Espanola Farmers’ Market has partnered with the El Centro clinics for a very effective fruit and vegetables prescription program (FVRx) funded by Wholesome Wave, a foundation based in Connecticut.This grant enables the entire family of children diagnosed with diabetes or obesity to recieve a dollar per day per family member to purchase fresh fruits and vegetables at the participating farmers’ market. For example, a family of seven was issued a weekly prescription for $49 (7 people x 7 days) which they presented to the Market staff for wooden tokens, then used those tokens to buy fruits and vegetables from many farmer/vendors.
Last season, about 20 families participated fully in this program. The Market redeemed $9,330 in purchases, over 90% redemption rate. We had to report the prescriptions weekly, listing the number of wooden tokens issued, the number redeemed and the code number of the prescription. The clinic was also reporting weekly, with coded data related to measurable heath monitoring to evaluate any improvement resulting from four months of eating more freshly grown food. This accumulation of statistics is what makes the Wholesome Wave FVRx program unique and effective. They are accumulating health data to be able to prove what we know intuitively, that eating healty food improves health.
This could potentially result in more funding throughout the country for preventative care under Obama’s health plans. Espanola Farmers’ Market & El Centro were the only market/clinic partnership to recieve this grant in New Mexico and only one of two rural markets in the country for this program. Most partners were in northeastern low income urban areas.
We have been invited to apply again for this season and have already been collaborating on building a more effective program, including printing bilingual recipe cards for farmers to distribute at their tables and having El Centro health workers at the Monday Market to guide the patients in their vegetable purchases and to provide other health information to our customers.
Sabra Moore, Market Manager
Recently, after months of silence, New Mexico Governor Susana Martinez became one of several Republicans to blur the Right’s anti-socialist line in the sand by adopting Medicaid expansion. As New Mexico is surpassed only by Texas in its ranks of uninsured, and leads almost every list of scary medical conditions known to humanity, adding 170,000 insured out of a population of 2,000,000 is obviously good for our statewide health.
But health wasn’t the primary reason Martinez bucked her party. Her decision is rooted in New Mexico’s economy.
I live and work in Rio Arriba County. Like most of New Mexico, it is rural. Forty-one thousand people inhabit a County that is larger than Connecticut and Rhode Island combined, often in remote mountain villages.
New Mexico leads the US in drug overdose deaths, while Rio Arriba’s death rate surpasses New Mexico by 2.5 to 1.
Contrary to popular belief, overdose deaths in these communities did not correlate with poverty: Taos and Tierra Amarilla experience lower death rates than nearby Chimayo and Española despite lower median incomes.
The communities with higher overdose death rates shared two important but unexpected distinctions. These towns bordered New Mexico’s wealthiest counties; a large percentage of adults thus commuted more than 30 minutes to work in Los Alamos or Santa Fe (or even Albuquerque), often as much as 60 to 90 minutes one way.
If an adult commutes more than 30 minutes one way, the commute exceeds the lunch hour making him or her unavailable to social networks during working hours. If a high enough percentage of adults are traveling more than 30 minutes one way to a job in a given community, then there is nobody left behind to care for children, bring soup to a sick neighbor, or retrieve forgotten homework assignments.
We are emptying southern Rio Arriba County of healthy adults during daytime hours for relatively low-paying jobs. Because we lack monetary resources, we have very little public or private afterschool programming. Gangs are targeting middle school age children, offering them drugs and alcohol to act as mules.
It appears that the best community-wide resolution to the drug epidemic in Rio Arriba may be the the return of good jobs to the County.
Health Care is the fastest growing sector of New Mexico’s economy, and its largest source of local wages. Twenty-five percent of all Rio Arriba wages can be attributed to healthcare-related jobs. These are also the best-paying jobs, and tend to include benefit packages. In our most remote villages, often, the local clinic is the largest, or even the only employer. Northern New Mexico College, located in Española, offers several health care degrees and certificates. The local hospital and clinics are among the best in the state. Rio Arriba is perfectly situated to expand employment through health care.
Medicaid expansion is one several important ways the Affordable Care Act (ACA) makes it possible to bring health care jobs home. Another has to do with the state-based Medicaid Reform prompted by the ACA.
In New Mexico, the health care delivery system is fragmented. In fact, use of the word ‘system’ in the same sentence as ‘healthcare’ is an oxymoron. Trying to make sense of the cacophony is like trying to put together a thousand piece jigsaw puzzle in which few of the pieces fit.
In 2008, the Rio Arriba Community Health Council produced a report demonstrating that, while the State of New Mexico spent $6.6 million providing behavioral health services to residents of Rio Arriba over 18 months, 75% was spent out-of-county, much of it on youth residential services in Texas or southern New Mexico without family involvement or aftercare based in our own community.
Basic services remained unavailable in-county because this huge expenditure was draining the budget. Local government has been forced through mandatory sentencing and other laws, to spend extraordinary amounts of money on law enforcement and preventable emergency room costs. Medicaid reform offers us the opportunity to build a health care system that focuses on producing health over profit, and enables us to provide basic preventive care close to home. Working with state government to return $3.3 million per year to our county for badly needed preventive care could result in 60-70 jobs. We will keep people healthy while enabling an additional 70 adults to remain close to families and neighbors during daytime hours.
There are numerous provisions in the ACA that encourage hospitals to reduce readmission rates for preventable conditions. The ACA provides incentives to hospitals to keep people healthy, and penalizes them for failing to connect discharged patients to follow-up care. The Center for Medicaid and Medicare Services (CMS) tracks hospital quality, and assists the public to compare hospitals online at Hospital Compare. Rural hospitals that capture 75% of the Medicare market share qualify for substantial federal subsidies, adding a further incentive to improve care and build relationships in the community.
