Delivery of Care

Health, not health care: putting health needs of a community first

A second Neighborhood Health Station in Rhode Island takes shape in Scituate, serving a rural community’s needs, based upon what residents said they wanted

Photo courtesy of WellOne

Peter Bancroft, the president and CEO of WellOne, is partnering with the Scituate Health Alliance to create a new Neighborhood Health Station to serve the rural community residents of Scituate.

Photo by Richard Asinof

The new Scituate Neighborhood Health Station will be located at corner storefront in the Scituate Village Shopping Center, in between Brigido's Market and the Rite Aid pharmacy, in a renovated 5,000 square-foot space, next to China Garden.

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By Richard Asinof
Posted 6/13/16
A new Neighborhood Health Station will open in October, serving the rural community of Scituate, located in a shopping plaza off Route 6, with the goal of serving some 2,000 patients in the first year. A partnership between WellOne, a community health center, and the Scituate Health Alliance, a nonprofit promoting accessible, local health care, the new facility is the second Neighborhood Health Station now in development, the other in Central Falls. The concept, championed by Dr. Michael Fine, the former director of the R.I. Department of Health, creates an alternative narrative to the best way to transform health care delivery in Rhode Island, focused on the needs of the community, not the needs of the providers, the health systems or the health insurers.
How will the concept of Neighborhood Health Stations be fully integrated into the operational plan of the State Innovation Model now under development? Is there common ground that can be found between health equity zones now underway in 11 Rhode Island communities and Neighborhood Health Stations, to address the social, economic and environmental disparities in health outcomes? When will CommerceRI have a serious discussion about the economic development potential of Neighborhood Health Stations? What kinds of public health research could the Brown University School of Public Health conduct to measure how the Neighborhood Health Plan concept improves the health outcomes in a community? In what ways will the R.I. Medicaid office need to change its concept of accountable entities, population health and shared savings to include Neighborhood Health Stations?
There are conflicting narratives around health care delivery, making it often difficult to discern the truth and consequences around changes being made around the delivery of health care service delivery in Rhode Island.
First, what is population health? Is it the number of individual patients that are insured and receive care from a specific health care system, provider group or entity? Or, is it a broader measure of health outcomes for a community and neighborhood that can be defined by the zip code of where the patients live?
Second, how is the voice of the patients – and the neighborhood and the community needs – captured as part of the conversation? Is a series of listening sessions conducted as required by IRS regulations to maintain nonprofit status by hospital systems? Or, does it reflect the actual needs of a diverse community, in a statistically valid survey?
Third, what are the metrics used in measuring resources? Is it about cost-cutting tied to achieving increased reimbursements by improving outcomes, creating better margins around chronic disease care? Or, is it measured in terms of prevention of chronic diseases? Or, is it about reduced infant mortality? On reducing toxic stress?
The problem with the competing narratives is that so little of these contrasting conversations and stories are ever covered in any detail by the news media in a comprehensive fashion. Instead, the world is divided in simple dichotomies: are you for it or against it? Are you insured or not?
Whether or not you are insured doesn’t get to the heart of the issue around population health, however. The dividing line between better health outcomes and better prevention has to do with the gap in benefits offered to high-end workers and from which low-wage and low-income workers are excluded.

SCITUATE – A new community health facility is scheduled to open this fall in a renovated storefront at the Scituate Village Marketplace shopping plaza off Route 6, designed to serve the needs of some 10,000 local residents that before had very limited access to local health services.

The new 5,000 square foot facility at 35 Village Plaza Way will be situated at the corner of the retail plaza, halfway between Brigido's Market and the Rite Aid pharmacy, across Route 6 from Cindy's diner. It will be open to everyone, not just Scituate residents.

The team of providers will include primary care clinicians, social workers, nurses, dentists and dental hygienists, physical and occupational therapists, paramedica and emergency medical technicians.

The Scituate Neighborhood Health station, much like its counterpart in Central Falls, offers a compelling vision and an alternative narrative to the one being now shaped by conversations around efforts to transform a dysfunctional health care delivery system in Rhode Island.

