October 3, 2022

Andrea Skolkin

Topic
Healthcare

Agency for Change Podcast: Andrea Skolkin, CEO OneWorld Community Health Centers

Andrea Skolkin

What I believe is that we are here for a limited time on the Earth and we don’t take care of others, the consequences are huge.

Announcer:

Welcome to Agency for Change, a podcast from KidGlov that brings you the stories of changemakers who are actively working to improve our communities. In every episode, we’ll meet with people who are making a lasting impact in the places we call home.

Lisa Bowen:

In 1964, President Lyndon Johnson declared a war on poverty during his State of the Union address. As a result, that year and the following saw a slew of legislation aimed at funding access to everything from education and food, to housing, employment, and medical care. But that last item, medical care, is the one that gave way to the creation of Federally Qualified Health Centers, or FQHCs. If you’ve never heard of this term, an FQHC is a primary care clinic focused on providing healthcare to underserved populations, regardless of their ability to pay. As a designated FQHC, these health centers, like the one you’re going to hear about today, gain access to important funding, which allows them to provide much needed care for those who are uninsured or underinsured. That’s why I’m thrilled to welcome OneWorld Community Health Centers to the podcast, and learn about the work they’re doing to keep Nebraskans healthy. So please stick around till the end of the show, as we find out exactly how they are helping vulnerable populations access healthcare, what the future of their industry looks like, and just what sets OneWorld apart from other medical providers.

Lisa Bowen:

Hello everyone. This is Lisa Bowen, vice president managing director at KidGlov. Welcome to another episode of the Agency for Change Podcast. Joining me today is Andrea Skolkin, CEO of OneWorld Community Health Centers, which provides culturally respectful quality healthcare with special attention to the underserved. Andrea, as someone who spent a good portion of my career in healthcare. I’m really eager to talk with you today and learn more about the great impact you and your team are making on the world.

Andrea Skolkin:

Well, it’s great to be here. It’s an honor to be asked.

Lisa Bowen:

Awesome. So before we dive in and talk about OneWorld, let’s talk a little bit about you personally, and how your path got you to healthcare. And what really inspired you to that industry.

Andrea Skolkin:

And it’s an interesting path because healthcare was not planned for me. It was, I think, a matter of circumstances. I grew up, I’m a second generation American born in America, from an immigrant family who my grandparents on one side, well, on both sides, didn’t speak English. So I knew a lot and learned a lot with those kind of values being brought up. Knowing that though, my grandparents weren’t around that long. And as a young person, I also had some kind of kinship or connection with older people. And so that’s really was my goal when I was in college, to work with older people. And I eventually got that chance after getting out of school and not knowing what to do, and experimenting and having a few different jobs. I did end up finally getting married later, a little later in life in my mid-thirties. And moved to Minnesota where I ran the Area Agency on Aging, which was a dream job for me. I had worked in direct service for older people.

Andrea Skolkin:

And that’s the path that got me here. And we moved to Omaha because my husband’s position. I had been about 10 years in my job as the Area Agency on Aging director in the seven county Metro area in Minnesota. And when we moved here, I thought, well, I’ll get a little bit of time off. Well, that didn’t last long and I went to work. And started working in the solidifying of a network of physicians that took care of—specialty physicians – [took care of the] uninsured. And then the position at OneWorld opened up and I said, yes, and that’s how I ended up in healthcare. I really didn’t have a healthcare background. And some people thought, well, what is she doing? She doesn’t know anything about healthcare. And I guess I didn’t know what I didn’t know, and how complicated it would be, but we’ve grown. I’ve grown and we’ve learned together.

Lisa Bowen:

Wonderful. How many years have you been at OneWorld?

Andrea Skolkin:

18 years.

Lisa Bowen:

Wow. That’s quite a career. That’s amazing. Amazing.

Lisa Bowen:

Well, let’s talk a little bit about OneWorld. So those people who don’t know and aren’t familiar with OneWorld Community Health Centers, can you tell us a little bit about what you and your team do there?

