The last eight months have been a back to the future adventure for Honor Martin, vice president of clinical services for Aspire of Western New York.
She started her career almost 30 years ago, spending her first decade in medicine at Health Care Plan.
“They were a staff model HMO and they did exactly what we we’re doing here. Everything – primary care, specialties, radiology, pharmacy – was under one roof.”
Martin spent five years as director of education and organizational development at Mount St. Mary’s Hospital in Lewiston before leaving in early 2014 to work for Aspire – a nonprofit founded in 1947 to treat, nurture and press helpful legislation for those with cerebral palsy.
Related story: Elmwood Health Center also has cast a wider net of care
Its mission expanded during the last 15 years to help those with a variety of special needs. The agency runs 45 group homes across the region as well as three health clinics: one on Oak Street in Buffalo and another on Lockport Road in Niagara Falls, which treat their traditional patients, and the Aspire of WNY Health Center at 7 Community Drive in Cheektowaga, which does the same – but expanded last December to offer of health and wellness services to anyone.
Other community health centers that once served more-specific patient populations have adopted similar models in recent years.
“If we can demonstrate that we’re able to take care of people that are so complex,” Martin said, “we certainly can care for complex people in the neighborhood. We’re anybody’s doctor who wants to come here”
Martin holds bachelor’s degrees in English from Daemen College and nursing from Niagara University. She also has a master’s in eduction from NU. She and her husband, William, an English professor at Niagara, live in Lockport. They have a son, Brendan, and daughter, Meghan Killen.
Q. You’ve spent most of your career in outpatient care.
Better results start with primary care, how well we prevent disease, how well we keep people healthy.
Q. Why change to a community-based practice in Cheektowaga?
We wanted to accommodate Dr. Elizabeth O’Neill, who came to work with us and wanted to keep some of her 2,000 private patients. We decided “Here’s a great opportunity,” and there was an importance of doing this, especially with the shortage of physicians throughout Western New York right now.
Q. Can you talk about the center staff?
We have thee primary care doctors and three nurse practitioners, a nutritionist, a very busy podiatrist, three psychiatrists, one neurologist, and offer physical therapy, occupational therapy and speech therapy, as well as behavioral health. We have four clinical licensed social workers. We’re kind of a well-kept secret. A lot of people view us as an entity that cares for the complex disabled, but we’re very well equipped to manage any population.
Q. Can you talk about the big picture for the person who’s been going to the same doctor for 30 years? What might things look like over the next five or 10 years?
I think there will be an emphasis on convenience, one-stop shopping, the ability of a patient to access care and services under one umbrella.
Q. When was the tipping point here in Cheektowaga when you said, “Maybe we can expand our services?”
We were able to recruit more physicians to allow us to expand, but I think the real driver was the changing health care landscape. We saw an important need to become part of the community health system.
Q. Were family members bringing in loved ones telling you, “I wish you could take care of me?”
Absolutely. For a while, our specialty practices saw people from the outside who were not developmentally challenged or had complex disabilities. But when we looked at the needs even of the immediate community – we’re right next to a large pocket of neighborhoods within walking distance – we thought, “Here we are. Why can’t we extend our services?” We knew we had the capacity to do that and enjoy the benefits of an integrated practice.
Q. Are there medical issues that spill beyond the range of special needs but are similar enough where someone can come in to your community health center and be comfortable about the care they receive?
Dr. O’Neill had a fairly large population of geriatric patients. She’s got a love for older patients. It was a great fit with our population. Another population that we’ve explored and would be absolutely on the ready to serve would be the veterans population. We have rehabilitative services, behavioral health services and primary health services. We can offer a lot of what would be replicated other places.
Q. What about insurance?
A lot of our patients are dual eligible, which is Medicare and Medicaid. We have contracts with all commercial carriers and third parties. You name it, we accept it.
Q. How has making your services available to a broader base rolled out during the last few months?
We’ve done a fair amount of advertising and tried to hit various markets. Obviously the surrounding markets are very important to us because we see the needs here. Also, we’re looking to reach those pockets of folks that don’t have a primary care physician, maybe are a little bit intimidated about seeking care and maybe are using emergency rooms for care, which is really not a very good way to get health care because it’s very fragmented. What we are offering here is a really good continuum of care with a number of services and it’s a more holistic approach because we do have the services available under one roof.
Q. Who’s coming in besides your traditional patient base?
Anybody that wants. We have people who come in just to see a specialist. Maybe they’re post-surgical and want to see a physical therapist. We do pharmaceutical management for psychiatry, and we are one of the few health centers so blessed to have the amount of psychiatry we have with three providers here. There’s a need in this community and it’s just not being met.
