Delivery of Care

The gift of good health, the promise of hope

First urban Neighborhood Health Station in the nation is poised to open in Central Falls next month, and with it, the promise to bring health care back to a community

Photo by Richard Asinof

Ray Lavoie, left, the executive director of Blackstone Valley Community Health Care, and Dr. Michael Fine, senior clinical and population health officer at Blackstone Valley, at the site of the Neighborhood Health Station in Central Falls. Construction is almost completed now, with an opening scheduled for this fall.

By Richard Asinof
Posted 8/6/18
The biggest story in health care not being covered by the news media is the pending opening of the Neighborhood Health Station in Central Falls, the first of its kind in an urban setting in the U.S. And, with its opening, it will be creating a one-stop shopping center for 90 percent of the health care needs of residents in Central Falls, combining primary care, urgent care, lab work, physical and occupational therapy, pharmacy, and basic imaging, integrated behavioral health, dentistry and eye care.
When will CommerceRI Secretary Stefan Pryor take an economic development tour of the new Neighborhood Health Station? What is the potential for a group such as Shri Yoga to hold yoga classes in the new facility? Will Food on the Move make the Neighborhood Health Station one of its mobile market stops? Will the School of Public Health at Brown University design new research around the data warehouse tools for population health in partnership with Blackstone Valley Community Health Care? What are the opportunities to create similar Neighborhood Health Stations in five Pawtucket neighborhoods? When will polling of potential voters in Rhode Island in the 2018 election ask good questions about health care, the number-one concern of voters nationwide?
Sometimes it seems that Rhode Island is too obsessed with rankings, comparing it to other states in national rankings that have little value. When it comes to place-based health care, two of the most important health initiatives where Rhode Island is a national leader are the development of health equity zones and neighborhood health stations.
One of the reasons why there has been so little news coverage of these two initiatives is the dearth of health care reporters in Rhode Island; another is what might be termed the acceptance of the inherent vice of the current health delivery system when it comes to risk.
A basic political question around Medicaid is this: are the large numbers of Rhode Islanders who are enrolled in Medicaid an economic strength or weakness? Perhaps that question could be reframed as follows: Are the large size of investments being made in the current hospital-driven health care delivery system a sign of economic strength or weakness?
Of course, the trick will be to get politicians running for office in 2018 to weigh in and answer either question.

CENTRAL FALLS – It is easy to become distracted when it comes to new stories about health care. Take last week. A strike by nurses against Lifespan ended, for the moment, with the reality that the labor strife could begin again shortly, if talks at the bargaining table do not move quickly toward resolution.

Regulatory filings by Blue Cross & Blue Shield of Rhode Island revealed that Peter Andruszkiewicz, the health insurer’s former president and CEO, received some $1.15 million in compensation in 2017, including a $781,00 bonus and $371,000 as part of a severance agreement, even though he left that position in May of 2016.

Also, the antitrust lawsuit, brought in 2013 by Steward Health Care of Massachusetts against Blue Cross & Blue Shield, was settled out of court. Steward had argued that Blue Cross had conspired with Lifespan and Thundermist to block Steward’s purchase of Landmark Medical Center [though Lifespan and Thundermist were not defendants]. In settling the lawsuit, Blue Cross continued to deny any wrongdoing.

The bottom line is that that the public may never learn what actually happened. In a footnote to the story, R.I. Superior Court Judge Michael A. Silverstein announced his decision to retire in September. Silverstein oversaw the receivership of Landmark Medical Center from 2008 until it was sold in December of 2013 to Prime Healthcare, a for-profit health system from California.

The projected total cost for the Unified Health Infrastructure Project, or UHIP, has grown to $647.7 million for the federal 2019-2020 fiscal year, up from $492 million, according to reporting by WPRI’s Susan Campbell. Despite the massive efforts by the R.I. Executive Office of Health and Human Services to make the Deloitte-built software system perform properly, there are many observers who question whether glitch-filled software will ever work. The state contract with Deloitte is scheduled to expire in March of 2019.

In Washington, the Trump administration issued new health insurance rules to encourage more Americans to buy inexpensive, skimpy health insurance plans for up to 12 months at a time, up from the current limit of three months. The short-term plans do not have to cover pre-existing conditions, and circumvents many of the consumer protections under the Affordable Care Act.

The good news
But perhaps the most important story connecting health care, better health outcomes, lower costs and economic development remained uncovered: the opening of the new Neighborhood Health Station 47,000 square-foot facility in Central Falls, scheduled for this fall, being built by the Blackstone Valley Community Health Care.

