Born in Las Vegas, Jamie Ware has traveled the country to learn and to advocate for public health. Now she has roots in Philadelphia, working as director of policy and member relations at National Nursing Centers Consortium (NNCC), a PHMC affiliate.

After earning an undergraduate degree in social work from Arizona State University and a master's degree in social work administration from University of Washington, she did union and political organizing in Washington State and in Nevada. “I worked for four years for the Service Employees International Union (SEIU) with health care providers in hospitals, public health departments and nursing homes, and with those providing in-home care. I helped them with moving policy and with contract enforcement,” she says.

Ware wanted to become a more effective advocate by becoming a lawyer. She moved to Philadelphia and enrolled in Temple University's Beasley School of Law, and soon after she landed her first summer internship at NNCC. She was a legal fellow at the Center for Health, Law, Policy and Practice at Temple University, and helped establish the Center. In January 2011, NNCC hired her as director of policy and member relations.

NNCC is the leading advocate for nurse-managed health care. Founded in 1996, NNCC strengthens the capacity, growth and development of nurse-managed health centers, provides quality care to vulnerable populations and helps eliminate health disparities in underserved communities. NNCC advocates for accessible health care through nurses as primary providers of health care.

Public Health Directions asked Ware about her job, the role of nurses and nurse-run health clinics, and what she would like the future to be.

Can you describe your current job as director of policy and member relations at NNCC?

I stay on top of the federal issues that impact nurse-managed clinics and the care that they provide for their patients. Also, I stay in touch with our membership to help them be aware of changing policies and nursing opportunities related to the Affordable Care Act.

How did your education and prior work history prepare you for the work you are now doing?

My work with SEIU introduced me to health care and healthcare policy. After my experience there, I wanted to get a better understanding of how law was created and interpreted in a courtroom and by regulatory bodies, so I enrolled in law school. I chose Temple University’s Beasley School of Law because it had the health law curriculum I was looking for and professors who are experts in health law, policy and practice. My first internship in law school was at NNCC. I was able to stay on at NNCC doing grant writing and policy work, then was offered my position as policy and member relations director.

Time and time again, nurse practitioners show that they provide care that rivals the care provided by physicians.”

How many nurse-managed clinics are there in Pennsylvania and Philadelphia?

There are 32 in Pennsylvania and 13 in Philadelphia, with four operated by PHMC.

What role do nurse practitioners play in operating health clinics and how has the field of nurse practitioners grown?

Nurse practitioners, and also nurse midwives, run over 200 primary care and wellness clinics across the nation that serve the underserved and uninsured. Today nurse practitioners are the fastest growing sector of primary care providers in the country.

Have you compared services in nurse-run clinics with services in physician-run centers, and what was the outcome?

Time and time again, nurse practitioners show that they provide care that rivals the care provided by physicians. Additionally, nurse practitioners score very high in overall patient satisfaction. In the Philadelphia region, nurses see their patients almost twice as often as other providers; their patients are hospitalized 30 percent less and use the emergency room 15 percent less often than those of other health care providers. This makes it clear that nurse practitioners play a critical role in the care of our communities.

Describe your achievements in the policy arena
and what you are working on now.

NNCC’s policy achievements have really been amazing considering the organization’s small staff. I think it is a testament to the leadership of our chief executive officer and NNCC’s ability to build strategic relationships. Two of the achievements we are most proud of occurred in 2007 and 2010. In 2007, NNCC worked with other state nursing groups to help Governor Rendell pass comprehensive healthcare reform in Pennsylvania. NNCC led the effort to get key language included in the bill that gives the state’s nurse practitioners and nurse-managed health clinics the freedom to provide better care to their patients. For example, the bill removed the requirement that a physician has to sign off on certain tests and referrals ordered by nurse practitioners in nurse-managed health centers. This is important because prior to the passage of the bill patients receiving referrals from nurse-managed health centers would have to schedule another appointment with their doctor just to get the referral signed, which can be extremely expensive. The bill saves nurse-managed health centers’ patients and providers a lot of money.

