Not Just a Medical Center; A Medical Home

The following is an excerpt from our 2011 Annual Report. 

What is a Medical Home?

medical homeA medical home is an approach to providing comprehensive primary care that builds partnerships between patients, their physicians and, when appropriate, their families.

The American Academy of Pediatrics was at the forefront of the medical home movement, detailing decades ago that every child needed a place where care was accessible, ongoing, patient and family-centered, of high quality, coordinated, and compassionate.

Today, those philosophies have been expanded to adults as they’ve been adopted by family practice and other health care associations.

In fact, the National Committee for Quality Assurance, a non-profit dedicated to improving health care quality, is now recognizing qualifying medical practices as Patient-Centered  Medical Homes.

medical center

Bethel Health Center family physician Dr. Terry Cantlin talks with patient Eileen Strickland-Holtham of South Royalton during a routine exam. The Bethel Health Center is one of five Gifford practices recognized as a Patient-Centered Medical Home.

Patient-Centered Medical Homes

Achieving the Patient-Centered Medical Home recognition is part of the Vermont Blueprint for Health’s goals for all primary care providers in the state.

The hope is to improve primary care so patients are getting regular needed care and other supports to maintain their health before facing more costly emergency or inpatient care.

“The medical home adopts a ‘whole person’ approach to primary care, encompassing medical, behavioral and self-management support,” says Gifford Blueprint Project Coordinator LaRae Francis. “It’s the entire health care team wrapping its arms around the patient to provide the support and resources he or she needs to manage his or her health
conditions.

“It aims to keep people healthier, enhance their quality of life and benefit them financially, both through reduced health care costs and secondary costs such as missed work.”

In 2011, each of Gifford’s primary care practices – the Gifford Health Center at Berlin’s pediatrics practice, the Bethel Health Center, the Chelsea Health Center, Gifford primary care in Randolph and the Rochester Health Center – was recognized as a Patient-Centered Medical Home following inspections by the National Committee for Quality Assurance.

The health centers, which serve a total 21,540 patients, each formed quality improvement teams to address expectations for a Patient-Centered Medical Home, primarily through honing and streamlining systems. Among those expectations, or standards, were access to care, communication, such as through timely callbacks to patients and tracking referrals and tests, such as lab results to ensure they are communicated back to the patient.

The process, says Vice President of Medicine Teresa Voci, allowed the health centers to identify and correct problems. It’s all work done behind the scenes, but also all work that makes care more timely for patients.

Labs, X-rays and referrals to specialists are all now better tracked to ensure the patient and the primary care provider know the results of those exams, notes Chelsea Health Center site manager and nurse Travis Worthen. Providers are also more often meeting with patients to go over results.

And the patient is increasingly a bigger part of the health care team.

“Historically, medicine has always told patients what to do and now medicine is really turning toward engaging the patient in a partnership for health outcomes,” Teresa explains.

Blueprint project coordinator

Blueprint Project Coordinator LaRae Francis has headed up efforts to implement the Vermont Blueprint for Health at Gifford and in the larger Randolph Health Service Area.

The work doesn’t stop with Gifford.

With the medical center’s primary care locations now all recognized, LaRae, as Blueprint coordinator for the Randolph Health Service Area (a Blueprint-defined area spanning from Randolph to White River Junction), is now looking outside of Gifford. She’s reaching out to White River Family Practice in Wilder and the South Royalton Health Center.

She hopes to help these private health centers also earn the recognition, further improving patient care in our region.

Gifford Honored with Legislative Resolution

Joe Woodin and Rep. Patsy French

Gifford Administrator Joseph Woodin stands with Rep. Patsy French, D-Randolph, in the State House on March 13. The House recognized Gifford and its recent national honors with a formal resolution.

MONTPELIER – The Vermont House of Representatives passed a resolution last week recognizing “the outstanding health care services provided by Gifford Medical Center in Randolph.”

The resolution recognized Gifford for its more than 100 years of service to the Randolph area and for its recent achievements and accolades.

In December, Gifford was named a Top 100 Critical Access Hospital in the nation by The National Rural Health Association. The hospital’s nursing home, the Menig Extended Care Facility, just last month was named one of the nation’s top 39 nursing homes by U.S. News and World Report, which recognized nursing homes achieving a solid year of five-star ratings on all Medicare benchmarks.

Gifford’s midwives were further recognized in 2011 as a “best practice” in the country by the American College of Nurse-Midwives for its positive results with vaginal births after cesareans and a “runner-up best practice” for having the fewest numbers of low birth weight infants and for its low use of vacuum or forceps.