Andrea Skolkin:

Sure. Our mission, as you pointed out, is to provide culturally respectful quality healthcare, with attention to those that are the have nots in our society. Meaning they don’t have as much income, or they don’t have the means or the way to get to healthcare. And our goal is to make sure that everyone does have access. Whether we’re helping them with transportation, or just are open doors and making people feel that they’re welcome.

Andrea Skolkin:

And so what do we do every day? We have quite a variety of services that we provide, and 17 clinical locations. Having grown quite substantially since when I came, which was 2004. And so we provide medical, dental, behavioral health. And numerous support services, including a literacy center in cooperation with the learning community of Douglas and Serpin County. A WIC program, some partnerships with each of the health systems in many ways. So there’s quite a variety services, but our core is the medical, dental, behavioral, then I forgot pharmacy. So what we want is that healthcare for people that don’t have insurance, and even those that do, is affordable.

Lisa Bowen:

Awesome. So would you say that the one thing that makes you different from a typical physician’s office, which is what most people think of when they think of healthcare, is your ability to serve the underserved and also that comprehensive care? It sounds like you guys really do everything under one umbrella. Is that right?

Andrea Skolkin:

Right. That is what makes community health centers unique. And there are seven of us in Nebraska, and more across the nation. But the concept is the old-fashioned malls where you could go and get everything you need in one stop. So that is the concept. Pack it in. And also, that when a patient comes, we’re not just checking in for what was going on that day, but trying to fill in the gaps of things going on in their lives. Because so much of healthcare is outside of that visit with the physician, we’re trying to make sure that we cover the gamut.

Lisa Bowen:

That is wonderful. So we talked a little bit about what a Federally Qualified Health Center is. Can you explain to your listeners a little bit more about that, and what that means to your ability to provide that special care that you do to your patients?

Andrea Skolkin:

Sure. And really in the Federally Qualified Health Center world, we’re still new. We just became one in 2001. Although we have 52-year history starting grassroots and volunteerism, and growing to what we are today. But that federal qualification, there was in the Johnson Administration and the war on poverty, that’s when community health centers were given birth to in the United States.

Andrea Skolkin:

And the concept was to put people to work in their communities, while bringing healthcare and making communities healthier. And so all health centers remained true to that, and we have lots of regulations. It came with money when we got designated with this federal designation. It comes with a base grant, which helps you defray some of the costs of caring for those that don’t have insurance, or have less resources and can’t pay. And that means that not only do you have all the healthcare regulations that everyone has, but jam another set of regulations on top of it. And then what makes us different than other clinics, or other nonprofits, is that my bosses, so 19 of them, more than half, one more, at least more than half, are patients of the health center. And in that way, we remain true to what we’re doing, and our patients have a voice and the community has a voice, and owns what the organization does.

Lisa Bowen:

That’s amazing. 19 bosses. Well, I don’t think anyone would wish that upon anybody. So I’m sure your days are interesting.

Andrea Skolkin:

They’re a good board though. We have a great, great team of leadership.

Lisa Bowen:

That’s amazing. Can we talk a little bit about, in your mission you talk about culturally respectful healthcare. Can you talk to me a little bit about what that means?

Andrea Skolkin:

Sure. So often we hear the word, cultural competence, and I think that, that’s kind of a myth. No one can really know about all cultures and be smart and all knowing. So that’s why we use the respect word, because most people understand what respect means. And so we want to make sure that people have autonomy and have dignity, and treat people as they would want their family members treated. And to be caring and listening, and meeting them where they’re at, though sometimes you have to kind of be directive. What we want is to be where they are, and try to put yourself in their shoes so that little steps that we get taken, to improve health, are done in partnership with the patient. And I think that, that is a demonstration of respect.

Lisa Bowen:

Absolutely. Absolutely. So we talked about OneWorld focusing on providing healthcare to the underserved. Which populations in Omaha are underserved, and what kind of unique needs do those people have?

