Episode 73 - Providence Community Health Centers

Joe: Coming up on this episode of "Putting Possibility into Practice," for more than a half-century Providence Community Health Centers has been serving the Providence, Rhode Island area. We'll be joined by their CEO to discuss its mission, how they partner with Greenway Health and how their first 50 years is paving the way for their next 50 years and beyond. This is "Putting Possibility into Practice" and it starts right now. 

I'm Joe Agostinelli, Social Media Manager at Greenway Health. And welcome to this episode of our podcast "Putting Possibility into Practice." If you are a returning listener, thanks once again for tuning in and if you are a new listener we'll go into some of the platforms that our podcast is available on that you can subscribe to and get notifications each week when new episodes are published at the end of this episode. On this episode, we are celebrating the success of Providence Community Health Centers who just last year celebrated their 50th anniversary of serving the Providence, Rhode Island area. And joining me today is their Chief Executive Officer, Merrill Thomas. Merrill, thanks for joining me today. 

Merrill: Thanks, Joe, for having me. Glad to be here. 

Joe: First of all, I mentioned that the Health Center serves the community of Providence, Rhode Island but why don't you tell our listeners a little bit more about who PCHC is and what you guys do on a daily basis to provide excellent patient care? 

Merrill: Sure. Thanks. So PCHC was formed in 1968 so, yeah, 50 years, last year. Community Health Center was 60,000 patients, we have over 12 locations, about 500 staff, doing a little over 200,000 medical visits. And you know, health care has really changed in the last few years. So it's not just medical, it's dental, optometry, podiatry, behavioral health, asthma, allergy. So it's really been interesting that over the last few years our scope of what we do is really increased. But we're the only health center in the city of 170,000 people. So we see about one out of three residents come to one of my health centers for care. 

So, you know, we are the safety net provider in our city. We do not have county or city health departments like other states. So the health centers in Rhode Island are the safety net providers for the whole state. And we take care of about 15% of the whole states. So a little unique here in Rhode Island in that sense but we've been doing this for a long time and so far so good. 

Joe: And you've been doing it for a long time and you alluded to, you know, in that answer that the new needs of patients and how over the last few years you've changed your focus. So how do you stay on top of what's happening in the healthcare industry in attending to patients needs? 

Merrill: Well, the needs is pretty obvious just from our own patients, you know, access. So a couple of years ago there was no optometrist in our neighborhood so I was told from our staff that we need some optometry care. And so I go to the state and tell them, "Well, we want to open up an optometry clinic." And they say, "Well, we don't need any more in the state because we have enough." I said, "Oh, we really don't have enough." So we opened up... We have now grown a 1000% our optometry business in the last four years. We have two full-time staff, residents, six students and we were told we don't need the care. So this is the kind of stuff that health centers were founded for and that we're here for the community. And our patients just don't have access because of all the different things, the language and other issues. 

So we step things up like that and then all of a sudden now it's core part of our business. And especially with optometry was really surprising to me was 50% of the visits are not about glasses.These are actually eye issues. And so this is another example of us just meeting a need and now it's integrated in. And the best part from your guys' perspective is this is integrated into my health records so that my doctor now when they see that patient from my optometrist knows what my optometrist did and has all that information in the record. If I send someone outside to an outside person we don't get the notes back, sometimes we don't know what happened and we don't get that into our chart. So that's another real benefit of having it on-site is having it in my medical records so the provider has better information to provide better care.

Joe: And on the topic of providing better care, now it's my understanding that you guys are also certified as a level-three patient-centered medical home by the National Committee for Quality Assurance. Now what is a patient-centered medical home? And for listeners who may not know... And I understand level three is actually the highest level. So what goes into not only achieving that but keeping that certification moving forward? 

Merrill: So this is really the... Again something that was kind of not funny but interesting is that aligning sort of externally what these accrediting people with a lot of stuff that health centers have always done. But it really focuses on, you know, putting the patient at the front of the practice. And so same-day access for visits is one of our big core values. We have about 80% of our visits are same-day visits. Care management, you know, the focus on the patient, patient access to their information and getting them in, getting them educated, knowing what the doctors advising them and quality results as well. We do a lot of quality reporting. So a lot goes into it and, yes, we maintain that.

And a little tidbit, I don't think you know about is we also are one of the very few health centers in the country that also have a behavioral health distinction as our medical home. There are only 43 in the country last year and we had 8 of them. So it's a real focus on the patient and we're proud that we're able to do that because that's always been who we're about. 

Joe: And in focusing on the patient, a little bit more on that behavioral health, how did that come about? 

