Community Health’s high-tech, affordable, accessible health care By Jill Jesso-White on April 30, 2020 in Community Health News What could possibly make a primary care network based in Rutland unique? It’s the kind of care you can get there with nationally-recognized programs, a focus on wellness, dental, behavioral health and pediatric specialties, walk-in Express Care, a culture of community and quality health care that almost everyone, insured or uninsured, has come to depend on. And in response to the coronavirus crisis, they rolled out a telemedicine program across its practices for all providers. Community Health, based in Rutland, is the largest of the 12 federally qualified health centers (FQHC) in the state of Vermont. Nationally, more than 1,200 FQHCs provide primary health care to one out of every 14 people. In Vermont, FQHCs provide care to approximately one in four Vermonters. Community Health opened in 2004 as Community Health Centers of the Rutland Region providing a network of medical, dental and behavioral health care. It’s grown to include seven medical facilities and a pharmacy – Rutland, Brandon, West Pawlet, Shorewell, Castleton, Community Health Pediatrics, Community Health Dental, Brandon Community Pharmacy – which last year handled close to 187,900 patient visits, providing care to over 41,800 patients in the Rutland County/southern Addison County region which includes over three-quarters of the residents of Rutland County. First established in 1965 as part of President Lyndon Johnson’s War on Poverty, FQHCs are primary care centers, located in underserved and rural areas, that provide high quality, cost-effective health care regardless of an individual’s ability to pay. The success of the FQHCs was recognized by Congress when creating the Affordable Care Act (ACA) in 2010 and the ACA legislation permanently authorized the program. How does an FQHC work? Who are the patients? And how has Community Health responded to the pandemic and the needs of its patients and community? Community Health’s CEO Don Reuther and CFO Mike Gardner shared their perspective on health care in this time of crisis. What is an FQHC? Reuther: FQHCs in general are safety net providers of primary, wellness and preventative care for those who are uninsured or underinsured. It is both our mission and mandate from the government that we see any patient regardless of their financial ability to pay. It’s a little different here in Rutland because the state health system has provided most of the citizens with health care coverage either through Medicaid and Vermont OneCare or through Medicare, which is a very large segment of our population. We serve about 65% of the entire population in the area the government has designated for us. We provide coverage and specialty services private practitioners either cannot or do not want to undertake. For example, we have two dental practices and one of the only dental groups that takes Medicaid which is about 40% of our patient base. In that sense we fill a unique void. Behavioral health is the same. We provide service to people who would have a very difficult time, if they can at all, to get behavioral health services. For private practitioners if they could get in the wait time is tremendous. We can pretty much see patients when they need that service. Gardner: Community Health currently provides services to 80% of Rutland County. We see any patient that shows up at our locations, regardless of their insurance status or their ability to pay for the services. Patients without insurance are encouraged to and assisted with applying for any insurance programs available. This past year Community Health has focused not just on treating patients that are sick, but also reaching out to patients before they get sick. FQHCs receive grant funds for treating patients below 200% of the federal poverty level with no insurance. These grant funds have been utilized to provide discounted medical and dental services for patients with no insurance. Community Health has provided $500,000 to as much as $1 million per year in discounted services as a result of these grant funds. How did the pandemic change your delivery of services? Reuther: One of the effects of the pandemic is that people are in self isolation and are very reluctant to come to the clinics in person, even though at our health centers we take every measure to prevent the spread of Covid, our patients don’t want to subject themselves to that risk. So, we accelerated the implementation of our Telehealth program for all of our providers to participate in, and in two weeks it was working. About 75% of our visits are done through telemedicine now. We are taking this as an opportunity to expand the way patients get service. We are hoping we can continue this even after the crisis is over because a lot of our patients are rural, they have comorbidities (having two or more simultaneous chronic illnesses). Telemedicine is a way to connect with them on a more frequent basis and make sure that we can practice preventative care with them as opposed to just treating them when they have incidental flareups. Gardner: Our struggle at the beginning of this crisis was to assist in treating COVID patients, while at the same time continuing to treat patients for their primary care needs without allowing the virus to spread throughout the community. We have been successful at doing this due to our rollout of our Telehealth service. Telehealth has been a goal of the organization for the past year, as this will be a primary component of providing care to patients in the future. This pandemic forced the organization to expedite the process of rolling out this new service. Through the COVD-19 crisis, Community Health has been able to continue operations without