The new Neighborhood Health Station will be the first of its kind in an urban setting in the nation, providing primary care and urgent care to about 75 percent of the nearly 20,000 residents of Central Falls, integrating dental care, behavioral health care, eye care, physical and occupational therapy and a pharmacy, all at one site, in walking distance for most Central Falls residents.

In addition, the Blackstone Valley Community Health Care health center’s comprehensive population health management analytics system will create the first community-wide data warehouse in real time to connect the social determinants of health with the primary care patients, a powerful public health tool.

Further, the new facility is the first major building constructed in Central Falls in more than a decade, representing a major economic development investment in the city’s future.

In a recent interview with Ray Lavoie, the executive director of Blackstone Valley, and Dr. Michael Fine, senior clinical and population health officer at Blackstone Valley, the two discussed the economic impact of the Neighborhood Health Station on Central Falls.

“There’s some evidence that suggests 25 percent of economic activity in rural areas comes from health care,” Fine said. “Twenty-five percent.”

The size of that number surprised even Lavoie, who responded with: “Wow.”

And, Fine continued, “I suspect that the same amount is potentially true in urban areas. But we are so used to the colonialism of hospitals that we’re used to economic energy that often comes from health care being expropriated to other places.”

The Neighborhood Health Station, Fine argued, “is really an opportunity to look at what happens when you bring health care back to the community, and see it not just as a health enterprise but also as an economic development enterprise.”

Lavoie believes that the new Neighborhood Health Station will have a major impact on population health for the residents of Central Falls. “We like to think that we’re providing them the gift of good health and good health outcomes. That is what community health centers are really all about.”

Lavoie stressed the importance of having a big welcoming facility with great visibility and easy access to one-stop shopping for all of their health needs.

“Folks in Central Falls, up to 50 percent of them, don’t have access to private transportation, so many walk to their appointments,” Lavoie explained. “Now, we’re going to make it much easier. And convenient,” he added, “so that 90 percent of a [Central Falls resident’s] health care needs can be met at one location.”

“We’re not very good at chasing people,” Lavoie explained. “I think word of mouth is very, very strong in Central Falls. That is the city’s only reliable advertising. And we’re banking on that to drive patients to our door.”

When asked what the headline should be about the opening of the new Neighborhood Health Station facility in Central Falls, Fine responded succinctly: “The headline is: There is hope.”

Here is the ConvergenceRI interview with Dr. Michael Fine and Ray Lavoie, two of the leaders in community health care in Rhode Island, talking about what the Neighborhood Health Station means to Central Falls – and to Rhode Island. It is the kind of good news story so often missing from the headlines around health care.

ConvergenceRI: Thanks for taking time in you busy schedules to meet with me.
I think this is our first-ever joint interview. You have an exclusive.

LAVOIE: You can’t get anymore exclusive.

ConvergenceRI: How do things look for the grand opening, which is scheduled for sometime in September? Do you have a date set for it?
Not yet. That’s because the contractor has been hard to pin down when it comes to discussing the construction schedule.

ConvergenceRI: There are also plans to tear down the older building, the former Notre Dame urgent care facility. Will that happen soon?
That was always in the plan. We may accelerate that a little bit. I would love to get that lot paved while the asphalt plant is still operating – so mid-December, approximately.

ConvergenceRI: Trying to get the building finished must be somewhat nerve wracking for you.
It is. I’m dying to get underway in there.

And I’m dying to get the old one torn down. Because I think when people see the new facility – you know you really can’t see the new one from the street.

When people see the new Neighborhood Health Station, I think, to me, that will signify the rebirth of Central Falls.

I think it will be important not only from a clinical operations perspective but also from the city’s perception of itself.

It is the first new substantial building that has opened in Central Falls in many years.

ConvergenceRI: That’s what Mayor James Diossa said at the topping off ceremony in the spring. Diossa said he’d never seen a crane like that in Central Falls.
In terms of health care, I don’t know of any organized community health center in a city that is going to be the place where most people get their primary health care. I don’t know of any other that exists in the U.S.
My guess is that they will soon start to exist [elsewhere]. But I think you’re right. I don’t know of another one, either.

Though certainly there are some health centers around the country that have major roles in [attending to] the health of the population they serve. I think of Unity in Washington, D.C., as a big player in providing health care to its community. And, I’m sure there are some I don’t know about.

I think what you are going to see over time, if you look at what is happening in Brooklyn, N.Y., and the pressure on their hospitals, is this: what has got to happen over time is that hospitals shrink and community health centers become much more creative.

ConvergenceRI: Is there an acknowledgement here in Rhode Island of the changes occurring?
My sense is that the state will land on the front page when it comes to insuring people be on the front page when it comes to giving people insurance cards; but not necessarily on the front page when it comes to new developments in the delivery system.

