Connections: December 2017

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Issue 10: December 2017

Interconnecting Regional Healthcare


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Meet Your 2017 Community Health Heroes! Featured:

Building Partnerships

NCI event brings together direct support professionals for a successful care management strategy session

A Farewell from NCI Director Brian Marcolini

After 4 years at NCI, Mr. Marcolini to pursue new venture with Alliance Healthcare Services


s I reflect on my time as NCI Director, I am humbled and honored to have been part of the healthcare transformation in this region.

When I left the world of pharmaceuticals and entered the world of healthcare reform, I was extremely excited but also a little scared. I was excited about the changes that I knew this region could make, but honestly, I feared the unknown. It takes courage to venture into healthcare transformation, which is full of unknowns. But one thing I have learned during my time as NCI Director is that we are all in this together; we can and will take on the unknown as a team. For me, there have been so many rewarding experiences during my time at NCI. First and foremost, I am incredibly proud of my staff. I have watched each and every one of them grow and develop as professionals, and I truly believe that NCI would not be where it is today without them. I feel very fortunate to have them as colleagues and friends. Secondly, knowing the lives we’ve changed has been extremely rewarding. I cherish all the patient success stories more than you all know. And lastly, I was afforded the opportunity to see the region’s first accountable care organization take shape, and I am confident in the success of the ACO and what it brings to the region. I would say the most challenging part of my tenure as NCI Director was getting people to understand that you cannot do it alone. There is not one single entity that can take on healthcare reform alone. While I want each entity to continue their mission independently, my hope for this region is to see all of us working together in support of an effective, sustainable, prosperous clinically integrated network. As this region enters the world of value-based payments, there are three aspects we must harness to be successful: the ability to aggregate data and analyze it, physician and clinical leadership, and a legal structure to formalize it into a contract. I am confident the North Country Initiative is the vehicle for value-based payment contracting for our region. I would like all of you to know that what you are doing matters, and that all of your efforts are leading to the development of something very special. What you will accomplish in the future is based on your ability to be open and honest with each other, continue to form partnerships, and find a way to become ONE TEAM. I believe in you and I believe in this region. Thank you,

Cooperation is Key for Navigating Value-Based Payments

By Dr. Steve Lyndaker NCI Medical Director


ust like you, I have been hearing about the transition from fee-for-service (FFS) to pay-forperformance for nearly a decade, and from my perspective, it has only recently become tangible and relevant to my work. In my private practice, Lowville Medical Associates, roughly 1015% of our revenue will come from pay-for-performance or quality initiatives — which means this is starting to get real! We need to have a working knowledge of Value-Based Payments (VBP) to ensure financial sustainability going forward,

both as individual entities and collectively in shared contracting. So, let’s start with the basics. Value-based care focuses on quality, not quantity. When participating in a VBP model, patient outcomes are measured, and efficiency and effectiveness are rewarded. Many different metrics can be used, depending on the individual contracts with either CMS or insurance companies. Probably the most familiar example of VBP is the Medicare Shared Savings Program (also referred to as an Accountable Care Organization), which many of you are a part of. Those of us currently participating in the ACO understand that if we collectively reach shared savings and satisfy the quality metrics of the program, we will be paid a portion of that shared savings and earn additional

NCI is hosting a blood drive! When: Wednesday, January 3, 2018

9 a.m.- 3 p.m.

Where: North Country Initiative

120 Washington St., Suite 230 Watertown, NY 13601

Walk-ins are welcome, but appointments are preferred. Visit and search for "North Country Initiative" in the "Find a Blood Drive" box. For more information, contact Celia Cook at

revenue beyond FFS. Bundled payments — or episode-based care — is another example of VBP. This single payment for an entire episode of care (often a surgical procedure) is based on improving value while providing a service in the least expensive manner possible and preserving quality and safety. Lastly, the Patient Centered Medical Home (PCMH) model also incorporates VBP concepts: enhanced per-member-permonth payments are given to PCMH Level III practices since these entities have demonstrated improved access and team-based care models. The take-home message here is that value-based payments are here to stay, in one form or another. Fortunately, our region has already adopted many of the VBP concepts. As an integrated network, we need to learn from each other and keep moving forward so we all benefit when participating in VBP contracts. The North Country Initiative will continue to pave the way and ensure our partners thrive in a value-based payment environment, because together we are stronger.

