Annette McBeth, Doug Jaeger and Mandy Houk (Photo by Jonathan Smith)
Health Care Home
Open Door Celebrates 25 Years of Breaking Down Barriers in Health Care For All
It’s a big, beautiful dream: affordable, safe health care for everyone. Since 1994, Open Door Health Center has been bringing that dream to life for the people of the Greater Mankato area.
Based in Mankato, the clinic provides top quality, affordable health care on a sliding fee scale to the uninsured and underinsured. In 2018 it served 11,480 patients from 55 counties in Southern Minnesota. It also treated 866 elementary school children through its School-Based Dental outreach program.
CEO Doug Jaeger has been at the helm of Open Door since 2015. He said the organization is constantly evolving to address the changing needs of the community.
“Open Door is for everybody and anybody,” Jaeger says. “We’re constantly looking at how we can partner with individuals, counties, and other organizations to facilitate and take care of the health care needs in the area.”
Jaeger and his team strive to uncover any obstacles that are preventing people from getting the medical and dental care they need. They start with the question: What is keeping people from coming in? Then they do whatever they can to eliminate those barriers.
“We are all about overcoming barriers to health care,” Marketing & Development Director Mandy Houk says. “A healthy community is a prosperous community. Everyone needs access to health care.”
This year marks the center’s 25th anniversary. As it looks back on the accomplishments of a quarter century, ODHC continues to evolve to serve the needs of all Minnesotans.
A Community Effort
Open Door was founded in response to a Region Nine Development Commission survey. The survey found that the Mankato area had a large number of underinsured and uninsured people. Many people were unable to pay for prescriptions, emergency care and dental care.
“People without insurance were not being served by primary care clinics and dental clinics,” Annette McBeth says. “That was a wake-up call.”
McBeth, one of ODHC’s founders, was vice president at Immanuel-St. Joseph Hospital at that time. She notes that with no access to affordable primary care, the uninsured frequently ended up in the hospital emergency room.
“On a national basis the data demonstrated that taking care of people who were underinsured or uninsured in the ER was not cost-effective,” McBeth says. “It didn’t prevent anything. It was just an intervention. There was a tremendous opportunity here.”
McBeth says the Mankato community pulled together to find a solution for the problem. With input from city officials, educators, health care providers, and community members, the decision was made to form a nonprofit clinic.
In 1994, Open Door Health Center opened its doors for the very first time. It was based on a simple premise: health is a basic right and all people should have access to health care services.
“No one person did this. It’s been a team effort right from the beginning,” says McBeth. “I am privileged to be part of the team that created this clinic.”
The clinic was initially located in downtown Mankato. In those early days, it was only open three hours a day, three days a week.
ODHC’s first patients were women and children, and its staff was primarily composed of volunteers. Its services were limited to medical and dental treatments.
By 2001, Open Door had expanded to 24 hours a week and moved to a larger facility. Thanks to a variety of grants, it was able to expand its staff to 25 paid employees and add new services.
Health Care Home
In 2002, a generous donation paved the way for a flood of changes. The Orthopedic & Fracture Clinic donated its 10,000-square-foot building to Open Door. Located at 309 Holly Lane in Mankato, the building became ODHC’s new and final home. At last the organization had room to grow.
According to Jaeger, at this point in its history the organization was poised for growth but still operating on a small scale. The clinic was serving about 1,000 patients a year and only using a portion of its new facility.
“We were still very small, very grassroots in doing things,” Jaeger says.
Everything changed in 2009 when Open Door was granted Federally Qualified Health Center status.
“2009 was our defining moment,” Jaeger says. “That’s when we became FQHC. It really catapulted what Open Door could do.”
The FQHC designation allowed Open Door to receive additional funding. Grants provided funding for needed equipment, facilities, and additional staff and services.
In 2012, a $4.8 million capital development grant from the U.S. Department of Health and Human Services paid for the renovation and expansion of the facility for improved patient care.
“This grant made the building what it is today,” Jaeger says. “It propelled us to innovate with our care suites. We also doubled our capacity in dental and started our behavioral health services.”
Open Door continues to expand its services. A new dental clinic was opened in Clarkfield in 2016. A second dental clinic was opened in Jordan in 2017.
Perhaps the biggest change 25 years of operation has brought, is growth in the number of clients served. Jaeger says in 2009 about 2,000 people were seen by Open Door. By 2016, that number had risen to 7,500 people. Last year that number swelled to 11,500 people a year. That’s a 48% increase from 2016.
