Transforming community care: How TCC students are making a difference in Lakewood, Ohio
By Nicholas Wood | Staff Writer
Accessing health care isn’t always as simple as walking through the doors of a clinic. For many, it’s a complex system to navigate, full of uncertainty, and plenty of hoops to jump through.
While growing up in Chicago, Vanessa Guzman, D.O., saw this side of the industry firsthand. Coming from a low-income family with Medicaid, she was constantly jumping between providers and never receiving quality care.
“I never really had a good family doctor or PCP,” she said. “It was just very difficult to navigate, and, in my community, I saw the disadvantages that come along with being from a different culture and speaking a different language–on top of that low income.”
After having these experiences and seeing her Mexican American community’s relationship with the medical system, Guzman wanted to make a change. As a first-generation student, she earned her undergraduate degree and went on to work with Cleveland Clinic’s Hispanic Clinic, where she participated in quality improvement projects to enhance care delivery.
When she eventually caught wind of Ohio University Heritage College of Osteopathic Medicine’s Transformative Care Continuum, she saw an opportunity to take this work to a new level.
The Continuum of Care
The Transformative Care Continuum (TCC) is an accelerated pathway to a career in family medicine for select Heritage College Cleveland students. TCC students spend three years in medical school, instead of the traditional four, before entering their residencies at Lakewood Family Health Center or Akron General. Throughout this experience, students work with health care teams in Cleveland, forge deep connections with patients they will serve long-term and participate in population health and quality improvement initiatives aimed at reshaping health care delivery in their community.
“This is the program that I was meant to go into,” Guzman said. “I want to do medicine, I want to be in my community, and I want to work in a place that values my voice and gives me the ability to make meaningful changes in my community. It’s the perfect fit.”
Guzman is a member of TCC’s third cohort. Now a second-year family medicine resident at Cleveland Clinic’s Lakewood Family Health Center, she’s playing an active role in the lives of her patients and community to provide the positive health care experiences she couldn’t access growing up.
“Our patients, our communities, our physicians and our health systems need to be one team against the poor health outcomes our systems have created over time,” said Leanne Chrisman-Khawam, M.D, TCC program director. “The system should be better set up to work well for everyone. It's time we have leaders coming from the bottom up, not the top down.”
When developing the core principles for the program in 2017, Chrisman-Khawam’s guiding question was, ‘What kind of physician does the future of the health care system need?’ The type of student who would participate in this program was also re-envisioned, with attributes such as resiliency, grit and the ability to face failure in mind, “Because,” said Chrisman-Khawam, “in changing the health system, you're gonna have more failures than success.”
“I expose students to an economic understanding of how health care works and the public policy conditions under which they will be operating. I try to work with them to better understand the patients they serve and address the barriers that individual patients see and feel on a systemic level,” he said. “If we start early, students can start seeing the system differently from day one, making them more readily able to tackle our biggest challenges to cost, access, quality and equity.”
Medical school education historically focused on basic clinical sciences equipping physicians with knowledge to treat the ailments of individual patients. Incorporating a health system science education, which broadens clinical skills by looking at factors outside the medical setting impacting health, is a relatively new phenomenon.
For TCC students, however, it is a vital component of their training as they work with patients and community organizations to understand how they can deliver more equitable care.
Assessing Community Health Needs
In 2022, Guzman and other TCC students examined solutions for systemic barriers to equitable care delivery in Lakewood, Ohio, by assisting with the city’s first independent community health needs assessment (CHNA). This assessment investigated social determinants of health in Lakewood through a series of focus groups and key informant interviews, culminating in an accompanying action plan.
“We got to meet people in the community that were doing active work, interview them, and ask what are some things that are still needed. What organizations do you think should be more involved? What are you angry about?” Guzman said. “I would take all that information back to the clinic and think, how am I doing? What are we doing here that could possibly make a change? It's something that I always keep in mind when I'm seeing patients.”
Quality improvement projects are woven into TCC curriculum, leading to a final capstone project aimed at addressing community needs for improved health, wellness and patient outcomes. Guzman participated in the CHNA to meet this requirement. This opportunity—as all quality improvement projects do—takes the health systems science education one step further by affecting tangible change in the community.
“Having an awareness of these issues when they become residents helps them stay invested in closing some of those gaps and correcting some of the disparities in health care,” said Sandra Snyder, D.O., family medicine residency program director at Cleveland Clinic and TCC site director for Lakewood Family Health Center. “Often, students get very passionate and committed to the community and it's really nice to have a fresh set of eyes that are trained differently working to make a difference.”
Changing the health care system also requires knowledge of how the system operates to impact health on a variety of levels. This is where Loren Anthes, assistant professor of Health System Sciences at Heritage College Cleveland, comes in.
The first cohort of Transformative Care Continuum students to complete residency finished in 2024.
Fostering a Network of Support
Since completing the CHNA and action plan, several community issues have begun to be addressed, including establishing a clinic for individuals with developmental disabilities and staffing Lakewood schools with pediatric and adolescent psychiatry medical students, residents and attendants to address the mental health needs of the city’s school children. Both of these were needs identified in the assessment that are now being addressed thanks in no small part to Guzman and fellow TCC students.