FINE: I don’t think the state has ever really understood the economic development perspective on health services. We understand that hospitals represent a certain portion of the employment, but we don’t understand the way that health care facilities interact with their communities from an economic development perspective.

There’s some evidence that suggests 25 percent of economic activity in rural areas comes from health care. Twenty-five percent.


FINE: And I suspect that the same amount is potentially true in urban areas. But we are so used to the colonialism of hospitals that we’re used to economic energy that often comes from health care being expropriated to other places.

This is really an opportunity to look at what happens when you bring health care back to the community – and to see it not just as a health enterprise, but also as an economic development enterprise.

ConvergenceRI: One of the things we have always talked about, Ray, is the quality of the electronic health records being developed by Blackstone Valley and their potential as a population health management analytics tool.
Once you have 70-80 percent of the residents of Central Falls as part of your electronic health records, will it enable you to do things that no other health system in Rhode Island can do?
I have some experience with the Health Department; there is a paucity of information when it comes to public health.

We really have only two significant sources of data about the public’s health. Do you know what they are? Birth certificates and death certificates; nothing else is population based.

If you want to know how common hypertension [high blood pressure] is in the population of Rhode Island, there is no way to measure that.

We can do extractions and projections based on small samples, but we have no place to record the blood pressure in a population, person by person. We have no way to know what the average BMI [body mass index] is in a population.

The [Neighborhood Health station and its data warehouse] gives us an opportunity to learn [these things] for the very first time; it will provide real-time access to clinical data about a population.

To me, every public health person in the country should be salivating.

LAVOIE: And, it is data not only about hypertension, but data sorted by race and ethnicity, age and gender.

ConvergenceRI: To ask a leading question, how does that data get translated into preventive and prescriptive health practices? Because if you can identify, recognize and analyze what is going on in the population, doesn’t that mean, from a community perspective, you can begin to make interventions?

ConvergenceRI: Can you pinpoint, for instance, if there is a spike of the number of teenagers giving birth?
Think of the power of this tool. From a public health perspective, it was interesting to know that Central Falls had four times the adolescent pregnancy rate of the state as a whole and nine or 10 times higher than some of the communities with the lowest rates.

But this puts us into the world of now knowing each individual kid who got pregnant. There were 35 in 2017, I think. [The Rhode Island Kids Count Factbook, in its analysis of Infants Born At Risk in Rhode Island 2017, found that there were 35 births to mothers younger than 20 in Central Falls in 2017.]

The [population health management analytics] lets us visit each kid, make sure that they have access to family planning to prevent a second early pregnancy, gives us an opportunity to visit their sisters and their cousins and their friends, and start to talk about family planning with those folks.

It gives us an intervention strategy. All of a sudden we go from percentages to humans.

That gives us a way – person by person, street by street, neighborhood by neighborhood – to begin to bring programming and support and community development to places that need it most.

ConvergenceRI: Does this analytics tool also mean that you can do more in terms of intervention and prevention of chronic diseases such as diabetes? Recently Dr. Peter Simon, a public health advocate for place-based health, said that the cost of health care for diabetes was going to bankrupt us in the long run.
We’re caught between the increasing incidence of diabetes, which is being driven by increasing BMI, which is being driven by marketing of food products. We caught between that, on one hand, and the cost of medications for diabetes, which are being driven by the marketplace through the blanking roof, such as the cost of insulin itself, which used to be cheaper than water.

LAVOIE: It will certainly give us more of an insight than we have ever had in terms of the real medical needs that have to be addressed, and that will help with staffing, to get the right kind of medical professionals on staff.

If we see the need, especially the need that is not being met, there are all sorts of improvements we can make.

This is being done in a community that no longer has a community hospital [with the closing of Memorial Hospital]. So we feel the urgency that much more.

ConvergenceRI: Can you talk about the context of the opening of the new Neighborhood Health Station in Central Falls, with its one-stop shopping approach to health care, now that Memorial has closed down?
It comes out of doing what the doctor orders. And that is always a tough sell. But we see a need for more and more preventative care. Again, if you do what the doctor orders, you probably won’t need that surgery.

That is what health centers are all about, more health maintenance and prevention, and, of course, chronic care management for those who are already [afflicted].

ConvergenceRI: And, you are very good at what you do. Is it still the case that you have one of the lowest costs per patient per year?
The entire data set isn’t shared, but I certainly believe that to be the case.

We do save lots of money for the health plans because our patients don’t require expensive care, which also speaks to the fact that our patients are engaged in their care.

If a clinician is multi-talented, they can treat many, many different diseases, afflictions and conditions.

And, if [those diseases] are caught early enough, that is going to prevent more expensive hospitalizations.

