More about the autor

Morning Feature: A Community Celebrates Health Care Reform

September 1, 2010

Morning Feature

BPI-MF-LogoFor years, Rio Arriba County has been the butt of jokes about its high overdose death rates and its supposed lack of coordination between providers. But on August 25, over 350 people showed up at my office (a huge crowd for a working day in Espanola!) to celebrate our town’s health care reform success. (More)

We were joined by our county commissioners, Senator Jeff Bingaman (D-NM), state legislators, our Secretary of Health, children, reporters, friends, musicians and a truckload of shelter dogs. We danced, listened to northern New Mexico folk music, feasted, heard speeches and adopted pets, all to celebrate an extraordinary local achievement.

And while we were at it, we published op-eds and secured coverage in three newspapers and a radio station explaining the benefits of health care reform. Celebrate with us below the fold.

I got to my office at six am. It was a beautiful day. Here is my office and this was the view from my window.

My Office

The View from the Health Commons

I have worked for Rio Arriba County for seventeen years. My offices weren’t always nice. When the county first hired me, we had no buildings. I scrounged around for free space and finally located a windowless storage closet in a structure of dubious physical integrity. The walls shook three times a day causing computers to crash. One Monday, I came into work and found a pile of rubble. Half of the building had collapsed.

I refer to the Rio Arriba Health Commons as “The Health Care Palace.” It is an innovative, state-of-the-art clinic overlooking our little town, Espanola, NM. The Commons is a one-stop-shop housing three separate entities. The building is broken into wings, grouping individual staff by function rather than agency: the behavioral health wing holds substance abuse treatment, mental health services, diabetes and weight management; the maternal child health wing includes WIC, Families First and case management for fragile children; the medical wing holds primary care.

We designed the Commons to encourage providers to collaborate across agencies creating a better experience for our clients and more efficient, creative care. The building builds community. The road leading up to the commons and some of the programs within were funded through ARRA, the economic stimulus package.

The Rio Arriba Health Commons

When I got to work at six, the maintenance crew was already busy. They had worked through the night. In truth, Ralph, Eric, Kevin, Richard and crew had been busting butt for months, grading, planting, cleaning and assembling furniture. Here they are.





Three separate agencies reside within the Health Commons: Rio Arriba County Health and Human Services (my shop), the Espanola Public Health Office of the New Mexico Department of Health, and El Centro Family Health (a non-profit federally qualified health center.) A few days after moving in, the county manager handed me a grant application. If my office put together an H1N1 clinic, we would be paid $38,000. At first, I filed the application at the very bottom of a pile of newspapers. I had no idea how to conduct an H1N1 Clinic. At most, we’d attract ten people. I couldn’t imagine spending $3,800 per immunization.

Finally, after three or four irate reminders, I marched the application across the commons to the WIC office. Rachel Wright, the nurse in charge of the public health office, and Laura Bentley, the WIC director, had a great idea: we could buy a mobile immunization unit in order to immunize people in the Wal-Mart parking lot. Then we’d get to keep the trailer. We could hold well-child clinics, WIC outreach and other events on a rotating basis in remote mountain villages throughout our 6,000 square mile county! The County would own, maintain and pull the trailer. Department of Health nurses would staff it.

Here is Laura at work in her office.

Rachel, Susan Gonzales (Director, Public Health Region 2) Lore Pease (Director, El Centro Family Health) and I are explaining to the crowd that without health care reform, and the flexibility federal and state agencies have shown since Obama took office, our building and our mobile unit never would have happened.

Under the previous administration, federal agencies played the role of grant police, using any pretext to revoke funding.
We are grateful the the CDC and NM DOH worked together to help us purchase our mobile unit. In the end, only six people showed up at our H1N1 clinic. But many more will be vaccinated in the days and weeks to come! Public health nurse Susana Ulibarri conducted many blood pressure checks in the trailer while the four of us pontificated.

Children opened up the festivities. Roger Montoya teaches dance to youth in our school: ballet, hip-hop and flamenco. Moving People Dance Company performed for dignitaries and visitors.

State legislators roamed the audience while I frequently checked my watch to make sure we were running on time and Elena, the event coordinator, fussed over tables, food and extension cords. People wandered through the health commons, visited table displays (including a pet adoption and a display of art by the youth at the YMCA Teen Center). Salim Bohsali of Bodywise Health Care handed out free massages.

