Working to change the culture of care

Bob Gorman

Bob Gorman

Fort Drum is full of acronyms, but the two most recent acronyms to come to the north country are courtesy of civilians: DSRIP and ALICE.

The state’s Delivery System Reform Initiative Payment (DSRIP) program is a short but tongue-twisting way of saying that too much money is being spent on people after they are sick and not enough is being spent on keeping people from getting sick.

ALICE stands for Asset Limited, Income Constrained, Employed, which is another tongue-twisting way of referring to the working poor.

The DSRIP punchline is this: The region wants to reduce hospital use by 25 percent within five years

The ALICE punchline is this: The state is getting dangerously close to having 50 percent of its households unable to generate enough income to cover the basic costs of living, let alone save for the future.

But first, DSRIP. Changing the culture of treatment to a culture of prevention is going to be difficult, especially when too many of us overdose on opiates, alcohol, tobacco, sugar, etc. Too many of us also suffer from mental, emotional and behavioral health issues. The easy thing to do is put off addressing a health issue in hopes it will go away. If we are wrong, well, there is an emergency room nearby.

Everyone in health care agrees with the direction, although hospitals are quietly trying to figure out how to eventually retool their budgets, staffs, etc., if one quarter of their patient load no longer shows up.

Leading that conversation is the North Country Initiative, which is operated out of the Fort Drum Regional Health Planning Organization. The Initiative has already secured $3 million to help the region’s hospitals with this transition, while identifying key targets such as suicide prevention, smoking cessation and diabetes reduction.

Also facing the change in direction is our nonprofit community, which is now expected to become part of a health care provider system. That sounds nice on paper, but it is requiring a complete turning of the ship for agencies that have historically operated as individual organizations.

“(DSRIP) is extremely relevant and is actually what I spend most of my days, and sleepless nights, working on,” said Korin Scheible, executive director of the Mental Health Association of Jefferson County.

“DSRIP is the main reason for our name change” from the Alcohol and Substance Abuse Council of Jefferson County to Pivot, said Executive Director William Bowman. That’s because Pivot is looking at the entire health care of an individual, not simply guiding people away from addictions.

“Currently the impact to our agency is mainly administrative, but there will be some programmatic aspects that will become part of our services as time goes on,” said Bowman. “We are looking at how our services impact the DSRIP goals of reducing unnecessary hospital admissions by 25 percent, and aligning our outcome measures to help determine that.”

Access Care and Resources for Health recently hired a staff person specifically to guide its agency through DSRIP. But it wasn’t easy. In a press release the agency noted: “ACR Health recognized the magnitude of DSRIP and made the difficult decision to take on a full-time DSRIP Coordinator, Poonam Patel. The lack of supporting funds to manage infrastructure and hire staff poses challenges as individuals in their full-time roles take on newly incorporated DSRIP responsibilities.”

Yet, all nonprofits that provides any health care services — such as behavioral health and opioid addiction — understand that treating an individual individually by each agency and health center or hospital is not always in the best interest of the person.

“We are trying to help treat the overall health — mind, body and spirit,” said Jim Scordo, executive director of Credo, which several years added a mental health clinic to its role in helping people end their drug addictions.

To better understand how DISRIP will affect the north country, please see this 20-minute tutorial at: https://vimeo.com/160913448

As for ALICE, a statewide United Way report released in November shows that 44 percent of the state’s households are generating incomes below the threshold needed to provide rent, food, medical care, educational opportunities for children and saving for the future.

In Watertown, the percentage is 57 percent. That number is in part the reason the state this year awarded a $1 million anti-poverty grant to the city, which has asked the United Way of NNY to administer. We have asked former Watertown Y executive director Peter Schmitt to lead this effort to help us better understand how we can help people receive services more promptly, and fund programs that help more citizens become self-sufficient.

DSRIP and ALICE alone won’t solve all the issues facing our community. But they are good starts and will be acronyms worth knowing about in the years to come.

Preserve the stories that make us great

 

Rande Richardson

Rande Richardson

We owe it to those who have come before to do all we can, as best as we can, as long as we can, to make this place great. As we head into the season of counting blessings and sharing those blessings with others, it’s a perfect time to point out how well the north country does both of these. Our citizens, organizations and businesses have maintained and grown a great tradition and heritage of civic pride and caring over many, many years. Without that tradition, some of our greatest community assets would not exist today. [Read more…]