Optometry (2008) 79, 594-602

History of community health center affiliations with TheNew England College of Optometry

Roger Wilson, O.D., and Vandhana Sharda, O.D.

The New England College of Optometry, New England Eye Institute, Boston, Massachusetts.

KEYWORDSThe New England

College ofOptometry;

Community healthcenters;

Clinical education;Academic affiliations

AbstractBACKGROUND: Since the 1970s, The New England College of Optometry (NECO) has been a leaderin community-based educational programming. This was accomplished through the development ofaffiliation agreements with health care facilities that care for the underserved, notably communityhealth centers (CHCs). The college’s clinical system, the New England Eye Institute (NEEI), developsCHC programs, manages professional services agreements, initiates teaching affiliation agreements,and leads staff recruitment and retention efforts.OVERVIEW: CHC collaborations, which effectively address disparities in access to health care andvisual health status, represent a significant component of the college’s primary care clinical trainingvenues. Since their inception in 1972, these CHC academic–community partnerships have providedmore than 650,000 eye examinations to the underserved and have trained more than 3,200 graduatesin community-based eye care, interdisciplinary care management environment, clinical preventionstrategies, and population health.CONCLUSIONS: This report describes NECO’s longstanding success with CHCs, explains the scope ofpractice at CHCs, explains how students are involved in the CHCs’ eye care services, and discusses thevarious management and business arrangements. The benefits and challenges of CHC affiliations withoptometry schools and colleges are also discussed.Optometry 2008;79:594-602

Community health centers (CHCs) are multidisciplinaryprimary care ambulatory community-based and community-governed health care facilities. Community health centersprovide primary medical, referral, and enabling services topoor and underserved communities. They were initiallycreated as ‘‘neighborhood health centers’’ in 1965 by theOffice of Economic Opportunity to provide care to thenation’s poor and underinsured.1 Since 1996, health centersincluded a consolidated group of public and nonprofit

Corresponding author: Roger Wilson, O.D., New England Eye Institute,

The New England College of Optometry, 940 Commonwealth Ave., Suite 2,

Boston, Massachusetts 02215.

E-mail: wilsonr@neco.edu

1529-1839/08/$ -see front matter � 2008 American Optometric Association. A

doi:10.1016/j.optm.2008.06.004

community-based health care organizations, which aredefined within the Public Health Service Act.2 Many receivethe designation ‘‘Federally Qualified Health Centers,’’ whichentitles them to ‘‘cost-based’’ reimbursement through Medi-care and Medicaid.1 Community health centers are adminis-tered under the Bureau of Primary Care, within theDepartment of Health & Human Services’ Health Resourcesand Services Administration. Health centers are located in allstates and territories of the United States and share a commonmission to increase access to health and related services andto improve the health status of underserved populations in aculturally and linguistically competent manner. Health cen-ters are also defined by their governance structure in thatthe entity must have a governing board with the majority of

ll rights reserved.

Wilson and Sharda Public Health 595

board members being patients of the center. This form of ma-jority community governance assures that programs are re-sponsive to community needs.1

Health centers are ideal settings to deliver frontlineprofessional health care education. Over the years, severalhealth care professions and professional degree programshave established successful academic affiliations withCHCs. In the 1970s, the Forsyth School for DentalHygienists instituted a highly successful training agreementwith the Martha Eliot Health Center in Boston, Massachu-setts.3 In a 1999 article by Cooksey et al.,4 Illinois CHCswere surveyed to assess the extent of academic affiliationsfor professional health care training programs. That reportindicated that nursing, medicine, physician assistant, socialwork, pharmacy, and other health care–related disciplines,with the exception of optometry, had training programs atIllinois CHCs. More recently, Brown et al.5 described aca-demic affiliations between community and migrant healthcenters and schools and colleges of pharmacy. This articlereported that one third of the 1,260 CHC/migrant healthcenters had affiliation agreements with academic pharmacyprograms, with more than 50% of the nonaffiliated CHCsexpressing a desire for establishing similar academic–CHC pharmacy programs. The benefits cited for havingan affiliation with a school or college of pharmacy includedon-site education for students, staff, and patients, recruit-ment of potential future workforce, and having studentsserve as part of the CHC provider staff.

