The Neighborhood for Health clinic at BMC's North Adams campus has received a CHART grant to continue its efforts to build a personalized, community care system. COO Diane Kelly, CEO David Phelps and Health Policy Commission director David Seltz, all center, pose with JPC staff and the big check.
NORTH ADAMS, Mass. — Berkshire Medical Center has received its $3 million grant to continue work in its Neighborhood for Health clinic.
The ubiquitous "big check" was delivered Friday by David Seltz, executive director of the state's Health Policy Commission, and comes from the Community Hospital Acceleration, Revitalization, & Transformation program, or CHART.
The CHART grant program makes phased investments for certain Massachusetts community hospitals to enhance their delivery of efficient, effective care. BMC's first phase grant allowed it to transform and develop a former patient wing on its North Adams campus into the referral clinic.
"It really is the work of Neighborhood Health and BMC in addressing real community needs, and I am so excited to be here to help support, celebrate, and to champion," Seltz said. "I really feel like the future of health care is here in the Northern Berkshires because the model that you guys are building is just really exciting."
The Neighborhood for Health, which was unveiled in early September, is a community-orientated outpatient medical service to personalize health care and bring together a host of social, medical and behavioral services.
Those include access to a nutrition counseling, diabetes education, tobacco-cessation, and outpatient detoxification among others.
Seltz said he recently returned from a health policy convention and was struck by how many challenges still remain, such as the need to continue to integrate behavior health and substance abuse remediation into care. He added that primary care access, too, needs to increase so people do not rely solely on the emergency room.
He said programs like Neighborhood for Health are a step in the right direction.
"Access to health care is necessary but not sufficient, and I think that the thing I really like about this model is its focus on the whole person and what they need," he said. "Medical care is an important part ... but if we are really going to change we have to start addressing the things ... some of the different challenges that you already have identified."
He said the CHART grant is a test in many ways, as is Neighborhood for Health, that he hopes will provide the state with some new insights and a model that will extend throughout the state and country.
"We are going to learn a lot through this project and this care-delivery mode, l and I think we are going to have some challenges and setbacks," he said. "But I want everyone in this room to know that the state and HPC is really here as a partner to help support you ... and the ultimate goal of having better care for the patients of Northern Berkshire County and Berkshire County."
Diane Kelly, chief operating officer, said the program is already showing results with lower re-admissions within 30 days.
The registered nurse said the 30-day re-admission baseline was 15.62 percent. The program has seen 254 patients since it was implemented and only 31 patients were readmitted in that time period. That dropped the readmission rate to 12.2 percent. In one month, nine expected re-admissions were avoided.
The goal is to drop the re-admission within 30 days by 20 percent in North County over the next two years.
On a more personal note, psychiatric nurse practitioner Tori Upson shared one case that exhibited the program's successes and challenges.
A patient suffering from medical, psychiatric, and social environmental problems often relies on emergency services to manage health issues that could be prevented. The patient becomes stressed and often neglects health needs, which often has them in the emergency room.
In this case, the program helped the patient identify his or her top concerns and connected the individual to services for better education on chronic disease and nutrition, along with connections to fuel, food, and transportation assistance.
Upson added that even though the patient fell back on to familiar patterns, the patient was able to return to the neighborhood for help and stabilization.
"As you can see, the Neighborhood Health has let us engage with patients in a completely novel way," Upson said. "Meeting them where they are at and identifying their concerns and their priorities, but still addressing the very real medical and psychiatric concerns that keep sending these patients back to the ER."
David E. Phelps, president and CEO of Berkshire Health Systems, thanked Seltz and his team and added that BMC has efforts throughout the county to improve health care.
"This work we are doing in North Adams is important but it is not all we are doing," Phelps said. "There is whole lot of work we are doing to meet the traditional needs as they are defined today and doing the best we can to provide high quality care."
Editor's note: the event was a formal recognition of previously awarded grant, not a second grant as incorrectly stated in an earlier version of the article.
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The Neighborhood for Health clinic at BMC's North Adams campus has received a CHART grant to continue its efforts to build a personalized, community care system. COO Diane Kelly, CEO David Phelps and Health Policy Commission director David Seltz, all center, pose with JPC staff and the big check.
