roots a few years ago and we have we are in our current location on east fourteenth nine twenty five east fourteenth and east oakland where there's of course a great great need and we opened the clinic really in design it's be a model of how to provide really community responsive care to low income members of the community there the need is tremendous and we know that we can't serve the need to says one clinic but what we're aiming to do is really to be a model of how to provide culturally competent accessible high quality care and we are also looking to build bridges and form relationships with other entities in the area to make sure that the what we learned in is that without a doubt to say the the providers including roots community health and not just say them but to support them and educate the  critical providers and in our community that serve the under served is its is a major job but it has to take place at this time because the incredible care act is i want to say it's kind of like a bulldozer this coming through you either get run over or you can get out of the way but what we decided do would be innovative and take a look at it and figure it out and figure out how with what we learned  understanding it and investigating it is how we can share this with the other doctors so that they can be successful and survive and thrive  and so we've started dr avalon actually started the roots community health center and later as a group a small group of us that have no real at this time personal interest but the reason why we came together is because we share this vision of having an organization that could help sustain these practices in the community because we started doing a  an assessment of the doctors and the term actually that came out of that within this group of us who said it was an emergency situation so that's what we have on our plate right now is what we're doing and we know we have to address the changes that are taking place in less than a year in alameda county and across the country but how do we do that where you know what the fordable care act coming we're looking at alameda county having something like eighty thousand people that are currently not covered become covered so access is going to be a huge piece of this if you can't get in anywhere then you can forget about sick care you can forget health care you can forget all of it so i think at this point in time one of our primary concerns is making sure people can actually get access and get into care i think one of the things that the kaiser has done extremely well is built that framework of access and that's one thing that we're looking at really closely is that as we build a network of providers how can we make sure that patients can get through can get in at their time of need because we have an access problem for low income people today as  and when you add eighty thousand people to the mix what is the plan and we know that the providers that have been in the community and you can call them private practitioners you know some of them are small clinics all these there are points of access to care and we're calling the points of access to care and there are culturally competent points of access to care and right now there's really no plan in place to ensure their survival with all of these changes and that's really where our focus is because there's no provisions right now looking at this and we're saying that this is critical because they've been providing the care for decades and generations and they are the providers of choice and so how can we help build scale and and increase their capacity because that's going to lead to the access to prevention you know is is basically going to be a key component of this so there's going to be health education and all these things but again if not every single practice can afford to have a health educator let's say then how can we use our relationship to say well maybe we can have a couple of health educators that specialize in certain areas and use them for the entire group so that the burden doesn't fall on each individual practice how can we utilize the electronic health records system to poll data to say who are the highest needs people that we need to target some of our efforts because it's going to be difficult i think to try to do everything for everybody it's not possible but again the kaiser models are very good at fame these age groups we need to target for this particular intervention but again we have to be able to use our data we have to come out of those paper charts and so again as a group i think that we can leverage some of those relationships in order to build the systems that are needed to create the access and this to us your patient that are you tracking this you know everything from demographic like how old they are what race they are things like that in are you tracking things like are you tracking their medications or what their diagnoses are but what you asked me earlier and you talk about a whole patient centered concept and you also mentioned prevention the patient centered concept has is at the heart patient centered medical home of the patients in a concept or at the heart of the accountable care act now this is a doctor of a lot already said and you did how important cultural competency is because you can have all these things in place but if you're communicating with your patients you know in a efficient way you're not delivering high quality care so that it's very important that you have that the electronic health record is the law you can look at the care you're giving him prove it you know that you do all that you have quality assurance he will allow you to have quality of quality assurance mechanism built into your practice and this information with a pool these people together they have to understand about prevention they have to understand the positive things the things that they can be innovative and make them accountable period work for them in our community in the future the community of the under served and a lot of people are watching that because with what we promised a lot of back to the door their hands up supposedly it's in another leave medicine but you go out i guarantee you there are a lot of doctors that we wouldn't assume i'm getting ready to do things for example to start taking medicare to start seeing these patients because all these patients they never wanted to see before now going to be people in which they can receive a higher level of reimbursement the problem there is they have not ever seen these patients and so they need to get back to communication quality and profile competency issue so we want to make sure that at least in our community and we're glad to well you know i think we all need to ask we all need the health care advocacy i think that's a big piece of it because if we can you know again we don't have a voice as providers then we can get the things we need the tools we need to be able to provide we need to provide on the scale we need to provide it i may know what i need to do with my patient have the cultural competency have the conversation do the the management but i can only do so much as one provider so again i think it's important that  income communities of color because like dr brown mention there are efficient systems out there but they're not accustomed to seeing our populations they're not accustomed to the sickness that they're going to encounter of the psycho social issues in if you're not accustomed to it and you don't have the culture competence and patients are