In 2010, NCCC helped to win a major victory for nurse-managed health centers and nurse practitioners across the country. The policy team, working in conjunction with national nursing groups and key congressional champions, was successful in getting language included in the Affordable Care Act that created a federal grant program specifically for nurse-managed health centers. This program led to $15 million in grant funding for nurse-managed health centers. The clinics receiving these grants are expected to care for approximately 70,000 underserved patients and provide clinical placements for 900 student nurses by 2013.

Today, the team and I are working hard to make sure Congress continues to provide funding to nurse-managed health centers. It has been difficult because Congress is so focused on debt reduction. But we have come up with some new strategies, and I am confident that with the help of our members, we will continue to make progress.

If you had a magic wand,
what three wishes would you grant?

Right now, only around 50 percent of the nation’s insurance companies allow nurse practitioners to act as primary care providers in their provider networks. So the first thing I would wish for is greater recognition by the courts and the insurance industry that there is a fine line between the free market strategies of businesses and discrimination against able and willing providers. The courts need to distinguish provider discrimination from businesses practices, and force insurers to do the right thing, and credential nurse practitioners as primary care providers when appropriate. Not doing so restricts consumer choice and limits access to care for underserved patients.

Next, I would wish for a greater recognition on the part of the federal government that nurse practitioners are the future of primary care, and thus federal policy makers need to ensure that nurse practitioners are able to participate equally in all federal health reform initiatives, like accountable care organizations, patient-centered medical home demonstration projects and the new insurance exchanges. In some cases, nurse practitioners are not able to participate though they are legally qualified to do so. This is problematic for our clinics and for their patients, because it means that nurse-managed health centers will not have access to the enhanced reimbursement and payment incentives that go along with participation in these programs.

Finally, I would like to see more recognition on the part of the states that the primary care landscape can no longer be colored by provider interests. States need to change their laws and regulations so that nurse practitioners and other advanced-practice registered nurses can work to their full capabilities and training. This was one of the main recommendations of the Institute of Medicine’s report, The Future of Nursing. Allowing nurse practitioners to perform all the functions for which they are legally qualified is really the only way to expand the country’s primary care provider capacity. If the states do not take these steps prior to the full implementation of the Affordable Care Act in 2014, our primary care providers could quickly be overwhelmed by an influx of newly insured patients.

Get to Know Some of PHMC’s Nurses

PHMC’s primary healthcare centers offer affordable, high-quality care to patients in their communities throughout the Philadelphia area. They share a simple mission: to provide comprehensive health care, family planning, disease management, social services and more to men, women and children. “Nurses are at the forefront of primary care,” says Melissa Fox, PHMC’s managing director of health. “PHMC provides quality, compassionate care to patients at our five health centers.” In this issue of Public Health Directions, in recognition of National Health Center Week (August 5–11), we talked with three of the nurses whose dedication keeps our health centers running.

Donna Brian, CRNP

Position: Clinical director, PHMC Health Connection

Education: Simmons College, BSN; University of Pennsylvania, MSN, PhD

Why Nursing: I have wanted to be a nurse my entire life. It might be because my father died of lung cancer when I was young. Maybe that inspired me to want to take care of people. Whatever the reason, I was always very maternal.

Professional Challenge: Space has always been a challenge for PHMC Health Connection. Our current location is very small. However, we are moving in a year. We recently received a $1.1 million dollar grant from the federal government. We’ll be relocating to a new building going up at 9th and Berks Streets that will expand our examination rooms from three to 12.

Hobbies: I knit baby sweaters and hats for all of the new mothers at our health center. Singing is an important part of my life. I sing in a choir and my husband and I perform at coffeehouses and weddings. I also enjoy visiting my children in San Francisco.

Erika Shea, CRNP

Position: Family nurse practitioner, PHMC Care Clinic

Education: Temple University, BSN; University of Pennsylvania, MSN

Why Nursing: I like to help people. Also, I knew that as a nurse I would have a wide range of opportunities.

Why PHMC Care Clinic: I have been working at the PHMC Care Clinic for two years. There are many reasons I work there. For starters, I like PHMC. It’s a great company to work for. And I like working with the team at the Care Clinic. Additionally, working here, I can see patients with a variety of medical problems. Each day is different.

Professional Challenge: It’s challenging to deal with clients’ insurance issues. It’s also a challenge to have a lot of patients with drug and alcohol issues and we get quite a few patients who have complex psychosocial problems.