Q. Are you starting to treat family members who’ve come here for years?
Yes, and employees. They never had the ability before, though we got many inquiries. They come in and see a lot of the people they take care of in the residences as well. That’s important. We would want our employees to trust the services we provide.
Q. Have outside primary care providers – whether they be a single physicians or groups – started referring some of their patients for physical therapy or occupational therapy?
We’ve done several mailings and let even our specialty practices know that we now have a broader capacity for folks to be seen here. We have extraordinary physicians here: Dr. O’Neill, as well as Dr. Margaret Libby and Dr. Anees Ahmad, who work here part-time. We have two nurse practitioners. One, Jane Blake, has been here 17 years and is very established and well-known, and Hollie Bojarski, who started as an RN in the residential facilities and went back to get her nurse practitioner degree. She’s a wonderful asset.
Q. What are your hours?
They are 8 to 4 weekdays. Two of our counselors see folks evenings. We are looking at instituting convenience hours, whether that be an evening or Saturdays. We want to make sure we’ve got the population to demonstrate the need.
Q. How are community health centers collaborating on a regional basis?
We are part of SNAPCAP, the Safety Net Association of Primary Care Affiliated Providers of Western New York . There are three practices similar to ours: Elmwood Health in Buffalo and The Resource Center in Chautauqua County. They’ve had the extra capacity we have now for a while. We’re part of this larger group of federally qualified health centers and (special needs-related health centers) that have come together as a group to mutually support each other on the primary care side and discuss the current problems and ideas. For us, it’s been a very valuable membership and partnership. When you’re with a larger group, you have visibility and when things come down from a state level, it’s nice to hear how other people are handling them in their respective practices. ... The ability to share information and advocate for one another is wonderful.
Q. Do you think community health centers and the changing health care model can take confusion out of the system?
Anyone – and I’ve been a nurse for 30 years – would look at this system and say, “OK, where do I start?” There’s so many things you have to arrange appointment-wise. It’s bewildering for a lot of patients. To help break down some of those barriers and facilitate care for these people, the care coordinator and case managers we and others have are an enormous benefit.
The same goes for having several services in one building. Because of the disabilities many of our patients have, and the need to make their needs known, the trust that builds between provider and patient here are really treasured. Because those relationships exist, and because of the quality of care, there is a comfort level for those folks to seek additional services through us. It’s a very special type of medicine. Not everyone can do it.
We’re inspired. We’ve learned that this might not be the route everyone else can take (in terms of treatment and services) but we’ll find a way to do this if it’s not the traditional way. A lot of us get very creative.
Q. What is the Delivery System Reform Incentive Payment (DSRIP) program and how has it changed the nature of centers like yours?
The whole movement toward Medicaid payment reform. What it has done is put people on notice that previously we always looked at health care as something that was necessary but out there. When you needed it, you accessed it. Health care is now being viewed as part of a structure of social determinants. It’s not only health care but what helps you achieve better health care? Is transportation important? Is housing important? Is good nutrition important? Is your ability to access needed services? Can you get in to see a specialist?
What are the things that create barriers and obstacles for you in health care and how do we get rid of them so that we look at health care more globally? One of the good things that has come about through the Affordable Care Act is that it’s changed everyone’s thinking. It’s not only how we deliver the health care but what’s the context in which the care is delivered? So we look at many more things. The whole landscape is changing rapidly.
Q. Can you talk about how reimbursement has changed and how you expect it to continue?
It’s coming. It will probably take the form of value-based payment. Everybody knows it’s out there, we just don’t know what the final framework is going to look like. We know it will be more of a payment for performance-type model, so it’s going to be based on quality.
We’re moving from a quantitaive-based system to a qualatative-based system. Is that a good thing? Yes. What it will do is reward providers for what they do best – take good care of people. In the past, we looked at “How many patients can you see? How quickly can you see them?” That’s still part of it, because how many you can care for is going to speak to the general community at large. But we’re also looking at how well you provide those services. Where is the patient-centeredness of those services? What are patients telling you that they need?
When we talk about the quality piece, we’re talking about the relationship between the person and the physician or the nurse practitioner or whoever’s providing the care and the quality and evidence-based care from those visits, what the outcomes are like. Are patients getting better? Are they maintaining their health? Are they caring for them the best way we know how? Are we improving with any changes that come down the pike, with technology, their care in the future?
We’re not the only ones in the mix. All the hospitals are looking at this, all the primary care folks, the vendors, those who provide ancillary supports. All of us are looking at a whole new way of delivering care. I think it’s important. I think it’s a very important time to be in health care.
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