Plans to consolidate primary care proceed

Over the past three years, New Haven’s largest providers of primary care have developed a plan to improve health care by consolidating services, and the resulting economies of scale. Under the plan, Yale New Haven Hospital (YNHH) would close its primary care center on the medical school campus, as well as satellite offices around the city, and renovate an existing facility at 150 Sargent Drive. Management of the new site would shift from YNHH to the New Haven Primary Care Consortium, comprised of the Cornell Scott-Hill Health Center and the Fair Haven Community Health Center.

“How can the three organizations who currently care for the vast majority of the underserved population in the New Haven area come together in a way that makes sense for patient care?” asked Suzanne Lagarde, MD, HS ’77, MBA ’14, director of the Fair Haven Clinic, as she explained the goal of the consolidation.

“We concurrently concluded that everybody benefits from collaboration,” said Michael Taylor, director of the Hill Health Center, in an interview broadcast on the website of the New Haven Independent. “We will be much more efficient.”

Taylor and Lagarde believe the plan would reduce duplication of services and lead to more continuity of care for patients. It would also make health care visits easier for patients by providing multiple services, including lab tests, imaging, and prescriptions in one location. Further, the Hill Health Center would log patient charts on Epic, the electronic medical record (EMR) used by the hospital and the Fair Haven Clinic. “Everyone going on the same EMR is hugely beneficial to patient care,” Lagarde said.

The plan—which would affect 28,500 patients served by YNHH, 35,000 patients at the Hill Health Center, and 18,000 at Fair Haven—faces some regulatory hurdles. In December, YNHH issued a public notice of its application for a certificate of need from the state’s Office of Health Care Access. If approved, the next step is an application to the Health Research Services Administration within the federal Department of Health and Human Services. Once approvals are in hand, the new facility is expected to open in the spring of 2019. The facility on Long Wharf, which currently provides laboratory medicine services, blood draws, and radiology, will undergo a $15 million renovation.

The consortium would manage the site and receive from the hospital an annual payment to cover costs and management fees. No staff, including doctors and nurses, at the hospital’s existing primary care facilities would lose their jobs. Some will move to the new site on Sargent Drive. “They will primarily continue to be Yale physicians, Yale providers, but there may supplements to that to maintain continuity,” Taylor said. “There will likely be a mixture of staff from both organizations.”

Under the co-management plan, the Fair Haven Clinic would handle pediatric services and the Hill Health Center would take on adult services, including women’s health.

While reaction to the plan is generally positive, and New Haven Mayor Toni Harp has endorsed it, one major concern surfaced at a community meeting of the West River Neighborhood Services Corporation in January, and at a meeting organized by Yale medical students in February.

“I think overall it is going to be good for the community,” said medical student Nicolás Munoz at the February meeting. “The main thing that bothers me is the transportation piece.”

Students and some faculty at the medical school worry that the location is too remote for people who rely on public transportation. A bus line does stop in front of the clinic on Sargent Drive, but a single bus line may not be sufficient. Furthermore, the plan would close satellite centers around the city, forcing people to travel for health care visits.

“Neighborhoods won’t have primary care centers, only one bus line goes to Long Wharf, and it takes a long time, a 35-minute bus ride from West River,” said medical student Karrin Weisenthal. She also questioned the idea of “putting a new health center in an industrial area where few people live.”

Ross Kristal, MD, a resident in primary care at YNHH’s St. Raphael’s campus, said he’s uncertain about how his patients would react to the change.

“For all I know patients are going to be really happy that these services are going to be implemented, and that the commute might not be a big deal,” he said. “Or they might be really mad that it is being moved to a different location, especially patients who take a bus.”

How to address transportation concerns is still being discussed. In addition to the bus line, Medicaid has a transportation program for patients and the Greater New Haven Transit District’s My Ride service provides transportation for people with disabilities. And members of the consortium noted that they evaluated several sites before settling on Long Wharf.

“I think conversations are being planned,” said Lagarde. “We are very cognizant that the goal is to make this as easy a process as possible. This is patient-focused, patient-driven, that is what drives every decision.”