Spotlight on redesigning the North Country health system

On Dec. 17, a morning of record-breaking cold (minus 20 in Lake Clear), the New York State Department of Health brought some heat to the North Country when it convened the first meeting of the North Country Health Systems Redesign Commission.

Attendees included state Heath Commissioner Dr. Nirav Shah; Ms. Courtney Burke, deputy secretary for health (Gov. Cuomo’s office); commission chair Mr. Dan Sisto and co-chair Dr. John Rugge (Hudson Headwaters Primary Care Network). Also serving on the commission are Citizen Advocates CEO and NCBHN member Susan Delehanty and Fort Drum Regional Health Planning CEO Denise Young.

Though we wish the catalyst for the commission were not the current crisis in health care delivery in the North Country, we are nonetheless thrilled that the state has focused on the North County, and we think there is no better place to develop and demonstrate rural models of care than right here.

The commission is charged with developing a sustainable health care system which achieves the triple aim of better care, better health and lower cost. To accomplish their charge, commissioners will have to navigate the many moving parts of health care reform, to include Medicaid redesign, Affordable Care Act, Prevention Agenda, state Health Innovation Plan, the Delivery System Reform Incentive Plan and most recently the move to 100-percent Medicaid managed care and the release of the Request for Qualifications from New York state health insurance plans.

The current siloed and fragmented system has taken nearly 50 years to build, and it cannot be changed well overnight. Yet the schedule is aggressive, and it needs to be, but it will take time and investment to integrate the system, and it will require an inclusive planning process with an opportunity for meaningful participation and input from all stakeholders.

Hospitals, nursing facilities, public health, departments of social services, housing providers, area agencies on aging and behavioral health to include mental health, peers and addiction prevention, treatment and recovery providers all need a seat at the table. To that point, we have expressed concern that OASAS (the state Office of Alcoholism and Substance Abuse Services) is not represented at the staff level in the commission.

Change to patient-centered managed care (integration) will require investment. A prime example of this type of investment is in information technology systems for behavioral health providers to facilitate true integration with primary care. In building things – or, in this case, redesigning health care systems – we know:

You can do it with high quality

You can do it fast

You can do it cheaply, and …

You only get to pick two of the above.

We would urge that the commission pick quality for the sake of the citizens of the North Country. We urge that they also pick speed because the North Country health care system is in crisis.

That excludes cheap. As we have already stated, change will require investment, and at least in the beginning, it is not clear that those dollars will be realized though squeezing out inefficiency from the system. Rather, new investment, which is available across the full spectrum of health promotion and health care provider agencies, will be needed. North Country Behavioral Healthcare Network welcomes the opportunity to work with the commission and partner with our primary care colleagues as we together forge new solutions for the people we live with and care for here in the North Country.


Barry Brogan lives in Saranac Lake and is executive director of the North Country Behavioral Healthcare Network, based in Saranac Lake, serving seven North Country counties.