The hospital’s day care, The Robin’s Nest Child Enrichment Center, earned the maximum five “STARS” from the state’s STep Ahead Recognition System, a voluntary quality program that is part of the Vermont Department for Children and Families’ Child Development Division. The program looks at compliance with state regulations, staff qualifications and training, daily activities with the children, improvement plans, and more.
Menig has also won many state awards for quality and national awards for resident satisfaction.

“Since before 2000, the Menig Extended Care Facility has allowed elderly Vermonters from the area to remain close to home, providing extremely qualified and compassionate patient care. My in-laws were able to use this facility in the last years of their life, making for an ideal connection for them and my family,” shared Rep. Larry Townsend, D-Randolph. “Randolph and the surrounding towns are blessed to have not only Menig, but Gifford as one of the treasures in our communities.”

Townsend initiated the Resolution and was among one of 12 legislators who brought forth the resolution, which was passed by the full House on March 13.

Gifford Administrator Joseph Woodin and Director of Development and Public Relations Ashley Lincoln were present to receive the resolution.

“We have appreciated some incredibly welcome, yet unsolicited awards over the last year or so,” Woodin said. “This is another unexpected honor.”

“We’re fortunate to have the privilege of caring for the people of this region. We’re humbled to be recognized for that work in such a public way.”

The resolution also recognized the hospital’s 12 consecutive years of meeting its state-approved budget and operating margin, and the recognition of all of Gifford’s primary care practices as Patient-Centered Medical Home by the National Committee for Quality Assurance.

Finally, the resolution called Gifford “a hospital of choice for Central Vermonters seeking high-quality care and an employer of choice for some of the region’s and even the nation’s best health care professionals.”

A special ceremony with Gov. Peter Shumlin; Vermont Department of Disabilities, Aging and Independent Living Commissioner Dr. Susan Wehry; Vermont Health Care Association Executive Director Laura Pelosi and others is planned for April 6 from 3-4 p.m. at Menig to recognize the nursing home’s most recent and largest-ever achievement – the top 39 national ranking. Menig was the only nursing home in Vermont to make the listing.

Gifford Holds 106th Annual Meeting

Joe Woodin and Sharon Dimmick

Newly elected Gifford Medical Center Board of Trustees Chairwoman Sharon Dimmick smiles at hospital Administrator Joseph Woodin at Gifford’s 106th Annual Corporators Meeting.

RANDOLPH – Gifford Medical Center held its 106th Annual Corporators Meeting on Saturday evening at the Randolph hospital, electing three new members to the Board of Trustees, sharing the successes of 2011, and welcoming Steve Kimbell, Vermont Department of Banking, Insurance, Securities and Health Care Administration commissioner, as the guest speaker.

Newly elected to the board were Leo Connolly, Fred Newhall, and Peter Nowlan following the retirements of long-time board members Barbara Harvey and Bruce MacDonald and the heavily-felt death of Dick Mallary. “We miss him terribly,” board member Bob Wright said.

MacDonald and Harvey offered a few parting words of thanks and encouragement.

MacDonald admitted to feeling reluctant when he was first asked to join the board in 2002. A decade later, his opinion had changed. “As a corporator I would encourage you to support the dedicated staff and management here,” he told the audience of about 90.

Barb Harvey, Bob Wright, Joe Woodin

Outgoing Gifford Medical Center Board of Trustees Chairman Bob Wright, at the podium, and Administrator Joseph Woodin, left, thank Barbara Harvey of Rochester for her years of dedication to the Randolph hospital’s board.

Harvey, a member of the board since 2004, thanked the hospital for its quick response to get medications into isolated communities in the days following Tropical Storm Irene, especially in her town of Rochester.

Also recognized was Wright, who ended his two years as board chairman. Elected to his role was Sharon Dimmick. Gus Meyer was named vice chairman, Paul Kendall was chosen as secretary and Lincoln Clark was named treasurer.

Before stepping down, Wright delivered his final chairman’s report, recognizing his fellow board members and the hospital as a strong community asset that meets quality standards, changing regulations and community members’ expectations.

The hospital also “made budget” for a 12th consecutive year and is moving forward positively due to the medical center’s strategic planning efforts and commitment to service excellence through a program the hospital calls BEST.

The hospital is in its fourth three-year strategic plan. The plan guides the medical center in its efforts to remain vital and meet patient needs. “We’ve tried very hard over the years to make sure we’re doing a good job and you’re choosing us,” Administrator Joseph Woodin said, touching on the medical center’s commitment to reviewing quality indicators at each board meeting, a slate of new providers who joined the hospital in 2011, technology improvements, and some unexpected awards the hospital received.

