Mascoma Community Health Center

village

Right Care, Right Costs, Right Here.

  • Local Health Care
  • The Plan
  • History
  • Board
  • Committee News
  • Minutes

What?

  • A health center between Canaan and Enfield serving 5 towns and anyone else
  • Owned and operated by local patients from the community
  • Will be open 6 days a week and with evening hours
  • Will offer health, urgent care, dental, pharmacy, lab and mental health
  • Affordable - Takes any insurance and self payments
  • Comprehensive, in-depth care with professionals who listen

Why?

  • Local control
  • Local access
  • High quality
  • Lower cost

What's happening?

Pledging will continue. We need to increase pledges from low to moderate income families. Generally a low to moderate income family of 2 would have income of no more than $38,000 a year and a low income family of 4 would have income of no more than $48,000 a year. A low to moderate single person would have income of less than $33,000. If you know people that might fall within those income levels, encourage them to pledge to try us.

On the organizational end, Mascoma Community Healthcare has adopted Articles of Association and Bylaws. The papers have been filed by local incorporators to register the corporation and trade name. By the end of April, the corporation had held two meetings and elected a Board of Directors, a Chairman of the Board and a Secretary. Dale Barney is Chairman of the Board and Alice Schori is Board Secretary. In addition, the board had selected the lot at the corner of Roberts Road and US Route 4 as the site of the new clinic.

The Board is listed below:

  • Carolyn Barney, Canaan
  • Dale Barney, Ex-Officio, Canaan
  • Dave Beaufait, Ex-Officio, Enfield
  • Scott Berry, Ex-Officio, Canaan
  • Barry Clause, Enfield
  • Lori Dacier, Grafton
  • Barbara Dolyak, Canaan
  • John Dow, Canaan
  • Karen Ewer Gray, Canaan
  • Gili Lushkov, Canaan
  • Ed McGee, Ex-Officio, Canaan
  • Sean Murphy, Canaan
  • Michael Paine, Ex-Officio, Canaan
  • Mary Paquette, Canaan
  • Mike Samson, Ex-Officio, Canaan
  • Alice Schori, Ex-Officio, Canaan
  • Jim Spaulding, Grafton
  • Peter Thurber, Canaan
  • Linda Von Reyn, Canaan

The Board is still looking for interested people to serve from Enfield.

There are seven committees working to implement the clinic. They include:

  • Building
  • Collaboration
  • Communication
  • Equipment
  • Finance
  • Fundraising
  • Staffing

These committees have Board Members on them, but they are open to members of the community to join. Much of the work of these committees needs to be completed this summer. We need the help of anyone who is interested.

The Plan: Create Good Health Care!


The Nature of Good Health Care

examining roomGood Health Care offers several local general practitioners who are teamed with a specific nurse practitioner to give every patient more depth in their care and coverage and at least two care providers that the patient knows personally and feels comfortable with. The health care providers work as a team with other services of the clinic like lab services.

Medical care should include pediatrics, pre-natal and professional mid-wives

Dental care including a dentist and dental hygienists should be included.

dental chairLaboratory services, Physical Therapy, Pharmacy, Nutrition, Therapy, Hospice, Home Visits and minor X-Ray services should be available.

Medical care should be coordinated with hospitals, specialists, local schools, daycares, senior programs, government programs, Veterans Administration, public housing and community assistance programs.

Assistance in getting insurance and maintaining insurance that is affordable should be provided.


Access to Good Health Care

blood draw stationGood health care should be local. It should serve the entire community and entire families. Care should be a matter of choice. There should be no requirements for use.

Appointments should be readily available and happen in a timely manner. Evening and weekend appointments need to be available. Appointments should allow enough time with the professionals to truly understand and manage health problems.

We should try to include current primary care doctors if possible. All patients should have access to local hospitals and specialists as needed.


Quality Control of Good Health Care

Good Health Care has built in quality control. It assures:

  • an organized health team that integrates patient, doctor, nurse practitioner, lab services, rehab, social services, mental health counseling, pharmaceuticals, nutrition, and dental care
  • close communication between the patient, the providers and between providers
  • that the team coordinates external services
  • full communication with the patient regarding plans, procedures, results and revisions
  • that the patient shares in the decision making with understanding, cooperation and agreement
  • that there is sufficient time available for the communication and coordination
  • provides independent quality control using a patient advocate to review records and patient history to assure that the goals for communication, understanding, decision sharing and coordination with external services is achieved
  • integrates team health care around a patient that include the doctor, a nurse practitioner, lab services, rehab, social services, mental health counseling, pharmaceuticals, nutrition, and dental care


Financing Good Health Care

labCost Care that is affordable assures that the cost of professionals, drugs, tests, procedures and rehab are as reasonable as possible, fair for all and the same for insured and uninsured patients.

