Robert Palussek, CEO, Legacy Community Health

In an interview with Invest:, Robert Palussek, CEO of Legacy Community Health, discussed the organization’s measured growth strategy, integrated care model, and efforts to expand access amid financial pressure across the healthcare sector. “We drive healthy change in our communities, and we make communities and people healthier so they can continue to contribute to society,” Palussek said.

How is Legacy balancing growth with its commitment to underserved communities?

We are cautious about growth. Legacy has grown quickly over the last decade, but we want to move forward intentionally in areas with particularly high needs. Houston has a well-functioning primary care safety net with health centers of different sizes. We are the largest in the region and in Texas, but our focus remains on providing comprehensive services where they are needed most.

We are trying to remove barriers by expanding certain service lines, using teleservices, and making access as easy as possible. As we expand geographically, we look for data showing that communities remain highly underserved. Specialty care may offer another opportunity. It can be difficult to find the right specialist with insurance, and it is even harder without it.

What guides Legacy’s decisions about new clinics and geographic expansion?

Our longstanding partnership with Houston Methodist is a strong example. Houston Methodist invested $50 million to help us open two clinics. A great deal of analysis and community assessment went into deciding where those clinics should be located. Four areas surfaced, and Acres Homes and Pasadena emerged as the top two. The Pasadena clinic is already flourishing, and we are seeing clear community demand.

We need to be strategic because we cannot have clinics sitting partly empty or schedules with substantial unused capacity. It is extremely difficult to operate a clinic over the long term if it does not contribute enough to keep the lights on. We use publicly available data and maps to identify areas where high levels of need remain and evaluate where to expand next.

What opportunities does Legacy see in Beaumont and surrounding rural communities?

We operate clinics in Beaumont. Beaumont itself is not rural under the federal definition, but the areas surrounding it are, and many people come into the city from those communities. We recently began a $30 million capital campaign. Our three existing clinics require significant attention, and we believe the better approach is to build one state-of-the-art facility similar to our Pasadena location.

That facility could become a gateway for expansion farther north into rural areas. The healthcare landscape is changing, so we need to be mindful about where and how we invest. Each investment must align with the community’s needs and remain sustainable.

How are funding pressures and rising costs affecting Legacy’s strategy?

My approach is to focus on what we can control internally. We do the best we can to deliver high-quality, affordable, and accessible healthcare with the mission at heart. Regardless of their ability to pay, patients should feel respected, valued, and appreciated, and they should leave knowing they received good healthcare.

Legacy is nimble and good at making the model work under different circumstances. Policy changes can make some periods more difficult. The sunsetting of Affordable Care Act subsidies is creating pressure because more established patients are continuing to seek care without a payer source, which will increase uncompensated care. The need has not gone away. Houston is growing quickly, and the infrastructure and number of service providers must keep pace with demand.

Many patients must choose among putting gas in the car, paying utility or phone bills, buying food, and paying for care. We respond with teleservices, free medication delivery, and education for high-risk maternity patients to help avoid costly inpatient visits or pregnancy complications. We operate on thin margins, so we focus on stewardship, liquidity for unexpected challenges, and investments that allow Legacy to remain financially stable.

How does Legacy’s integrated care model remove barriers beyond the exam room?

Our clinics are designed around the whole family. A mother may bring a child for a pediatric appointment but also need obstetric or dental services, while another family member may need behavioral healthcare. We try to stagger appointments and maximize the one-stop-shop model so patients can receive multiple services and understand the full range of care available at the site.

Our support extends beyond the exam room. A referral department of approximately 20 to 25 people helps patients navigate a complex process, find specialists, secure authorizations, and follow through with appointments. Case management is especially important for patients living with HIV, who may need support connecting with services, filling medications, or simply having someone to talk to.

We also make patients aware of other resources. Our obstetric clinicians and team members organize baby showers for expectant mothers, particularly younger mothers, to explain available support and address issues people may be reluctant to discuss, such as postpartum depression. Behavioral health is another major area of demand. We provide more than 200,000 behavioral health appointments, with the majority delivered virtually because that format makes it convenient for patients to maintain an ongoing relationship with a therapist.

Community health centers are located in the communities they serve. We often hire medical assistants, front-desk staff, and other contributors from the surrounding neighborhoods. That local presence builds trust and helps us remain a trusted provider of choice.

What has worked best for recruiting, retaining, and developing Legacy’s workforce?

Even though a larger health system may sometimes pay more, people do not necessarily leave for an additional dollar or two. They also leave when they do not feel appreciated or do not like where they work. Over the last two years, we have invested heavily in culture and in helping employees understand their impact.

Front-desk staff, contact center employees, referral team members, medical records staff, medical assistants, and behavioral health representatives often spend more time with patients than a doctor does. We want them to recognize how important they are to the care process and to fulfilling our mission. We are building a culture where people feel appreciated and understand the value they bring to healthy, strategic growth.

Transparency and career paths are also important. We hold town halls every other month so people understand where the organization stands. Employees can move from the contact center or front desk into medical assistant roles, and some pursue nursing school and return to Legacy. Explaining why we are growing helps employees remain connected to our future.

Where do you see the strongest opportunities for Legacy over the next several years?

Houston’s economic indicators and continued growth create significant opportunities. For Legacy, the priority is execution and impact. We have clear goals and focused strategic planning efforts underway, including determining which specialty services our patients need and how those services can work within our model.

We drive healthy change in our communities, and we make communities and people healthier so they can continue to contribute to society. That means connecting patients to the right care in the right place at an affordable price and passing along medication savings that can make treatment attainable. We are also focused on primary care for adults and children and on optimizing capacity across our existing services.

How are school-based health and strategic partnerships expanding access?

Our school-based health program is an area of particular pride. We have 40 clinics across three school districts, and I expect additional growth. Students can receive care on campus during school hours, and the clinics can also serve their siblings and the children of teachers. Students return to class after their appointments instead of missing the rest of the day, which preserves more face-to-face instructional time.

We are also considering mergers and acquisitions and other strategic partnerships. Some community health centers in Texas and across the country are struggling because revenue is not keeping pace with expenses. Rural hospitals have faced similar pressures and closures. There may be opportunities for health centers to join through strategic partnerships. Scale can help Legacy expand access, gain efficiencies, and remain financially stable while smaller organizations may find it increasingly difficult to sustain services on their own.