Bristol clinic navigates changing health care landscape

BRISTOL — At a time of rapid change in health care throughout the state and nation, Mountain Health Center is thriving.
In just under three years, the Bristol-based doctors’ office has doubled its employees, increased its total patient load by close to 1,000, and doubled the number of office visits it can handle yearly.
Mountain Health’s expansion goes hand in hand with its designation in November 2013 as a Federally Qualified Health Center, or FQHC.
Since winning that designation, Mountain Health has continued its transition from what had been a small but dedicated bunch of MDs in a humble house-turned-office on Mountain Street to a one-stop-shopping suite of offices at Bristol Works that offers — as FQHCs are designed to do — medical, dental, mental and behavioral health care services, and outreach and educational assistance. Mountain Health also offers alternative therapy services, as part of its FQHC mandate to serve the needs of its specific community.
“We’ve grown so fast and so quickly it’s felt a little bit like — we dub it oftentimes a ‘sprint marathon,’” said Mountain Health Executive Director Martha Halnon.
Part of Mountain Health’s success in its still relatively new incarnation as an FQHC is an attitude of collaboration and a willingness to take risks that health expert Kate Simmons says is part of the strength of Vermont’s FQHC network.
“This is a time of immense transition for the health care system in the state and in the nation. There’s a lot changing,” said Simmons, director of Vermont Operations and director of Community Health Accountable Care for the nonprofit Bi-State Primary Care Association. “We’re living in a time of transition and health care reform and so the health centers in general have been entities that are willing to try new things.
calendar year 2014, Middlebury area includes Bristol
“Health care centers are trying to respond — as are all the practices statewide — to health care reform and the need to increase access even more than it already is.”
Simmons said that the challenges of navigating these often stormy waters have shown that FQHCs statewide have been good at innovating and in finding ways to collaborate with their community partners.
FQHCs are tasked with delivering health care to medically underserved communities. The federal Department of Health and Human Services identified Addison County as medically underserved in 2009.
Important characteristics of FQHCs are that:
•  All people are served, regardless of ability to pay.
•  Fees are charged on a sliding scale.
•  The organization is community-based, with a local board of directors.
•  It provides comprehensive services, so that medical, dental, mental health, behavioral, preventative, wellness education and outreach services are offered under one roof.
•  It works with communities to identify and meet health care needs and to remove barriers to health care access.
Mountain Health’s transition to a Federally Qualified Health Center is part of a statewide pattern.
The first Vermont FQHC, Northern Counties Health Care in St. Johnsbury, opened in 1976. By 2000 it was joined by Community Health Centers of Burlington. In 2012, there were eight FQHCs statewide, and today there are 12.
In 2000, the state’s two FQHCs operated a combined total of seven sites. Today Vermont’s 12 FQHCs operate 60.
Simmons emphasized that FQHCs have a long history of bipartisan support. Founded in 1965 as part of President Lyndon B. Johnson’s Great Society, the recent expansion of FQHCs has received federal support from both sides of the aisle politically.
“They definitely grew a lot in the ’90s and the 2000s and also under Obamacare,” said Simmons. “Under President (George W.) Bush there were several initiatives to support the health centers, as well as under President Obama. They really have had support federally across the political spectrum. They are very well loved and well supported.”
At present, Mountain Health’s core staff includes five medical doctors and two nurse practitioners (plus another MD on a per diem basis). They are supported by a 14-person staff that includes administration, education and outreach.
Given the breadth of the federal mandate for FQHCs, Simmons credits Mountain Health especially for the collaborative approach that makes this breadth possible.
For example, much of Mountain Health’s mental health and behavioral staff come through partnerships with the Counseling Service of Addison County. Through CSAC, Mountain Health provides its patients with access to a mental health counselor, a specialized drug and alcohol counselor, a licensed clinical social worker, a case manager and a psychiatric nurse practitioner.
Central to providing what medical professionals call “wrap-around services” is that the service providers can be brought together under one roof. CSAC practitioners come to Bristol so that patients aren’t left to struggle with referrals and string together disparate bits of care on their own.
“As an FQHC we address things holistically and are able to partner with other agencies that already may be providing some of these services,” said Halnon. “A good example is CSAC and how we utilize them and work together.
“That warm handoff is so important. To be able to go, ‘Let me just walk you down the hall and introduce you to someone that I want you to talk to’ is huge.”
Through a similar collaboration, Mountain Health patients also have access to a dietician.
But bringing in dental care has been challenging. For the first two and a half years after becoming an FQHC, Mountain Health partnered with independent practitioners in Vergennes, Middlebury and Bristol (dentists Derek Cimler, Brian Saltzman and Jim Cossaart), as it worked toward establishing its own dental practice. WHO PAYS THE BILLS FOR HEALTH CARE SERVICES
calendar year 2014
In April 2016, it established Mountain Health Dental Care at the Bristol Works complex, with one dentist, James Faulkner, and one dental hygienist. Soon after helping to set up the new practice, Faulkner decided to retire. He is being replaced by dentist John Viskup, who will provide dental care two days a week. Halnon said that Mountain Health hopes to add a second part-time dentist by October and will continue its partnerships with Cimler, Saltzman and Cossaart.
Another strength in how Mountain Health has responded to community needs, said Simmons, is by providing alternative therapies.
On staff, Rachel Edwards provides massage, acupuncture and other complementary therapies and is also the center’s community and patient health educator. Among Edwards’ specialized skills is something called acudetox, where acupuncture is used to address opiate and other addictions, as well as to address chronic pain, insomnia and other ailments.
In her role as patient educator, Edwards is currently developing a series of workshops that will be offered to patients and community members for free.
The first of many challenges for any would-be FQHC is winning federal recognition.
“It is immensely competitive the first time you apply to become a health center. It’s a very competitive process,” said Simmons. “Many health centers go through the process a couple of times or more than that before they are awarded funding.”
But, Simmons said that “once the federal government makes a commitment to a community with a health center, the federal government really wants to continue supporting care in that community.”
Halnon ruefully admits that the center’s mountain of federal paperwork is an ongoing challenge.
“There’s an immense amount of regulation and work that goes with it. Keeping up on everything that we are required to do, crossing all the t’s dotting all the i’s,” she said.
Both Halnon and Simmons agreed that FQHCs face many of the same challenges as non-FQHCs.
Chief among them, Simmons believes, is person power.
“FQHCs face a lot of the same challenges that practices face statewide,” she said. “There’s a shortage of primary care providers, physicians, mid-level, nationwide. And so the health centers like all the other practices in the state struggle with that.
Ultimately, both also emphasized the challenges of facing the unknown.
“(Practitioners) need to be ready, they need to keep a focus on the needs of their community but also on how trends are changing nationwide and statewide and to be ready to change with that as it happens and evolve,” said Simmons.
“It’s changing all the time,” said Halnon. “And now with health reform — what does that mean? I don’t know that anyone really knows what that means yet or what it’s going to look like. But we know something’s going to change. And it really is around public health and how do you address that? … How do we work better together that way?”
Reporter Gaen Murphree is reached at [email protected].

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