Andrea Skolkin:

Well, underserved means a lot to a lot of different people. For us, it means, I think the first criteria, if you will, is income. People that don’t have a lot of resources. We use the marker of 200% of poverty. So for a family of four that’s $50,500 today. Which I thought growing up, really when college, if I made 45,000 I would’ve made it. But in today’s world, that money doesn’t go very far. So getting healthcare is a barrier, or there are barriers and challenges.

Andrea Skolkin:

The next piece of what we do is try to make sure that minority populations who are often not feel welcome in the health system, or it might be strange, or immigrants, or refugees, have the access to healthcare in Omaha. I think it’s pretty well known that we have a large Hispanic population, and a large African American population. And while it’s a welcoming city, there are challenges in getting healthcare. And so those are the two major populations that we focus on. And then language, we want to make sure, because there is a larger Hispanic population and growing in Omaha, and in the state of Nebraska, that we can provide care in the Spanish language. So about 65%, maybe 67% of our employees are fluent in Spanish. Many of whom they’re native speakers. And that’s another part of that word, respect.

Lisa Bowen:

That’s amazing. And communication is such an important part of that provider, patient relationship. So that is, it’s amazing that you guys are so conscious of that there. So next, let’s talk a little bit about misconceptions. I’m from south Omaha and born and raised there. And I’ve always thought when I hear OneWorld, I think south Omaha. But when I was doing some research before the podcast and saw that you have 17 locations, that’s amazing. You guys are serving well beyond south Omaha.

Andrea Skolkin:

We are, and always have been quite honestly. We just caught up with ourselves. We are home. Our home is south Omaha and that’s our largest location. And it’s a very interesting having you be from south Omaha. It’s a very mixed population, probably half Latino and half non-Latino. And also an older generation that lives in south Omaha, along with the younger. So that is south Omaha and it has been a port of entry for its history.

Andrea Skolkin:

So we probably have more services in our south Omaha location. But when we looked at who was coming to the health center, what we see is over 70 zip codes. And so might not have been that many, maybe in 2004, but that makes transportation a challenge. And we want to be easily accessible, and so that was really the impetus for us to move forward with different locations. We want to be where the people are. We do some home visits, but we’re not in people’s homes. We’re a clinic and people have to come to you, so we want to make it easy.

Lisa Bowen:

That’s great. Access, the need to access healthcare is definitely not isolated. And I love that you’re bringing it to the people. So what other sort of misconceptions do you feel people have about the work you do with underserved populations?

Andrea Skolkin:

The biggest one, and I don’t hear it as much now as when I started is, oh, you do good work with those people. So I think that’s, whether you call that a myth or just what people say, I think people don’t realize how many people don’t have health insurance. And it’s sons and daughters and neighbors and all kinds of people. And just because someone might own a home and live, west Omaha doesn’t mean they have enough disposable income.

Andrea Skolkin:

Also, our patients cost share. And those that are uninsured, we have a sliding fee scale. So the myth is that we’re free healthcare. We’re not free. We do have fees, and we do take Medicaid, and we do bill insurance. It’s just for people who are lesser affluent, we do slide our fees. And that’s where the government money and private philanthropy comes in to help. A myth is people don’t want to get ahead, or they’re just spending their life on Medicaid. And that really is not the case. And it is really hard to get on Medicaid. It’s quite trucking when you go through an application, how much they ask for. And some of the questions are tricky, and if you don’t answer them right. But people really do want to better themselves. And especially you have a better life for their children. So it is not because people are lazy, or they’re just not being productive. It isn’t the lack of want, it is just not a handout, but a hand up.

Lisa Bowen:

I love that. What are some of the challenges that OneWorld Community Health Centers experienced during the height of the pandemic, and how did that force you to adapt as an organization?

