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Overview and History
The Upper Peninsula Association of Rural Health Services, Inc. is a private non-profit corporation that
was founded in 1981 to provide medical and dental services to the residents of Medially Underserved Areas
of the Upper Peninsula of Michigan. Originally, the Association was created by joining two federally funded
Rural Health Initiative projects, one on a Native American reservation in the eastern part of the U.P. and
the other in the far western corner in the town of Ewen, Michigan. Since these sites were 250 miles apart
with 5 hours of driving between them, a central office was eventually established in the middle in Marquette.
UPARHS grew to include a stand alone psychiatric clinic in the northern town of Houghton and in l985 opened
the Northern Menominee Health Center in Spalding, in the south part of the region. As needs changed and
it became more difficult to recruit NHSC psychiatrists, the clinic in the east was returned to the Bay
Mills tribe in l988 to operate as a Tribal health program and the Houghton Psychiatric Clinic was closed
in l990.
Since that time, UPARHS has developed the Dickinson-Iron Dental Clinic in Crystal Falls, Michigan
(November, l996), added dental services to the Ewen Clinic site (January, l997) and opened the Northern
Menominee Health Center South in Menominee (May, 1998). UPARHS also took over the operation of the West
Mackinac Dental Clinic in Engadine, in the eastern U.P. which is funded through a State Primary Grant that
they administer. The Sawyer Dental Center, Gwinn, was established in 2003 also as part of the state grant
funding.
The Ewen Medical-Dental Center celebrated its 25th Anniversary in 2002 and the Northern Menominee Health
Center celebrated 20 years in 2005.
Throughout these years, UPARHS as a Federally Qualified Health Center has been the recipient of Sec. 330
funds through the Community and Migrant Health Center program. Approximately 29% of revenue is generated
through the federal grant, 66% from patient revenue (Medicare, BC/BS, Medicaid, self-pay) and 5% from other
sources such as donations. At least 68% of the federal grant must be used to cover a sliding fee program for
the uninsured patients.
The goals of the Association, as established by the corporate bylaws are as follows:
Provide leadership for the development of high quality rural health services in the medically
underserved areas of the Upper Peninsula of Michigan.
Provide comprehensive primary health care to all people in the local service areas who require such
care without regard to physical handicaps, mental handicaps, political beliefs, religious beliefs, race,
sex, color or age.
Provide related medical and nursing education.
Provide leadership in the development of related services that would improve or extend the current medical
services in the various local areas of the Association.
Provide administration for the integrated health centers that are owned and operated by the Association.
In striving to meet the above objectives, the Association shall endeavor to provide quality services,
staff, facilities and achieve financial self-sufficiency at each health center, aided by the input from the
respective local committee members.
Governance
The Association is governed by a twelve member Board of Directors. A majority of the governing board members
are required to be consumers of services at the health centers. As a group, they represent the demographic
profile of the service area in addition to bringing expertise in the fields of business, social services,
finance, insurance, public health, education, local government, health service deliver and community affairs.
The Association by-laws establish the method of selection of board members, committee structure and
responsibilities.
Need Statement
UPARHS serves approximately 4,500 medical users with 10,000 to 15,000 encounters annually. We also have
5,000 dental users with 12,000 to 16,000 encounters each year.
The single most prominent barrier to care within this population appears to be lack of health insurance and
therefore postponing or not receiving care until there is extreme need. This applies to patients who refrain
from receiving dental treatment until the pain is too great, persons not filling prescription because of the
cost, foregoing specialty care because they are afraid they cannot afford it and so on. There may be some
cultural barrier to care for the Latino people, but we attempt to reduce that barrier through the services
of an outreach worker and caring staff.
Patients also experience geographic barriers in terms of having reliable transportation to travel distances
to the health center, hospital or specialists out of the area. Again, the health centers provide some
transportation, but this still limits a person receiving care elsewhere.
Delivery System
UPARHS offers direct medical/dental services at six locations:
Northern Menominee Health Center, Spalding, Michigan (medical & dental)
Northern Menominee Health Center South, Menominee, MI (medical & dental)
Ewen Medical-Dental Center, Ewen, MI (medical & dental)
Dickinson-Iron Dental Clinic, Crystal Falls, MI (dental only)
West Mackinac Dental Center, Engadine, MI (dental only)
Sawyer Dental Center, Gwinn, MI (dental only)
The administrative office of the Association is located in at 220 W. Washington Street, Suite 430, Marquette,
Michigan 49855.
The clinics at Spalding and Ewen are owned by UPARHS. The sites at Menominee, Engadine, Sawyer and Crystal
Falls are in rental space. All providers and staff at all sites are directly employed by UPARHS.
Medical services consist of general Family Practice provided through Board Certified Family Practice
Physicians as well as Physician Assistants and Nurse Practitioners. Services include diagnosis and treatment
of acute and chronic diseases, lab, x-ray at some sites, minor surgery and inpatient care as needed.
Oral health services including emergency care, fillings, extractions, exams, cleanings, root canals, dentures,
partials, etd. are provided directly on site by UPARHS dentists and hygienists. Referrals are made to dental
specialists as needed.
Mental health care is referred to the local Community Mental Health providers. Due to the limitation of state
funding, these programs are more in jeopardy and unable to serve the patients that they used to see. UPARHS
will be beginning to explore providing services directly to the less severe population.
UPARHS does participate in the Health Disparities Collaborative as a means to begin working more closely with
our patients to manage chronic disease care.
To address the cultural and linguistic needs of the local Latino families, UPARHS has hired an outreach worker
of Latino descent who provides interpretation and case management services for the families. Sign language
interpretation is available for hearing impaired patients through trained UPARHS staff.
UPARHS strives to provide continuity of care through expanded hours to include evenings at all clinic sites
and Saturday mornings at two. The health centers all participate in a 24-hour call system with a professional
answering service that connects to our staff person on call.
UPARHS has had an established performance improvement system in place for years. We strive to improve patient
satisfaction and reduce risks where ever possible. UPAHRS has been JCAHO accredited for the third time last
year and has worked diligently to improve all processes. We also strive for care coordination at all levels
and have implemented tracking systems for referrals, hospital admissions and discharges etc.
UPARHS also collaborates as part of an Integrated Service Delivery Network with the Sec. 330 clinics in the
Northern part of the lower peninsula of Michigan for computer support issues. We collaborate with the
neighboring Sec 330 grantees in Wisconsin regarding dental issues.
UPARHS collaborates with the local health departments and hospitals on issues such as breast and cervical
cancer screening programs, family planning, immunizations, etc. We pariticipate in the Michigan Child
Immunization Registry and other local programs.