access Specialist, who worked with her team to find an ASL interpreter to join Zoe’s appointment that day.

Once together, the team tackled some long-standing challenges. Zoe was set to begin medication for a recent diagnosis of ADHD and had other behavioral and nutritional concerns to address. They also discussed communication challenges at home and Dr. Hendricks identified assistive technologies to explore.

Their initial appointment lasted two hours and Zoe remained engaged for the duration.

“The ASL interpreter made such a difference,” said Gladys. “I didn’t know that was even possible before this appointment.”

Dr. Hendricks was delighted to see Zoe truly participate as part of her own care team for the first time.

“When we connect, we are able to make progress,” said Dr. Hendricks. “I am so proud to be a part of a team that makes things like this happen.”

Zoe and her mom, Gladys.
Dr. Hendricks (left) and Jacquie at Mosaic’s Redmond High School-Based Health Center.

Debby, Kris, Kerry, Casey and Galina

Helping the houseless

Back in the early 2010s when Bend’s economy went down, work also went down, and Kris found himself without a job. A mill worker for 23 years, Kris could no longer pay his bills and he and his wife Debby lost their home. Desperate and without other options, they packed their possessions in a motor home and moved to a makeshift camp on public land.

One year bled into two and before they knew it, they had lived there for seven years.

“Some people want to be there,” said Kris. “For us, we had no choice. We were stranded in those woods.”

Mosaic’s Mobile Clinic parked at the entrance to the site weekly, but Kris and Debby’s camp was far away, and the trek was daunting. It wasn’t until Debby started developing foot ulcers so painful that she couldn’t stand that they decided to seek help.

“I started riding my bike up there to get checked out and tell them about Debby,” said Kris.

While Kris’ main motivation was Debby, he had health problems of his own. The mobile team found his heart was in constant atrial fibrillation and he was in danger of going into cardiac arrest.

“Kris’ situation was so dire that he needed emergency care,” said Kerry Gillette, PA-C, the Mobile Clinic’s primary provider. “Once we got him stabilized, we started making plans to reach Debby.”

The Mobile Clinic was too large to travel to Kris and Debby’s camp, so providers used all-wheel drive vehicles to make the journey. They discovered that Debby had untreated diabetes that was leading to her foot ulcers. Frostbite from bitter winters out in the camp were also exacerbating her symptoms.

Mobile medical services helped, but a long-term solution was needed. Mosaic partnered with other organizations including REACH, Deschutes County, Band of Brothers, FUSE and Central Oregon Veterans Outreach to find the couple a permanent apartment. Mosaic also helped the couple enroll in OHP, secure supplemental security income, and establish with providers close to their new home. They now attend regular appointments to address their ongoing health needs.

“They literally helped us out of the dirt,” said Kris. “I just think the world of everyone.”

From left: Mobile Outreach Coordinator, Casey; Provider Kerry Gillette, PA-C; and Medical Assistant, Galina.

Combating COVID-19

Below is a photo montage highlighting the partnerships that fortified Mosaic’s vaccination efforts and overall COVID-19 response.

The following videos further expand on the partnerships behind two key COVID-19 efforts at Mosaic.

Power of Partnership: Masks

Power of Partnership: Vaccines

Collaborating for change

Mosaic is governed by a volunteer, patient-majority board of directors with representatives from Crook, Deschutes and Jefferson Counties. We are grateful for our board members who share their time and talent with us to ensure that everyone has access to quality care throughout Central Oregon.

Patient Advisory Councils

Our patient advisory councils play an active role in improving the Mosaic experience. Their insights and expertise are instrumental in helping Mosaic continually enhance care delivery and communication across the system. We are extremely appreciative of their donated time and knowledge.

Supporters

Mosaic’s work is made possible through a broad funding collaborative including individuals, organizations, foundations and government entities. We are honored to be the conduit for donations that bring quality care to those who need it most.

Special thanks to Samantha Weald and Ely Roberts for capturing portraits for this report.