Andrea Skolkin:

The biggest problem in the beginning of the pandemic is that it hit the Latino population really hard. And we had people flocking to us and we were ill prepared to manage it. And much overlooked by people in power because we don’t care. We finally were able to cobble together all the resources. Eventually resources did come, but we really had to stand up and be loud to get those resources. So I think that’s a lesson learned. COVID had a huge impact on our employee population and the community. We had the highest rate of COVID, and a lot of COVID deaths. And we were providing care beyond just testing. So we would follow those that test positive through two weeks, help them get food, get a place to stay, be isolated, all those things. And we had to add, if you want to call it a service line, which we now call COVID, and it continues this day. It’s not as big a volume as it was in 2020.

Lisa Bowen:

Not done yet though, are we?

Andrea Skolkin:

Yeah, we’re not done. And it’s something we’re learning to live with, I think, across the nation and here in Omaha. But we had, in our strategic plan, to do telehealth. And we ended up doing it in a very short time period, versus thinking we would learn how to do a pick the right system. And we didn’t have time for that, we just did it. And we actually switched systems in the middle, but that is a lesson learned and being able to do that. We had done it with behavioral health, but not in primary care. So I think that’s something good that came from COVID. So out of bad came good.

Lisa Bowen:

Of course you had to figure some things out more quickly than you probably would’ve. Huh?

Andrea Skolkin:

Yeah. And it was also kind of, well scary for our employees. It was kind of a rallying cry. When you go through something together, it’s very much builds your teamwork there. Not to say there weren’t a lot of stresses and strains, but it just reminded us why we’re here, and why we have to be here, and why we do what we do.

Lisa Bowen:

So we know that healthcare changes on a regular basis, and it’s like a roller coaster trying to figure out what’s going to happen next. What kind of trends are you seeing right now on healthcare, and how do you think they’ll impact the work that you’re doing at OneWorld?

Andrea Skolkin:

Well, the big talk right now and has been for a couple of years is in this value-based care. Meaning that we’re getting paid and we get incentives if we do well in clinical outcomes, or save the insurance company money. So I think that, that’s going to continue for a while, but I think it will move to a different model. More like an insurance company where they’re paid per person. So I think that’s coming where the providers, physicians offices, and us will get paid a certain amount. And then you have to take care of the patient within that amount and be able to make it work. I don’t think we’re headed to socialized medicine. I don’t think that that’s coming in our country. I think we have too many industries that rely on healthcare and the payments and the jobs that I hope we come with a kinder system.

Andrea Skolkin:

And to make that happen is a challenge because of how things are paid. And even in the value-based care system it’s a challenge to meet all of the outcomes when some of the patients aren’t even your patients, and you’re being held accountable for it.

Andrea Skolkin:

I think the Affordable Care Act is here to stay, all the marketplace. I would like to see more affordable products in the marketplace so that everyone has some kind of payer source. I think that would help the economy a great deal. I think prescription drugs, they’re going to be clamping down on kinds of tests and radiology, and those kinds of things, because I think people are overcharging. So I think we’ll see more of that. And the more things get regulated, the harder it is to take care of a patient. So there’s a good side to it. Meaning yes, we want to reduce costs and provide the best outcomes. But at the same time, there’s a lot of micromanagement, and I think there’s going to be more of that, and more regulations.

Lisa Bowen:

Makes it hard for you to do your job sometimes, doesn’t it? So what kind of community initiatives is OneWorld taking part in right now? Are there any events or anything up and coming that we need to be aware of, or that you want people to know about that you’re working on?

Andrea Skolkin:

Well, we just had our big back to school event, and every year that’s a big event for us. We have an annual dinner that celebrates our volunteer providers, and that’s in November. We have a coat giveaway for children that’s really sponsored by our employees. And so those are ongoing. We have, in terms of community wide, we’re part of a community collaboration to reduce unintended pregnancy, and sexually transmitted diseases, because it’s still at epidemic proportions. We’re in monkeypox right now. We have had a couple of cases of monkeypox here. And other, I’m trying to think what other collaborations we’re in.

