With $812,500 Grant, Gifford to Expand Access to Primary Care

By:  Chris Fleisher

Randolph — Access to primary care, dental and mental health services looks to improve in the Randolph area after the town’s largest health care provider was designated a federally qualified health center.

Last week’s announcement that Gifford Health Care, the parent company of Gifford Medical Center, was approved for the federal designation means that more low-income residents in central Vermont will have access to the treatment they need.

Gifford was awarded $812,500 to spend on contracts with other providers in the community, such as dentists or mental health professionals, and also grow its own services. The designation entitles Gifford to higher payments from Medicare and Medicaid and low-cost prescription drugs, and goes to the heart of reform efforts to expand primary care.

“I think the primary care foundation in health care is fundamental to any reform efforts,” said Joe Woodin, Gifford’s administrator. “We’re trying to position ourselves to be a role model.”

Federally qualified health centers are “safety net” providers that offer primary care to underserved rural and urban areas.

The funding is part of the Affordable Care Act, also called “Obamacare,” and U.S. Sen. Bernie Sanders, I-Vt., hailed the awards as “a huge step forward for health care in Vermont.”

The news came as a surprise to Gifford officials, who were not expecting to be approved so soon, Woodin said. Gifford has been working toward the designation for two years.

Gifford has just begun the groundwork to expand health care access in Randolph, Woodin said. The medical center will hire additional clerical staff to manage contracts with outside providers, and hospital leaders will figure out the details of where and how to grow services during the next year.

“There’s going to be a lot of learning in the first year, in terms of how we roll this out,” Woodin said.

Dental and mental health care will be of particular interest, as those are two areas where the entire state ha s struggled to meet the need for care. Gifford expects to work with local dentists as well as the Clara Martin Center, which has a variety of psychiatrists, therapists, social workers and other staff working in mental health, Woodin said.

The need to treat low-income Randolph-area residents has grown as the local economy struggled, said Chris Wilson, a Randolph dentist. Fewer jobs means that Randolph residents have had less access to insurance and, therefore, have gone uninsured or enrolled in Medicaid, the federal insurance program for the poor.

But the Medicaid program pays a fraction of the cost of care, and many health care professionals don’t accept it. Wilson treats children who are covered under Medicaid, but not adults.

“We’re just really limited in what we could do for adults on Medicaid unless we did it for free,” Wilson said.

Medicaid reimbursements coming to Gifford will rise with this new designation. Wilson said he and other dentists were eager to work with Gifford to improve access to dental care.

Officials at Clara Martin were not available for comment on Tuesday or Wednesday.

In addition to expanding access, Gifford officials also hope to improve the coordination of care. Mental and oral health traditionally have been treated separately from other types of medicine, even though they clearly were related, Woodin said. A man with a tooth abscess, for example, might end up in Gifford’s emergency department if the tooth goes untreated. Similarly, many hospital emergency departments end up caring for people in psychiatric crisis.

“We sort of put (mental and oral health) in categories outside of traditional medical coverage,” Woodin said. “As we continue to march along with health care reform, those two disciplines are going to be brought into the fold.”

Just providing access, alone, does not mean people would avail themselves of care, Wilson said. Some people are afraid to go to the dentist, he said, and oral health needs to be something that patients value as part of their overall health. In that respect, Gifford’s award has limits in what it can do to improve the health of the population in Randolph and surrounding communities, Wilson said.

“Access to care? Yes, that (funding) will hugely help,” Wilson said. “(Patients) valuing the service? I hope so.”

Officials at Bi-State Primary Care Association, an advocate of primary care in the Twin States, said they expected Gifford to fill a big gap in primary and preventive care in Vermont. Gifford’s catchment area extends from White River Junction to Berlin, Vt.

The Bi-State association worked with Gifford on the application to become a federally qualified health center, and Chief Operating Officer Lori Real said Gifford’s “model of care is transformative” and would serve its communities well.

“We were impressed by Gifford’s deep roots in the communities they serve,” Real said in an email. “We’re very excited about the comprehensive model of care they have transitioned to for the purpose of improving access to primary and preventive care in the region.”