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