The new Neighborhood Health Station is a partnership between WellOne, a community health center in Pascoag originally founded in 1909, serving the rural communities of Burrillville, Foster and Gloucester and North Kingstown, and the Scituate Health Alliance, a local nonprofit that has been exploring ways of providing local, accessible and affordable health care to Scituate since 2000.

The design of the services being offered was based in large part upon a comprehensive health care needs survey of Scituate residents – detailing what the residents said they wanted, according to Peter Bancroft, president and CEO of WellOne.

The Scituate Neighborhood Health Station, building upon the ideas championed by Dr. Michael Fine, the former director of the R.I. Department of Health and now with the Blackstone Valley Community Health Care center, seeks to transform the concept of wellness, Bancroft told ConvergenceRI in a recent interview.

“In this country, we have a system where we get paid to treat illnesses, instead of keeping people healthy,” Bancroft said. “We get paid by the number of procedures we perform.” The new Neighborhood Health Station, Bancroft continued, “is a shift in philosophy, with a focus on the population of the community, and what we can do to keep the population healthy.”

The concept seeks to combine primary medical, dental and behavioral health care in a way that strengthens the community, in collaboration with an expanded team that may include therapists, community health workers, emergency medial technicians, athletic trainers and nutritionists.

As Lynn Blanchette, Ph.D., vice president of the Scituate Health Alliance and a faculty member of the Rhode Island College School of Nursing, explained it, the vision braids together the kinds of relationships that are critical to the health of a community.

“In addition to the health and wellness that comes from a relationship with providers of medical and dental care, this new model will incorporate other areas that impact your health such as a healthy community,” Blanchette told ConvergenceRI. “Where people know and take care of one another, where we maximize the capacity of other organizations in the community, and we work together to achieve maximum health and wellness.”

In Scituate, the model will include an expansion of the activities of the health alliance and the nursing care that is already in place, along with first responders, the prevention programs and the schools, senior center and libraries.

The Neighborhood Health Center will also address the lack of local care providers. In recent years, “the availability of locally accessible primary care services in Scituate has been declining,” said John Marchant, president of the Scituate Health Alliance, in the news release announcing the project.

“As the inventory of practicing primary care providers has declined, the demand for primary care services has increased,” Marchant continued, due in part to the implementation of the Affordable Care Act and a corresponding increase in patients with insurance coverage. “This project will address that shortage.”

The construction of the new Neighborhood Health Station is being financed by WellOne, in partnership with Citizens Bank, based upon a business model that conservatively projects serving 2,000 patients in the first year, according to Bancroft.

And, if and when the Neighborhood Health Station grows, there is room to accommodate expansion at the shopping plaza, according to Bancroft.

Some of the start-up costs were funded by grants from the Rhode Island Foundation through its RIGHA Fund.

Here is the ConvergenceRI interview with Peter Bancroft, president and CEO of WellOne.

ConvergenceRI: Can you talk about the importance of creating a Neighborhood Health Station in a rural community?
BANCROFT:
We’re working in tandem with the Scituate Health Alliance on this initiative. It’s a collaborative effort; we have an advisory group that meets on a monthly basis.

Together, we are working through the conceptual approach, in addition to the work that’s going on to develop the physical plan.

ConvergenceRI: How does the Neighborhood Health Station expand the footprint of WellOne?
BANCROFT:
WellOne has been around for more than 100 years, principally focused in rural areas of Rhode Island. In most of those areas, there are limited options to access local health services.

In Burrillville, WellOne is the only medical provider; in Foster, we’re the only local provider of dental services and behavior health services. In Gloucester, where we serve a significant number of residents, there are no locally accessible services.

Many local residents are commuters; there are others who don’t travel frequently outside the community, particularly the elderly.