In Mankato alone, Open Door is serving about 4,500 people a year. But there are segments of the population that are still slipping through the cracks.
“Our area has 10,000 to 11,000 people that fall below the poverty line, so we’re serving about a third of that population at this time,” Jaeger says. “Unfortunately, there is still a growing number of individuals and families with an unmet health care need.”
State of the Art
Today Open Door Health Center is a state-of-the-art medical facility. It strives to provide a health care home for its clients by housing medical, dental, behavioral health, and other related services all under one roof. There are also on-site legal services, interpreter services, insurance enrollment services, and a pharmacy.
“We’re trying to look at every avenue of need,” Jaeger says. “We’re trying to create an environment where they feel safe, secure, and know that they can come to one location and get everything taken care of.”
The clinic on Holly Lane is a beautiful, modern building that was fully renovated in 2013. A two-story entry and floor-to-ceiling windows flood the building with natural light. Earth toned furniture and a center fireplace invite clients into the spacious waiting area. Glass panels etched with falling ginko leaves separate the reception area from the waiting area.
Beyond the waiting area, a dental clinic with 17 dental treatment areas anchors the east side of the building. Down another hall, a series of Behavioral Health offices appear. In the medical area, care suites with a separate consulting room and exam room provide room for families and translators to join the conversation while also providing privacy for medical treatments and evaluations.
“We’ve evolved in the services we offer and we’ve evolved in how we meet our patients’ needs,” Houk says.
As the facility has expanded, so has the staff, which now includes 105 medical professionals. Open Door is now also a training facility for aspiring medical and dental professionals. Participants include students from the residency programs at Mayo and the University of Minnesota, and nursing students from Minnesota State University, Mankato.
“We’re training the future health care professionals of the area,” Jaeger says. “We have students training with our providers from all facets of our organization. The most recent addition is dentists.”
ODHC has always had a strong partnership with area health care providers and community organizations. Many were involved from the outset, playing a critical role in opening the clinic in 1994. Through the years they have remained supporters of the center.
Jaeger stresses that there is no competition between Open Door and other community health care providers.
“Mayo and the Mankato Clinic were both founders of Open Door and they continue to be partners with us. They have representatives on the board,” Jaeger says. “We are partnering together to take care of the needs of the community.”
There have been many other community partners through the years. The Orthopedic & Fracture Clinic donated the building that now houses the clinic. The United Way contributed funds for expanding hours of operation.
These partnerships persist to this day. Many community leaders have served on the organization’s board and provided guidance. They also provide supplemental services when patients require treatments that ODHC does not offer.
“We are very fortunate to be supported by partners that include our board members and affiliates such as Mayo and Mankato Clinic,” Houk says. “We couldn’t treat some of the diseases we treat here if these organizations weren’t assisting us with specialty tests and providers.”
ODHC clients also benefit from the organization’s partnership with affiliates such as the Genoa Pharmacy, which provides on-site prescriptions, and Southern Minnesota Regional Legal Services, which provides free legal help at the clinic.
“Our model is integrated medicine,” McBeth says. “Everything is under one roof.”
While ODHC has grown exponentially, the need for affordable health care in the community continues to outpace growth. Some of this is due to population increases. But McBeth believes the need for assistance has also increased due to the changing insurance landscape.
“We’re the richest country in the world and yet insurance companies and being able to pay your bills continue to get in the way,” McBeth says. “We haven’t resolved it yet today.”
The trend toward higher deductible insurance plans has had an impact on ODHC. The clinic is seeing more and more clients who have insurance but can’t afford to pay the deductibles.
“We’re seeing patients that have jobs, that have insurance, but their insurance doesn’t cover them until they’ve hit a deductible of $5,000, $6,000, $9,000 even as a family,” Houk says. “Let’s say you make $40,000, but your insurance doesn’t pay a cent until you’ve paid $7,000 out of pocket. So what do you do as a family?”
Many families are coming to Open Door to take advantage of its sliding scale fees to bridge the gap until its insurance kicks in.
Open Door is also trying to keep pace with the increasing demand for behavioral health services. With six therapists and two nurse practitioners in psychiatry on staff, the center is struggling to meet the community’s needs.
“Right now we are bursting at the seams,” Jaeger says. “We’ve run out of room.”
Jaeger says the demand for behavioral health care has been heightened by the opioid crisis. To respond to the growing need in this area, the center has begun providing medication-assisted therapy for addiction as part of its office-based therapy.
Houk also sees clients being drawn to the center because they’re attracted to the quality and variety of services it offers.