At last Senator Bingaman arrived and Alfredo Montoya, the Rio Arriba County Commission Chairman, took the stage. Dignitaries were ushered into the first few rows.

Senator Bingaman and his staff had plenty of time to get situated. Collaborations involve many people and our Commission Chairman tried to mention each one by name from the legislators and funders to the nurses and paramedics to the maintenance crew.

(From left to right in the first row: Secretary of Health Alfredo Vigil, State Rep. Nick Salazar, Speaker of the State House of Representatives ((and father of Congressman Ben Ray Lujan, Jr.)) Ben Lujan, Sr., US Senator Jeff Bingaman, Candidate for Lt. Gov., Brian Colon, Mike Lopez ((staffer for US Senator Tom Udall)), and Northern New Mexico College Regent Alfred Herrera take in Commissioner Montoya’s display of gratitude.)

Then came the speeches:

The “other” Alfredo, Dr. Alfredo Vigil, is the current Secretary of Health. He was the Director of El Centro Family Health, one of the Health Commons Partner, when the project was first conceived. Dr. Vigil remained surprisingly poised when a gust of wind blew the flagpole and flag over onto his head.

Senator Bingaman looks dashing in sunglasses. Commissioner Montoya was profuse in his praise of Senator Bingaman’s single-handed successful crusade to prevent the Bush from closing emergency departments thatserve the uninsured in hospitals across America, and for his efforts to usher HCR through a recalcitrant Congress.

Candidate for Lt. Governor Brian Colon spoke.

And, (which of these things is not like the others?) ME!!!!

I described Rio Arriba County’s successful pilot of the Pathways Care Coordination model which incentivizes production of individual health outcomes rather than numbers of discrete services performed. Rio Arriba, state and federal evaluators collaborated to develop the pilot, which is held up by AHRQ (Agency for Health Research and Quality) as a national model. Our care coordinators serve pregnant women at high risk for substance abuse and are accountable to produce two outcomes: the baby is born free of unprescribed substances and with a healthy birthweight. In two years, 25 babies have been born, three with low birthweights and three with unprescribed substancs in their bloodstream, an astonishing 88% success rate. No babies were born with unprescribed substances in their bloodstream in the most recent fiscal year.

Rio Arriba is also funded through a state Total Community Approach grant to conduct substance abuse assessments and study the referral system. In 2008, the first year of the grant, the county conducted 170 assessments but was disallowed from following up with care coordination. Only twenty percent of referrals resulted in treatment. In 2009, Rio Arriba was allowed to follow up with care coordination and the success rate tripled. Sixty percent of referrals resulted in treatment, proving that care coordination works and that Rio Arriba can!


I also thanked Dan Burke, a former employee of El Centro Family Health under Dr. Vigil. The Health Commons was Dan’s idea. He banged on doors persistently despite gnashing of teeth and rolling of eyeballs until we stopped throwing his proposals in the garbage can and listened. He made people believe a health commons was possible in Rio Arriba. Here is Dan on the right (back of head version) talking to Dr. Bjorklund (current El Centro Medical Director) and Dr. Vigil.

After speeches it was time to hand out plaques and cut the ribbon.

State Representative Debbie Rodella hugs Dan Burke (actual front of head version) while current El Centro director, Lore Pease, looks on.

Dignitaries and placque recipients (from left to right: County Manager Tomas Campos, J.R. Trujillo ((the guy who got us the land)), US Senator Jeff Bingaman, Mike Lopez ((Tom Udall’s office)), NM Secretary of Health Dr.Alfredo Vigil, Rio Arriba County Commissioner Elias Coriz ((the other guy who got us the land)), Rio Arriba County Commissioner Felipe Martinez, NM House Speaker Ben Lujan Sr., Rio Arriba Health and Human Svcs Director Lauren Reichelt ((TheFatLadySings)), State Representative Nick Salazar, Dan Burke, State Representative Debbie Rodella and Rio Arriba County Commission Chairman Alfredo Montoya.

Here we are cutting the ribbon. Same people, different order.

After all the speeches and awards, it was time to eat. Over three hundred people got in line. Cipriano Vigil, a Rio Arriba Living Treasure and his orchestra serenaded waiting throngs. Norma Naranjo of the Feasting Place provided a traditional Native American lunch. (Norma grows and cooks her own food). She served beans and chicos, green chile chicken enchiladas, horno bread, prune pie, mint tea, posole, salad and banana pudding.