Those awards include a recognition for Gifford as a Top 100 Critical Access Hospital in the nation, a listing by U.S. News and World Report last month naming the hospital’s Menig Extended Care Facility as one of the nation’s top 39 nursing homes, and a national “best practice” award for Gifford’s midwives.

Woodin also praised volunteers’ efforts and briefly reviewed plans for a senior living community on 25.6 “Hillside” acres Gifford owns in Randolph Center.

The immediate goal, said Woodin, is to reconstruct the 30-bed Menig Extended Care Facility on the property and create industry-standard private patient rooms in the vacated space once Menig has moved out. The next phase would include 40 independent living units. The long-range plan includes assisted living units and opportunities to build more independent living. The hospital is currently going through the permitting process and hopes to break ground on the new nursing home before next winter.

Woodin called 2011 financially difficult. Employees went without wage increases and some cut back on hours. “Last year was a very tough year,” he said. But, “compared to other hospitals, we do quite well. We’re very stable and it does allow us to make these necessary investments.”

Vermont Blueprint for Health

A main focus for 2011, and consequently the focus of the hospital’s newly released 2011 Annual Report, was Gifford’s role as a medical home. All five of Gifford’s primary care practices were recognized as Patient-Centered Medical Homes by the National Committee for Quality Assurance.

The designation is part of Vermont Blueprint for Health efforts to improve care for the chronically ill through advanced primary care. Gifford is working diligently on Blueprint goals, including bringing together a diverse Community Health Team and employing an outpatient care coordinator whose job is to help patients with socioeconomic needs and connect them to community resources.

“We’re offering them an opportunity for better health,” Vice President of Medicine Teresa Voci said of patients who are now receiving help navigating various systems and reducing barriers to care.

The results, said Voci, are healthier patients who are better able to manage their chronic conditions and reduced health care costs.

Commissioner Kimbell

Commissioner Steve Kimbell

Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISCHA) Commissioner Steve Kimbell leads a talk on health care reform at Gifford Medical Center’s 106th Annual Corporators Meeting Saturday at the Randolph hospital.

Kimbell spoke on health care reform, explaining the various state boards and agencies involved in the ambitious effort to create a single-payer health care system in Vermont and a federally-required health benefits exchange.

According to Kimbell, some think the task the state has undertaken under Act 48 is “crazy,” but the law is necessary to try to rein in health care spending to better match annual inflation rate increases.

And the state has had past success on payment reform, Kimbell noted, holding up the Vermont Blueprint for Health and the Catamount health plan as examples of the state’s record of successful reform.

“A lot of groundwork has been done to set the stage for health care reform,” said Kimbell, calling Catamount “up and running,” “successful” and “a model of where we’re trying to go.”

But, he acknowledged, if citizens don’t change their health habits, reform efforts will fail.

Audience members asked questions about dental access and incentives for preventative care. MacDonald questioned how savings could be found. “It’s hard to visualize for us in this organization … how you can recover that much cost just knowing on a monthly and annual basis how hard it is to run this organization,” the former Gifford board member and accountant by trade said.

A lot of economy will be found in Vermont hospitals functioning as a system, but also still keeping their community identity, Kimball said.

He also spoke of provider retention. “What’s the impact on the provider community?” he asked. “How they get paid is going to be something we’ll be sticking our fingers in very deeply. I believe there is plenty of money in the system that everyone can settle somewhere.”

Hospitals will not close under the plan, Kimbell ensured, which broadly speaking will pay hospitals and providers to keep people healthy rather than per visit or procedure.

Awards

Two awards were also given out Saturday evening. The $1,000 Philip D. Levesque Memorial Community Award was awarded to the Quin-Town Center for Senior Citizens.

Formed in 1972, the Quin-Town Center provides meals, including Meals on Wheels; educational programming; and socialization opportunities for seniors in Rochester, Hancock, Granville, Pittsfield and Stockbridge. In 2011, the center provided 5,950 meals to 350 seniors in these communities. The grant will help pay for a commercial refrigerator, replacing smaller models from the 1980s.

Receiving the $1,000 Dr. Richard J. Barrett Health Professions Scholarship was Sarah Davis of Northfield. A member of Gifford’s inpatient team, Davis is a full-time licensed practical nurse, a mother of three and a full-time student at Norwich University, where she is seeking a bachelor’s degree to become a registered nurse.

Davis has been working in health care since the age of 12, when she when she became a junior volunteer at a nursing home. By age 14, she was a personal aide at Level III home for the elderly and at age 16, she completed her licensed nursing assistant course. She’s worked at Gifford as an LPN since 2007.

She is also the first member of her family to go to college.