CENTRAL FALLS – Well beneath the radar screen, amidst the constant rumblings of the health care delivery system – the restructuring of acute care community hospitals, the ongoing transformation of care delivery being managed under the State Innovation Model, and the efforts to move from rewarding volume to paying for value through accountable care entities – a new model is emerging for health care in Rhode Island: the neighborhood health station.

The premise is simple and direct: to design health care services based upon the needs of the community, rather than the needs of the provider.

One of the first such neighborhood health stations is now being built in Central Falls, in a way that is much more than just constructing a new building at the site of the Notre Dame urgent care center and Blackstone Valley Community Health Care facility on Broad Street to be its home.

As Central Falls Mayor James Diossa described it to ConvergenceRI, the coalition of community stakeholders so far includes the City of Central Falls, Blackstone Valley Community Health Care, Memorial Hospital of Rhode Island, the YMCA of Pawtucket, the R.I. Council of Churches and Progreso Latino.

“They have come together and are laying the foundation for a concept that will transform public health in our community,” Diossa said.

Diossa talked about his vision for the Neighborhood Health Station in Central Falls: “It will be a one-stop-shop for community health needs,” he said. “In just one building, primary care physicians, community health workers, dental professionals, psychologists, and social workers will all work together to address the variety of health services needed in a community like Central Falls.”

Diossa continued: “We even envision nutritionists and exercise professionals to be included in this comprehensive approach to building a healthy community.”

To Diossa, the neighborhood health station will serve as a beneficial tool of economic development. “The presence of an all-encompassing neighborhood station will improve access to health care and instill the focus on preventative care amongst residents,” he said.

Further, Diossa explained, by offering access to preventative care from a variety of services, the neighborhood health station will allow Central Falls residents to go to one location, instead of relying on emergency department visits.

By focusing on primary care and creating an overall healthier community, the neighborhood health station promises to cut down on more expensive health care costs down the road for individuals.

“Cutting down on emergency room visits and avoiding expensive future care, provides a direct savings to residents, employers, and insurers,” Diossa said. “Lower health care costs also have the benefit of attracting businesses to a community with productive and healthy residents.”

A new kind of relationship
The neighborhood health station in Central Falls is very much a work in progress, developing a new kind of relationship in an iterative process, with the participants meeting every two weeks to talk through how the new collaborative approach will work and knit together resources.

As Ray Lavoie, the executive director of Blackstone Valley Community Health Care, the community health center serving Pawtucket and Central Falls, told ConvergenceRI, the concept requires a new way of thinking about health care delivery.

“The approach being taken by the Neighborhood Health Station [in Central Falls], our attempt to deliver 90 percent of the health services needed by 90 percent of the population of a geographic region, cannot be simply a rearrangement of medical office locations nor can it be achieved simply with various co-location schemes,” Lavoie said.

It requires breaking down existing silos, Lavoie continued. “To be successful at improving population health in the community, and to accomplish this at a lower cost to the healthcare system, clinical information must be readily available to all treating clinicians in the community.”

Up until now, Lavoie explained, clinical information has been held in silos: one silo being the existence of distinct medical practices and another, the deployment of dissimilar EMR systems from different vendors.

“Blackstone Valley has set out to solve this structural problem by building a community health record that will be for clinicians, owned and operated by clinicians, for the benefit of all members of the community,” he said, with the Rhode Island Foundation providing funding through its Fund for a Healthy Rhode Island to help launch this initiative.

Once operational, the community health record will deliver clinical information to the treating clinician, about the patient of interest, at the point of care, according to Lavoie.

In addition, Lavoie told ConvergenceRI, the new community health record will have built into it an analytics engine that will report on quality metrics, providing frequent insight on cost and outcome measures of interest to the community, payers and funders.

“We’ll want to know how we are moving the needle on improving population health and at what cost, essential capabilities for an accountable community,” Lavoie said.

An ongoing conversation
One of the champions of creating neighborhood health stations is Dr. Michael Fine, the former director of the R.I. Department of Health and who is currently working part time with Blackstone Valley.

Fine talked with ConvergenceRI about the importance of the participation of the municipal services departments from Central Falls in the ongoing conversation around the neighborhood health station, including the city housing authority and the emergency service responders.

“Emergency medical services, or EMS, are not functionally connected to the health care system,” Fine explained. “They operate as a vacuum, sucking people up from the community and dumping them at hospitals.”

Currently, Fine continued, emergency responders do not have any capacity to triage; if you call them, they have to respond, and they take you to the hospital.

In turn, many people don’t have a clue about how the health care market is organized.

In the ongoing conversations around the neighborhood health station in Central Falls, with the inclusion of the city’s emergency responders, there are now discussions about the potential for reorganizing those services and connecting them to primary care for the first time, according to Fine, as a way to address emergency department overuse and unnecessary hospitalizations.

The goal, according to Fine, is to have primary care physicians and emergency responders making decisions together.

This kind of innovation, the real-time communication between primary care providers, specialists, and emergency responders, becomes linked to the “community health record” being developed by Blackstone Valley.

In Central Falls, with a population of about 20,000, there are about 3,000 EMS runs a year, or about 10 runs a day, according to Fine.

Some of them, Fine said, are truly emergencies – terrible chest pains, someone who feel down and broke a leg, and require transport to the emergency department.

However, by forging a new relationship between emergency service responders and primary care providers, and having access to a community health record in real time for the patient, along with access to a nearby neighborhood health station, Fine is hopeful that a new approach can be realized through the integration of EMS services with primary care.

“We’re working with the health department to develop regulations to have primary care doctors be able to call EMS and have the emergency responders go out and assess the patient,” Fine said. “And, then to make the decisions around what is appropriate care together.”

That’s a big deal, Fine continued, with the parallel development that there would be a kind of mobile integrated care that would allow emergency medical technicians to treat patients in the field.

“You can begin to see the merging of what are silos into a single system of care,” he said. “The key is in building relationships.”