Optometric clinical education training programs at CHCsis not a new model, having begun in the early 1970s in Bostonat The New England College of Optometry (NECO). At thattime a decision was made to broaden the clinical educationfor students and increase practice opportunities for faculty byreaching out to the community and forming academicaffiliations with community-based programs, with an em-phasis on CHCs. This article reviews the history of NECO’sCHC affiliations and describes the successes and mutualbenefits derived from these enduring community–campuspartnerships.

Optometric education and the clinicalsystem of The New England College ofOptometry

In 1972, NECO signed its first affiliation agreements with 3Boston area CHCs, including the Dimock Center, the Dor-chester House Multi-Service Center, and the South EndCommunity Health Center. In these first affiliations, thecollege contributed the ophthalmic equipment to establishthe eye service and provided faculty at no or little cost to theCHC to serve as attending optometrist(s). This was possiblebecause of federal grants that were being awarded to thecollege at that time. Because of less stringent laws pertainingto compliance and privacy, some aspects of the program wereshared, notably records and revenues. At that time, uncom-pensated care was commonplace, with little or no emphasis

placed on the patient’s insurance status or ability to pay forservices.

A 1976 article by Charles F. Mullen, O.D., described thechanges to the clinical system of NECO as follows: ‘‘Theclinical system was charged with the educational respon-sibility of developing optometric students into competentpatient care professionals who could apply scientificknowledge, tempered by clinical insight and overall con-cern for the patient.Coincident with this education mis-sion, was a commitment to providing eye care to indigentand inner-city residents who either could not afford to meetthis health need or were unable to do so.’’6 Dr. Mullen’scontributions to the development of NECO’s community-based clinical system laid the foundation for the college’sfuture enduring successes with CHCs.

Eventually, as was true of the other services offered at thehealth center, the eye clinics became fully owned andoperated by the CHC, with the center assuming responsibil-ity for all aspects of the program. This encompassed theownership of equipment and its maintenance (NECO oftenmade a donation of the original equipment initially placed atthe health center), administrative aspects of the practice,medical records, billing for services, and collection ofrevenues. NECO’s formal relationship with its CHC affiliateshad changed, with a ‘‘blended’’ affiliation agreement havingbeen developed to cover the terms of both faculty appoint-ments and responsibilities to the center and the teachingprogram. By the 1980s, NECO began negotiating moreformal annual professional services fees with CHC to cover anominal portion of the faculty salary expenses. In thismanner, both organizations continued to benefit; CHCswere able to provide patients with professional eye servicesof the highest quality at a reasonable cost, enabling NECO tobenefit from the opportunity to train its students in a settingwith a large number of patients from diverse backgroundsand complex health care, eye care, and social needs.

In 1994, Hoffman et al.7 reported on the state ofNECO’s CHC affiliations and relationships. By that year,the number of CHC programs affiliated with NECO hadgrown to 10. The mid-1990s also saw other changes tothe college’s clinical education approach with CHCs.NECO began to assign some third-year students to a part-time clinical rotation alongside the fourth-year students.By the end of the 1990s, some second-year optometry stu-dents were also assigned to clerkships, and by the year2000 some first-year students were assigned for clinical ob-servations of both optometrists and primary care physi-cians. To complete the 1990s comprehensive clinicaleducation reform initiatives at CHCs, NECO began its firstCHC-based residency programs. The Dimock Center’s res-idency was established in 1994, and the Dorchester HouseMulti-Service Center residency began in 1995. Both ofthese programs have since been accredited by the Accred-itation Council on Optometric Education. Also in the 1990sthere were sufficient numbers of CHC affiliations in NE-CO’s clinical system to allow for all fourth-year studentsto be assigned to at least one 3-month full-time clinical

