CANAAN, NH| by Nora Doyle-Burr | June 15, 2019
Original article can be posted at: https://www.vnews.com
CANAAN — Mascoma Community Health Center officials aim to join forces with a Franklin, N.H.-based federally qualified health center.
If approved by federal officials, the partnership with HealthFirst Family Care Center would expand services for both organizations and bring the two-year-old Mascoma clinic on Roberts Road near Route 4 the benefits that go along with becoming an FQHC.
Those perks include a federal grant to help support operating expenses, an opportunity for providers to take advantage of an educational loan forgiveness program, a boost to reimbursement rates from government insurance payers Medicare and Medicaid, access to a lower-cost prescription drug program and federal malpractice insurance.
“The biggest thing for us is because it helps us be more financially stable, we can expand services for our patients,” Scott Berry, the Mascoma clinic’s volunteer executive director, said in an early June phone interview.
The proposal the two groups filed with the U.S. Health Resources and Services Administration this spring outlines a plan to make the Canaan clinic a third site of the 25-year-old HealthFirst, which has an operating budget of about $7 million and currently serves about 10,000 patients with 55 staff members spread across two clinics in Franklin and Laconia, N.H. The three clinics would be managed by one board with local representatives from the three communities.
Because Mascoma Community Healthcare would retain ownership of the 13,000-square-foot Canaan building, which opened in June 2017 with a $3.5 million loan from the U.S. Department of Agriculture Rural Development program, the current board would continue to operate, though its mission would change, moving away from a governance role to become more of a supportive one focused on fundraising, advocacy and outreach.
The Mascoma clinic’s annual operating budget is about $1.5 million at this stage, said Mike Samson, the center’s volunteer finance director and Canaan’s town administrator. At this point, the clinic is break-even in terms of earned income, but due to delays in reimbursements it is not yet break-even on a cash basis. He expects the clinic will achieve that — regardless of whether the HealthFirst partnership works out — in seven to nine months.
“Growth is fairly consistent,” Samson said.
The clinic, which now has about 2,800 patients and 19 staff members, is adding about 100 new patients each month, Berry said.
But the partnership with HealthFirst would accelerate that growth by allowing the Mascoma clinic to add behavioral health care and nutritional services that officials there have wanted to offer, but have not had the resources to do so. For HealthFirst, the partnership would expand access to dental care for patients in the Franklin area.
“Health centers in New Hampshire, as a general rule of thumb, try to help each other out,” Richard Silverberg, CEO of HealthFirst, said in a phone interview.
Mascoma officials chose to pursue this relationship with HealthFirst because they already had been consulting with Silverberg as they worked to establish the Canaan clinic, according to Berry, a former senior director of value performance, measurement and patient safety at Dartmouth-Hitchcock Medical Center.
“It’s about aligning with the kind of organization that has the experience that will help us grow faster and better,” Berry said.
The Mascoma clinic already is having a positive impact on the communities in the region, said Alice Ely, director of the Public Health Council of the Upper Valley.
The clinic, which primarily serves the communities of Canaan, Dorchester, Enfield, Grafton and Orange, has increased access to services, especially dental care, Ely said.
“I think it’s absolutely been a great addition to the community,” she said.
Ely said the clinic also provides care in a cost-effective way that patients like because they feel connected to their providers.
Moving forward, Ely said the addition of the nutritional services will make a difference for patients managing chronic diseases such as diabetes.
Having a FQHC in the territory covered by the Upper Valley Public Health Council, which includes the communities of Canaan, Dorchester, Enfield, Grafton, Grantham, Hanover, Lebanon, Lyme, Orange, Orford, Piermont and Plainfield, may also expand opportunities for public health organizations across the region by making certain federal grants more accessible, Ely said.
FQHCs in the greater Upper Valley include Springfield (Vt.) Medical Care Systems, which includes Springfield Hospital and several outpatient clinics including one in Charlestown; Randolph-based Gifford Health Care, which includes Gifford Medical Center as well as several outpatient clinics, including in Bethel, Chelsea, Sharon and White River Junction; Little Rivers Health Care, which has offices in Bradford, East Corinth and Wells River, Vt.; and Ammonoosuc Community Health Services, which has a clinic in Woodsville.
Mainly, Ely said, achieving FQHC status will give the Mascoma clinic stability.
“That gives them space to start to say, ‘OK, what else can we do?’ ” Ely said. “They have the physical space to do more. It was always … part of the plan.”
If the organizations do get the federal grant, which they expect to hear about in August, they would have four months to expand their services, Silverberg said.
The expansion would require recruiting behavioral health providers to Canaan, which given the shortage of such workers could be tricky, but Silverberg, himself a licensed clinical social worker, said he has some old-fashioned methods for attracting such workers.
Over the years, Silverberg said he’s built up relationships with the region’s graduate schools and he’s “not at all bashful about going out there to the schools.”
“There’s only so much you can do over the internet,” he said.
If the organizations’ effort is not funded this year, it may be next year, Silverberg said. Regardless, the organizations plan to continue to collaborate, he said.
In general, FQHCs keep close tabs on the needs of their communities because they have patients on their boards, Edward Shanshala, CEO of Littleton, N.H.-based Ammonoosuc Community Health Services, said in a phone interview.
Community health centers see their role as helping to connect patients with services to meet all of their needs, Shanshala said. That includes medical treatment — primary care, behavioral health care and dental care — as well as assistance with social determinants of health such as transportation, food and housing.
“We don’t house people,” Shanshala said. But Ammonoosuc providers “work with people who do house people.”
The organization helps bring together community groups that provide a wide range of services. In some cases, Shanshala said, this involves bringing care into the community. For example, Ammonoosuc, which in addition to Woodsville has locations in the New Hampshire towns of Littleton, Franconia, Warren and Whitefield, has recently begun providing behavioral health care in local schools, he said.
By coming together, the Mascoma and HealthFirst groups will be able to minimize administrative costs, Shanshala said.
Doing so will leave “more resources for direct patient care,” he said. “I like that.”
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