While everyone ate, I escorted Senator Bingaman, our Commissioners and a bevy of reporters on a tour of the commons. Why don’t you join us?

Senator Bingaman and County Commission Chairman Alfredo Montoya.

Beatrice Valdez, a case manager, is bringing clothing to clients.

This is her clothing closet.

Isadora works for WIC.

Our nutrition education classroom has a chalkboard, a kitchen and a meeting table. And of, course, we promote breastfeeding!

WIC Receptionists.

Commissioner Elias Coriz, Senator Jeff Bingaman, HHS Receptionist Trudy Duran, Chairman Montoya and the back of my head visiting the behavioral health wing.

Trudy Duran, my receptionist, was surprised to see us.

So was Melissa Martinez, a case manager.

My desk

Cross-posted from Blogistan Polytechnic Institute

  • TheFatLadySings

    Sorry guys! I was up all night working on this! I tried and tried to post on daily kos and kept getting attribute error tags. It’s been so long since I’ve posted a photo diary there that I forgot why I stopped doing it!!!!!!

    • NCrissieB

      WordPress (the HTML engine for BPI) accepts a wider range of HTML coding than does Scoop (used at DKos). All I can suggest is to replace the HTML codes for your photos in the DKos diary with unmodified (no justification, etc.) code from PhotoBucket or wherever you keep those photos.

      • Jim W

        Will the first 3 paragraphs post at DKos?

        They could be linked to more at BPI.

        • NCrissieB

          winterbanyan posted a link-stub for Thursday’s Morning Feature. Both TFLS and I tried to fix the HTML coding and it still wouldn’t post at DKos. Maybe once DKos 4.0 comes out – supposedly it will be released the day after the Detroit Lions win the Super Bowl – we won’t have this compatibility issue.

  • NCrissieB

    Wow … what a great event and a wonderful story, TFLS! :grin:

    I hadn’t realized this was the grand opening of your new center. Much-deserved congratulations, and I’m thrilled to hear the people of Rio Arriba County will get better health care!

    Good morning! ::hugggggs::

  • TheFatLadySings

    I am really sorry this didn’t go up over at Daily Kos. And frustrated and disappointed too. It is so worth putting up. Is there any way we can reschedule it and can we work together to figure out what is wrong with the code?

    I’m really sorry for missing my scheduled date!

    • NCrissieB

      Post a stub at DKos … your first paragraph from here, a three-paragraph summary of the event, and a link to more info (with photos) here?

  • winterbanyan

    Great, great story, Lauren. Made me grin from start to finish. How wonderful for your community, and what a community.

    Hugggs, and good morning!

  • OHKnighty

    Excellent diary TFLS

    Have had similar problems with posting diaries with pictures over there. Looking forward to your post at dk.

    :smile:

  • DBunn

    An amazing accomplishment, TFLS! Big congratulations & huggs…

    I am interested in every part of your story, but will mention one thing that caught my eye in particular– your honest account of initial resistance to two ideas that dropped on your desk from “somewhere else”. These two annoying and presumably infeasible ideas eventually turned into two crown jewels celebrated in this diary, namely the integrated Health Care Commons itself and the mobile clinic-in-a-trailer. I salute your forthrightness! (And BTW, that type of resistance to ideas from outside is very widespread among us humans, in my observation. When I worked in software development contracting, I saw it all the time. Might even have done it myself on occasion… )

    Here’s a personal story with a similar ending. A few years back, I became board president of one of two FQHCs (Community Health Centers) in my county. Early in my term, the county DOH sent a letter to the two FQHCs, I don’t even remember what it was about, and copied the Board of Supervisors, which I think is equivalent to your County Commisioners. I met with the Executive Directors of the two FQHCs to consider how we would respond to the letter. It became clear to me that the EDs saw the letter as a threat or imposition from “outside”, and saw the DOH as a troublesome entity to be kept at arm’s length and fended away by any means possible. Frankly, I was shocked at this attitude, but I was able to recognize the syndrome from my experience in other realms.

    I suggested to the two EDs that the letter might be an opportunity, not a threat. Because the DoH had copied the Board of Supervisors on the letter, we could copy them on the reply. Thus, we would be shielded from whatever dysfunctional or burdensome outcomes they feared from DOH because we had the Bd of Supes as our witness to the interaction. I further suggested that instead of running away from the DoH, we should run towards them. Instead of avoiding them until they hunted us down, we should set up a regular schedule of meetings so we could discuss whatever we were doing, and look for points of cooperation, overlap, etc. After all, we were all working on the same project, the health care safety net in our county.