It should adopt a sliding scale system for those who can't afford insurance or full payment for service based on what they can afford.

Develop a community insurance policy that is affordable.

labReduce waste and duplication of service and offer service in the lowest cost environment (not an emergency room).

The goal is to cut primary care costs by 50% and drug costs by at least 75% and reduce or stabilize insurance premiums to keep insurance affordable.

New money isn't needed – there is enough existing money to fund the change.


Accountability in Good Health Care

medical check-in deskThis clinic would be controlled by the users in the community, not by a hospital or the State or federal government or a town government. It would be funded by the users with a shared sense of responsibility and shared expense but with generally much lower expense.




The currently proposed organizational and services schematic for the local clinic:
organization chart for 8000 patients

Click to View PDF

History & Progress....

Mission and Goals

Mascoma Valley is Enfield, Canaan, Grafton, Orange, and Dorchester. Mascoma Community Healthcare, Inc. is dedicated to creating a community designed, managed and funded comprehensive health center that addresses medical, mental and dental health issues with complementing lab, x-ray, pharmaceutical and physical therapy services. The goal is to have the health center in operation with at least 2,400 patients by the end of 2015. We currently have more than 2,500 people who have pledged to use the health center.

The health center will provide services at a cost that is at least 25% less than what is currently paid by individuals and employers through insurance plans. Mascoma Community Healthcare, Inc. is working to develop insurance products that capture these savings and reduce premium costs by as much as a quarter. The health Center will serve all people regardless of age, income, or insurance status.

History

Under the sponsorship of the Town of Canaan, a citizen dialog about health was undertaken for the five towns in May of 2013. All members of the five Mascoma Valley communities were invited to share their thoughts on what constituted good health care as well as their fears and concerns. More than 400 people from Grafton, Orange, Dorchester, Canaan, and Enfield participated in nine community wide meetings between May and December 2013. People spoke to their frustration with rapidly increasing premium costs, high deductibles, dropped coverage, and premium sharing. They told of their dissatisfaction with 15-minute appointments, delays in getting appointments and fragmented care where there was little communication between providers.

A steering committee, formed from attendees of these community wide meetings, set about to design a clinic model that offers preventive healthcare, treatment of illness, ob-gyn service, gerontology, family practice, mental health, dental care, x-ray, laboratory and physical therapy services. It will be a clinic that serves children, families, elderly, working moms, people working two jobs, rich, poor, insured, underinsured and uninsured.

The community-wide organizers took the plan back to the communities and asked people to commit to using the health center once built. The clinic has won the support and pledges for the use of the facility from over 2,500 community members that represents about 25% of the residents of the five towns. This pledge number continues to grow.

Organizational Structure and Achievements

A group of incorporators then created a 501(c)3 corporation (with tax exempt status) in April of 2014 that will fund and manage the new clinic under the direction of a 25 member board of directors with 17 directors coming from patients using the facility. The Board includes three physicians, a nurse manager, a nursing educator, a pharmacist, billing coder, architect, medical manager, financial advisors, clinic operator, fundraisers, and public health professionals. A list of Board members and their brief biography is attached.

A location equidistant for all the Mascoma residents located at the corner of Roberts Road and Route 4 in Canaan, NH was optioned by the Board. That site is 5 miles from Enfield, 9 miles from Grafton Village, 2 miles from downtown Canaan and 6 miles from Dorchester.

Facility

After consulting with several engineers and architects the Building Committee has determined that a 10,600 sq. ft. structure can accommodate the planned services of medical, dental, pharmacy, laboratory, radiology, behavioral health and physical therapy. Its design will fit into the rural nature of the community and the immediate surrounding environment. It will be slab on grade and have a wood exterior. The site will be leveled from the center of the property to the north end. The lot includes approximately two acres of the 4 acre site. It will meet all local ordinances as well as any appropriate medical/dental regulations. Septic will be handled on site and meet all certification requirements. Parking will be created to accommodate anticipated traffic flow for a health center servicing 8,000 patients. Appropriate water runoff management will be a component of the site plan.

The cost of the land, building, contingency, engineering, architectural work and closing costs is estimated to be $3,000,000.