ConvergenceRI: You’ve also integrated behavioral health, dentistry, and at the new facility, Lifespan will have a physical therapy unit there.
Yes. Physical therapy, occupational therapy, and labs; advanced radiology will provide x-rays, and maybe in the future, ultrasounds.

We’re pretty excited about that. And, of course, there will be a pharmacy, located right on the site.

Folks in Central Falls, up to 50 percent of them, don’t have access to private transportation, so some of them walk to their appointments.

So, now, we’re going to make it much easier. And convenient, so that they can get 90 percent of their health care needs met, at one location.

ConvergenceRI: Perhaps the folks at the R.I. Public Health Institute may want to make the Neighborhood Health Station in Central Falls one of the stops where its Food on the Move mobile market will stop.
I am always anxious to integrate fresh, nutritional and healthy food into what we do.

LAVOIE: I’ll never forget the groundbreaking event we held in October of 2016 in partnership with the Vaseline healing project.

The Vaseline folks purchased lots of fresh vegetables, corn and eggplant and green peppers, etc. And, it was given away, for free.

Two women came up and hesitatingly asked, “How much is it?” and when they were told it was for free, they started to cry.

Ever since that day, I’ve wanted to do much, much more of that, providing food. There is widespread food insecurity here.

I cannot think of a supermarket in Central Falls. I don’t know what residents do for fresh fruits and vegetables. You know the saying, an apple a day keeps the doctor away. We are going to turn that around so that people visit the doctgor for that apple.

ConvergenceRI: Have the folks at R.I. EOHHS ever come out to visit you to learn what is going on?
Eric Beane [the secretary at EOHHS] has been out to 39 East Avenue in Pawtucket, with a promise to return to see the new facility. Others have also visited for a population health demo.

ConvergenceRI: In my conversations with him, Beane has always seemed very genuine.
Yes, he is. He was very interested in what we are doing with data warehousing, and we have promised to keep him updated on our progress.

They know they have to do something. There are hundreds of different technologies out there that everyone is trying to sell them. But I think he was genuinely impressed.

We plan to integrate the social determinants of health [SDOH] in our data warehouse, which will be assigned to each and every patient, based on census data, which will give us educational levels and income levels, among other data.

This data will be used to compare a SDOH risk score. Those scoring the highest on the SDOH risk score scale will be offered additional screening and access to care management services.

ConvergenceRI: What is the headline you’d like to see when you open? How would you sum up what the Neighborhood Health Station means, and where you’d like to go?
We certainly think we can have an impact on population health for the residents of Central Falls. We like to think that we’re providing the gift of good health and good health outcomes. That’s what community health centers are really all about.

Patient engagement is a big issue; it is a barrier in delivering health care a lot of times. But, I think this big welcoming structure will have great visibility. We’re not very good at chasing people.

I think word of mouth is very, very strong in Central Falls. It’s the only real reliable advertising there is. And, we are banking on that to bring them to our door.

FINE: The headline is: “There’s hope.”

What I think we are likely to be able to accomplish is population health improvement, and lower costs, by meeting people where they are and by providing them with what they need.

Ray has helped change a certain piece of how we deal with our own internal services. Which I think has opened many doors.

Once upon a time, you had to be a Blackstone Valley patient to use our dental and optometry and other services. And, if you were seen at the urgent care center, you weren’t considered a Blackstone patient.

That is all changed; dental care has become a door to primary care, eye care has become a door to primary care, urgent care has become a door to primary care, and that’s a really different space than where we were in a few years ago. It’s an open-door approach.

We also have data. Remember, we’re the only place in the country that I know of where everyone who uses EMS gets a phone call from the city, not from us, but from the city, asking: “How are you?” 72 hours later.

They also ask: Are you OK? Do you have primary care? If you don’t have primary care, here’s how we can connect you to primary care.

That is an ongoing, day-by-day approach.

It is a way to take the 3,000 people a year that use EMS and bring them into the primary care system as well.

LAVOIE: We’re very anxious to get underway. A lot of time and effort has gone into the Neighborhood Health Station. We think we are hitting the streets at just the right time.

Accountable entities [by the state’s Medicaid office] are being launched at the same time we’re throwing our doors open.

And, this will be great for the people of Central Falls.

FINE: For me, the people of Central Falls ought to be grateful to Ray and Blackstone Valley for making this happen.

I look forward to the day when there is not only the Central Falls and Scituate neighborhood health stations but also one neighborhood health station in every Pawtucket community.

And, neighborhood health stations in every Rhode Island community, so all of Rhode Island has access to primary care in their own neighborhood and in their own community, from 8 in the morning to 8 at night, open on weekends, so that they have health care in their own communities, and leverage spending on health care.


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