By Elizabeth (Betsy) Vicencio | Photos Supplied
Healthcare is in trouble. Unprecedented workforce shortages, unyielding pressure on providers and hospitals with diminishing reimbursements and ever-increasing denials for services provided, and an aging, sicker population as a result of the pandemic and deferred care are the underpinnings of a complete health care system disruption.
Yet, providers and healthcare professionals in our region keep showing up. We are fortunate to have a collective of dedicated, committed people who work every day to improve the health of their neighbors, friends, family, and strangers.
No one healthcare system or provider will solve this crisis. The solutions lie with collaboration, communication and tenacity. Not just garden variety tenacity, but that dig deep, redefine yourself, imagine what really could be if we decided to just do it and just do it better.
What is most extraordinary are the local efforts to develop and execute healthcare innovation and collaborations, participation in value-based (outcome-based) payments and advancements in population health. We asked some of our local providers to speak to these topics.
Independence and Collaboration
Kris Ambler, MD – Owner of Ambler Medical and President of Northern New York Independent Physicians Association
The advances in information technology continue to be applied at the medical practices in our region. The majority of practices in our community have integrated their electronic medical records with the hospitals, regional labs and imaging centers to allow for quick access to medical records, lab and radiology results. Practices have also integrated their electronic records with data aggregators that allow for population health initiatives. These data aggregators allow for quick assessments of numerous measures pertaining to specific patients, a practice or system wide. Information such as which patients need a mammogram or colonoscopy, which patients have suboptimal diabetes control or are at higher risk for adverse outcomes can be quickly identified and given additional attention.
Our practice, as well as eight private practices in Clinton County, participate in multiple value-based payment arrangements with insurers and have for years. A number of physicians in Franklin and St. Lawrence counties also participate. This collaborative work benefits everyone. The patients are supported and physicians have additional data to make critical decisions and are not siloed when reviewing data. I am proud to be a member of the physician community in Plattsburgh. We are innovating every day. Many practices have partnerships with behavioral health groups, explore new approaches to chronic conditions and continue to share emerging practices. Our geography has always been an obstacle when it came to information sharing, but we have overcome that, and our patients benefit from our collaborative efforts.
Cooperation Through Partnership
Richelle Gregory, Clinton County Director of Community Services
Real innovation cannot be attributed to one practice or agency, rather it is the partnerships and collaborative efforts in the community — the agencies that do not make a profit, but still do the work. The employees who go out on a Friday evening for a crisis without funding simply because they care. Those that are reducing silos and working together to serve the unique needs of individuals and to tackle issues that are facing our community simply because it is the right thing to do. More than ever, we need to shoulder the responsibility of our community together.
Clinton, Essex, Franklin and Hamilton Counties worked together, advocated and were able to secure Mental Health Association of Essex County as our local 988-call center. This local provider understands the local needs and nuisances of our community. We are working to create a crisis response that is individualized and homegrown.
Clinton County established a System of Care, a statewide initiative to serve high needs children and families in our community. Healing Empowerment, Advocacy Resiliency and Transforming Trauma (HEARTT of Clinton County) is the local System of Care. In addition, to working to identify barriers and find solutions for families, HEARTT will launch a user-friendly web-site that will help families find services in Clinton County.
All four local Law Enforcement Agencies (University Police, State Police, Sheriff’s Department and Plattsburgh City PD), NAMI-CV, Clinton County Director of Community Services, BHSN Crisis Manager of the County Crisis Helpline attended the Crisis Intervention Team kick-off. This team will lead the transformation of the crisis response in our community when there is an intersection with Law Enforcement.
The community continues to evolve and embrace quality tele-health. Through trial and error, we have been able to implement practices that improves communication, collaboration and partnership.
Innovation Leads to Success
Elizabeth Pearl, MPT – Owner of Pearl Physical Therapy
At Pearl Physical Therapy we have completely changed how we approach every patient through the implementation of Lifestyle Medicine, a cutting edge, state of the art, evidence-based treatment modality while remaining mindful of financial feasibility in the current health care system.
Lifestyle Medicine identifies targeted areas to be addressed by the patient’s team –a Doctor of Physical Therapy and a Registered Clinical Exercise Physiologist. Areas of consideration include nutrition, sleep, stress management, and socialization.