Andrea Skolkin:

The meeting that I’m about to go to is a new nonprofit that is working on a family resource center for mental health prevention, I would say. And trying to help families get connected to what they need, versus having them end up in either juvenile with law enforcement. So that’s a new community collaboration that we’re involved in. We’re also in this, we’re the operating partner for the south Omaha Learning Center, and that’s teaching parents English. And then they better interact with their young children through school, and it’s proven to show academic success. So that’s another collaboration. We partner in lots of ways. We’re working with the Stevens Center right now to put some medical clinic services into this transitional housing, which is across the street in south Omaha. We have a myriad of different community.

Lisa Bowen:

You don’t just have that word in your name, you really do live that. You are a true community health center. And all of those things you’re involved in are just a testament to that. You mentioned two words that I was pretty sure you were going to mention today, monkeypox and mental health. I mean two big things you’re dealing with. And mental health has always been an issue and won’t get any easier anytime soon. But I do love that it’s the topic of lots of conversations lately.

Andrea Skolkin:

Yeah. And as well, it should be. We’re good at having emergency rooms, but we’re not good at anything else related to mental health. We need more services.

Lisa Bowen:

So what do you think the future holds for OneWorld? You mentioned lots of things you’re working on, but do you have any specific goals you’d like to accomplish during your time as CEO?

Andrea Skolkin:

Well, my goal so to speak, or my mantra is that I really don’t want anyone to lose sleep over feeling like they can’t get healthcare. And I want people to know that we’re here. So I do see that we’ll have a little more expansion, maybe not as huge as we’ve had. We do have a new clinic opening kind of in the Ralston area for children’s dental in the beginning of 2023. So there will be some expansion because we just want to be in the neighborhood, so people can get to us.

Andrea Skolkin:

And workforce is a big issue across all employers including the nonprofit industry. So doing some work, and being a little more innovative in how we’re recruiting and retaining our staff. Our staff have become as important to me, in fact probably more, I shouldn’t say that, than our patients. Kind of watching their pathways, and watching people grow who’ve been hired from the community and taken their first job, and now I’ve moved into leadership positions. So that makes me feel really good. And I would like to see more of that as the time goes on.

Lisa Bowen:

Okay. So Andrea, I’m inspired by motivational quotes. Can you give us a few of your own words of wisdom for our listeners?

Andrea Skolkin:

What I believe is that we are here for a limited time on the earth. And if our job is to take care of others, and if we don’t take care of others, the consequences are huge. It gives me great feelings. It is just very important to take care of others. And that is the purpose of being here. Because when all is said and done, and I’m gone and other people are gone, what is left is what you were able to create around you. So we want make the world a better place. And OneWorld is doing our part.

Lisa Bowen:

Wonderful. So for our listeners who would like to learn more about your work, how can they find out more about OneWorld?

Andrea Skolkin:

Well, they can go to our website, www.oneworldomaha.org. One is spelled out, no spaces or underlines. Or they can call at (402) 502-8845. That’s an administrative number. If they need an appointment, we’d love to help. Whether it’s medical, dental, at this number is (402) 734-4110.

Lisa Bowen:

Well you’ve shared of wealth of information today with us. And I could talk about healthcare with you all day long, but we should probably wrap it up. So as we end our time here together today, what’s the most important thing you’d like people to remember about the work you and your team are doing at OneWorld Health?

Andrea Skolkin:

That it’s important that everyone be healthy, not just you or your family member. But if we can help everyone be healthy, our community is healthier, and it’s more vital and vibrant, and a place that you want to live, work and play.

Lisa Bowen:

Thank you so much. I fully believe that the world needs more people like you, Andrea. Thank you so much for taking the time to share your information with us today, and to teach us what community health is really about.

Andrea Skolkin:

Thank you for the opportunity.

Lisa Bowen:

Thank you so much.

Andrea Skolkin:

Bye.

Announcer:

We hope you enjoyed today’s Agency for Change podcast. To hear all our interviews with those who are making a positive change in our communities, or to nominate a changemaker you’d love to hear from, visit KidGlov.com at K-I-D-G-L-O-V.com to get in touch. As always, if you like what you’ve heard today, be sure to rate, review, subscribe, and share. Thanks for listening, and we’ll see you next time.

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