In Depth: A Conversation with Neighborhood Outreach Access to Health (NOAH)
Arizona Physician sat down with Neighborhood Outreach Access to Health (NOAH)'s Chief Medical Officer, Suganya Karuppana, MD, MSHD, CPE, CHC, CPHQ. Dr. Karuppana shares with Arizona Physician's readers NOAH's programs and services, plus we ask her thoughts on the current state of primary care.
ARIZONA PHYSICIAN: Please tell us about NOAH. How did Neighborhood Outreach Access to Health begin? What services does it provide for patients?
DR. KARUPPANA: Neighborhood Outreach Access to Health (NOAH) has provided affordable, high-quality healthcare services throughout Maricopa County for over 25 years. As a Federally Qualified Health Center (FQHC), NOAH is focused on reducing barriers to healthcare including cost, lack of insurance, language, culture, and other Social Determinants of Health (SDoH).
Serving a diverse population of 50,000 neighbors at every stage of life, NOAH’s model of care places patients’ needs at the center of attention while delivering comprehensive health services including medical, dental, behavioral health, psychiatry, nutrition, pharmacy, preventive health, enrollment assistance, and health education programs.
NOAH was established in 1997 in response to local school districts’ concerns that not all students were able to access quality healthcare. Volunteers and a nurse practitioner visited schools across the Scottsdale and Paradise Valley Unified School Districts to provide on-the-spot care for children, especially those from Title I schools and low-income families.
By 2001 NOAH had deployed a mobile clinic and established a brick-and-mortar health center at the Palomino Primary School in the
Paradise Valley School District. Recognizing the community need was larger than school-aged children, NOAH became as a 501(c)(3) organization, achieved FQHC status in 2013 and began supporting children, youth, adults, and seniors. The Palomino Health Center grew to serve adults and children and added dental care while NOAH opened the Heuser and Paiute Clinics in central Scottsdale.
NOAH continued to grow and expand its footprint to areas throughout the Valley. Today, NOAH employs a team of nearly 500 health care providers, support staff, and administrative positions and operates seven health centers across the valley including Cholla Health Center in Scottsdale, Desert Mission, Midtown, Palomino, and Venado Valley in Phoenix, and Copperwood I and II in Glendale.
NOAH by the Numbers:
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Founded in 1997
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21 Physicians
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29 Advance Practice Providers
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21 Psychiatric Providers
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47 Behavioral Health Counselors
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6 Nutritionists
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6 Dentists
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473 Total Employees
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7 Locations:​
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Phoenix, Glendale, and Scottsdale​
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Services include:
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Family medicine, internal medicine, pediatrics, psychiatry, telehealth, nutrition, pharmacy, counseling, dental, and community resources.
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Visit NOAH at noahhelps.org or (480) 882-4545​
ARIZONA PHYSICIAN: What is NOAH’s focus? What does it do better than other primary care providers?
DR. KARUPPANA: Addressing patients’ needs from a whole-person perspective allows NOAH providers to work as a team to develop the best plan of care for every patient. When patients are seen by a team of NOAH providers, they can share any questions or concerns about their overall health and participate in creating the plan for their healthcare going forward. This unique approach is the foundation of NOAH’s mission to provide compassionate, quality healthcare for all.
ARIZONA PHYSICIAN: You’re currently the Chief Medical Officer at NOAH, what are some of the challenges you see facing your organization?
DR. KARUPPANA: There are quite a few challenges facing community health centers in general. There is a national shortage of primary care providers, making it difficult to meet the health needs of our community. The cost of doing business has increased dramatically over the past few years (supplies and wages) but the reimbursement rates for our services have not increased. Finally, funding for health center programs is always at risk for renewal with each election.
ARIZONA PHYSICIAN: Do you see the current reimbursement models sustainable for primary care groups such as yours?
DR. KARUPPANA: There is a disconnect between how community health centers have historically been reimbursed, (through a prospective payment model from Medicaid and Medicare), and the full risk capitated value-based care arrangements that most commercial payers and advantage plans would like to move toward. Each reimbursement model requires a different care team structure, and while we have one
foot in each world, it will not be sustainable or achievable.
ARIZONA PHYSICIAN: Dr. Karuppana please share with us how you came to NOAH?
