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Mt. Ascutney Plans For Preventive Care



Valley News Staff Writer
Wednesday, November 07, 2018

Windsor — Early in Samantha Ball’s time at Windsor Community Health Clinic at Mt. Ascutney Hospital and Health Center, a female patient called her in tears.

The woman lacked health insurance and had found a lump in her breast, Ball told the Green Mountain Care Board during a meeting last week at the Windsor hospital. Through Vermont Health Connect, the state’s health insurance exchange, Ball was able to help the woman get insurance. The patient then quickly got the care she needed for what turned out to be stage 3 breast cancer.

“She is doing wonderful,” Ball, who now is coordinator of the community clinic, said in an audio recording of the meeting. “I get a Christmas card from her every year.”

Helping patients sort out how to pay for the care they need is one of the ways Mt. Ascutney and its partners are working to improve the health of people in the community. They say they’re doing this work in part because they believe it’s the right thing to do for patients, but also because Mt. Ascutney is preparing to increase its commitment to the accountable care organization OneCare Vermont and the risk-based contracts it oversees.

Through such contracts with payers such as Medicare, Medicaid and Blue Cross Blue Shield of Vermont, hospitals receive per-patient lump sums, rather than being paid for each visit or procedure. If a patient’s care ends up exceeding the annual amount, the hospital is on the hook for the difference.

In 2018, Mt. Ascutney has participated in such a contract with Medicaid. Next year, it also plans to make similar arrangements with Medicare and Blue Cross, Mt. Ascutney CEO Joseph Perras said at the meeting.

Such contracts provide an incentive for Mt. Ascutney to promote community preventive health strategies, many of which Mt. Ascutney already had been developing in recent years.

Guided by the results of the hospital’s community health needs assessment — which uses surveys to assess the community’s priorities — Mt. Ascutney’s community health team and Windsor-area partners are working to address a wide array of challenges, including access to mental health and addiction treatment, recreational opportunities, family and economic support; transportation; adult dental care, medications and healthy foods.

“Nobody’s surprised at this list,” Jill Lord, Mt. Ascutney’s director of community health, said at the meeting. “This is where we need to go to make a difference.”

Doing so means preventing illness in healthy people and preventing worsening health in people with chronic disease, Lord said.

“We want to optimize the health of the people that we serve,” Lord said.

To prevent illness, Melanie Sheehan, Mt. Ascutney’s regional prevention manager, said she works with regional planners, selectboards and planning commissions to keep public health in mind when doing their work. For example, Sheehan said towns can use zoning regulations to encourage retailers selling products to adults, such as tobacco and alcohol, to locate their shops away from schools and other child-focused facilities.

Also on the prevention side of things, Courtney McCaig told the board about Mt. Ascutney’s family wellness program, which is embedded in its pediatric practices in Woodstock and Windsor and focuses on supporting the emotional and behavioral health of children and their caregivers.

“Caregiver health is paramount for children,” McCaig said. It “sets the stage for them to flourish.”

In her work with families, McCaig said she focuses on a variety of topics including reading aloud, art, exercise, healthy eating and parenting, which she said “underpins everything else.”

The approach seems to be working, McCaig said the program has grown from helping about 20 families in 2013 and 2014 to more than 200 last year.

Public health work in Windsor and beyond also is focused on improving access to mental health care. Like Mt. Ascutney, George Karabakakis, the CEO of the Springfield, Vt.-based Health Care and Rehabilitation Services, said his organization is focused on working with community partners to improve care.

To that end, HCRS, the designated community mental health agency for Windham County and most of Windsor County, offers a wide range of services for adults, children, people with developmental disabilities, those in crisis and those struggling with housing. HCRS has placed care coordinators at Mt. Ascutney, in six police departments and 58 schools, Karabakakis said.

“We know if we’re going to be improving access, we need to be in the community,” he said.

To tackle the challenge of rising obesity rates, Mt. Ascutney participates in a statewide effort called RiseVT, said Alice Stewart, Mt. Ascutney’s RiseVT manager.

Targeting the communities of Windsor, West Windsor, Weathersfield and Hartland, the program is working with community members, librarians and recreation directors to increase access to nutritious foods and exercise, according to Stewart.

One piece of this work is doling out $25,000 in small grants for purchases like ropes for bringing an unused climbing wall back into use or additional sizes of snowshoes so a library can loan them out to families, she said.

Other efforts include expanding school backpack programs, which send food home with children for the weekend, and improving the quality of the offerings at food shelves. Stewart said the group is putting together lists of foods that are appropriate for people with various health conditions so clinicians might eventually be able to write prescriptions for specific food shelves.

It’s “ambitious, but we really think that it could make a difference,” Stewart said.

Mt. Ascutney and its partners also try to help people sort out how to pay for health care. In addition to helping patients sign up for insurance coverage, Ball helps patients obtain vouchers for medication and dental care. She also helps people apply to pharmaceutical companies for free medication.

Eight of 15 applications to pharmaceutical companies were approved last year, for a total of about $24,000 in free medications, Ball said. But that was down from prior years when more than $50,000 was granted.

“They’re becoming harder and harder to do,” Ball said.

For some, the financial struggle is ongoing. Ball told the board about a family that had racked up $20,000 in credit card debt to pay for necessary medication. Ball has tried to find them financial assistance, but their income is too high for most of the help available.

Helping people choose the right Medicare plan, for which enrollment now is ongoing, also can help ensure that their prescriptions are covered, Ball said.

“People are going to be able to access (medications) because they’re going to be on the right plan for them,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.