Paul Bass Photo
Inside 150 Sargent, proposed new primary care site.
Tens of thousands of New Haveners next year will receive basic health care in a new spot with an experimental approach — if state and federal regulators say OK.
The new spot is 150 Sargent Dr., currently a Yale-New Haven Hospital-run ambulatory care building next door to the Long Wharf Theatre. Yale-New Haven is seeking permission to close its current main primary care center at 20 York St., as well as its primary-care satellites at 1450 Chapel St. and 2080 Whitney Ave., and move the whole operation to an expanded, renovated, more modern central facility at 150 Sargent. It’s looking to spend $15 million redoing the building as part of the deal.
That’s the new part. The experimental part involves its management. Yale-New Haven would no longer run the center under the plan. Instead it would contract with New Haven’s two grassroots neighborhood-based agencies — Fair Haven Community Health Care and Cornell Scott Hill Health Center
— to manage it.
So the move to a new Long Wharf facility would affect not only the 28,500 largely low-income patients currently served by Yale-New Haven, but the future of the two health centers and their 43,000 patients, not to mention the doctors and staffers who currently work out of the hospital’s primary care center.
“Change is inevitable,” observed Hill Health Executive Director Michael Taylor. “It’s going to happen, and we need to evolve with the industry.”
How will this change work, and what will mean for New Haven? Read on for an “explainer” based on an interview with Taylor and his counterpart running Fair Haven’s center, Suzanne Lagarde, and on answers provided by Yale-New Haven to emailed questions.
Lagarde and Taylor at WNHH FM.
What makes this unique?
Rarely do large academic hospitals work with community health centers to run a primary care center serving large low-income communities. Lagarde and Taylor cited the University of Mississippi, which does it in Jackson, and said San Francisco has a similar center. They know of few others, especially with two neighborhood centers involved in the deal.
How will the plan work?
Yale-New Haven will pay the two centers an as-yet-unspecified annual fee to manage the center based on their experience providing community-based care to lower-income patients. Yale-New Haven’s current doctors and staffers would keep their jobs and move over to the new center, according to the hospital. The clinics might add some of their own staff as well.
What’s in this for the two neighborhood health centers?
Lagarde and Taylor took over their institutions several years ago at critical junctures. Both Fair Haven and Hill Health grew out of the War on Poverty; they were first-wave community health centers and established reputations as models. But as the health care industry changed, both institutions faced existential fiscal threats. Taylor and Lagarde have succeeded in stabilizing finances at their institutions, adapting to new medical needs, and expanding care. But these remain hard times for community health centers, especially with major federal cuts looming. This deal would help the centers stay financially sound. Both Lagarde and Taylor stressed that their existing neighborhood-based centers will remain operating as before.
The new operation on Sargent Drive will help the center achieve economies of scale and offer new services, they said. For instance: All three institutions will be connected to a central electronic medical records system (Yale-New Haven’s EPIC, which Hill Health does not currently use). That will help them manage care for patients at all their facilities, Taylor said. “We will all know in real time, for example, when someone is going to the emergency department. We can reach out to those patients and steer them towards more effective care.” “We will get internal alerts, because we’re all on the same platform. This is 21st century health care,” Lagarde said.
She said the clinics’ experience with community health care will enrich the learning experience for Yale Medical School interns and residents at the primary care center — and perhaps lure more of them to take permanent jobs at the health clinics.
How will Yale-New Haven calculate how much to pay the health centers?
A hospital spokesman gave this response: “It is set up so that the health centers don’t suffer any losses from their operation of these new clinics. We are providing start-up funding to each [center] to cover certain one-time costs associated with getting the program up and running. We also are providing in-kind donations of certain services and supplies. Going forward, we will establish a budget each year.”
Taylor and Lagarde said it’s understood that the annual payment will include a management fee on top of covering all costs. “We will incur no additional costs,” Taylor said.
What’s in this for patients?
On top of benefiting from their institutions’ knowledge and experience, Taylor and Lagarde said, the new center will be bigger than the current facilities and include “state-of-the-art” equipment.
Also, patients who now get behavorial health services and X‑rays and be able to purchase pharmaceuticals at the same location where they see their primary care doctor, rather than have to travel to several different spots, Lagarde said.