DR. KARUPPANA: Community Health Centers (aka Federally Qualified Health Centers - FQHCs) in Arizona are all part of the Arizona Alliance of Community Health Centers (AACHC). This is our state Primary Care Association (PCA) which provides technical assistance, training, and support to the FQHCs in the state. As a member of AACHC for the past 12 years through my work at 2 prior health centers, I had come to learn about the great work done by NOAH and met several members of their team.
ARIZONA PHYSICIAN: You previously worked at Valle Del Sol and Adelante Healthcare. What did those experiences teach you about community based primary care?
DR. KARUPPANA: My experiences at these Community Health Centers (CHCs) taught me a few things. First was that I felt most fulfilled in my work when providing care to an entire community, regardless of insurance or ability to pay. Having the sliding-fee-scale and discount services for uninsured/ under-insured patients was a core value to me as a physician. Second, I learned that I was not alone, that many others shared these values. Not only the hundreds of people who worked at my community health centers, but there was the statewide organization (AACHC) with 24 other community health centers as well. Then I learned there is a National Association of Community Health Centers (NACHC) with 1400 CHCs across the country with over 9000 clinics serving more than 22 million people. That tells me this community health center movement is creating a huge impact on our health care system and the lives our communities coast to coast.
ARIZONA PHYSICIAN: What insights do you have into the next
generation of physicians? What do they think about when it comes to primary care?
DR. KARUPPANA: I think there are likely a wide spread of interests and priorities that lead physicians to choose different specialties. Some prioritize shift work, so they don’t need to be on call or bring work home. Others love the immediate gratification of fixing something with their hands and then moving on to the next challenge. And others love building relationships, being a part of families, educating, and working toward prevention. If they read this and feel like the third description best described them, then primary care is their niche.
ARIZONA PHYSICIAN: How would you describe the current state of primary care for patients?
DR. KARUPPANA: There are still significant challenges accessing primary care providers for patients. Because of this shortage, most primary care providers are booked out weeks in advance and it is difficult for patients to get same day access to their primary care provider when they have an urgent issue. This has led to patients turning to urgent care/ emergency room more and more for same day needs. Our patients often don’t understand the importance of continuity of care and the complexity of care when information is disjointed across health records, they of course are looking for the simplest way to get today’s issue addressed. It will take a system overhaul to re-instate the role of a primary care provider as the first point of contact for a person’s health care needs.
ARIZONA PHYSICIAN: How did we get to the current situation with a shortage of primary care physicians?
DR. KARUPPANA: There are quite a few reasons for what created the shortage of primary care physicians. First, medical school training is extremely expensive, and most students finish medical school with several hundred thousand dollars of debt. Primary Care is the lowest reimbursement rates. Students coming out of school with high debt are often swayed by the weight of their debt into higher paying specialties for residency. Specifically in Arizona, we have very few primary care residency spots compared to other states and based on our population. Studies show that most physicians end up practicing close to where they complete their residency training. Given our lack of primary care residency in Arizona, it is no surprise that we have an extreme shortage of primary care physicians in Arizona.
ARIZONA PHYSICIAN: We see continued consolidation in the market of practices merging into larger groups and hospitals buying out practices. Does that trend help or hurt primary care?
DR. KARUPPANA: With anything, I believe there are some positives and some opportunities with this trend. The larger groups/ hospitals likely provide some needed infrastructure and standardization which improves quality of care regarding staff training, protocols, drills. But often the larger groups can feel more impersonal, patients can struggle to see their primary care provider regularly because there is always someone else with a sooner appointment the call center provides as an alternative. The shortage of providers is the primary driver of the shift to urgent cares and alternative providers, but also the large groups who offer alternative providers rather than an appointment with the primary care provider also normalizes that experience for patients, making it harder for them to see the value in the longitudinal doctor patient relationship.
ARIZONA PHYSICIAN: What future would you like to see for primary care?
DR. KARUPPANA: I would like to see enough Primary Care Physicians to meet the health needs of our community. I would like to see more primary care residency programs in Arizona, particularly in CHCs so we can grow our future workforce. I would like the payment structure to change so we are paid for the value we bring rather than our volume of visits. I would like patients to be able to come in to see their primary care provider for the same day/ urgent issues and have a panel size and schedule to accommodate the day-to-day variation that would occur. I would like to see more primary care physicians in leadership positions, public health positions, health care advocacy/ legislative positions, because of the unique perspective we have on health, health care, social determinants of health, and the well-being of our communities.