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Clinic version 2.0: an operating model that seems destined to succeed

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Welcome to North Country Family Health Center v. 2.0. We have worked hard to make this version a highly functional program that will better serve our customers far into the future.

In version 2.0, you will find a friendlier and far more efficient interface. We have streamlined our operating processes while enhancing the delivery system. We have improved our financial intake system and eliminated some layers of processing in order to provide a leaner, more efficient program.

This version replaces version 1.0, which had replaced the badly outmoded and barely functional North Country Children’s Clinic v. 7.2. That program has been completely scrapped and should be removed from your hard drive.

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The North Country Family Health Center is not, of course, a computer program. As the successor to the Children’s Clinic, it extends a 40-year-old institution in the north country that has long served the needs of the region’s most financially bereft residents, providing clinic and in-school health services, including dentistry, to thousands of residents who otherwise might not have received any health care services at all.

When the center announced in October that it was throwing in the towel, shutting down because it was flat broke, the state and the community immediately responded because, frankly, the center was too important to fail. With the state Health Department and Samaritan Medical Center leading the way, and any number of other community leaders lending expertise or support, an emergency move by Samaritan kept the clinic open. And in the ensuing three months, the state and Samaritan have created a new, more functional operating plan that should keep the clinic and its services going into the foreseeable future.

A lot of credit must go to Samaritan CEO Thomas H. Carman, who has quietly led Samaritan’s growth for the past decade. Mr. Carman is a rarity among civic CEOs; he doesn’t spend a lot of time pointing out his achievements and most of his best efforts remain behind the scenes. In the rescue of the health center, he gives the bulk of the credit to clinic interim executive director Joey Marie Horton and interim finance director Kelly Clark. And they have shown their expertise in this rapid but monumental effort to turn the clinic around, and deserve the praise. But without the direction of Tom Carman, you have to wonder if the old Children’s Clinic wouldn’t have finally expired.

It was clear in October that simply dumping more cash into the same old operating system was not a viable solution to the persistent financial ailments that plagued the clinic. Health care has entered a new era, with the Affordable Care Act only one part of the rapidly changing landscape that all health care providers are going to have to navigate. The clinic was suffering from an inefficient management structure, an outdated vision of how to fund operations, billing processes that were woefully behind the times and no clear view of where and how to obtain funding for services.

Enter Samaritan and its management team, and the state Health Department. With the premise that what was, could no longer be, a new operating plan realigned management structure to offer the most efficient guidance, found a new manner of funding by taking advantage of a federally qualified health center designation to obtain the highest possible reimbursement for the services it provides its the poor and lower middle-income clients, sought and obtained loans and grants to meet immediate needs, reduced the staff by a net of 12 employees to make the operations leaner and more efficient, improved the billing process by outsourcing it, improved the flow of clients through the clinic by making changes to reduce the negative effects of no-show clients, jumped into a consortium to reduce medical malpractice insurance costs and set up a plan to quickly get rid of unsecured debt by paying off vendors who are owed about $180,000. And these are just the highlights.

The plan, on its surface, looks to be, at last, a long-range proposal that will keep the clinic alive. As the Times reported in November, the Children’s Clinic history was one of small ups and long downs, one of a nonprofit agency that could not come up with a sustainable process to keep going without emergency infusions of cash. That it stayed alive for 40 years while lurching from crisis to crisis shows how important its services are, and shows why this community in the end couldn’t let it fail.

So Mr. Carman and his capable team deserve the credit for this. The clinic needed deep structural improvements to stay alive, and between Samaritan and the Health Department, those improvements were found and implemented. For the north country, all that work over the past 90 days has yielded spectacular results, and the people who did the work should be saluted for their efforts.

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