Merrill: So it's the same process. You go through NCQA and there's a separate application process. It's pretty new there so I don't know if a lot of people know about but they actually have a track where you can fill out the information on how we... So we have integrated behavioral health. So we have social workers on-site and we have people there for warm handoffs, we also have a Medicaid assisted treatment program. We also have other links to, you know, serious behavioral health issues. So it really goes into the whole behavioral health is now really part of our business as well as the healthcare. So the head and the mind need to go together in the body. So we've been able to integrate our behavioral health to a point that now that's part of the medical distinction as well. 

Joe: Great. And I know you alluded to this a little earlier, but how does the center partner with Greenway Health for those who may not know? 

Merrill: So we use a Greenway Health's energy project for our electronic health record. And again, with 12 locations, it's just really fantastic to not have to worry about paper anymore and to have that electronic health record be our tool. We are also a part of a network based in Florida called Health Choice Network. And so I work together with 60 other health centers and we sort of do it together. 

But the tool from Greenway is really the core that runs our practice management system which is, you know, registration, billing and then also the record-keeping for electronic health records. So those are all now very important in this new era of quality and paper performance. And so we need to have all those indices that we could never do when it was on paper. 

So having that EHR is now pretty much the core of being a practice that can even meet medical home certification. And so we count on that. We've been with Greenway since 2012, I believe. And one of the things I'm most proud of is that the vendor keeps, Greenway, keeps investing in the product and increasing it. And so that's the other thing is healthcare keeps changing and so we need to keep adapting with it. 

So for me, that's very important that we have a partner that doesn't have a stale or dead product and is moving ahead even with the, you know, new things that come. So we are actually working right now on population health and that's where one of the pilot projects on that with our group. Because there's so many more demands on our system now to integrate even the social determines of health into what we're doing and have the case managers be able to input into the system and the doctors know that. So it's a key core of what we're doing. 

Joe: And would population health [inaudible 00:08:56] from location to location a difference in the needs of those who you're treating or is it pretty much the same throughout the state? 

Merrill: I'd say it's mostly the same. I mean, we run the homeless program at one site and that's a 95%, you know, no surprise, 95% of those people it's rated very, very high on social determined needs. But we're gonna be rolling it out for all of our patients by the end of the year. So we're gonna be interested in seeing what we find out. But the main issue right now is we are an accountable entity pilot program with our Medicaid program and so we have requirements to have a follow-up of care within seven days of discharge. And so we need to be able to track that and make sure that everyone's on the same page. 

So having the social workers and the case managers being able to input and track their information as well is now as just as important as the doctor's information. So, you know, to me it's like once you have some information, people keep asking for more and so we need more tools to do that and be able to flag those people and integrate it. So I think it's a core piece of our business now. It really is a cornerstone of being able to do health healthcare now in these current times. 

Joe: And what advice could you give other federally qualified health centers or FQHCs as they are known who may be considering a partnership with Greenway? 

Merrill: So I think the, the biggest thing is that the federally qualified health centers really are a different beast when it comes to our requirements. Our UDS, hopefully, people know what that means, but our requirements on our annual reporting are very unique and those need to be in place and meaningful use. There's a lot of unique reporting things that we need to do that traditional vendors have not really done because if you look out nationally, we're maybe 1% of the whole market. So, you know, we're not the typical hospital or private practice clinic. So I think that's been an important key again for why we're partnering with Greenway is that you guys have stepped up and invested to make sure that the model that we have in energy really works for us. 

So those reporting features those really have to be key, though. To me, I don't even know how you have a discussion about an EHR if they can't do those things. So I'm not a big fan of vaporware and promises and, "Yeah, we're gonna get to there. It's going to work," or "Yeah, you have to buy a third-party product to make it work." No, it works already. And they change it every year, so you've got to stay on top of it, so I think that's another part. So to me, that's the core of any electronic health record that we look at. It has to be able to do our core business. And I'm just amazed when I find out health centers sign up with vendors that don't. 

Joe: And then what are some of the biggest challenges facing health centers today as you guys, you know, enter now year 51?And how is Greenway helping you guys meet some of those challenges each day? 

Merrill: So like I said earlier, the healthcare keeps changing every year. So we have about 70% Medicaid patients. And Medicaid is this, you know, a combination federal and state program. And so with the ACA being implemented in 2014 in our state, I was fortunate to have a Medicaid expansion. I know many other parts of the country they have not had that and it's a big political back and forth. 

But for us, this really reduced our unemployed, uninsured rate from 40% down to 10%. So it's had a big impact and then expanded the number of patients wanting to come to us. So we have to stay current with that. But it's not just enrollment that's grown, it's also the changing in the states way they want to manage Medicaid because cost is always an issue. 

