Case Study

CrescentCare’s Health Campus

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8 min read

NOLA’s single phone line grows into an institution

On August 15, 2017, in the presence of government leaders, financing partners and local residents, the community health organization, CrescentCare, broke ground on its new health campus at 1631 Elysian Fields Avenue in New Orleans. The dirt overturned by the ceremonial shovels represented the latest chapter in a story of impressive growth for this much revered—and much needed—nonprofit whose guiding principle is, “Healthcare should be about what you need, not only about what you can afford.”

CrescentCare began operations in 1983 as the New Orleans/AIDS Task Force, in response to the devastating effects of the human immunovirus epidemic plaguing the nation. The organization began as a single phone line and answering machine in the Faubourg Marigny neighborhood. Within a few years, an AIDS information center and hotline were established and services continued to expand as the impact of the epidemic became clear. Case management and mental health services were added in 1990 and a meal delivery program became operational in 1992. A community mobilization project with offices in the French Quarter was established in 2000. Following Hurricane Katrina in 2005, Mercy Hospital-Lindy Boggs Medical Center closed its doors for good, leaving Mid-City New Orleans without vital healthcare services. In an attempt to at least partially fill the void, CrescentCare took advantage of provisions of the Affordable Care Act (ACA) and expanded its services, qualifying as a Federally Qualified Health Center (FQHC) in 2013 and adding dental care in 2014. In addition to a financial grant, the FQHC designation enables enhanced Medicare and Medicaid reimbursement and certain cost savings.

“The organization has grown very quickly since Katrina, and particularly in the last five years,” says Alice Riener, CrescentCare’s chief legal and policy officer. “And so, we haven’t always had the luxury of planning. Previously, we were always dealing with landlords, having to make medical clinics work in office building suites that weren’t designed for them, and adapting as best we could. Here, we finally had the opportunity to design a space that’s conducive to the work we do, so we can both expand our services and consolidate other facilities.”

For the first time, the Health Campus will allow CrescentCare to provide comprehensive services under one roof. These include adult primary care, pediatric care, dental, HIV services, case management and behavioral health services to individuals at all income and insurance levels—including no insurance—in a building specifically designed and built for the purpose.

Gulf Coast Housing Partnership, a mission-driven developer with projects from Texas to Florida and dedicated to “transformative development,” is the development partner and project manager. “The relationship between Gulf Coast Housing Partnership and CrescentCare is a brilliant embodiment of GCHP’s mission,” states Kathy Laborde, president and CEO. “We are known as affordable housing providers, but there is so much more to quality living besides housing. We work to provide facilities where we can bring healthcare and financial services to the residents.”

Wraparound Holistic Services
The demand for CrescentCare’s services seems to be in a continual growth spiral. As an example, as of October 2017, 10,000 HIV tests had already been administered and processed since the beginning of the year. And if one considers that many, if not most, of these represents counselling and, when positive, case management and treatment, it is easy to get a sense of the magnitude of the challenge. The growing opioid addiction crisis is only adding to that challenge.

“From our roots as an AIDS service organization, our ethos is very much about providing the care people need, regardless of their ability to pay,” Riener declares. “We believe that healthcare is a human right.”

Even her definition of healthcare is expansive.

“Yes, doctors and nurses are critical, but also social workers, nutritionists and every other thing. We provide what we call ‘wraparound holistic services’ because we know how that works and that it provides the best health outcomes.”

CrescentCare has a published schedule of fees based on income level, indicative of the wide variety of patients that come through its doors. But no one is ever turned away, even if they cannot afford the minimal amounts. (“Anyone who wants to come to us, we will take happily, regardless of ability to pay,” says Riener). This approach has often presented the greatest challenge. While the aftermath of Hurricane Katrina provided what Riener calls an “opportunity,” it nearly overwhelmed the organization. “Katrina was a reckoning for us,” she says. “We almost had to shut down. But there was an outpouring of support from within the area and around the country that kept us going. The leadership said, ‘We don’t ever want to go through that again,’ and indeed, New Orleans went through a transformation that has been lasting.”

Almost since the founding of the original New Orleans/AIDS Task Force, finding and securing adequate space has been an issue. About four years ago, a committee of the board of directors was formed to explore possible solutions, with the strong preference being a site in which diverse services could be combined. “We worked closely with Gulf Coast, which was instrumental in helping us think it all through and identify possible locations. We did a lot of mapping, which involved current clients, other health centers, housing concentrations, bus routes and other factors. We came up with several acceptable locations and netted about 15 possible properties.

“We made an offer on one location, but the owner wanted about double what we thought the property was worth. So, when we couldn’t make that one work, we concentrated instead on sites where the owner wasn’t [being unreasonable] and wanted to sell. We got down to this one site on Elysian Fields. It took us about a year to raise the money.”

The budget for the $23.5 million Crescent Care Health Campus breaks down to $1.5 million for acquisition, $15.5 million for construction, and $6.5 million in collective soft costs. Financing came via a $21 million New Markets Tax Credit allocation, a $10 million permanent loan from Primary Care Development Corporation (PCDC), $7 million in NMTC equity through PCDC, Hope Enterprise Corporation and Chase Community Development Banking. The remaining $6.5 million came from CrescentCare itself and its capital campaign. Hope, a community development financial institution dedicated to improving the lives of financially distressed individuals and families in the Mid-South, will further its partnership with CrescentCare by opening a Hope Credit Union Branch on the ground level of the new building. Gould Evans, LLC, architecture firm, which has an office in New Orleans, designed the project. DonahueFavret of Mandeville, LA, is the general contractor. CrescentCare hopes the Health Campus will be fully operational by January 2019.

Baked in the Pie
CrescentCare’s stated mission is “to offer comprehensive health and wellness services to the community, to advocate empowerment, to safeguard the rights and dignity of individuals, and to provide for an enlightened public.” Community participation is “baked in the pie,” going back to its original and ongoing mission as an AIDS service organization. Equally significant, certification as a FQHC stipulates that at least 51 percent of board members receive their medical care through the organization.

“It’s very important to us to have clients on board and that the people getting care from us are invested in the organization. We take that very seriously,” says Riener. “It means that each health center is responsive to what the community needs and that people getting the services are in a position of power.”

Since 1991, CrescentCare has received funding from the Ryan White HIV/AIDS Care Act. The program is administered by the Department of Health and Human Services and is named for the heroic Indiana teenager who contracted HIV from a blood transfusion given to treat his hemophilia, who did so much to attempt to destigmatize AIDS, and who died of the disease in 1990 at age 18. Ryan White funds are designed to support patients when no other resources are available. “It’s a brilliant piece of legislation, passed just four months after Ryan’s death,” Riener notes. With those funds and provisions of the Affordable Care Act, Riener says CrescentCare is helped in its ability to provide medical care to AIDS sufferers and their families, supportive services and “take a lead role in advocacy.”

This has not been the easiest political climate in which to expand healthcare and related services to the needy and underserved. Riener concedes, “We did a lot of soul searching about taking on this level of risk [by committing to the Health Campus], then adds, “but when we started thinking about it, there was no shortage of need. And despite the change in the political climate, none of those factors have changed.”

Story Contact:
Alice Riener
[email protected]