Hobbies: I like to read, swim with my kids, garden and go for walks.

Rebecca Neitheimer, RN

Position: Care manager, Rising Sun Health Center

Education: Temple University, BSN

Why Rising Sun Health Center: I started working as a flu nurse at Rising Sun Health Center in February 2010. I worked between here and PHMC Health Connection. I came to Rising Sun full-time as a care manager in April 2010. My favorite part of working here would have to be the patients. I really enjoy working with all of them. It’s very rewarding. I just applied for Temple’s Doctorate of Nursing Practice program. My ultimate goal is to become a family nurse practitioner. I was motivated by Rising Sun because it’s nurse-practitioner run.

Professional Challenge: Our patients often face many personal challenges. Sometimes we see drug abuse, alcohol abuse and family issues. It can be a challenge to help our patients help themselves. But we work together as a team to treat our patients.

Hobbies: I enjoy going to the beach and spending time with my family.

Introducing PHMC’s Health Center Patients

PHMC served more than 13,000 people in our network of health centers last year, offering primary care, social services, behavioral health services and more. Public Health Directions talked with three patients who receive their regular care from PHMC health centers and asked them why they chose PHMC.

Keith B.

Neighborhood: West Philadelphia

Healthcare Home: PHMC Care Clinic

Why PHMC Care Clinic: I love the PHMC Care Clinic. I have been going there since May 2011. When I needed HIV treatment, I went there. My clinician, Alvin Kingcade, is the greatest. He always takes his time with me and explains everything to me. He always wants to know what I’m thinking. I see him once a month and I also attend a support group every Wednesday. The Care Clinic is the best. Everybody knows my name. And it’s close enough to me that I can catch the bus there. I think it’s the best HIV care in town.

Donna W.

Neighborhood: Hatboro

Healthcare Home: PHMC Health Connection

Why PHMC Health Connection: In 2009 I found a lump on my breast and was given a clinical exam by Donna Brian. After I got diagnosed with stage three breast cancer, Donna helped me get health insurance and treatment from specialists at Albert Einstein Hospital. When I first went to PHMC Health Connection, I said, “I don’t have any money and I’m not working.” I was very scared when I got there. But everyone there was so friendly and nice. I really thought the experience there was wonderful.

Kathleen J.

Neighborhood: Olney

Healthcare Home: Rising Sun Health Center

Why Rising Sun Health Center: I have been going to the Rising Sun Health Center for the last three years. I go there because it is convenient—walking distance from my home—and I’ve always had a good experience. At Rising Sun Health Center, everyone treats me real special, from the front door to the back door. Six years ago, I was diagnosed with Type 2 diabetes, so I go to Rising Sun Health Center to help manage it. It’s a real struggle, bad habits are hard to change, but with the help of the staff at Rising Sun Health Center, I’m trying.

Meet Some of Our Therapists

The Behavioral Health Services component at PHMC encompasses 16 behavioral health treatment programs in the Delaware Valley. The mission of PHMC’s Behavioral Health Services component is to help people of all ages develop the knowledge, skills and supports necessary to recover from emotional and behavioral challenges, find purpose and meaning in their lives and achieve their full potential as individuals and as family and community members. PHMC’s Behavioral Health Services programs work individually with clients to address all aspects of their addiction, mental illness and/or abuse. Each program utilizes a comprehensive, holistic and culturally sensitive approach that focuses treatment on the emotional, physical and spiritual effects of recovery from addiction or mental illness. “PHMC is lucky to have some of the most talented therapists in the city,” says Leslie Hurtig, managing director for behavioral health at PHMC. “Day in and day out they help people of all ages to overcome major life challenges, including recovering from physical or sexual abuse, learning how to live without drugs or alcohol, or preparing to reunite with their children.”

Hilary Sees

Position: Residential therapist, The Bridge

Education: St. Joseph’s University, BS; Chestnut Hill College, MS

Why Therapy: I have always, even from a young age, been interested in child psychology. People fascinate me, especially children because they have an amazing ability to be honest about the world around them. In this field, we see children who go through a lot and it’s a great opportunity for me to offer a corrective, therapeutic response.