596 Optometry, Vol 79, No 10, October 2008

Table 1 Number and year of students and residents assigned in academic year 2007-2008 at each health center

Health center First year Second year Third year Fourth year Residents

Boston Health Care for the Homeless 36Codman Square Health Center 6 6 20The Dimock Center 10 15 24 1Dorchester House Multi-Service Center 6 20 1East Boston Neighborhood Health Center 15 25Geiger Gibson Community Health Center 8 20Joseph M. Smith Community Health Center 48 12 24Martha Eliot Health Center 2 10 15 10New England Eye Roslindale - NEER 12 45 4North End Community Health Center 2 8South Boston Community Health Center 12 25 16South End Community Health Center 6 6 8Upham’s Corner Health Center 3 4

rotation. NECO now mandates a full-time CHC rotation asa graduation requirement (see Table 1).

The 1990s brought about other changes to the affiliationagreement between NECO and the CHCs. The professionalservices fee base was re-evaluated, and the base fee wasreset such that it was approximately 40% to 50% below thesalary for a clinical faculty member. The CHC continued toreceive a financial benefit for contracting with NECO forstaff optometrist(s), and the college was beginning to coversome of its personnel expenses while assuring ongoingaccess to large numbers of patients for its students.

During this era, rather than a unified NECO–CHCstrategic approach to workforce, each center’s eye careservice had evolved based on what the CHC leadershipteam and governing boards felt were in their best interests.Some CHCs preferred to hire their own staff optometrists,whereas others preferred the NECO professional servicescontract mechanism. Thus, by the end of the 1990s, eventhough all CHC affiliates had a formal teaching affiliationagreement in place, some CHCs had NECO facultyappointed to them (via the professional services agree-ment), and some had their own employed optometrists whohad NECO adjunct faculty appointments. In this mannerNECO ensured the quality of teaching for its students.

Hoffman et al.7 were prophetic by speculating about thefuture significance of CHCs to NECO’s mission of commu-nity-based clinical care and education by noting: ‘‘ManyBoston hospitals are familiar with the NECO–health centerrelationship and collaborative programs. As hospital–healthcenter partnerships evolve and health care reform is imple-mented, NECO and the neighborhood health centers willbenefit from their record of productivity, compatibilityand commitment. As partners, they will play an expandedrole in the delivery of primary care services. As we enterthe next century, NECO will continue its participation inthe Boston health care reform movement, ensuring the con-tinued training of its students and faculty, the well-being ofthe citizens of Boston and the advancement of the optomet-ric profession.’’7

In 2002, NECO’s Board of Trustees made a determina-tion that the complexities of delivering eye care, includingissues pertaining to potential professional liability claims,compliance with state and federal laws pertaining to healthcare, quality of care, patient rights, payer credentialing,clinical productivity, and clinical revenue cycle manage-ment, would be better served by creating a separate501(c)(3) corporation for its clinical system. This newlycreated subsidiary corporation was named the New EnglandEye Institute, Incorporated (NEEI). Under this structure,NEEI is wholly owned by the college. Furthermore, be-cause NEEI is a nonprofit health care organization, it isable to apply for certain types of grants that are not avail-able to a college. Although there are plans to merge thegoverning boards of NEEI and NECO to ensure NEEI rep-resentation on key college board committees, the separatelegal structure of NEEI will be preserved in order to focuson the patient care, clinical education, and community ser-vice aspects of the college’s mission.

NEEI has grown into an extensive clinical network, withmore than 45 fee-based (owned and operated) and contract-based (professional service agreements) practice locationsand programs. In 2007, NEEI organized into 3 distinctpatient care departments, with one wholly devoted torelationship management with CHCs and its principalhospital affiliate, Boston Medical Center (BMC). NEEI’swork with CHCs includes the negotiation and updating ofprofessional services contracts, arranging for teachingaffiliation agreements with NECO, professional staff de-velopment, professional credentialing for clinical privilegeswithin the NEEI network, assisting CHCs with payer panelcredentialing, new CHC program development, best prac-tice initiatives, sponsoring of seminars (such as for codingand billing), and personnel management including profes-sional staff recruitment and retention.

