Can parallel health systems merge?

COMING TOGETHER: Blackstone Valley Community Health Center CEO Ray Lavoie, center, and Rhode Island Health Center Association President and CEO Jane Hayward, speak with facility Assistant Medical Director Jose Polanco. Hayward says that the state’s community health centers have brought the “process of a team caring for patients to an art form.” / PBN PHOTO/MICHAEL PERRSON
COMING TOGETHER: Blackstone Valley Community Health Center CEO Ray Lavoie, center, and Rhode Island Health Center Association President and CEO Jane Hayward, speak with facility Assistant Medical Director Jose Polanco. Hayward says that the state’s community health centers have brought the “process of a team caring for patients to an art form.” / PBN PHOTO/MICHAEL PERRSON

Amid the push and pull of developing and implementing new models for payment and delivery of health care, two parallel systems have emerged in Rhode Island – large, consolidated hospital networks and community-based health centers. As the state moves into the new world of health care reform, their points of convergence are still unmapped and potential opportunities for collaboration largely untapped.
For acute-care community hospitals in Rhode Island, the story has been one of financial struggle, declining revenue, receivership, pending sales and consolidation, as they transition from the “hospital as hotel” business model toward a global-payment model.
Lifespan, the state’s largest hospital network and largest private employer, recently announced plans to restructure its workforce, laying off more than 100 employees and freezing 500 open positions, in an effort to cut up to $150 million in operating expenses. Lifespan blamed the falling revenue in part on the changes created by health care reform and reductions in Medicare and Medicaid payments, according to spokeswoman Gail Carvelli.
At the same time, Lifespan has also increased its network consolidation in the marketplace. It opened its own pharmacy at Rhode Island Hospital. It received state approval to partner with Gateway Healthcare, the state’s largest community health provider. It partnered with OB-GYN Associates, one of the region’s largest obstetric and gynecological practices. It also moved ahead with plans to invest more than $100 million in rebuilding its health IT infrastructure to create a platform of interoperability across all of its hospitals, with the goal of moving its care to be more “patient-centric,” according to Dr. Timothy J. Babineau, Lifespan’s president and CEO.
The goal of health care reform is not just to enable patients to have access to insurance, but to help them have affordable health care options, says Jane A. Hayward, president and CEO of the Rhode Island Health Center Association.
“Not all care can be provided in the community, and not all care should be provided in a hospital,” Hayward told Providence Business News. “As we continue to build out a new system, everyone may have a different role to play.” Hayward agreed that the state’s hospitals are in a period of great flux, But, she observed, the state’s network of nine community health centers have chosen a different track toward achieving sustainability and better, more affordable health care.
“Community health centers have brought the process of a team caring for patients to an art form, surrounding the patients with the resources they need, increasing access to behavioral-health and oral-health services,” she said. “We’re doing health care in the most-efficient manner.”
Community health centers currently serve about 14 percent of the state’s population, Hayward said, and they are preparing to see as many as 65,000 new patients with the increased eligibility guidelines for Medicaid beginning Jan. 1, 2014, including adding new staff.
“Community centers try to manage costs by keeping people out of emergency rooms and out of hospitals,” Hayward said. “They’ve become very good at managing chronic diseases, such as asthma, diabetes and heart disease.” Community health centers have expanded their hours of operations, creating evening office hours and being available on weekends, six or seven days a week, she said.
The reality of today’s sophisticated community health-center network – an innovative cost-effective health care system with numerous state-of-the-art medical facilities – is a far cry from past perception of such centers being storefront operations in poor neighborhoods.
“We’re the public-health primary-care structure in the state,” Hayward said. “What has happened over the last 15 years,” she continued, has been a transformation. “Community health centers are no longer these little storefronts; they have become innovative, sophisticated providers of primary care.”
Hospital networks might learn from Blackstone Valley Community Health Center, which has pioneered the integration of data at the point of care from a team-centered approach. In 2011, Blackstone bent the medical-cost curve in avoided medical costs of $5.1 million for its 11,000 patients. In 2012, that trend continued, with $3.85 million in savings in avoided medical costs, according to Raymond Lavoie, the center’s executive director, a combined savings of about $9 million in two years, while achieving high grades in measured medical outcomes. Moving forward, Lavoie said that Blackstone is expecting about 2,000 new patients in 2014 as health care reform is implemented. In addition, about 500 to 800 of the center’s currently uninsured patients are expected to become eligible for Medicaid under the expansion of coverage, according to Lavoie.
Blackstone is also pursuing a new collaborative partnership with Care New England, Rhode Island’s second-largest hospital network, to build laboratory and radiology interfaces with the health center’s IT system. “Care New England’s pending merger with Memorial Hospital will be key to this strategy in the long run for Pawtucket and Central Falls patients,” Lavoie said. In addition, he cited the fact that Blackstone’s network partner, WellOne’s North Kingstown site, uses Care New England’s Kent Hospital for laboratory, radiology and inpatient support, while Blackstone’s patients deliver their babies at Care New England’s Women & Infants Hospital. “Dennis Keefe and Care New England definitely see the value of working with primary-care providers, and especially community health centers,” Lavoie said.
The same week Lifespan announced its layoffs, it also celebrated its continuing partnership with Providence Community Health Centers, supporting the second-phase of an economic-development initiative on Prairie Avenue in South Providence that had begun in 2003.
Mark Montella, senior vice president of external affairs at Lifespan, called the investment by Lifespan – leasing 27,000 square feet in the new refurbished building and relocating a number of programs to that location – “a unique moment, an attempt to jump-start some economic-development activity in South Providence.”
Currently, Providence Community Health Centers cares for 40,000 patients at 10 different locations, with about half of its patients under 19 years of age.
Future partnerships with community health centers, Montella continued, would not take on the same look. “One of the major indicators of health status is being able to have a healthy and sustainable economy,” he said.
At the same time, Montella continued, the number of people seeking charity care at Lifespan has more than doubled in the last few years. Providence Community Health Centers, Montella continued, “has their own challenges. Many people cannot afford to pay for services.
“Candidly, I don’t think we really know what the impact of the Affordable Care Act will have on some of the population,” he said. “Some people will still not be able to afford care. The safety net will still be a challenge. How do you really have systems of care that can be seamlessly integrated? I don’t know who has the secret elixir yet. I think it’s a matter of experimentation.”
Hayward, who called herself an “optimistic pragmatist,” believes the two systems will eventually converge. “My sense of health reform is that there will be one thing for sure: new alliances and new partnerships. I think there will be some strategic alliances between community health centers, because I think there has to be, in order for us to achieve the goals of health reform.”
How the two parallel systems are able to coordinate health care delivery and find points of convergence will determine, in part, whether health care continues to be “a wealth extraction system,” as R.I. Department of Health Director Dr. Michael Fine has described it, or evolves into a more affordable health care system.
“The real challenge is how you organize and manage care in a cohesive fashion. You need someone to be the catcher’s mitt, so that when people are not in a hospital, they have organized, coherent care,” Fine said.
Fine has proposed an innovative, alternative system of health care delivery for Rhode Island, called The Primary Care Trust, with neighborhood health stations serving communities in rural and urban areas as providers of all services in a continuum of care, integrating home health, social work, behavioral health, physical therapy and primary care.
The new configuration, Fine said, of consolidated hospital networks, robust community health centers and large, private group practices, are not solutions by themselves for Rhode Island’s health care delivery problems, but rather, serve as the starting point. “By assembling neighborhood health stations across the state, entire populations of health can be addressed,” he said. •

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