Equipment

A complete list of equipment needed and vendors has been prepared. The Start-up budget (sufficient for 5,000 patients) includes:

Office and general areas $65,353, Pharmacy $66,860, Laboratory $348,604, Dental $314,419, Examination Rooms $37,051 and Radiology $100,137. The total budgeted is $932,424. Additional equipment will be added out of cash flow generated by patients over 5,000.

Funding

The project will cost $3,500,000 and will be designed to serve up to 8,000 patients. Initially, staffing and services will be sized for a patient population between 2,400 and 3,600. We are seeking to raise $350,000 in community donations of which $180,000 has already been pledged. A total of $750,000 of local donations and state grants will be maintained as an operating reserve with mortgage payments and loans receiving priority.

Business Plan Highlights

Source of numbers: All financial projections are drawn from actual numbers. All equipment costs are actual, full retail costs. Building costs are guaranteed at no more than $200 per square foot. Salaries and utilization rates were generated from Ammonoosuc Community Health Services in Littleton, NH, Goodwin Community Health in Somersworth, NH, The Health Center in Plainfield, Vermont and The Uniform Data System (UDS) that is part of the Health Resources and Service Administration. Reimbursement rates were derived from Anthem Blue Cross October 2013 schedules and current Medicare reimbursement rates. Dental rates were obtained from Ammonoosuc and Plainfield. All non-salary expenses were derived from Ammonoosuc and Goodwin and the most conservative (highest) costs were used. Goodwin's Medical Director with 14 years of experience through 2012 sits on the Board of Mascoma Community Health Center. The Director of Ammonoosuc provided all of their financials to use as well as personal guidance. We have used and will continue to use Helms & Company of Concord, NH to independently review our business plan.

Source of patients: Before the business plan was started, Mascoma Community Healthcare solicited 1,600 pledges of people in the five towns who committed to join the new practice. That number has grown to more than 2,500 pledges or 25% of the five towns. Of the pledges, there are at least 150 people from 28 other towns who have also pledged to join the practice.

Make a contribution to support the health center as we organize. It's tax deductible. Checks should be made payable to Mascoma Community Healthcare, Inc. and mailed to PO Box 550, Canaan, NH 03741.


Click to view the final plan from 2013 for healthcare in Mascoma Valley.


Proposed Organization & Services Plan


Click to view larger

flow chart of services




Rankings of Health Care Issue Exercise:



Slideshow and Video of the Organization Meeting: May 2013

graph of increasing health costs 
PDF Version (Slides Only)
YouTube Video (Slides and Narration of Discussion)



Video from 2012 on how towns, schools, and employers can work together toward affordable care.

Affordable Care Video

Board of Directors

Articles of Agreement and Bylaws

The new Mascoma clinic will be owned and operated by a non-profit corporation located in Canaan. The management of the corporation will be by a Board of Directors. The Board sets budgets and fees, hires and fires, sets management policy and evaluates the effectiveness of the service.

The Board has 25 members of which about 16 will be voting members and patients (or pledges prior to opening). The remaining 9 members will be non-voting and professionals or people who may eventually provide services to the clinic. No one receiving compensation may be a voting member of the Board. In the future, nominees for new Directors will be selected by a committee of community members and existing Directors. Suggestions for Directors will come from the patients in the communities. Terms for Board members will be two years and staggered.

There will be committees reporting to the Board of Directors on various topics, and the committees will be composed of Directors and community members who are not Directors.

All Board members, as well as employees, must follow very strict rules prohibiting conflicts of interest.

Board Members

Board Chairman: Dale Barney (603)523-4407

  • Carolyn Barney, Canaan
  • Dale Barney, Ex-Officio, Canaan
  • Dave Beaufait, Ex-Officio, Enfield
  • Scott Berry, Ex-Officio, Canaan
  • Barry Clause, Enfield
  • Lori Dacier, Grafton
  • Barbara Dolyak, Canaan
  • John Dow, Canaan
  • Karen Ewer Gray, Canaan
  • Gili Lushkov, Canaan
  • Ed McGee, Ex-Officio, Canaan
  • Sean Murphy, Canaan
  • Michael Paine, Ex-Officio, Canaan
  • Mary Paquette, Canaan
  • Mike Samson, Ex-Officio, Canaan
  • Alice Schori, Ex-Officio, Canaan
  • Jim Spaulding, Grafton
  • Peter Thurber, Canaan
  • Linda Von Reyn, Canaan

We have a very talented team!
Read their BIOGRAPHIES here!