The college is responsible for the quality of teaching andclinical education at CHCs, faculty appointment andrecredentialing for the teaching appointment for all clinicalfaculty, quality of teaching, assignment of students to

Wilson and Sharda Public Health 597

Table 2 NECO/NEEI affiliation agreements at each health center in 2008

Health center Professional services staffing Teaching affiliation agreement

Boston Health Care for the Homeless x xCodman Square Health Center x xThe Dimock Center x xDorchester House Multi-Service Center xEast Boston Neighborhood Health Center x xGeiger Gibson Community Health Center x xJoseph M. Smith Community Health Center x xMartha Eliot Health Center x xNew England Eye Roslindale - NEER x xNorth End Community Health Center x xSouth Boston Community Health Center x xSouth End Community Health Center x xUpham’s Corner Health Center x

clinical rotations at CHCs, postgraduate residency pro-grams at CHCs, faculty development pertaining to clinicalteaching, and assisting CHC-based faculty in educationalplanning at their facilities. Thus, with NEEI and NECOworking in concert, there is an appropriate balance betweenstriving for excellence in patient care and excellence inclinical education at CHC affiliates.

The teaching affiliation agreements, managed out of thecollege’s academic affairs offices, have evolved into dis-tinctly separate legal documents, with specific languagepertaining to how students are appointed to CHCs and howprofessional liability coverage extends to clinical teaching byoptometrists who have faculty appointments (regardless ofemployer). This approach clarifies the differences betweenresponsibilities of the optometrist(s) as professional staffmembers (outlined within the professional services agree-ment) versus teaching responsibilities as clinical faculty.

There were also compelling legal reasons that necessi-tated distinguishing between caring for patients and clinicalteaching. The involvement of students in patient careremains strong, with students being able to conduct mostof the examination testing and procedures. Attendingoptometrist faculty are fully responsible for patient careand directly supervise each patient encounter, as with anyother clinical education program.

Regarding professional staffing, in 2008, 9 of the 13CHC affiliates hire and appoint 100% of their professionaloptometric staff via an exclusive NEEI professional ser-vices agreement, 2 hire nearly all of their optometric staffdirectly while contracting a small component of staffingwith NEEI, and the remaining 2 programs exclusively hiretheir own optometrists, with no NEEI staffing relationship.Every CHC staff optometrist, regardless of employmentstatus, has a faculty appointment with the college (seeTable 2).

The Massachusetts League of Community Health Centersestimated that between 1972 and 2007, NEEI’s CHC affil-iates have provided approximately 650,000 eye visits. These

affiliations have also enabled NECO to train approximately3,200 optometric graduates in the field of community-basedeye care (Hunt JW Jr. [president and chief executive officer ofthe Massachusetts League of Community Health Centers],personal correspondence to Elizabeth Chen [president, TheNew England College of Optometry] September 11, 2007).In 2008, NECO’s CHC affiliations numbered 13, with 3 addi-tional CHC programs in development. All 13 have teachingagreements with the college, and 2 have optometric residencyprograms under the category of ‘‘Community Health Optom-etry,’’ which was recently added by Association of Schoolsand Colleges of Optometry (ASCO) in 2006 (Wall M [exec-utive director of the Association of Schools and Colleges ofOptometry], personal correspondence to Wilson R [vicepresident, Health Center Programs, New England Eye Insti-tute] Nov 26, 2006) (see Table 3).

NECO continues to benefit in many ways from itslongstanding relationships with CHCs, especially becauseCHCs enable the college to train students in settings inwhich specific public health curriculum components can beboth practiced and experienced. Indeed, according to theNational Association of Community Health Centers, CHCstake a proactive stance in addressing health disparities bydeveloping strategies to identify, confront, and respond todisparities in access and health status.8,9 The college placesgreat importance on training its graduates to engage incommunity service and public health awareness efforts intheir practice settings. NEEI’s mission is devoted to im-proving the visual health of populations through collabora-tive and community-oriented patient care, education, andresearch. The college views that health centers are at theleading edge of public health initiatives aimed at improvingthe health status of communities. Thus, CHCs are viewed asideal partners to meet some essential curriculum goals. Theprinciples of healthy community concepts10 and clinicalprevention and population health11are common strategiesused by health centers and are in harmony with curriculumobjectives at the college.