“[Guzman] was very essential,” said Snyder. “She did a lot of the focus groups and a lot of the boots-on-the-ground work in gathering data, presenting it and challenging us to think critically about the gaps we can help close at the clinic.”
These meaningful attempts to close gaps in care delivery are also a testament to the spirit of collaboration inherent in the TCC program and fostered by the CHNA.
“All of these factors impacting health are interconnected and there's no way one organization could solve all of those challenges,” said Kate Ingersoll, executive director of Healthy Lakewood Foundation (HLF), a nonprofit advancing programs, policies and practices addressing health disparities in Lakewood. “Coming together with that recognition has not only raised everyone's awareness and understanding of issues in the community, but also strengthened our capacity to work together.”
The health care industry currently faces increasing issues of provider shortages. This, as well as a lack of awareness of available resources, hinders care delivery and patient health outcomes. Cooperation amongst physicians and community health organizations works to alleviate these issues by establishing trust and communication.
Kristin Broadbent, president and CEO of the Three Arches Foundation—another primary collaborator throughout the CHNA process and public charity funding initiatives addressing inequitable access to health care in and around Lakewood—emphasizes this aspect of the assessment’s outcomes.
“Because of the limited bandwidth nonprofits often face, it's really important to be able to have partners out there that you can work with,” Broadbent said. “That warm handoff is so important, especially in healthcare. Working together is better for the health of the community and the individuals that are being served.”
Creating a Supportive Community for All
While implementing new programs and establishing a communication network between resources are significant and positive outcomes of the health assessment, there is still work to be done.
“It's been a really rough few months for trans people,” said Jordi Luke, CEO of Haus of Transcendent (HOT), a Cleveland-based non-profit addressing the social determinants of health for LGBTQI2S+ people (‘2S,’ meaning ‘two spirit,’ a term used by some Indigenous communities to describe a person who identifies as having both a masculine and a feminine spirit).
A major finding of the CHNA was an urgent need for better services, inclusion and safety for transgender individuals seeking care in Lakewood. According to Luke, there is a significant lack of resources for trans and non-binary people in the Midwest.
“Cleveland in particular has no affordable housing specifically for LGBTQI2S+ folks,” Luke said. “There's also a lot of backlash right now, with hundreds of laws being passed across different states, including Ohio, terrifying trans people right now.”
Despite the challenges, Luke and the team at HOT are still working to improve quality of life for LGBTQ+ individuals. Currently, their biggest project is a broad network of resources, called HOT Help, which provides housing and health services to LGBTQ+ individuals in crisis. This emergency assistance program is supported in large part by a grant provided by HLF—a collaboration driven by the CHNA.
“We know from the CHNA that LGBTQ+ folks, especially trans folks, in our community are facing struggles with housing and mental health issues,” Ingersoll said of HLF’s collaboration with HOT. “Some of the safety net support services aren’t really responsive to those folks, and there's such a profound level of vulnerability. If a trusted member of the community can come and provide immediate support, and build on that person's capacity to access other types of help, then that's one role that we can play.”
Recently, HOT was able to help financially stabilize eight transgender individuals in the community with HOT Help. Additionally, in response to the CHNA’s findings, Luke observes more discussions in the community about the needs of LGBTQ+ individuals.
“More funders are aware of our needs, and these types of assessments are critical because larger institutions, foundations organizations, and systems often require data to drive what they will prioritize. This assessment validates what we already know for those that live and breathe the community,” Luke said.
In addition to HOT’s mission gaining support from Lakewood community organizations, Luke also worked with TCC students to educate them on the unique needs of LGBTQ+ people so they are equipped to address the needs of this population in their care delivery.
The Future of Healthcare
This collaboration across a variety of organizations, this level of investment in community health harkens back to TCC Director Chrisman-Khawam’s image of the physician of the future: someone attuned to the needs of a diverse population; someone aware of how the healthcare system operates, and critical of the inherent barriers it creates; and someone with an investment in the long-term health of their community beyond the walls of a clinic.
Wide-scale systemic change is going to take time to achieve, but with TCC students, like Guzman, and transformative projects, like the CHNA, a glimmer of this future can be seen.
“I would urge healthcare leaders to make programs like TCC their number one priority,” Luke said. “Instead of scaling and reducing investment, invest more in this space and publish what they're learning with the larger community. By doing that, they have an opportunity to get it right—to be on the right side of history.”
These are small steps on the long road toward a total transition to a value-based system, but a beacon of hope for those who have historically viewed quality care as an inaccessible luxury like Guzman once did.
“I just feel really fortunate to be part of this program and the CHNA. It's been a unique opportunity that’s opened up discussions about how people can come together for a common good, and also just opened my eyes in so many ways,” Guzman said. “It’s just been a great opportunity for me and I know that in the long term, it's gonna shape the way that I practice medicine…you know, maybe I could be the person to make a change in the community.”
Ohio University Heritage College of Osteopathic Medicine
© 2025 Ohio University. All rights reserved.