So we now have an accountable entity for our Medicaid program. We're one of the five pilot sites in the state and they are looking to, you know, control the cost curve and so that means much more coordinated care. And so in order to do this accountable entity, I need a lot more information and information tracking. So that's why the Greenway tools come important because I actually have 180 quality indicators that we track and then we have not only the UDS.. And by the way, we were one of [inaudible 00:13:26] national quality leaders last year, so we were glad to be able to do that with the scoring. But that's all based on, you know, the EHR being in place and having to be able to track all those indices that we tracked there for Hetus and different things. 

But on the Medicaid side, this is where the population health tools now come in and the additional information reporting is all you need to have that kind of information to be able to now managing today's because the financing keeps changing. So that's the part, it's not a stable world in healthcare. And so not only is the healthcare maybe changing in requirements that way but the way we're being paid is being changed. So the biggest challenge is I gotta stay on top of that and stay in business for the next 50 years. I gotta be able to adapt and survive and thrive in this new world as well. So it's sort of this combination of you got to keep adapting to stay in the game. 

Joe: And that leads me to my next question. So in October I saw you guys had your gala for your 50th anniversary and we're just actually, well, I'll now pass the halfway mark of your year 51. So where do you see the health center going in the next 50 years? Or maybe we'll start with the next five and then we'll look to the next 50?

Merrill: I don't think I'll be here for that next one. But the fun thing right now is we're actually trying to build an additional new building because we've got so much demand for space and we're actually out of space. But so we've got a new building we're trying to build next year and then we're also looking in this new world of additional services that we might be serving on-site. 

Again, we've found that the more we can integrate care and so I think there'll be more specialty care that will become part of ours. Another service that we've started is a seven-day a week clinic, we called PCHC express, which is sort of like urgent care [inaudible 00:15:28] but not quite exactly. It's not really walk-in but it is. But they have seven days a week from eight in the morning till nine at night access for patients, then nine to five on the weekends, keeping them out of emergency rooms. So this is for our own patients that we can, you know, see from all my sites and then also anyone from the outside can come as well. But we're gonna be expanding another clinic like that. 

And so I think, you know, competition-wise, there's a lot of pop-up urgent care centers and other things like that. But our center is a little different in that we really want to integrate it with our primary care. So if your doc is on vacation, you know, we don't want you to go into the emergency room or if it's on the weekend at seven o'clock and you can't get in, please call us first. 

And so we want to be more efficient and accessible. And I mean, who wants to spend six hours in an emergency room waiting with a whole bunch of people in the line? So basically, you know, come in, we speak your language, we have your medical record, let's deal with what you have dealing and then get back to your doc next week. 

So a lot of things like that I think where we're being more responsive to the customer needs but also then expanding. Because we can actually do things better, quicker, cheaper than a lot of big hospital systems where it's so costly to go there. So I think that's gonna be more of where we're moving to, so it's kind of exciting. 

Joe: Yeah, no, it sounds a lot going on there and certainly adapting to the changing needs of the patient and your community, always great to hear. 

Merrill: I think the other part that makes us unique, and again, I dunno who listens to these, but our mission really is to improve the well-being of the communities we serve by providing high-quality, accessible, patient-centered care regardless of cultural background, social barriers or ability to pay. So we do not turn anyone away based on dollars or status or color or language. And I think that's a pretty unique place to be in it.

For me, I've been doing this for quite a few years. That's what really drives, you know, this mission of why we're here. And we take all comers and we just want to make people healthy and better. And so we don't ask a lot of questions on some things but it doesn't really matter. And then even if you can't pay we'll see you and we have a sliding fee scale and we'll see you anyhow and figure it out. But I think that's what makes the health centers fun. 

Joe: And now, you know, certainly serving the community and meeting the needs of your patients and the community as a whole, so congratulations on all you guys have accomplished and all that you are setting out to accomplish in the future as you continue to provide excellent patient care. 

Merrill: Thank you. 

Joe: And I want to thank my guest on this episode, Merrill Thomas. He is the Chief Executive Officer of Providence Community Health Centers located in the Providence, Rhode Island area. And if you are listening from that area, I do invite you to visit their website to learn more about them at www.providencechc.org. Again, that's www.providencechc.org. And for more information on some of the products and services that we talked about in relation to Greenway Health, you can visit our website at www.greenwayhealth.com. 

And if you have enjoyed this episode and we hope you did, we invite you to subscribe to our podcast if you have not yet done so on your podcast platform of choice. You can find "Putting Possibility into Practice" on iTunes, Google Play Podcasts, Stitcher, fm.player, SoundCloud, Spotify, Libsyn, iHeartRadio, and TuneIn Radio. Plus look for more podcast platforms coming soon.

I'm Joe Agostinelli, the Social Media Manager at Greenway Health. And this has been another episode of our podcast, "Putting Possibilities into Practice." Thanks for listening.