598 Optometry, Vol 79, No 10, October 2008

Table 3 Health center visits for fiscal year 2007 and scope of on-site eye services

Health CenterAnnual visitsto eye clinic

Full scopeeye care Optical Ophthalmology

Pediatricspecialty care

Contactlenses

Lowvision

Boston Health Carefor the Homeless

1,600 x x

Codman Square Health Center 5,000 x x x x xThe Dimock Center 8,500 x x x x xDorchester House

Multi-Service Center9,000 x x x x

East Boston NeighborhoodHealth Center

10,000 x x x x

Geiger Gibson CommunityHealth Center

2,000 x x

Joseph M. Smith CommunityHealth Center

2,500 x x

Martha Eliot Health Center 3,000 x x xNew England Eye

Roslindale - NEERN/A x x x x

North End CommunityHealth Center

1,919 x x x x

South Boston CommunityHealth Center

6,000 x x x x x

South End CommunityHealth Center

3,000 x x x x x

Upham’s CornerHealth Center

1,500 x x x

Boston area community health centeraffiliations in 2008

Boston CHCs continue to operate as primary care multi-disciplinary health care facilities, with comprehensivepatient care services delivered using a variety of adminis-trative and business models. Some CHCs maintain free-standing independent status with nonexclusive referralrelationships to local area hospitals for advanced care andsurgery cases. Others are more formally affiliated with

hospital partners and academic medical centers, sometimeseven operating as a department of the hospital, whereasothers operate under the license of a hospital affiliate butmaintaining relative independence.

Even as CHCs have evolved and become more main-stream as health care organizations, NECO and NEEIhave maintained and strengthened their relationships (see Ta-ble 4 and Figures 1-3). Professional services’ contractingwith NEEI is in yet another new phase of development, con-sistent with changes in health care management. It is

Table 4 NECO/NEEI-affiliated Boston area health centers

Health center Web site

Boston Health Care for the Homeless www.bhhchp.orgCodman Square Health Center www.codman.orgThe Dimock Center www.dimock.orgDorchester House Multi-Service Center www.dorchesterhouse.orgEast Boston Neighborhood Health Center www.ebnhc.orgGeiger Gibson Community Health Center www.massleague.org/MACHCs/HHS.htmJoseph M. Smith Community Health Center www.jmschc.orgMartha Eliot Health Center www.childrenshospital.orgGreater Roslindale Medical and Dental Center

(New England Eye Roslindale - NEER)www.roslindale.orgwww.newenglandeye.org/roslindale

North End Community Health Center www.massgeneral.org/northendSouth Boston Community Health Center www.sbchc.orgSouth End Community Health Center www.sechc.orgUpham’s Corner Health Center www.uphamscornerhealthctr.com

Wilson and Sharda Public Health 599

common practice for NEEI senior management to meet withthe senior managers of the CHCs to negotiate and developjointly agreed-upon performance agreements for the eye ser-vice, including productivity goals and revenue targets. Thechief executive officer, chief medical officer/medical direc-tor, chief operating officer, and the chief financial officer ofthe CHC are typically at the table. Legal counsel reviewsthe agreements before final approval and signatures.

In an attempt to assure continuing success linked to thenegotiated goals for the eye care programs, NEEI often

Figure 1 Martha Eliot Health Center.