“We have great translation services. We have community health workers. We have great practitioners and nurses. Our behavioral therapy is awesome,” Houk says. “People are choosing Open Door. It feels like a health care home.”
Dental Needs Surge
Demand is also high at Open Door’s three dental clinics. At the Mankato location, the dental waitlist is currently at about 300 people. Jaeger says ODHC is growing as fast as it can, but its efforts have been hampered by a shortage of available dental assistants.
“Right now our only holdup is the number of providers that we have,” Jaeger says. “The more providers I can hire, the more people we can serve.”
ODHC is finding new ways to expand its reach and respond to dental needs. Its School-Based Dental Outreach program treated 866 children last year. Working with 13 area elementary schools, including all of those in ISD 77, the program provides a dental exam, fluoride treatment, and sealants to prevent decay.
“A lot of these kids have a lot of decay. They’re in second, third, fourth, and fifth grade and it’s the first time they’ve seen a dentist. It blows my mind,” Houk says. “We have a desperate desire to serve those children that nobody else is serving.”
After their assessment, the children are sent home with educational materials on proper dental care. They are also given information on any problem areas that need to be watched and a referral to a dentist.
On Nov. 19, 2019, Open Door will host its first gala. It will be an opportunity for the many individuals, organizations, and businesses that have supported the clinic over the years to come together and celebrate the accomplishments of 25 years.
But even as the nonprofit looks back through the years to acknowledge the strides it’s made, its leaders always keep an eye to the future.
“We are always asking ourselves, ‘Where are the needs in the region and what can Open Door do to keep health care local?’” Jaeger says.
Houk outlined Open Door’s top four goals for the year ahead. First is reducing the population using the emergency room for primary care. Open Door has been addressing this issue since the beginning, but it continues to see a need in this area.
“That’s one of the biggest costs in health care, the overuse of the emergency room for things that should be done in a medical office,” Jaeger says. “We will continue to work with the other health care organizations in town to identify how we can get to these populations and educate them on the benefits of clinic-based health care. If we can keep them from overutilizing the ER, then they can better treat those that truly need the emergency room when they walk in.”
The second goal is to find ways to better penetrate unserved populations. These are people that are either unaware ODHC exists or have fears or misperceptions that prevent them from using the facility.
“We have immediate plans to reach the segments of the populations in and around (Blue Earth) County that are underserved, that do not know about Open Door,” Houk says. “Our goal is to increase awareness.”
Houk said ODHC has changed its outreach strategy. The outreach coordinator has been asked to get out into the community where he can connect with underserved populations.
“His job is to get to know them,” Houk says. “For example, he can meet with Somali families or Latino college students or the elderly people of St. James to make sure they understand our services.”
Open Door’s third goal is to increase its capacity for treating dental patients who have no other options. Houk says they are finding creative ways to reduce the dental waitlist at the Mankato clinic so children can be seen more quickly.
“We just hired a dental therapist to increase our capacity. We will begin pulling children off of the waiting list in August,” Houk says. “This will leave more room for adults on the waitlist and it will get the children seen more quickly.”
The organization’s final goal is to get the word out that ODHC is open to anybody and everybody, whether they have insurance or not. It’s working hard to increase visibility with public events and outreach. These three organizations are partnering with Open Door to increase awareness in 2019: Mayo Clinic Health Systems, Community Bank, and Genoa Pharmacy. This spring, it held a “Friendraising,” a community health care street fair that paired free health screenings with a mariachi band and a visit from the Mankato MoonDogs mascot. This summer ODHC joined parades in St. Peter and North Mankato, distributing toothbrushes to thousands along the way.
“We want the general population of Mankato and Blue Earth County to know that Open Door is an option for everyone,” Houk says.
With each new initiative, Open Door Health Center moves closer to its ultimate goal: health care for all. Someday, McBeth hopes the center will help her realize her dream.
“As I reflect on my life, this is my legacy, this is part of why I am here on Earth,” McBeth says. “In my lifetime, I hope to see everyone with health care.”
Three Things You Should Know About Open Door
ODHC offers more than just medical care. ODHC provides quality affordable dental and behavioral health services, too.
ODHC is dedicated to overcoming any barriers to health care: language, transportation, legal issues, or the need for insurance coverage.
Everyone is welcome at Open Door. Whether you have standard health insurance, high deductible health coverage, state aid, or no insurance at all you are welcome at Open Door.
Open Door Health Center
309 Holly Lane
Mankato, MN 56001