To watch NCI's video, which details our region's strategy for entering value-based arrangements, visit




n November, the Fort Drum Regional Health Planning Organization (FDRHPO) and North Country Health Compass Partners announced the recipients of the 2017 "Community Health Hero" award. The award — given in honor of National Rural Health Day — recognizes North Country residents who have demonstrated outstanding public service and a commitment to improving health and wellness in their community. One hero was selected from Jefferson, Lewis and St. Lawrence counties. These are their stories:

Lance Ronas - Jefferson County

Ten years ago, if you had told Lance Ronas that he would one day be called a “community hero” for his work to create the Indian River Ambulance Service, he would not have believed you. That’s because, in 2007, when Mr. Ronas first pitched the idea to merge ambulance services from the towns of Theresa, Antwerp, and Philadelphia, he did not receive a warm reception from volunteers or community members. When most people heard the idea, he said, they thought he was trying to steal their ambulances or charge them extra money. “I was called deceitful, a thief, and a shyster,” he said. “People don’t like change.” However, because of his foresight, perseverance, and dedication to bettering the health of his community, Mr. Ronas now has been recognized as a hero. He is one of three individuals in Jefferson, Lewis, and St. Lawrence counties to receive the 2017 Community Health Hero Award, which is given in honor of National Rural Health Day – celebrated nationwide on November 16th. The Fort Drum Regional Health Planning Organization and North Country Health Compass Partners, who sponsored the award, accepted nominations from the community for individuals who exemplified “outstanding public service toward the improvement of community health and wellness.” Mr. Ronas, who has been a paramedic for nearly a decade and an EMT for more than 25 years, said the idea to merge emergency medical services was always about improving care for residents of the three-town Indian River community. He became driven to make the merger happen after witnessing his mother suffer

while waiting for an ambulance in February 2007. “My mom had a heart attack and her ambulance didn’t show up for at least 20 minutes,” he said. “I saw that we needed to take our level of care up a notch.” And so began many months of planning, paperwork, public meetings, and trying to convince his colleagues and neighbors that joining forces to create the Indian River Ambulance Service would benefit everyone in the community. With the help of his good friend and colleague Kelly Morgan – and a few other supporters – Mr. Ronas did these things for free, and on top of work and volunteering commitments. The Indian River Ambulance Service was incorporated as a nonprofit organization in June 2010. It now has 42 providers – including 11 paramedics – who provide 24/7 emergency medical services to the three towns and beyond. It also serves as a training and education hub for community members who want to become EMTs. “When we founded this place, it was to be an educational epicenter,” Mr. Ronas said. “We needed to train EMTs, and today, if you ask agencies around us, they’ll say that they’re getting membership from here.” The ambulance service also offers CPR courses for members of the public, allows community

Left: Pat Fontana, FDRHPO Rural Health Network Manager, presents Lance Ronas with the 2017 “Community Health Hero” award for Jefferson County with Ann Smith, North Country EMS Program Agency director. Center: Pat Fontana presents Dan Myers with the "Community Health Hero" award for Lewis County. Right: Dr. Mark Franke accepts the "Community Health Hero" award for St. Lawrence County with his wife, Karen.

members to drop in and have their blood pressure taken, and provides other services to help build and maintain community health and wellness. Though the community was apprehensive at first, Mr. Ronas said most residents are now thankful for the collaborative ambulance service – and he gives them all the credit for its success. “If we are successful, it’s for the buy-in – not only by community leadership, but by the community at large,” he said. “I might be the ring leader, but our logo shows two hands coming together, and that is what we are all about.”

Dan Myers - Lewis County

For Dan Myers, founder of Double Play Community Center in Lowville, receiving the 2017 Community Health Hero Award was a reminder that his more than a decade of hard work is making a difference. “It’s something that you never really realize, when people are noticing the work that you do,” he said. “It was nice to see that people recognize the difference I’m trying to make in the health of our community. I’m very honored.” Starting with just an idea, Mr.

Myers began building Double Play Community Center from scratch in 2006. He saw a need for a recreation and wellness center that provided fun, affordable programming for Lewis County families, and so he began researching, conducting surveys at the county fair, meeting with community stakeholders – anything he needed to do to make his idea a reality. “It took me until 2011 to start programming at a local Catholic school gym,” Mr. Myers said. “This can be a difficult area; change can be very difficult, and it’s not always easy to spread the word.” But word did spread, and Mr. Myers quickly gained the support of community agencies and volunteers. Today, Double Play Community Center engages more than 700 individuals and families in Lewis County, providing sports, fitness, art, music, and other recreational activities to residents ages 3-93. It also provides scholarships and free programs to low-income families to ensure all residents have access to enrichment opportunities. In fact, reaching families in need is what keeps Mr. Myers motivated to continue growing the Double Continued on the next page...

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Play Community Center. It was his motivation for dedicating himself full-time to the center last year, taking a significant pay cut when he left his job as a special education teacher at Lowville Academy and Central School. “Everything that I’ve done was with the thought that this was going to be my future,” he said. “The ability to be able to help and reach more people on a full-time basis was crucial, even though it’s something where I’m making half of what I used to.” “It’s not something about me, it’s about something for the community,” he added. “I think Lewis County deserves a community center that fills the needs of every single individual that wants to get healthy, or have the opportunity to better themselves with music or art. The key component of our mission is to improve the quality of life.” Recently, Double Play Community Center was awarded a $40,000 grant from the county to continue its outreach in the community. Mr. Myers said the nonprofit has put an offer on a property in the Lowville village limits, hoping to bring all of its programs – now offered at three locations – under one roof. “What we’ve accomplished in the last 11 years really shows a true sense of sustainability and feasibility

for the future,” Mr. Myers said.