Figure 2 Codman Square Health Center.

charges the CHC an administrative retainer fee, which isusually embedded into the professional services agreement.The CHC pays the retainer fee to NEEI to secure the servicesof certain professional staff optometrist(s) from NEEI withan associated expectation that the NEEI optometrist willwork with the CHC leadership team to achieve the agreed-upon goals. NEEI then negotiates its employment contractswith its professional staff to include an administrativestipend, which is paid in addition to base pay, for meetingor exceeding the agreed-upon goals for their CHC eyeservice. According to the terms of the NEEI contract withits optometrist(s), the administrative stipend remains in placeas long as the optometrist agrees to work at the CHC as aNEEI optometrist and as long as the CHC agrees to pay theadministrative retainer fee to NEEI. In this manner allstakeholders participate in the establishment of goals andthe subsequent success of the CHCs’ eye care service.

Other clauses under development in the professionalservices agreement include performance compensationeligibility, bonuses and language discouraging the directnegotiation of employment between an NEEI optometristand the health center.

Even though the majority of CHC optometrists areemployed by NEEI, some centers offer performance com-pensation and bonuses to their staff. In the revised agree-ments, NEEI requires any eligibility and payouts forperformance compensation and bonuses to be paid directlyto NEEI and NEEI then rewards its staff accordingly.Finally, in the past, some CHCs and NEEI optometristsentered into nonsanctioned direct-employment negotia-tions. The new professional services agreement and theappointment letters to NEEI staff both expressly forbiddirect employment inquires from either party.

NEEI and the academic medical center linkto CHCs

In 2004, NEEI developed another component to its profes-sional services staffing, this time strategically linking NEEI

Figure 3 Optometric intern examining a patient at Codman Square

Health Center.

600 Optometry, Vol 79, No 10, October 2008

with BMC, the principal hospital affiliate of many Boston-area CHCs. This was accomplished through negotiating aprofessional staffing agreement with the chairman of theDepartment of Ophthalmology at BMC. NEEI professionalstaff optometrists provide full scope eye care within thedepartment’s faculty practice plan, providing adult com-prehensive care, pediatric care, advanced contact lenspractice, and low vision care to BMC’s patients. Theoptometrists have staff appointments in the Department ofOphthalmology and are fully credentialed providers withinthe BMC system. (NEEI optometrists who work at theCHCs that operate under BMC’s license also have BMCstaff appointments and appointments to the Department ofOphthalmology.) Thus, NEEI and BMC have collaboratedat both the frontline level of care (CHCs) and at the level ofthe academic medical center (BMC) to assure that patientshave access to and continuity of the highest quality of careoffered by both professions.

BMC has become a key collaborator with NEEI, enablingseveral NEEI practice locations to add new or additionalaccess to on-site comprehensive ophthalmology and intro-ducing on-site subspecialty ophthalmology services to someof NEEI’s CHC affiliates. The BMC relationship betweenCHCs and NEEI plays an important role for CHC patients,acting as a bridge for CHC patients between primarymedical care services and advanced medical and surgicalservices. By fostering a patient-centered collaboration,NEEI, CHCs, and BMC have strengthened access to a fullscope of eye care services to Boston’s most needy residents.This unique collaboration has also allowed the college’sstudents, residents, and optometric faculty to benefit fromexposure to a wide range of clinical and social problems,including the co-management of complex patients withadvanced medical and surgical needs with their colleaguesin ophthalmology.

Blended business models could be thefuture of CHC affiliations with NEEI

In 1997, a marketing study commissioned by a greaterBoston area health center identified eye care services as oneof the most desired programs requested by the center’spatients (unpublished data). The health center, GreaterRoslindale Medical and Dental Center (GRMDC), a healthcenter that was technically structured as a department ofBMC, was planning a new 2-story building in the heart ofthe neighborhood’s thriving square, with the health centerto be located on the top floor of the facility. The entire firstfloor of this highly visible, centrally located building was tobe left unfinished, with the hope of enticing a complemen-tary (but noncompeting) health care partner, ideally eyecare. In 2002 and 2003 the health center’s governing boardmade the bold move to deploy its resources out of the upperfloor, anticipating that its tenant–partner would be respon-sible for the build out of the first floor. This ideal streetlevel location, along with the appeal of an ‘‘upstairs’’

referral opportunity from GRMDC, and the prospects of ahighly favorable long-term lease arrangement was thehealth center’s strategy for attracting potential partners.