Why The Bridge: I’ve worked at The Bridge since 2008. I started out as a case manager, but I was also in school for my master’s degree in clinical and counseling psychology in the child and adolescent track. Then, I worked in outpatient therapy part-time, as my clinical internship, before joining the team as one of five therapists at The Bridge. I am one of two Spanish-speaking therapists. I’m really proud of the work we do here at The Bridge. It’s rewarding when the boys leave the program and still choose to have contact with us. Nearly all of the boys here are court-committed to be here, but when they leave they will still call to tell me how they’re doing and ask for advice.

Professional Challenge: It can be difficult to see a Bridge resident really thrive here and then return to the same environment. I’ve seen a few clients leave and get rearrested. Recently we also had two boys that left who got killed. That’s hard on us.

Hobbies: I like exercising outdoors, especially running on Kelly Drive and doing the Art Museum steps. I also love to cook. You may find me in the kitchen doing some cooking therapy [laughs].

Keri Bernhardt

Position: Therapist, Joseph J. Peters Institute (JJPI)

Education: College of New Jersey, BA; Massachusetts School of Professional Psychology, MA

Why Therapy: I’ve always wanted to help people. I grew up listening to people’s problems and figuring out how to best help them. Currently I am working with adults, specifically people with histories of sexually inappropriate behavior. It is a population that needs more help than they typically receive.

Why JJPI: I have been working at JJPI for two years and it’s rewarding to see the changes and progress that people make, especially when they meet personal and treatment goals. It’s encouraging to see that people can change and improve.

Professional Challenge: It’s a challenge to work with clients who lack support in their life.

Hobbies: I love reading and spending time with my nieces. I also love watching new movies.

CHANCES Therapist Team

CHANCES, a PHMC-run outpatient and intensive outpatient substance abuse treatment program, provides care for up to 100 women with children. “I have an amazing team,” says Colette Green, director of CHANCES. “They work very well together to problem-solve and help our clients.”

Nathalie Vallieres

Position: Therapist, CHANCES

Education: University of Pennsylvania,BA; Teachers College, Columbia University , MA, EdM

Why Therapy: After college, I started working in New York doing academic and social counseling with teenagers and I really liked it. So I decided to go back to school for counseling.

Why CHANCES: I have been working at CHANCES for four years and I really enjoy the women I work with. It is inspiring to see the strength in their stories and what they go through and continue to go through.

Professional Challenge: It’s tough to see my clients get influenced by outside pressures such as family members. But the therapists at CHANCES form a good team. We help and support each other. We all do really care about each other. It’s tough sometimes because we are all human and our work affects us. But we all go through it together and it helps to have support from coworkers.

Hobbies: I run. Exercising is great stress relief. I’m signed up for two marathons, the Dublin Marathon in Ireland in October and the Philadelphia Marathon in November.

Kimberly Doughty

Position: Forensic Therapist, CHANCES

Education: Shippensberg University, BS; Shippensberg University, MS

Why Therapy: My interest in therapy stems from my work in criminal justice and my interest in drug and alcohol work. I’ve always been a helper. I decided to go be that person that people could talk to. As a forensic therapist at CHANCES for the past year, I’m involved with the courts. I go to court weekly and stand on behalf of CHANCES clients who are court-stipulated.

Why CHANCES: I like the interaction with the women here, the people we serve. I also love the fact that we are a team here. We are a family. My coworkers are really supportive.

Professional Challenge: In the field of addiction – it’s difficult when you are faced with the relapse of the people you serve. But it’s rewarding when we can help them push through that roadblock.

Hobbies: I am getting back into running; I’ve signed up for the Philadelphia Marathon in November. I also like going to poetry readings and I like to go scarf shopping. That’s my signature piece.

Theresa Peronace MACP, SAC

Position: Therapist and family services Coordinator, CHANCES

Education: Temple University, BA; Arcadia University, MA

Why Therapy: My undergraduate degree is in biology and I was intending to apply for medical school. I attended medical school for six months or so, and I found myself more concerned with my patients’ emotional well-being rather than their physical symptoms. So I left medical school and applied to graduate school.

Why CHANCES: I started at CHANCES as an intern my third year of graduate school and then I started part-time as a family services coordinator. I have been here two years. I like working at CHANCES because it’s all women and children, I get to witness women empowering women and supporting other women. It’s really inspiring to see how dedicated they are to healing.