Committee Chairs and Contact Information:

Building Committee: John Dow (603)523-3033

Building Committee: John Dow (603)523-3033

Collaboration Committee: Mike Samson (603)523-4501 ext 5

Communication Committee: Scott Berry (570)412-9474

Equipment Committee: Peter Thurber (603)523-9832

Finance Committee: Mary Paquette (508)965-6539

Fundraising Committee: Carolyn Barney (603)632-4127

Staffing Committee: Gili Lushkov (603)523-4354



hot air balloonsProgress Report July - September 2014

There are monthly Board meetings at Canaan Hall on the second Monday of the month. It is anticipated that there will be a Board meeting at the Community Building in Enfield on November 10th. At that Board meeting, there will be an unveiling of the building plan for the clinic.

Fundraising Committee

Mascoma Health Center needs to raise about $325,000 to pay for architectural work, engineering and working capital for the opening of the facility. The Fundraising Committee is tasked with this effort. The committee has approached seven major contributors and has received interest from five of those grantors to date. Several will be participating at the end of the year and we have received several donations already. The largest contribution to date has been a contribution of $50,000 from the Jack and Dorothy Byrne Foundation to be followed by a second $50,000 contribution later this fall. The smallest has been a donation of $5 from a self-employed person in Canaan. Many of the Board members have also made donations. Other expected donations total about $145,000. Our unfunded need is still about $80,000. During the next few months, we will be asking five other organizations for help that may help us reach our goal. Donations are tax deductible.

Building Committee

The Building Committee evaluated four architectural firms and explored the possibility of building a highly energy efficient health center. Unfortunately, the energy efficient project could not be developed with the funding source we were planning to use.

We negotiated a contract with Lavallee Brensinger Architects of Manchester, NH in September and design work was started. The first phase was to finalize start-up and full build out staffing levels. This was translated to the types and number of rooms that we wanted to have. The square footage number was calculated and we anticipate a preliminary design within the next three or four weeks. A schematic plan and cost estimates will follow.

Staffing Committee

The Staffing Committee has worked with the staffing recommendations of Karen Ewer Gray who serves on our Board and has served as the Clinical Director of the Avis Goodwin Community Health Center in Somersworth, NH. Her experience coupled with the recommendations of other practitioners and the Ammonoosuc Community Health Service in Littleton, NH have led to staffing based on the balanced use of professionals at all levels of training. These include doctors, nurse practitioners, medical assistants, lab and x-ray technicians, behavioral health nurse practitioners, dentists, hygienists, and dental technicians.

The budget assumes that our lowest level of patients will be 1,600 patients a year. So far, we have had 2,300 people tell us they will join us. We have built staffing levels for 1,600, 2,400, 3,600, 4,800, 6,000, and 8,000 patients a year. Compensation levels were checked to make sure that our salaries would be competitive. During the spring of 2015, we will begin a recruitment process to find the people who will offer us the strongest mix of skills. Initially, our medical focus will probably be centered on family practice, pediatrics, and diabetes.

Finance Committee

The Finance Committee opened bank accounts and set up financial controls on spending authorization. Over the next two months, they will be evaluating income and expense projections for each level of the projected patient levels. These financial projections will be integrated into a master monthly pro-forma budget over the next six years that will be provided to lenders and grant sources.

Equipment Committee

The Equipment Committee has diligently looked at all of the equipment needed to implement the Health Center. It includes the equipment for examination rooms, dental suites, labs, radiology, pharmacy, mental health, physical rehabilitation, electronic health records, and administration. The total is more than $1.2 million dollars. It is anticipated that this amount will be reduced prior to opening to between $700,000 and $900,000 to equip the areas that will be first in demand. We will combine leasing and grant funding to acquire this equipment and may well buy newer used equipment to hold down costs.

Communications Committee

The Communications Committee has been actively recruiting new people who are committing to join the health center. Since May the number of pledges increased from 1,800 to more than 2,300. The effort will continue until the Health Center opens in 2015. So far we have people pledging from 27 Upper Valley towns in Vermont and New Hampshire - from Springfield, VT to Stockbridge, VT and from Bristol, NH to Wentworth, NH. 36% of Orange and 33% of Canaan have pledged. 9% of both Enfield and Dorchester have pledged and Grafton is in the middle with 23% pledging. The Committee organized a reception for the public to meet the incoming Board and to ask questions about the plans for the Health Center which was hosted by Cardigan Mountain School. Over 90 people attended the reception. In addition to this, Committee Members have operated information booths at events throughout the five towns to continue to spread the word. Next, the Committee will launch a public awareness campaign. Watch for their new tag line: Mascoma Community Health Center. The right care. Right cost. Right here.