November 30, 2018

State scrutinizes YNHH primary-care plan

Liese Klein
Liese Klein
Yale New Haven Health and community health center executives as a public hearing on Wednesday conducted by the state Office of Health Strategy.
Ellen Andrews of Connecticut Health Policy Project speaks on the proposed New Haven Primary Care Consortium.

Yale New Haven Health's proposal to consolidate its primary care sites at 150 Sargent Drive and turn over management to the city's two community health centers was put under a microscope on Wednesday at a state-mandated public hearing.

The state Office of Health Strategy's Health System Planning Unit conducted the three-plus-hour hearing, held in a building on the campus of the Betsy Ross Arts Magnet School in New Haven. The public forum was the last step before the state rules on the three providers' application for a Certificate of Need, required to set the plan in motion.

Cynthia Sparer, YNHH's vice president of operations, opened the hearing by detailing the benefits of providing Yale's primary-care services — now offered at three sites near Yale New Haven Hospital — in a single location.

First proposed in 2015, the plan would create a consortium of YNHH, Fair Haven Community Health Center and Cornell Scott Hill Health Center. YNHH doctors, staff and trainees would provide care at the Sargent Drive site under the management of the community health centers. YNHH has stated it would pay the community health centers $8.9 million in the first year of the consortium's operation.

"There are things we can take on together," Sparer said, describing benefits including shared patient data, more accessible mental health care and a full scope of services under one roof. YNHH currently serves 25,000 primary-care patients, with the community health centers combined serving about 43,000 more patients. The centers would keep their neighborhood clinics open across the city, according to the plan.

Michael Taylor, CEO of Cornell Scott Hill Health Center, testified that he had seen similar consortium efforts work well in his previous work in Mississippi, San Francisco and Pennsylvania. When Yale approached Hill Health, "it was very clear to me what the benefits could be because I've seen them play out in other communities," Taylor said.

The OHS will rule in two weeks whether it will approve the New Haven Primary Care Consortium, as the plan has been dubbed. With approval and after about $16 million in renovations to the Sargent Drive site, the new health complex is expected to begin serving patients by September 2019.

At the hearing, concerns about the plan focused on transportation to the relatively remote location, increased patient and state costs and access to reproductive health and abortion services.

Only a few bus lines serve the Sargent Drive area, but Sparer said that 66 percent of YNHH's patients drive to their primary-care appointments and would benefit from the new site's 250-plus free parking spots. The center would also maintain a contract with Uber and offer "grace periods" to patients arriving late due to transportation issues.

As federally funded entities, the two community health centers require a co-pay from even the lowest-income patients, but the fee is often waived, said Fair Haven Community Health CEO Suzanne Lagarde. Yale clinics currently offer free care for those with incomes below 2.5 times the poverty level. Sparer said YNHH would set up a hardship fund to help cover costs for patients required to pay for care under the consortium.

Federal law also limits reproductive health services to patients at community health centers. Sparer said that YNHH would maintain its family planning clinic at its current location and continue to provide referrals for abortions and other services. "The services would not be provided at 150 Sargent Drive but would be continue to be maintained at our York Street campus," Sparer said.

Public comment on the plan ranged from concerns about transportation and care quality to enthusiastic endorsements from YNHH primary care physicians and board members of the community health centers.

Ellen Andrews of Connecticut Health Policy Project argued that the plan will cost taxpayers as YNHH shifts active management to the community health centers, allowing it to save on costs due to increased rates of reimbursement from Medicaid. YNHH has said it loses $174 per Medicaid patient visit at the system's current reimbursement rates.

"These additional costs to the state budget could result in cuts to the Medicaid program or other services," Andrews said. Five other hospitals systems statewide have already transferred clinic patients to community health centers, she added, adding to the state's costs. "It is very possible that more will consider this option to raise revenue," she said.

Clarification: Yale New Haven Health and its consortium partners have two weeks to submit documents in response to the hearing officer's questions; the OHS has up to 60 days from the date the hearing closes, Dec. 12, to rule on the Certificate of Need application.

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