During 2002, NEEI conducted a strategic planningretreat. In conjunction with key stakeholders from thecollege community, students, and affiliate constituents,NEEI’s senior management team developed a strategicplan that included meeting clinical program needs throughfurther growth in the clinical system. As part of theplanning process, need for additional clinical placements,particularly for third-year students, emerged as one of themost critical issues. To meet this need, it was concludedthat efforts should be directed toward owning anotherclinical facility (in addition to the college’s principalclinical practice, which already served as the primaryplacement location for third-year students). There was anadditional planning goal to adding this new practicesitedthat it somehow be linked to a multidisciplinaryhealth care entity to assure a high level of cross referrals.

Thus, in early 2003, NEEI’s Board of Directors madean initial inquiry to the governing board and executivedirector of GRMDC, with a request to discuss adding eyeservices to the health center’s first floor. Once that initialcontact was made, NEEI management and health centermanagement embarked upon the negotiation of terms forthe program. The final terms included NEEI having along-term lease for the health center building’s entire first-floor space, NEEI’s agreement to build out the space for acomprehensive eye service to be owned and operated byNEEI, and a Clinical Collaboration Agreement to besigned by NEEI, GRMDC, and BMC to assure the qualityof the patient care relationships. In 2007, having workedin concert with NEEI’s board of directors and ultimatelythe college’s board of trustees, NEEI negotiated the finalterms of the project, commenced the build out, andopened New England Eye Roslindale (NEER) in mid-2007.

NEER became NEEI’s first wholly owned and operatedfull-scope eye care program located within a CHC. Toassure a seamless provision of health care and services, theClinical Collaboration Agreement laid out a framework ofcooperative and collaborative initiatives between NEEI,GRMDC, and BMC to assure ease of access to all servicesfor local area residents, without regard to insurance statusor ability to pay and in compliance with all state and federallaws. NEER offers the full scope of eye and vision careservices, including comprehensive eye care and a full-service optical. On-site consultative ophthalmology ser-vices are being planned in collaboration with BMC.

Because NEEI wholly owns the eye care practice, NEEIis free to market its services to the community and acceptany person as a patient. NEER serves patients of GRMDCand the surrounding community. To further assure itssuccess, NEEI contracted with a marketing consultant todevelop and oversee the implementation of a professionalmarketing approach at NEER. Monthly marketing meetingsare held with the consultant, the director of eye care at

Wilson and Sharda Public Health 601

NEER, and NEEI senior management. As a result, NEERand its staff are highly visible in the community, beingmembers of numerous community groups, presenting pa-tient education programs throughout the community, andproviding screenings to local area school children.

As planned, NEER serves a significant role for NECO’sthird-year clinical program, providing the college with 24%of all third-year CHC clinical placements as well as servingas a site where fourth-year students rotate for low visionexperience. Because of NEEI’s strategic approach to col-laboration and marketing, NEER has proven to be im-mensely popular, both with providers at GRMDC and localarea residents. NECO students are finding NEER to be anideal setting to learn both patient care and best practicestrategies for a ‘‘start-up’’ practice, as well as learning howto effectively interact with a community and build apractice.

Because the NEEI and NECO boards were cognizant ofthe benefits relating to the college owning and operatingclinical facilities, the opening of NEER was viewed as animportant turning point for how NEEI may collaborate withnew CHC partners. Ownership of the practice enables thecollege to have greater control of the setting and increasedflexibility in educational programming, such as designatingNEER as a mostly third-year venue. Finally, NEER’sopening and its success is contributing to and strengtheningthe diversification of the revenue sources generated withinNEEI.

