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Families First Health & Support Center

Portsmouth Herald - 6/4/2017

Families First Health & Support Center, located in Portsmouth, and Goodwin Community Health, located in Somersworth, announced their intent to merge, becoming one organization by the end of 2017.

The strategic merger will create a single, regional organization that improves patient care and health outcomes through clinical integration, increases access to care and services, and positions the new organization to meet the demands of a rapidly changing health care system.

It also brings operational efficiency, economies of scale, and advantages in recruiting and retaining clinical staff.

Both Families First and Goodwin will continue doing business under their current names and at their current locations.

Once the merger is complete, Goodwin CEO Janet Laatsch will lead the merged organization as chief executive officer. Laatsch, who has expertise in finance and nursing, has served as Goodwin's CEO since 2005.

Helen Taft, Families First executive director since 1989, will retire once the transition is complete. "In an ever-changing health care environment, it is important to be pro-active and responsive to community needs," Taft said. "I've been here almost 28 years and recognize that it's important to look to the future."

A single board of directors will oversee the combined agency. It will have 21 members, more than half of whom, 51 percent, will be patients at one of the health centers, as is the case now. The new board will be made up of a roughly equal number of members of the two current boards.

"Community health centers have a federal requirement to have board members who are consumers," Laatsch said. "They know the needs of the community."

She listed the increasing needs for behavioral health, dental care and, most recently, substance abuse. "We are looking out for a vulnerable population," Laatsch said. "We are leaders in this. Families First and Goodwin are very similar and very like-minded."

Being pro-active in a changing environment

At the same time, agency leaders recognize that each organization is too small to benefit fully from changes in a health care environment that increasingly provides financial advantages to larger organizations, so they are joining forces to improve their positions.

"At some point, we will be paid by patient outcome," Laatsch said. "We will have value-based payment and incentives if we meet certain goals. Being larger in numbers will help with this."

Laatsch said insurance companies, including Medicaid, are going toward this "wave of the future."

"They look at things such as decreased emergency room utilization, preventative measures, patient outcomes and patient satisfaction," she said. "We want to be prepared."

Looking at Medicaid expansion, which is currently in New Hampshire, but not in Maine, both organizations have already seen the value of patients getting tests and following up on preventative measures that they were not able to afford without Medicaid.

"Even Medicaid is managed through outside organizations," Laatsch said. "The N.H. Department of Health and Human Services handed the money over."

New Hampshire Medicaid's Care Management program uses two health plans to manage health care for recipients. Medicaid recipients enrolled in the MCM program work with the health plan they either selected or were assigned, those being N.H. Healthy Families and the Well Sense Health Plan.

When asked if Medicaid expansion might end in 2018 in New Hampshire, Laatsch said that was another reason to have more numbers of patients.

Although one goal of the merger is to increase the reimbursement received from insurance companies, Goodwin and Families First collectively have more than 3,200 uninsured patients, as well as many more who are underinsured.

It takes a diversified range of funding sources - insurance reimbursement, patient fees, government funding, grants and donor contributions - to ensure that everyone can be served.

"The sharing of resources and staff retention are big factors as well," she said. "With a larger staff we can get better health benefits for them." With the merger, there will be a combined staff of 230.

"The substance abuse programs are meeting a huge need," Taft said. "And since Medicaid expansion, we have decreased our uninsured from 55 percent to 25 percent. The homeless population has more access to testing and other services as well."

Taft said the rationale from Families First's point of view is to become bigger, serving the entire Seacoast of New Hampshire and into southern Maine.

"It gives more clout when negotiating with managed care plans and in being successful in this new reimbursement world that is coming," Laatsch said. "Value-based payment could be five years in coming."

Both have services that can be shared.

"Families First has the van that visits the homeless population, parenting programs and home visiting for prenatal patients," Laatsch said. "We have the pharmacy program for discounted medications and the Women, Infants & Children program."

Goodwin's savings to the community is about $11.3 million, Laatsch said.

Recent studies show that, on average, each patient receiving care at a health center saved the health care system 24 percent, annually.

With 4,847 patients served by Families First Health and Support Center in 2014, the estimated annual savings is $6.1 million at $1,263 saved per patient.

"From my point of view, it is important to look at this merger as being pro-active by maintaining our services in an emerging health care environment," Taft said. "We have two successful entities positioning themselves in the most effective and cost-efficient way with quality of care and outcomes."

How the merger came about

The merger was first discussed in August 2013 with a 10-person committee consisting of four board members from each organization and both executive directors.

While the joint committee met every month for more than three years, each organization performed its own due-diligence process. Committee members then brought in outside legal and financial experts to advise them. A grant from the New Hampshire Charitable Foundation'sThomas W. Haas Fund, Elizabeth G. Plumer Charitable Trust and Piscataqua Region Community Fund covered costs of outside consultants and other expenses for the merger to date.

The foundation invested in this work because it supports the goal of proactively lowering costs and improving quality. Going forward, merger expenses will continue to be covered by grants, so that all donor contributions remain dedicated to community health programs and services.

"We applaud the strong leadership of these two organizations, and are pleased to support their efforts to bring greater scale to critical community health service," said Katie Merrow, vice president of community impact at N.H. Charitable Foundation.

Impact on patients

Nothing will change before the merger is complete in fall of 2017, and very little will change for six to 12 months after that.

Both Goodwin and Families First will be in the same locations, go by the same names, and provide patients with the same access to the high-quality health and wellness services they've come to expect.

There will be no immediate changes to fees, but the sliding fee scale will be adjusted from time to time, as it always has been. As is the case now, fees may be waived in cases of hardship, such as homelessness.

In the long run - ranging from a couple of months to a couple of years after the merger - patients will be able to access more services, have more choice about where and when to be seen, and benefit from advances in technology that a larger organization has more capacity to invest in.

Two public forums will be held to share more detailed information and answer questions and both Taft and Laatsch encourage the community to attend and become better informed.