ConvergenceRI: How many people does WellOne currently serve in northwestern Rhode Island?
BANCROFT:
We serve about one-third of the residents in Burrillville and in Foster. Burrillville has a population of about 17,000; Foster is about 4,200. That translates into thousands of residents in each community. In Gloucester, we serve a significant number, but not quite to that magnitude.

When we were approached by the Scituate Health Alliance about collaborating, we recognized that there were the same kind of dynamics in that community. Scituate has around 10,000 residents, and the availability of local care is somewhat limited.

Dr. Michael Fine once had a family practice there, but that ended. Another primary care physician has announced plans to close his practice in the fall.

ConvergenceRI: What sets the concept of a Neighborhood Health Station apart from, say, the merging of a local primary care practice and a community health center?
BANCROFT:
It’s a concept of bringing health care locally so that people can access those services. It’s more than providing primary care and dental services.

One of the visions of the Neighborhood Health Station is to work more closely with fire and rescue agencies, so that when one of the patients is transported to the hospital, that information is shared with the medical facility, so we can monitor the information, when that patient is discharged, what follow-up care is needed, what medication the patient is taking.

We are changing the concept of wellness. In this country, we have a system where we get paid to treat illnesses instead of keeping people healthy. The Neighborhood Health Station is a shift in philosophy, with a focus on the population of the community, and what we can do to keep the population healthy.

[For chronic conditions such as] hypertension, obesity and diabetes, it’s about what we can do to help patients manage those conditions and create a healthier status for the long term.

[For a patient with diabetes learning how to keep their diabetes under control], that may involve learning about healthy eating: bringing a nutritionist into the [Neighborhood Health Station], have patients attend sessions around healthy eating and making healthy meals, and working out in a gym or a pool or engaging in recreational activity, with the goal of keeping the community healthy.

It represents a paradigm shift of what health care has been historically.

ConvergenceRI: How does the Neighborhood Health Station in Scituate, a rural community, contrast with the one being developed in Central Falls, a high-density urban environment?
BANCROFT:
The development of Neighborhood Health Stations in both Scituate and Central Falls demonstrates that this model can work in communities with very different demographics – in both a dense urban setting and a rural community.

Because you take this concept and really tailor it to the particular needs of the community, based upon a community needs assessment, even if the goals and objectives are not that different.

ConvergenceRI: Did you do a survey of Scituate residents to identify those needs?
BANCROFT:
Yes, we did, about a year ago, to explore this concept.

We conducted a statistically valid study of community residents with a health needs questionnaire, to help inform the process.

We wanted to know if this was something the community was interested in, and if we built it, would they come?

The results of that health needs questionnaire corroborated that there was an interest.

We also wanted to make sure that we had a viable business model, if we were to move ahead with [the Neighborhood Health Station].

It’s still a business, there are costs associated with it. [We needed to answer]: How many patients do you think you can attract? Does this look to be sustainable?

We went through the process; a lot of work was done before we even started, looking at the location, and the bricks and mortar.

ConvergenceRI: What location did you choose? Are you building or renovating?
BANCROFT:
We’re leasing space, in a shopping plaza right on Route 6, the Scituate Village Marketpalce. There was significant vacant space in that plaza.

We’ve leased four empty walls. It will take several months to renovate.

ConvergenceRI: What was the cost?
BANCROFT:
The total price is a little north of a million bucks. WellOne is making an equity contribution, with bank financing providing about 60 percent of the cost, working with Citizens Bank.

ConvergenceRI: What are the business projections for how many patients the Neighborhood Health Station needs to attract to be successful?
BANCROFT:
We prepared a best-case, a most-likely case, and a worst-case scenario. I am an accountant by training; I tend to be conservative. We are projecting to see 2,000 patients in the first year of operation, with the potential for it to be more than that.

If we need to expand the footprint, if the patient demand is higher, we can accommodate growth.

With these things, you have to get the word out in the community; the practice builds over time.

ConvergenceRI: When do you plan to open the new Neighborhood Health Station?
BANCROFT:
We plan to open in mid- to late October. We’ll definitely be doing a ribbon-cutting and a grand opening.

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