Yale-New Haven also notes that primary care patients at the current Chapel Street site, at the St. Raphael campus, will move from “trailers” to “much nicer, roomier space” on Sargent Drive.
Isn’t Long Wharf harder to get to for most people?
Long Wharf is indeed in a less populated part of town than York Street or Chapel, and harder to get to without a car. The new facility will offer easier parking for people who drive. It is on a bus line, Taylor and Lagarde noted.
That said, some people in, say, the Hill, may find it easier to walk to Hill Health on Columbus Avenue to see a doctor rather than schlep to Sargent Drive. The move of the primary care center will definitely cause some people to switch locations for care.
What’s in this deal for Yale-New Haven?
Yale-New Haven estimates it loses an average of $174 on every visit with a Medicaid patient. That’s because government subsidies don’t cover the full cost. Declining subsidies forced the former Hospital of St. Raphael to the brink, leading it to sell to Yale-New Haven rather than close. The thinking is that Fair Haven’s and Hill Health’s expertise, along with the economies of scale, could deliver the same quality care less expensively.
So Yale-New Haven is looking to save money? Will some staffers lose their jobs?
Actually, they say cutting costs is not one of the goals.
“The goal of the Consortium is to continue to improve care to the community not to reduce cost or achieve savings. No one’s employment will be eliminated as a result of this change consistent with our practices and history,” stated a hospital spokesperson.
So how else can Yale-New Haven benefit?
If it can improve care for the poor — and strengthen two valuable neighborhood health centers — the hospital will be able to claim it is providing “community benefits.” Tax-exempt hospitals like Yale-New Haven are required by law to document that they provide community benefits. This recent story in Politico documents in depth how Yale-New Haven has worked hard to improve what had been a spotty community benefits record over the past 15 years, and the challenges that remain.
What does the public think about this?
Too early to know. The public will have a chance to weigh in as the regulatory process advances.
And how will that process work?
Yale-New Haven started the process on Dec. 7 by issuing a public notice in the New Haven Register classifieds section that it plans to apply for a certificate of need from the state Office of Health Care Access to close its current primary care center locations and centralize them at the renovated 150 Sargent facility under Fair Haven’s and Hill Health’s operation.
Now the hospital has until March 7 to file the actual application, according to OHCA Associate Health Care Analyst Steven W. Lazarus. OHCA’s review process then includes an opportunity for public comment. In addition, Yale-New Haven has started holding community meetings to explain the plan and solicit feedback.
Then, assuming OHCA grants the certificate of need, Fair Haven and Hill Health will need approval from the federal Health Resources and Services Administration. After that process end, the project’s organizers needs to convince the state Department of Health to issue a license to operate at 150 Sargent Dr.
That sounds like a long process.
Actually, work has begun on renovating 150 Sargent. Lagarde explained that once HRSA grants approval, the agency expects the facility to be up and running within 120 days. So that would not leave enough time to start then from scratch. Taylor said the new center could open within a year.
How does the public weigh in?
Thirty days after OHCA deems Yale-New Haven’s application “complete,” members of the public can request a public hearing within 30 days and/or submit written comments to state Deputy Public Health Commissioner Yvonne Addo. This web page gives details about all that.
Has anyone yet expressed concerns?
Privately, doctors at the primary care center have said they’re concerned about whether the new center will retain all the services found at the current center, such as patient legal services, patient relations, children’s health legal services, social work, and child life specialists for pediatrics.
What does Yale-New Haven say about that?
“It’s our goal to ensure a smooth transition to the new center with a patient-centered approach to meet the needs of our diverse patients and maintain and possibly enhance the resources” contained in that list.
What about the stuff Yale-New Haven currently does at 150 Sargent?
The hospital plans to keep all current services there until the new primary care center moves in. At that point, “radiology and blood draw will remain” at the center, according to a spokesperson.
And what will Yale-New Haven do with its the three current primary care center sites?
Something, for sure — but at this point it’s not sure.
Click on or download the above audio file or the Facebook Live video below to listen to the full interview with Michael Taylor and Suzanne Lagarde on WNHH FM’s “Dateline New Haven” program.