    Cut to a few years later– the county’s direct client services administered by DoH have moved into a beautiful new Health Care Commons campus which they share with the other FQHC. The former uncoordinated, widely separated, inadequately housed, and difficult to access services are now co-located very near to the main population center being served. Everyone is much happier, especially the service recipients.

    From the Department of Unanticipated Consequences, one result has been that the DoH is now very aware of the other FQHC, with whom they interact every day, and not so much aware of the one I work with. The other FQHC is about 4 times our size and serves the concentrated urban core, while we serve the rural, sparsely populated, far-flung, and easily forgotten hinterland. Our next and never-ending task must be to close that awareness gap. We may be smaller, but we do important work too. We may be out of sight, but we can’t be out of mind. Our people are people too :)

    But enough about me, this is your day TFLS. Congratualtions again for climbing the mountain, and good luck with the next challenges!

  • JanF

    Excellent story focusing on people and success. Good for Senator Bingaman being able to push back against the cuts from the Bush “Administration”. It must have been a difficult time to be in state and local government agencies whose primary job was caring for people.

  • TheFatLadySings

    Thank you, DBunn, for your wonderful story. In Dan’s case, I actually did not believe there was any way the county would agree to such a difficult and expensive project. It sounded like a wonderful idea. I just didn’t think my bosses would want to take the lead. I was wrong.

    When Lorenzo called me with the grant app for the H1N1 clinic, it sounded like a tremendous amount of work for no purpose. The season was near its end and people were not responding to free immunizations. I thought we’d end up getting roasted in the paper for spending $38,000 to immunize a handful of people. As it turned out, I was right about the number of people. But Rachel’s idea made the project worth the money and effort. I never, NEVER would have thought of purchasing a mobile unit myself.

    Crissie- on the other issue, I can probably do that. I think the shredder must have changed since I last posted a photodiary because I worked from previously acceptable html template. I’m going to experiment with my templates late at night this weekend and see if I can identify the problem.

    Would it be possible to get another date to post this diary on morning feature in the near future? I am trying to encourage people to hold celebratory gatherings of their own successes as a way to defuse negativity.

    Finally, sorry I disappeared and didn’t answer these comments. My test kit arrived today and I was at the hospital undergoing tests to see if I can donate a kidney to Kitsap River. They took about 20 vials of blood. I actually have track marks on my arms!

    • NCrissieB

      Lauren, I emailed you. Please reply to the email before you go to bed? If you can have this ready to crosspost for tomorrow (Thursday), please crosspost it. If you’d like to and will be able to tend the diary at DKos tomorrow, but don’t know how to get the crosspost ready, I can get a copy-paste version ready. If you can’t tend it tomorrow, let me know and I’ll write the Morning Feature I’d planned for Thursday.

    • DBunn

      My sympathies for the difficulties in publishing the diary over on DKos, TFLS. Apparently the HTML gremlins were being extra-contentious, and at just the wrong time. Maddening.

      Especially since it was such an important diary, on a topic dear to my heart, and that I’d been looking forward to for weeks. Many others would have been interested, IMO (and still will be, if the experts can figure out how to get it past the DK gremlins). A view into your community, and a vision for how health care services could be delivered in many other communities.

      I covet your mobile unit. Would love to have something like that here, but I suspect the financial numbers wouldn’t work too well for us. We have long suspected that access is problematic for latino workers & their families on some of our remote ranches, but it’s a small population and it would be hard to get dollars to flow to that particular need relative to other unmet needs. Not just initial capital, but operational budget. Part of the problem is the arbitrary barrier known as the “county line”– if the unit could serve multiple counties, the numbers might make more sense, but coordination headaches would multiply as well.

  • TheFatLadySings

    Hi Crissie, I left you several emails. I was trying to sort out the html code in order to post tomorrow and forgot you can only post once in 24 hours. I published a test to try to figure out what is wrong and deleted it right away but I think I will probably not be able to post. I still don’t know what’s going on with the html.

    If you want, you can post it for me and I can monitor. Please let me know as soon as you get a chance. I was up all night trying to get the code written so I’m pretty sleepy.

    • NCrissieB

      I replied by email. :smile:

  • J Brunner fan

    Thanks so much, excellent diary and such great pictures.

    :smile: