Local center sets good example
by: Chuck Haga, Grand Forks Herald
'Our organization is small, creative and fast-moving'
As the increasingly strident struggle to reform the nation’s health care system continues, Dr. Jon Berg suggests there may be lessons in the workings of a small 
community clinic serving people in Grand Forks County. Valley Community Health Center, with medical clinics in Larimore and Northwood and a dental office in Grand Forks, recently was named by federal health officials as one of the best rural centers in the nation in caring for people with diabetes and cardiovascular disease.
Dr. Jon Berg (left), a physician with Valley Community Health Center, confers with Thelma Meyer at the Good Samaritan Center in Larimore earlier this week. Valley Community Health Center was recently recogonized by the federal Health Resources and Services Administration as one of the top "high performing" community health centers in the country.
Herald photo by John Stennes.
LARIMORE, N.D. — Fire alarms sounded in the Good Samaritan Center here as Dr. Jon Berg started his examination of Thelma Meyer.
Neither missed a beat.
“Blood pressure is good,” Berg said, as Meyer glanced to the hallway beyond her room, where despite the clanging din, nurses went about their duties without any sign of panic.
The alarm was a test, and Meyer, 94, has been through many tests.
“When I see them get excited out in the hall,” she said, “then I’ll get excited.”
As the increasingly strident struggle to reform the nation’s health care system continues, Berg suggests there may be lessons in the workings of a small community clinic serving people in Grand Forks County.
Valley Community Health Center, with medical clinics in Larimore and Northwood and a dental office in Grand Forks, recently was named by federal health officials as one of the best rural centers in the nation in caring for people with diabetes and cardiovascular disease.
As part of its mandate to provide care to the underserved, Valley this week began offering a “healthy neighbors plan” designed to overcome reluctance among some potential patients to accept help with the costs of health care.
Valley also is in the early stages of talks with Altru Health System about opening a branch medical clinic in Grand Forks, reaching out to more patients with limited income and little or no health insurance.
“Altru is proving to be a supportive but careful partner,” Berg said. “Their permission is not necessary, but their support is. … Such talks always move slowly, but I think this will happen.”
Mandate: Serve the underserved
Valley Community Health Center, governed by a board of directors chosen by members of the community, opened in 2004. Its mandate from the federal Health Resources and Services Administration is to “serve the underserved,” people whose access to health services is limited by distance, income, language barriers or lack of insurance.
The Northwood and Larimore clinics both stem from the private practice of the late Dr. Robert Delano, who served Northwood from 1953 to 1989 — and delivered Berg in 1954, when Berg’s mother was in Northwood for a wedding.
Berg joined Delano’s practice in 1985. A year later, the practice was bought by the Grand Forks Clinic. It became part of Altru in 1997.
During the administration of President George W. Bush, rural health centers were established around the country to act as health care safety nets in areas with high elderly populations and high rates of diabetes, heart disease, teen drinking and other “health disparities.”
With the advent of the Obama administration and its focus on health care reform, the nation’s 7,000 community health centers gained a highly-placed advocate in Mary Wakefield, former director of UND’s Center for Rural Health, who was appointed HRSA director in February.
At a health care “listening session” organized in Grand Forks early this month by Sen. Kent Conrad, D-N.D., Wakefield said the status quo is “absolutely unsustainable,” as people face higher medical insurance premiums, reduced benefits and greater risks of losing coverage.
The existing system is “threatening the financial stability” of individuals, families, businesses, hospitals and government at all levels, she said, and those challenges are aggravated in rural areas by distance, lower incomes and higher proportions of elderly residents.
“Reform is must-do,” she said, even if people disagree on the details.
June 30, almost $2 million in federal stimulus money was awarded to community health centers in North Dakota. Valley’s share was about $443,000.
Savings through prevention
With Wakefield in charge, HRSA recently identified Valley and 25 other community health centers in the country as “high-performing organizations,” and invited their leaders to Washington to offer suggestions on health care reform.
Valley’s experience demonstrates the value of a collaborative, community-based approach to health care, Berg said, especially in the treatment of such chronic diseases as diabetes and heart disease.
He also favors a shift in emphasis (and spending) to primary and preventive care and to getting patients to take more personal responsibility for their health through diet, exercise, not smoking and other steps.
“If you can get people in for preventive care, we can make great savings” in costs to patients, providers and government, he said. “We could avoid strokes, heart attacks, diabetes — conditions that wind up costing so much in the end.
“But getting to some of these hard-working North Dakotans, who are proud of pulling their own weight, is a tough sell.”
Valley Community Health Center employs about 50 people, full and part time, including two medical doctors, four nurse practitioners (one providing mental health care) and two dentists.
Fees are on a sliding scale keyed to patient income and family size. The clinics are compensated through better reimbursement rates from Medicare and Medicaid than private-sector providers receive.
“Our organization is small, creative and fast-moving,” Berg said. “But we don’t have big pockets.” To survive, it depends on a mix of patients, including some with “good insurance.”
Berg said he hopes reform includes changes in the ways Americans pay for their health care.
“Today, we pay for procedures,” he said. “If I do a lot of procedures, I make a lot of money.”
It would be better, he said, to link rewards to outcomes. But under the prevailing system, good primary and preventive care that helps patients avoid costly treatment later doesn’t necessarily reward providers.
“We’re saving some people a lot of money” by treating people effectively on the front end, Berg said, “but we don’t see any of that.”
Change “is beginning to happen,” he said, citing studies by Blue Cross Blue Shield and other insurers looking to find ways to encourage and reward good practices.
A stoic lady
Back at the Good Samaritan home, Meyer sat patiently as Berg went through his checklist.
“M-e-y-e-r,” she said, spelling her name for a visitor. “It’s the German version. But I’m Norwegian.”
“How are you feeling, Thelma?” Berg asked over the blare of the fire alarm.
“No complaints.”
“Are you sleeping OK?”
“Yes, except when I have to get up in the middle of the night to use the restroom.”
She’s eating fine, too, she said, now that a son is bringing in steak, shrimp and other goodies to supplement the nursing home’s offerings.
Originally from Aneta, N.D., Meyer lived on a farm near Petersburg, N.D., after she was married. She’s been a resident at Good Samaritan since November 2006.
She has largely paid her own way for health care, she said, and will “until it runs out.”
A visitor asked if she’d always been healthy.
“I must have been,” she said. “I’ll be 95 soon.”
Is she paying attention to the health care reform debate? Is she worried about what’s to come?
She smiled.
“I’ll be 95 soon,” she said again.