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Health Systems Redesign Commission offers suggestions to improve care


There may be a long road ahead for improving the care of the region’s residents and the viability of its health care providers, but a new report could provide a path for these outcomes.

Recommendations from the North Country Health Systems Redesign Commission, released Friday, include increased access to primary care and telehealth services and further financial support for facilities making changes to improve their care.

“We have lots of barriers, but it starts a good long-term conversation, and it’s a push in the right direction,” said commission member Tedra L. Cobb, president and owner of consulting firm Tedra L. Cobb and Associates.

Since December the commission has developed the guidelines for the nine-county area stretching from Jefferson to Washington counties. The group submitted its report Monday to state health commissioner Dr. Nirav R. Shah.

Among other recommendations from the commission were: allowing more flexibility to payment regulations; increasing cooperation between providers; incentivizing the service of medical graduates in the Adirondacks; integrating behavioral health care and primary care; and increasing the number of assisted-living facilities. The ideas build on the State Health Innovation Plan.

“I expect the recommendations that have emerged from this effort will have a significant impact on the delivery and quality of health care in this challenging region of our state,” Daniel Sisto, the commission’s chairman, said in a prepared statement. Separately, Dr. Shah said in a prepared statement that he looked forward to implementing the recommendations in the next few months.

The report comes as several area health care providers face economic problems. These include Gouverneur Hospital and the North Country Family Health Center in Watertown. Several medical entities have formed affiliations in recent months, most recently Carthage Area Hospital and Samaritan Medical Center. Multiple municipal hospitals are weighing changes to improve their viability, such as becoming a 501(c)(3) not-for-profit organization in the case of Massena Memorial Hospital.

“What’s at stake is the health of our population,” said Denise K. Young, executive director of the Fort Drum Regional Health Planning Organization.

The report paints a grim picture of the region’s care system and health care problems. Area residents have higher rates of childhood obesity, smoking and binge drinking compared with the rest of the state, along with fewer Medicaid enrollees, more uninsured residents and greater suicide rates.

The region’s size creates problems concerning access to specialty or behavioral health care, travel times for care and slower emergency response times. The 86 active primary care physicians per 100,000 people is about 40 percent fewer than the 120 per 100,000 average statewide. The number of families in the region with income levels below the federal poverty rate, $22,800 per year for a family of four with two children, is 32 percent higher than the rest of the state.

These problems, according to Assemblywoman Addie J. Russell, D-Theresa, underscore a need to improve the region’s care. “The old system wasn’t addressing our needs,” she said. “I have tremendous hope that by spotlighting the failures of the previous system, we can design the new system to be the kind we deserve here.”

Commission members who spoke with the Times said that state support will be critical for the recommendations to succeed. The transition from a focus on in-patient care to primary care is a major change to the business model, one that may be even more complicated from pressures at the state and federal level from the Affordable Care Act.

“It’s going to take time, it’s going to take everybody being committed, and being committed to being persistent and determined to make this happen,” Mrs. Young said. “We don’t have any other choice. We need to make this transition so we can serve this population right, and do so in the most cost-effective manner.”

Beyond cost controls, “we have to continue to ensure that the people of the North Country have access to the best quality, modern health care that we can provide” while keeping local jobs and investments, state Sen. Patricia A. Ritchie, R-Heuvelton, said.

If successful, board members see the potential changes as having a positive impact for the area.

“If we can survive the transition, we get to a much better place, in terms of outcomes and care,” U.S. Rep. William L. Owens, an advisor to the commission, said.

The final report can be viewed at

North Country Health Systems Redesign Commission report
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