Summary: The benefits and challenges ofCHC affiliations

Academic affiliations with CHCs can serve an importantfunction for schools and colleges of optometry, especiallythose that are trying to grow patient numbers for theirstudents. Health centers are extremely busy health carefacilities, which offer a pure form of interdisciplinary careand team-oriented patient care management. Training insuch an environment is an ideal venue to work withmultiple disciplines, to hone clinical skills, and to gainboth competence and confidence in working with diversepopulations. Thus, affiliations with health centers enable aschool/college of optometry to develop a more diversifiedportfolio of clinical programs, thereby strengthening clin-ical education offerings and clinical services delivery.

The professional services contracting/staffing modeldeveloped by NEEI has served the college well for morethan 36 years, enabling health centers to provide a neededservice to its patients by expert clinicians. These affiliationsrequire strong leadership, constant communication, ongo-ing relationship management, and a commitment on thepart of the educational institution to work in a collaborativefashion with the CHC so that both parties benefit from therelationship. Mutually agreed-upon management decisionsand working together as peers are the keys to successfulcollaborations.

The primary risk to the professional services contractingagreement may indeed be the CHC’s own belief of how itshould execute its mission to provide the highest quality ofcare. Many CHCs equate high quality to mean that teachingprograms should be of limited scope, with a preference forpatients to be cared for directly by a health center–employed provider. Although NECO and NEEI have hadgood success at integrating optometry students into theCHC workforce, recently some affiliates have reduced thenumber of student slots. Others have limited the numbers ofless-experienced students (favoring fourth-year students),and some CHCs have chosen to move to a direct-caremodel with their own employed optometrists.

The direct employment and direct care model is perceivedto be the most significant challenge for the college’s CHCprograms going forward. Although health center adminis-tration and governing boards still favor having teachingprograms on-site to make contributions to workforce devel-opment, the trend may be toward a combined teachingprogram–direct care model. This would result in an overalldecrease in the number of clinical placement slots anda decrease in the number of optometrists appointed via aprofessional services agreement. Thus, schools and collegesof optometry that collaborate with a CHC should endeavor todevelop binding legal agreements, including clauses thatallow for appropriate planning in the event of a CHC’sdecision to scale back its commitment to a teaching programor contracting arrangements.

Perhaps a better model to adopt is the establishment ofcollege-owned and operated eye care programs housed inCHCs, much like the NEER model described in this article.NECO and NEEI made the decision to further diversify CHCaffiliations through this model as with the recent opening ofNEER. This was a strategic decision to secure the college’sfuture ability to train students in a CHC environment. Thebenefit to this model is that ownership of the program liessquarely with a school/college, thereby strengthening theability to control the clinical care and teaching environments,developing educational programming to the greatest benefitof the academic program. If NEER continues to be success-ful, NECO may very well look at other CHC partners todevelop similar programs.

The New England College of Optometry has been ableto effectively meet its clinical education and servicemissions by collaborating with community-based organi-zations, notably CHCs. Health centers represent a signifi-cant percentage of the college’s local teaching affiliates,uniquely providing the cornerstone of comprehensive pri-mary care clinical education experiences for all of itsstudents. Furthermore, CHCs offer the opportunity to teachand practice public health principles and cultural compe-tency. Students benefit from the vast array of challengingand complex patient problems, which are often multisystemand advanced in nature because many CHC patients havenever had appropriate health care. Faculty optometrists findCHCs an ideal practice environment. The numbers ofunique clinical cases and the challenges of administration

602 Optometry, Vol 79, No 10, October 2008

have enabled faculty to develop professionally and con-tribute to the literature of community-based scholarship andhealth services research. As CHC professional staff, theyroutinely participate in medical staff meetings, manage-ment meetings, outreach activities, and community events.

Finally as with other professional degree programs(notably in medicine12,13), it is the college’s hope that thepublic health outreach programs implemented by CHCsand its graduates’ exposure to unique populations will con-tribute to optometric workforce development for under-served areas across the nation.

References

1. Taylor J. The fundamentals of community health centers. National

Health Policy Forum, background paper, August 31, 2004. Available

at: http://www.nhpf.org/pdfs_bp/BP_CHC_08-31-04.pdf. Last ac-

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