furloughing staff. How is that possible? Reuther: We have a commitment to our 370 employees that lasts long beyond when his crisis is over so we want to be sure our employee family is taken care of and that we do everything that we can to retain them and make sure that they are in the best possible circumstances. It is an economic drain to us, and we have applied for the payroll protection loan, and other Covid-related funding to bridge those gaps. The response from the staff to this health crisis has been amazing. We set up a remote working program and the staff has been great identifying their particular roles remotely and If they can’t do their jobs remotely, they have identified what other things they can do to help out. For example, we have staff at home making masks which are in critically short supply in the clinics (we require all patients to wear a mask). We have a dental hygienist who is now working in the payroll department. They have stepped up wherever we have needed them and doing all that they can. How has Community Health kept up with technology changes? Gardner: Community Health, like most health care organizations, has struggled due to the continuous changing landscape of how health care is provided. Over the past 10 years Community Health invested millions of dollars implementing an electronic medical record (EMR) for recording and tracking patient care. This was a game changer for how care is given to our patients. Patients can speak to any Community Health provider and be confident that the provider can see the patient’s entire medical record, regardless of which Community Health provider has treated them in the past. The EMR has also opened opportunities to be more proactive at treating patients for their primary care needs. Reports can now easily be generated showing which patients have gaps in care. Nursing staff is able to reach out to patients that have not been seen for their chronic conditions, with the goal of being proactive with the patient’s condition. Our goal is to keep our patients healthy, not just treating them when they get sick. How is Community Health going to fund the expansion of health care technology? Reuther: We are going to have to absorb a majority of those costs. Fortunately, we are in good financial shape. These are investments we need to make not only in our practice but in our community. In the short term it’s going to cost us, but we feel that in the long term the Telehealth program is so beneficial to our patients that it is a good investment. I equate it to building a large health center. We are providing access and treatment, and we are willing to take that cost on and knowing that if we can build this system then our patients are going to be much better off in the long run. Can you compare Community Health with other FQHCs where you have worked? Reuther: Here in Vermont there is much more collaboration between community partners, between Rutland Regional Medical Center (RRMC), the Visiting Nurse Association, Rutland Mental Health and us. It’s much easier to put programs in place efficiently and effectively when we have all of the partners working together. The other thing is the scope of our services. In urban areas where I have worked, you are serving a small fragment of the population. It is much more difficult to come up with a cohesive plan to treat patients under normal circumstances and under a crisis like this it makes it very difficult. We are fortunate here to have the strength in place that we do. What are your greatest challenges in the near future? Reuther: We want to expand Telehealth services. It’s a cost-effective way of providing health care to the residents and so far they have embraced it very well. We are also looking at expanding our behavioral health services. Right now, all of our visits are being done by telemedicine and so we want to build on that. The goal is that when a patient is in crisis they can reach out to us and get counseling right away. The largest number of emergency room visits are concerning anxiety and depression, and if we can make our services more available and real time we can cut down on that and reduce the cost of care for the entire community. Gardner: The biggest challenge for health care organizations in the future is the fact that federal and state governments have the power to make or break an organization based on the laws and reimbursement models that are passed. Health care is a huge part of our GDP, with many layers of involvement from many different industries. For example, recent easing of regulations for providing telehealth services during the COVID crisis has been beneficial and life saving for our patients. Health care for all exists today when it comes to providing primary care here in Rutland County. The FQHC model provides this for our community. We treat every and any patient regardless of their insurance status or ability to pay. I am proud to be part of Community Health. It really feels good having helped so many patients over the past 15 years with their medical and dental needs. Their health is our mission! Don Reuther is the CEO of Rutland-based Community Health, a nonprofit network of health care practices serving Rutland and southern Addison counties. Reuther has spent his career in health care, including 17 years of FQHC experience. Most recently he was chief operating officer of Baltimore Medical System. Mike Gardner is the CFO at Community Health. He has been the CFO for Community Health since its inception back in 2004 and served as interim CEO in 2019. During his time with the organization, the size of the organization and the services provided have more than tripled. Community Health is not only the largest FQHC in Vermont and New Hampshire, but is also the most cost-efficient FQHC.