Collaborations include ongoing relationships with local providers of diversified specialties including those in orthopedics, pediatrics, acupuncture, and mental health. Data is analyzed based on clinical performance, comparing outcomes regionally as well as nationally.
In the absence of value-based payment reimbursement, our approach to caring for community members is whole person, patient-centered and driven by improving not only traditional physical therapy outcomes, but evidence-based health markers as well. In 2022, our practice ranked #395 out of 5078 physical therapy providers in the nation regarding outcome data for improvements in care.
Bringing Care to Those Who Need It Most
Richard Webber & Gilbert Desmangle, MD – Owners of Lake City Primary Care
Our approach to CARING for people’s health does not focus on making certain that we have checked all the necessary boxes in order to satisfy insurance companies or an Accountable Care Organization (ACO). We first focus on the health needs of the human being in front of us and then ensure that we have completed the requirements required by “Value” based payment systems. We participate with many of those systems, but use them as a tool rather than a foundation for providing healthcare.
But they do not guide or determine how we look after people who rely on us for their care.
I am fortunate to work with office staff, nurses and providers who care about others as much as we do. They go home at the end of each day knowing that they have made a positive difference in someone’s life, with a feeling of satisfaction and accomplishment that cannot be measured with a data point or a dollar.
Meaningful innovation and collaboration in today’s medical world should lead to an improvement in patient care. The needs of the patient cannot be forgotten in the drive to deliver services or make a dollar. Many of corporate medicine’s current innovations are leading to the depersonalization of healthcare and are actually increasing healthcare costs.
Our practice makes use of many healthcare innovations including new treatments, procedures and technologies. However, we do so always and only if patient care is improved by that innovation, and that means care for all our patients.
There are groups within every patient population that innovations can leave behind. In our practice, we focus on a group of patients who are frequently left without care — those who cannot leave their homes. They may be home bound as a result of age-related ailments or disabling diseases that impact even young members of our community. We provide home visits to our patients one full day per week. While this does not benefit our practice financially, it gives the staff of Lake City Primary Care something much more valuable, a feeling that we are contributing to the health and welfare of our community in a way that differs from most practices.
Our Healthcare Epi-Center
Michelle LeBeau, RN, MHRN – President/COO of UVMHN at CVPH and President of UVMHN at AHMC
CVPH was a founding member of the Accountable Care Organization (ACO) since in 2014 and has participated in a variety of value-based contracts with Medicare, Medicaid and six commercial payers. In these contracts, we are accountable for both controlling cost and still improving quality. Most of these contracts put us at some financial risk if we cannot meet these goals.
CVPH is one of four corporate owners of the Adirondack Health Institute, the regional leader at the forefront of innovative efforts to promote and facilitate mental health care, addictions care and social care into the fabric of health care for Medicaid recipients in the Adirondack region. AHI led the Medicaid redesign efforts of the Delivery System Redesign Incentive Program (DSRIP) from 2014 -2020) and is expected to play a leadership role in the next federal Medicaid waiver likely to roll out in the fall of 2023.
CVPH, with support from the Adirondacks ACO, led the North Country Regional Vaccination Network, a seven-county collaborative of Public Health, hospitals, Federally Qualified Health Centers, pharmacies and primary care practices that accomplished the daunting goal of vaccinating the region against SARS CoV-2. Within that network, CVPH staff vaccinated health care workers from all sectors of health and social care in the Clinton County region, allowing these healthcare workers to safely continue caring for the population of our region.
Solving the future of healthcare is a daunting task. We have some of the brightest minds and the most dedicated people in our region who are a part of the collective solution toward a brighter tomorrow, all doubling down on our commitment to improving the health of our people. Finding the sweet spot where demand for services and available resources balance happens when we accomplish three things; right sizing our expectations of each other, creating time and space for conversation and collaboration, and helping each other succeed.
We are all a part of the solution – community members/patients, healthcare providers and professionals. The collective intestinal fortitude of our healthcare community is rebounding. Our recovery is imminent.
Elizabeth (Betsy) Vicencio is Chair, UVMHN-CVPH Board of Trustees and Trustee, UVM Health Network