Dr. Mark Franke St. Lawrence County

When Karen Franke told her husband, Mark, that she had nominated him for the 2017 Community Health Hero Award and he’d won, she introduced the surprise timidly, knowing his humble nature: “You’re either going to hate me, or know how much I love you,” she told him jokingly. Dr. Franke, a dentist at the Community Health Center of the North Country, said he had no idea what the award was or that his wife had nominated him, but when he found out, he was thrilled. “I had no idea either about the award or the fact that I had won, so it was a true surprise,” he said. “As I’m not one to seek out attention or publicity, I suppose I thought about it for a while, but I settled on the fact that she does love me.” Dr. Franke has worked in Canton at the Community Health Center of the North Country since 2000 and has become known in the community as the “dentist whisperer” for his unique ability to foster a trusting relationship with patients of all ages and needs. “Working at the Community Health Center has its different challenges – as you can imagine – other than those encountered in

other private practices,” he said. “We treat a large number of patients with special needs, and a good number of our patients are low-income individuals, including children.” With patience, compassion and a genuine desire to help his community, Dr. Franke has volunteered his nights, weekends, and other time outside of working hours to accommodate his patients with special needs. On “Give Kids a Smile Day,” he volunteers his services to give low-income children a free dental exam, and he does the same for local senior citizens on “Senior Smile Day.” He also visits local elementary schools during National Children’s Dental Health Month (February) to speak to children about the importance of oral health, and is an advocate for water fluoridation throughout St. Lawrence County’s towns and villages. “While neither myself or the other dentists that I work with have special training in treating patients with special needs, or children, we do whatever we can do to meet their needs,” Dr. Franke said. “Even with the sometimes-never-ending problems our patients face, even the smallest success makes my day and makes the practice of dentistry so worthwhile.” At age 64, Dr. Franke is nearing retirement from his more than 30year career in dentistry. He said he plans to spend time with his wife, five daughters, and 13 grandchildren while continuing to be involved in the community. “I certainly won’t be sitting around doing nothing,” he said.

Correction An article in last quarter's edition of "Connections" failed to mention that funding for Mental Health First Aid Trainings came from the Jefferson County Youth Bureau and Fort Drum Regional Health Planning Organization. Thanks to these funders, the North Country Prenatal Perinatal Council was able to train 164 adults in Youth Mental Health First Aid in 2017.

Building Partnerships North Country Initiative Hosts its First Care Management Event


n October 13th, the North Country Initiative hosted “Strategies to Build Partnerships Across the North Country” — its first event dedicated to Care Managers in the North Country. It was held at the Hilton Garden Inn in Watertown and featured guest speaker Dr. Amy Boutwell, president of Massachusetts-based “Collaborative Healthcare Strategies." The target audience for the event was individuals providing direct support to patients across the entire care continuum, including: care managers from primary care and community-based settings; hospital discharge planners; Dr. Amy Boutwell an behavioral health, home health, palliative care, pharmacy and nursing home staff. Dr. Boutwell is a nationally recognized thought leader in the field of reducing readmissions and improving care for high-utilizers, advising statewide initiatives in Massachusetts, New York, Maryland, Virginia, Georgia, and nationally through the CMS Healthcare Improvement Innovation Networks (HIINs). She has worked with NCI on two separate Medicaid Accelerated eXchange (MAX) series and works with the NYS Department of Health.

In October, Dr. Boutwell guided the group through a full day of discussions about partnership opportunities, cross-setting collaboration strategies and other topics relevant to care management in the North Country. Some ideas that came out of the day included better methods to: “close the loop” with referral sources and care team members, improve communication between members of the care team, and develop a listing of points of contact at all organizations to promote consistent and effective communication between entities. NCI received great feedback regarding the event from many participants. Jessica Gonyou of Transitional Living Services said:

“I think that was one of the most productive days we have had as far as networking and gaining information we can take back and use to make change and improvements to our everyday work. I know I made some great contacts today and feel refreshed and motivated to move forward with new ideas and information." Thanks to all who attended "Strategies to Build Partnerships Across the North Country." We hope you found the program interesting and informative!

Guests at "Strategies to Build Partnerships Across the North Country" listen to guest speaker Dr. Amy Boutwell.