going to share the proper information and they may not listen to the advice if you have provided they may not be compliant so i think you know we we need to look at obesity to look at all or all of these things but we also need to address the shortage of physicians who are practicing in our communities and i think that you mentioned that and i want to speak to that just a little bit is one of the things that we're really looking at is creating some sort of a pipeline of providers to come into our communities because it's there's there's a shortage we we've heard that there's a shortage of primary care providers nationwide but it's even worse in our communities and so when our doctors are looking and saying why don't want to come and set up a practice in the area you know that's low income is very difficult to survive i'll just go work for whatever hospital maybe whatever large health care system you know we think that there should be viable are changes because we know that physicians and other providers would like to come into the community and provide care but they need to be able to have a decent way of life as well so that's another thing we're focusing on is been able to attract providers into the area because i think you're absolutely right we need to be able to focus on all of these outcome s but we need we need you know to have people that are available to do that and systems in place to do that and then the other piece of me looking at deficiencies if you have a doctor that has to do their own billing or a doctor that is spending is bogged down in paperwork that they can't get out from under then they're not going to have as much time to spend their patients and to build a healthy environment in there and their clinic setting to have messages one of the things that we love about kaiser is the messages that they put out there you just go on their campus and then there's there's there's health positive healthy messages everywhere you go all of these things lead to healthier ways of life in americans but if we individually don't have the time to invest in all these things and it makes it very difficult and so again as a collaborative that's something that we want to focus on being able to do is really look at how to provide real health care well and also we think it's important that both of you come on we don't want business as  trauma in life cycle out of all time it can affect those children's lives when they are done if they make it to be only two generations exactly can continue to grow and it actually is been studies that shows that the biochemistry of their bodies and the hormonal nature of their body changes to a point where trauma later in life is with where they're not affected as much by seeing trauma because they've seen it so many times but that's actually been proven to affect them later their health later so having access to again to culturally competent behavioral care and therapy and care for the background and from going through our lives the way we have but i just want to say one thing and that is you talk to but we would talk about access and you were talking about women's hair and some of the issues that are feeling that we have to deal with in the exactly because they get to the care source too late so that's another access issue so i mean we keep saying this but access access access is exactly were things that  drives this whole groups community health alliance concept the organization would put me together you have to have access it has to be competent you know in all the things that go with it and we're aware of everything that  like saying this but dr i have a lot and i've come to the conclusion that things like community health centers which are being called the traditional people who take care of the communities of under thirty people choice in this new system they're going to go where they want to go so that might be that might be a little intimidating for the bells in systems where people have had to go there because they didn't have a choice and cell i think it's very interesting i think even where we're located you would be surprised at how many people pay cash have p p o s and they choose to come to c s because they feel comfortable because they get care and they feel cared for and so and this is something that we're going to see multiplied and affordable care as a people will have choice and i think if you have not been customer service friendly if you have not had to think about your reputation because of whatever whatever systems or sources of funding or things like that in the past then you have to think about it now and for some it will it will be you know it will be easier for others it's going to be i think going to be difficult but everything is changing that's one thing that we can say for sure but one other thing real quick politics you have to kind of pretty much understand the legal system in the sense that it relates to her community medical practice and so we know that we won't only succeed if the number will absolutely i mean i think we we have been activists just by virtue of being in the community health center world we both have long histories in the federally qualified health centers which are really came out of civil rights and came out of the belief that there should be held equity and i think that that's really why we're doing what we're doing is because that we we firmly believe in this and believe that there need to be other models out there and we'd like to be a part of creating that model one of the things that has really come out of us you know starting to build this alliance is that we do not have a political voice at all we have not really found a platform up to this point and we'd like to change that and so i think that getting this conversation at a national level is important there needs to be support it can not be ok to say well we'll just let these private practices go extinct because we're going to put all of our money into large hospitals and into the other federal systems there are the stor right and i think that the jury's still out on whether you know they can really the larger systems can really provide more efficient care that they actually are rather expensive and so i'm somehow or another these community providers have managed to get by with the sustain but really to expand and so this is not just something that we're doing only at a grassroots level though that's what we're doing but we would also like to take our message and use our  are major parts of it that no matter who wins the election and cannot be stopped we're focusing on the fact that we will have who we want to have in the white house and then we will move forward with it but like we've been saying is we are just at the very beginning of our journey on this path we still have a lot of energy it's almost like something that's been inside of us for years ok it's now it's expressed it's we're expressing it and we're allowed in the last thing i want to say is it's really delighted by the kind of i think the biggest transformation for us and what we're looking at is that you know we've all been very independent up and to this point we've done medicine how we've done medicine but i think that there that things are changing now benchmarks are being set and we have to set the standards and we have to come together and i think that that transformation of really coming together maintaining our independence but coming together and working towards our survival is going to be the survival of our community of our patients of our people