Professional Challenge: I always want to do more for the women than I can do. Addiction is a difficult disease. It’s tough because it makes me feel powerless myself. It’s a process where the women need to make the changes for themselves.

Hobbies: I love being outdoors. I’m recently engaged, so I like to spend time with my fiancée. We have two American bulldogs. I’m also a big book nerd.

Emily O’Hara, LSW

Position: Therapist, CHANCES

Education: University of Iowa, BSW; Bryn Mawr Graduate School of Social Work and Social Research, MSS

Why Therapy: I have been interested in social work since undergrad. I wanted to work in a profession where I could work alongside women who have gone through a lot in their lives. I enjoy working together with the women to help restore their strength as they move forward in their recovery journey.

Why CHANCES: I have been here for two years. I enjoy the all-female atmosphere and empowering the women to achieve the goals they set for themselves in the recovery process. I find the work to be really inspiring and fulfilling. The women give me so much more than I can give them. It’s amazing to hear their stories. They are resilient. It’s just really inspiring work.

Professional Challenge: Time and stress. It’s really busy work. Sometimes there’s no spare moment in the day to breathe.

Hobbies: I enjoy spending time outdoors with my family and golden retriever.

Dara Fraser, MS

Position: Therapist, CHANCES

Education: Spelman College, BA; Chestnut Hill College MS

Why Therapy: I have had family members who struggled with addiction, that’s why I chose this field. And I’ve always been there for my friends and I’m also a big people person, so therapy makes sense for me.

Why CHANCES: I have worked at CHANCES for two years. It’s really rewarding to see the growth in clients and watch them get back on their feet. I also love working with the therapists at CHANCES. We’re a real team. We can let loose and laugh. We de-stress each other very well.

Professional Challenge: It’s difficult when you get close to a client who stops coming.

Hobbies: I am a huge reality TV fan. My favorite show is Survivor.

Jaime Correia, ATR/BC

Position: Therapist, CHANCES

Education: Arcadia University, BA; Hofstra University, MA

Why Therapy: I’ve always been an artist, so I went to school for interior design and I realized it wasn’t as fulfilling as I had hoped. I wanted to do more with free expression. Art helped me through a lot of trying times, and I wanted to give back. I can use art therapy as a tool for clients to express themselves.

Why CHANCES: I have been working at CHANCES for a year and it’s great to connect with the women and learn from them. It’s also nice to work with this particular team of therapists. We all get along. It’s nice to have that camaraderie.

Professional Challenge: It’s hard sometimes to say goodbye and terminate the relationship when you have had a meaningful relationship with a client.

Hobbies: I play roller derby for the South Jersey Derby Girls.

While this issue of Public Health Directions is devoted to how PHMC touches our clients, our reach is so broad that we have captured only a small corner of our world. If you want access to the entire PHMC universe, we now make that easy.

Introducing PHMC Matrix, an online resource that helps you answer “Where in the world is…a treatment program…services for children…residential programming…HIV outreach…tobacco control efforts…” and much, much more.

PHMC Matrix is a web-based, searchable directory of the programs that PHMC and its affiliates provide. By using tags, or keywords, you can Search on terms to find what you’re looking for.

Lots of options

Go to our comprehensive tag listing and click on the one you choose.

Or, using the Popular Tags list, select from the most prevalent topics encompassed by our programs.

Maybe you want to find the programs that provide substance abuse treatment for women with children. You can do that by entering all of those terms together, in the search box.

Plus, you can go to a complete list of all our programs and affiliates, if you want the bird’s-eye view.

Here's how

Log onto PHMC Matrix at http://matrix.phmc.org. No passwords, no registration—just start traveling the world of PHMC.

Having access to a regular source of health care is a critical component to ensuring continuity of healthcare services. Nationally, 19.5% of adults 18 to 64 years of age do not have a regular source of health care—that is, a person or place they can turn to when they are sick or when they want advice about their health.1 Across the four regions of the US, the percentage of adults without a regular source of care is lowest in the Northeast (12.9%) and Midwest (17.3%) and highest in the West (21.8%) and South (22.5%).¹

11.5% of adults 18 to 64 years of age in Southeastern Pennsylvania do not have a regular source of care

With information collected by PHMC’s Community Health Data Base (CHDB), we can examine local, community data about access to care among our region’s residents. Based on CHDB’s 2010 Southeastern Pennsylvania Household Health Survey, we find that in Southeastern Pennsylvania (SEPA) 11.5% of adults 18 to 64 years of age do not have a regular source of care, representing 280,100 adults in our region. This percentage varies across the SEPA counties, as 8.4% of adults in Bucks, 10.0% of adults in Montgomery, 10.1% of adults in Chester, 12.2% of adults in Delaware, and 13.8% of adults in Philadelphia do not have a regular source of care.

