Kentucky Racing Health Services Center
Background & Goal
Low wage and demanding independent contractor jobs such as assistant trainers, grooms, hot walkers and stable workers are essential to Kentucky’s thoroughbred horse racing industry. These migrant jobs which require workers to follow the horse racing circuit, spending the majority of the year in Kentucky, and then traveling to other states in the winter and summer months. As independent contractors earning on average $15,000 a year, health insurance is neither provided nor affordable. For those on work visas, government health assistance is not an option, leaving the emergency room as their only source for primary care. A significant percentage of this population is Hispanic and Spanish speaking, unfamiliar with the language and surrounding culture. The demands of the job, often beginning at 4:00 a.m. seven days a week, coupled with isolation from loved ones, takes a toll on the physical and mental health of the migrant racetrack worker. Beginning in 2005, Dr. Whitney Nash, PhD, APRN and the Kentucky Racing Health Services Center began to address the multiple barriers to care confronting this vulnerable population. Founding Director Nash, joined by KRHSC’s current Director, Sara Robertson, DNP, APRN have made it KRHSC’s mission to provide the full spectrum of primary care to these workers and their families, including primary and secondary prevention of chronic diseases such as diabetes, hypertension, hyperlipidemia and asthma.
Drs. Nash and Robertson’s KRHSC is a not for profit nurse-designed and nurse-staffed clinic. Four primary care nurse practitioners work on a rotating basis, with one nurse practitioner consistently at the clinic during operating hours. In addition, KRHSC employs a women’s health nurse practitioner and a psychiatric nurse practitioner to enable comprehensive care at one location. Since physical and financial accessibility is essential for these patients, the clinic is located one block from Churchill Downs and visits are a flat rate fee of $5.00, which includes lab work. KRHSC’s care model embraces holistic, patient-centered care which includes health education and prevention, as well as health screenings and disease management. To achieve its mission, KRHSC fostered two critical affiliations – one with the Kentucky Racing Health and Welfare Fund and the other with the University of Louisville. The Kentucky Racing Health and Welfare Fund, a not for profit entity dedicated to providing medical, dental care and retirement benefits for workers in the thoroughbred industry, provides funding to KHRSC derived from uncashed pari-mutual tickets at horse racing tracks throughout Kentucky. KRHSC’s second affiliate, the University of Louisville, coordinates with KRHSC to give students, including community nursing, nurse practitioner, Spanish language, pre-nursing, pre-medicine and medical students, as well as dental residents, the opportunity to improve patient care while advancing their skills.
Evidence of Success
KRHSC has improved access to quality care by serving 1500-1800 patients a year who, without the clinic, would either turn to the emergency room for intermittent care or forgo care altogether. To identify and treat their patients’ needs, KRHSC’s nurse practitioners order approximately 2400 laboratory tests annually, free of charge with the $5.00 flat fee, and write approximately 2700 prescriptions. KRHSC manages 30 to 35 diabetic patients at any one time, all having received an HbA1C test within the year they present to the clinic. Of these patients, 94% are prescribed metformin (or have a documented contraindication), 91% are given a referral for a diabetic eye exam, and 84% have a documented foot exam. In addition, 86% of pre-diabetic patients with an HbA1C of 6 or higher take metformin as compared to the industry average of 24%. The women’s health nurse practitioner sees approximately 240 patients a year, with 37% of these patients receiving a pap smear, and the psychiatric nurse practitioner sees about 125 patient visits a year. Notably, this increased access of care is achieved with cost savings. During the five year period prior to the opening of KRHSC, the Kentucky Racing Health and Welfare Fund expended an annual average of $629,000 to outside, independent medical providers and labs to care for workers within the horse racing industry. Since KRHSC’s opening in 2005, the Kentucky Racing Health and Welfare Fund has experienced an increase in cost savings which follows the shift of these patients away from outside, independent providers and labs to the KRHSC clinic. During the first 5 year period following the opening of the clinic, Kentucky Racing Health and Welfare Fund expensed an annual average of $567,000 for medical providers and lab expenses, equating to a 10 percent reduction in cost. During the second 5 year period since KRHSC’s opening, provider and lab costs dropped to $433,000, representing a 24% decrease from the first 5 year period.