NCI Director Brian Marcolini Receives "20 Under 40" Honor As featured in NNY Business Magazine:

lthough he has only been a father for eight years, Brian D. Marcolini has learned most of his important life lessons from his children. These lessons started on day one of fatherhood, when his son, Owen, was born not breathing. His son is healthy today, but Mr. Marcolini said Owen’s stay in the neonatal intensive care unit was one of the most terrifying times of his life. “That was a struggle for me, to be able to cry and be held by somebody,” he said. “Before kids, I probably would have hidden all of that. People didn’t know when I struggled with something; I was too proud to admit it.” Since that day, Mr. Marcolini said, his two boys and wife, Marcie, have taught him to be an “open book.” And for him, that’s an important part of life – whether he is at home, volunteering in the community, or working as director of the North Country Initiative. Mr. Marcolini was hired in April 2014 to become the first director of the North Country Initiative – a collaborative of hospitals, physicians, and community providers working together to reform healthcare delivery in northern New York. He and his staff work to achieve three overarching goals: to get the region working together as a team; to create opportunities for sustainability in a changing healthcare environment; and to improve health outcomes for our region’s patients. “What’s exciting about this job for me is really the success that’s coming out of it,” he said.


“The region is benefitting from our providers being sophisticated in healthcare reform. Our patients are seeing the beginning of new services like community health workers and behavioral health peer supports. People are taking accountability for patient outcomes, and that’s coming from the concepts we promote here at NCI.”

found a level “ofI have responsibility to a community that I didn't grow up in...

For Mr. Marcolini, who previously worked for a decade in sales and marketing at Merck Pharmaceuticals, getting the region to work together has been no easy task. He’s had to convince healthcare partners to step outside their comfort zones and – in some cases – change the way they’ve been doing business for years. He said the job has required “grit,” a trait instilled in him years ago by a high school baseball coach. “There have been plenty of people who have told me no,” he said. “There were people who, when I took this job, said there is no way a pharmaceutical sales rep is going to be able to do this. If I hadn’t had the grit or the belief in myself, we wouldn’t be here today.” Hearing success stories from local patients has also kept him motivated. Indirectly, work done by NCI has helped individuals lose

weight, manage chronic diseases, seek help for mental health concerns, and more. “We might not be able to change the world through one thing that we do, but if we can change one person’s world, that’s huge,” he said. “That keeps me going and makes me want to do more.” When he’s not working at NCI, Mr. Marcolini is devoted to mentoring and coaching local youth. Particularly through sports, he strives to empower the next generation because he believes the future of our community depends on it. “It’s easy for a child to grow up and leave the area, but I think it is a lot harder if that child grew up being involved with people or having a mentor here,” he said. “That’s why I spend so much of my time vested in the youth. As much as we can be examples now, if we don’t have somebody coming up behind us, it doesn’t matter what we do.” To further support future generations of leaders, he believes local officials should explore opportunities for new industry and technology in the north country – something he has kept in mind when analyzing the local healthcare landscape. “I have found a level of responsibility to a community that I didn’t grow up in,” Mr. Marcolini said. “I always knew I wanted to see the community succeed here, but now I feel an ownership to help do it.” Staying in Watertown, Mr. Marcolini will soon be taking the next step of his career as business development director for Alliance Healthcare Services.



Quick Facts • 24 years in operation • 25 employees • 134,441 trips in 2016 • 222,665 volunteer hours in 2016 • 5,482,530 miles driven in 2016

Jefferson County • 9,842 trips per year • 269,257 miles per year • Average of 27.4 miles one-way

Lewis County • 2,877 trips per year • 102,976 miles per year • Average of 25 miles one-way

St. Lawrence County • 6,299 trips per year • 214,445 miles per year •Average of 40.7 miles one-way


eginning with this issue of "Connections," the North Country Initiative will highlight a local community-based organization — or "CBO" — each quarter in its "CBO Spotlight" section. This quarter we recognize the Volunteer Transportation Center! Established in 1993, the Volunteer Transportation Center (VTC) drives millions of miles each year, assisting community members in Jefferson, Lewis and St. Lawrence counties. Over the last 24 years, this non-profit organization has provided essential rides to healthcare appointments, food sources, and other health-related destinations for residents. Through the generosity of the community and many partnerships across NNY, volunteers drive over 5 million miles annually.

Who is Eligible? Senior citizens over the age of 60, individuals with disabilities or visual impairments, and those who

have no other means of t ra n s p o r t at i o n to medical appointments and food sources — including food pantries or grocery stores — are eligible for volunteer transportation. The VTC provides its services free of cost to eligible individuals; however, because transportation is expensive, donations are appreciated. VTC's staff, board of directors, and volunteer drivers look forward to a time when transportation to community activities and services is accessible to all North Country residents — regardless of economic or special needs. For those looking to utilize the Volunteer Transportation Center's services, visit www. volunteertransportationcenter. org or call the office closest to you:

Jefferson County (315) 788-0422 Lewis County (315) 376-3777 St. Lawrence County (315) 714-2034

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