This article will more closely examine the situation in Philadelphia County, where one in five adults in Central Philadelphia (19.9%) does not have a regular source of care, while 6.7% of adults in the Upper Far Northeast section of Philadelphia are without a regular source of care.

Demographic and Socioeconomic Disparities

In Philadelphia, certain population subgroups are more likely not to have a regular source of health care, such as younger adults, men and adults without insurance.

As age increases, the percentage of adults without a regular source of care decreases—20.5% of adults age 18 to 29 years, 17.5% of adults age 30 to 39 years, 10.6% of adults age 40 to 49 years, and 8.8% of adults age 50 to 64 years do not have a regular source of health care.

More than one in five adults who are either unemployed (21.0%) or students enrolled in school or in a job training program (20.9%) do not have a regular source of care, a higher percentage than for adults who are employed (13.7%), retired (8.5%), disabled or unable to work (8.3%) or homemakers (7.5%).

One in five adults who are either unemployed or students enrolled in school or in a job training program does not have a regular source of care

As the level of educational attainment increases, the percentage of adults without a regular source of care decreases—17.7% of adults with less than a high school education, 15.8% of adults with a high school education, 13.6% of adults with a college degree, 10.8% of adults with some college education and 9.8% of adults with a post-college education do not have a regular source of care.

Asian (20.0%) and Latino (19.9%) adults are more likely than white (12.9%) and black (12.7%) adults to lack a regular source of healthcare.

Men (18.2%) are nearly twice as likely as women (10.1%) not to have a regular source of care.

More than one in seven adults living below 150% of the Federal Poverty Level (15.4%) do not have a regular source of care compared with 12.7% of adults living at or above that level.

Men are nearly twice as likely as women to not have a regular source of care

Not having a regular source of care is closely tied with not having any public or private health insurance, as 37% of uninsured adults do not have a regular source of care, while 9.3% of insured adults do not have a regular source of care.

Preventive Health Screening Disparities

In Philadelphia, lacking a regular source of care is associated with not receiving annual screenings such as blood pressure and cancer screenings.

More than one in three adults without a regular source of care (34.8%) did not receive a blood pressure screening within the past year compared with one in ten adults with a regular source of care (10.3%).

Women without a regular source of care (45.8%) are more likely than women with a regular source of care (32.2%) to have gone without a pap test for cervical cancer within the past year. Similarly, women age 40 to 64 years who do not have a regular source of care (60.6%) are more likely than their counterparts with a regular source of care (34.4%) not to have received a mammogram for breast cancer screening within the past year.

Four in five men age 45 to 64 years who did not have a regular source of care (79.9%) also did not have a prostate cancer exam within the past year, compared with fewer than half of men with a regular source of care (48.9%).

Cost Barriers to Care

In Philadelphia, adults 18 to 64 years of age who do not have a regular source of care are more likely than their counterparts with a regular source of care to have experienced cost barriers to care, including not receiving medical care and dental care.

Adults without a regular source of care (29%) are twice as likely as adults with a regular source of care (14%) not to have sought care within the past year because of cost factors.

Adults with no regular source of care (39.8%) are more likely than adults with a regular source of care (27.7%) not to have received dental care in the past year because of the cost.

In summary, among Philadelphia adults the lack of a regular source of health care correlates with notable demographic and socio-economic disparities. The situation is more prevalent among younger adults, the uninsured, men, and Latino and Asian adults than among the general population. Additionally, not having a regular source of care is found to be associated with not receiving annual screenings such as blood pressure and cancer screenings. And adults without a regular source of care are more likely than adults with a regular source of care to have foregone medical and dental care because of the cost.

^{1 National Center for Health Statistics (NCHS). Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011.}