At Hope Clinic, the focus is on health, not just “caring for the sick”

Andrea Caracostis, 51, is the CEO of Hope Clinic, a federally qualified health center headquartered in the Asian city, with four locations across Houston. The clinic offers services to everyone, regardless of the patient’s ability to pay.

The Hope Clinic provides pediatric, OBGYN and family practice, psychiatric, dental, and vision services to low-income and uninsured individuals. Federally licensed health centers receive federal funding to subsidize uninsured patients who receive care at the clinic and provide comprehensive services ranging from primary care to dental services to mental health services in areas with low income.

Texas has the highest rate of residents without health insurance in the nation, about 1 in 6. Houston’s rate of uninsured people is even higher, about 1 in 5.

Caracostis, a graduate of medical school in Bolivia, earned her master’s degree in public health in 2003 from Texas A&M University and began a long career in public health. Before Caracostis moved to Texas, she worked at federally licensed health centers in North Carolina as a primary care physician, serving mostly migrant farm workers and seeing about 20 patients a day. She also worked as a consultant with Migrant Submission Network, an Austin-based federal contractor before joining Hope Clinic in 2007.

Caracostis spoke to the Chronicle about how the pandemic has affected the clinic and the ongoing projects they have underway. The interview has been edited for more space and clarity.

Q: How is the clinic doing after the COVID surges?

A: We slowed down during COVID, but we’re really back to our normal operations right now. We have vaccinated many people and our staff are 99% vaccinated. People still need our services. They still get sick, pregnant and the children still need health visits. We are fully operational.

Q: Can you tell me a bit about the population you work with?

A: We provide more than 170,000 visits per year, and provide care to everyone, regardless of their ability to pay. We provide high quality care and this allows us to have insured and uninsured patients in one space. We bill the uninsured on a sliding scale. The lowest rate is $35 and the highest is $85 depending on income and family size.

Q: Do you think affordability is one of the reasons people choose to use Hope Clinic?

A: Yes, it’s a big motivation to get treatment, but I also think it’s the quality of care. There are other options for uninsured people to get care, but they might not have the one-stop shop that we do. We offer many services ranging from care coordination, transportation vouchers, psychiatrists to cooking classes.

Q: Many of these services are not about physical health. Why is it important to take a well-balanced approach?

A: The health system is very much based on a system of “caring for the sick”. We wait for people to get sick and then we see them. Hope Clinic is proactive in trying to keep people healthy. We don’t just provide care when you’re sick, we make sure you stay healthy. We make sure you are up to date with your vaccinations and screenings so you can be a productive member of society.

Q: What are you doing at Hope Clinic that you are passionate about?

A: On the operational side of innovation, they do three things. (A prenatal program, a liver disease study, and a cooking program.)

First, we do remote patient monitoring. We started this project with our pregnant women where we connected them to an app, which has an educational platform, and they can watch all the prenatal educational materials at their leisure. This can be in bed, after dinner, or after the kids have fallen asleep. We also monitor which videos they watch more often to make sure we give them enough information.

We also give women who are at risk of developing high blood pressure a blood pressure monitor. Let’s say they have a history of high blood pressure in their family, or they’ve had high blood pressure in the past, or maybe they’re a little overweight. So we look at the risk factors, we give them a blood pressure monitor, and then we teach them how to use it. We can also monitor how often they take their blood pressure. We can see if the trend is up or stable. We can really be proactive about their prenatal care rather than waiting for something to happen. We have more than 500 women registered in this app.

Q: When did you launch this app?

A: We started it about a year ago. I find that very exciting. The app is called Babyscripts.

Q: What inspired you to launch this app?

A: We used to have prenatal classes, but with COVID we couldn’t get our wives together anymore. We had looked for ways to provide them with education without having to bring them to the clinic. Even putting on a zoom band can be tricky because some people don’t have the time or the technology. So, when we looked at alternatives, we decided to create this app.

Q: Are prenatal classes back?

A: We haven’t brought it back yet. We are only using the app for now. Now that the levels (of COVID cases) are lower, we could go back. But our space for classes is used to do the COVID vaccines. So we don’t have room at the moment.

The second thing we are doing is a study on liver disease. So if you look at the statistics, liver cancer is on the rise. Historically, this has been due to hepatitis B or cirrhosis. but now you see an increase in liver cancer due to what are called metabolic diseases: diabetes, hypertension, overweight. All these factors and eating habits cause the liver to become very fatty. When it gets greasy, it gets hard, which is a precursor to liver cancer.

However, it is very difficult to identify people at risk for liver cancer unless they are already sick, if they already show symptoms of liver problems, and it is usually too late. So we do research using a machine called FibroScan. And a FibroScan is an ultrasound of the liver that can measure liver stiffness. So we’re looking at how a primary care physician can quickly identify any changes in the liver. The second part of our research, which will be an intervention. It will lead to dietary and lifestyle changes.

Q: Where are you in the process of this project?

A: We started this pre-COVID and we still have two years to go.

Q: Has COVID slowed down the process?

A: Yes, it slowed him down a lot. This slowed down people signing up and getting them to come for FibroScan. We were trying to limit the number of patients in our clinic. But now our patients are vaccinated and our staff are vaccinated so we can get it going again.

Q: Why are you studying liver disease specifically?

A: This has a lot to do with our work around hepatitis B (a type of liver infection). Many years ago when I joined the Hope Clinic, I knew there was a great disparity in the Asian American community with Hepatitis B.

The third project is our Bite of Hope project, which is our culinary program. This is our way of taking preventive measures. We work with healthy people. We work with restaurant owners and students in schools. We are the only clinic in Houston, and possibly even the country, that has a chef on staff.

We worked with a group of small mom and pop businesses during COVID that were sinking. We have worked with these restaurants to help them change their culture. Our chef helped them review their menus and taught them how to replace sugars and replaced some of the starches with healthier plant-based options, while keeping the flavor. We started with eight restaurants last year and currently have over 50 restaurants that have gone through this transformation process.

Q: What made you want to work in a federally licensed health center?

A: I like FQHCs because they strike the perfect balance between federal government involvement in supporting patient health, patient paying because it’s not free care, and community involvement because that we receive donations and grants from other organizations. Everyone contributes. I love it because it’s not just when you’re sick, we provide comprehensive patient care.

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