Instead of wasting money on billboards, Rio Arriba County is collaborating with Española Hospital to coordinate a series of immunization clinics designed to entice seniors with free preventive care including immunizations for pneumonia, influenza, tetanus, whooping cough and shingles; medication reconciliation clinics where a medical professional examines all of a patients’ medicines to insure they can be taken together; and enrollment fairs.
We hope the fairs will increase our share of the Medicare market, qualifying the hospital for a $1.8 million subsidy, decrease hospitalization rates through proper prevention, and increase payment sources through Medicare and Medicaid enrollment. It is much easier for me as a local government official to work with our hospital to improve care when the system incentivizes collaborative hospital behavior. Moreover, a further revenue capture of $2 million to our system could mean an additional 40 jobs.
Changing the shape of our healthcare system to one that produces healthy people strengthens communities by building community networks and community attachment.
It’s a win-win for everyone!
Last year, Rio Arriba County ranked last in the New Mexico for immunizations of Seniors. In one year, we went from last to second by bringing our immunization campaign directly to neighborhood senior centers. This year, we are expanding our push, bringing immunizations for influenza, pneumonia, tetanus and whooping cough to the senior centers once again, but als joint pain prevention, Medicare enrollment, heart and diabetes checks, and more. The site managers of each community we visit are organizing some of their own activities as well. As a result, the tone of each outreach mirrors the personality of that community.
Espanola Hospital, the NM DOH and El Centro Family Health have accompanied us to each site to provide medical staffing. We need to pass the Hospital Mil Levy, and to raise our Market Share among Medicare recipients from 45% to 75% in order to qualify for the $1.8 million federal subsidy for Sole Community Provider Medicare Hospitals. Rather than marketing through ads, Espanola Presbyterian Hospital is assisting us to bring preventive services directly to Rio Arriba Senior Citizens.
We’ve had other providers helping us as well: AmberCare, NM Disability Rights, and the Espanola Energy Employee’s Resource Center for folks who have been harmed by radiation.
In Dixon, they held an arts and crafts fair; we came up with a collaborative solution to a crisis; and we visited the home of a Centenarian. Each of these events has been so inspiring. I hope these videos help you to enjoy them, too!
After climbing a steep iMovie learning curve, I am finally able to post our video of the outreach in Chimayo! We administered 52 vaccines before running out! In addition, Site Manager Elias Fresquez hosted a car show (with awards), a farmers’ market, education for seniors by the Public Regulatory Commission, among other things. County Commissioners, the Mayor of Espanola, the Sheriff, school board members and other officials mingled with the public. A great time for everyone!
All this and more in our second minimentary of the series: Hospital in Chimayo!
On August 31, the Rio Arriba Community Health Council and its member agencies went to the Senior Center in the village of Truchas to conduct joint pain prevention classes, immunizations, diabetes screenings and other preventive services. We met a lot of folks and learned that co-pays, even small ones, are a huge barrier in our small farming towns. The RACHC will be working to find ways to eliminate or reduce co-pays for key services such as immunizations.
In the meantime, this is our story:
It’s not a coincidence that the Affordable Care Act has spawned a host of bills in states dominated by the religious right masquerading as anti-abortion legislation, but in fact punishing women for being able to bear children.
In the last year, attempts have been made in the US House of Representatives and the state of Arizona to defund Planned Parenthood. “Personhood bills” have been introduced in the same time frame in Virginia, Oklahoma, Mississippi and Colorado seeking to ban both birth control and abortion. Bills were also recently introduced in Georgia and Tennessee to criminalize miscarriage, potentially making it a capital offense. And who can forget Virginia’s effort to force medically unnecessary vaginal ultrasounds on females with the temerity to seek medical care?
The ACA may be the most important piece of civil rights legislation effecting women since we gained the right to vote in 1920.
Sadly, the value of the ACA to women remains America’s best kept secret.
Yesterday, when we opened the box of mugs we ordered to promote our council and website, we were surprised to find lovely mugs commemorating Jessop’s 70th birthday. Today, I came to work expecting all of our hard work to bring us into compliance with the ACA to be thrown out the window. Instead, I got to celebrate Jessop’s 70th!
Apparently, CNN was taken by surprise too, as they posted a front page story for ten minutes proclaiming the law as having been struck down.
I wish I knew how to post the screen save. You’ll have to click the link to see the visual!
“When the people find that they can vote themselves money, that will herald the end of the republic.”-Ben Franklin
When asked by a woman what sort of government had just been created, Frankin famously replied: “It’s a Republic if you can keep it.”
Last week, I had the great good fortune to attend a number of panels on money in politics at Netroots Nation (NN12) including the panel composed of Senators Sheldon Whitehouse (D-RI), Jeff Merkley (D-OR) and Sherrod Brown (D-OH) along with Trevor Potter (former council to Presidents Reagan and Bush cum comedy sensation), and Becky Bond of CREDO. The panel was moderated by former Congressman Tom Periello (D-VA).
I have always believed that despite the goodness of individuals, there is an inner Nazi lurking within every nation, snarling for its late-night human snack. The Senators confirmed my worst fears.
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Continue reading »
I want to thank each and every member of the RACHC who came to the March meeting to get to know me. I enjoyed answering your many questions about health care.
It has taken me some time, but I’ve even learned to use your blog in order to continue our dialogue. See, you can teach an old perro new tricks!
I would like to be the one to announce, in response to your request, that the Rio Arriba Board of County Commissioners will be supporting the work of the health council with seed money in the upcoming fiscal year. It won’t replace the zeroing out of health council funding by the Department of Health, but it will enable you to continue the outstanding work you have been doing.
Several nights ago, I had the opportunity to speak to the League of Women Voters in Los Alamos. Many questions were asked about water and the environment. While I did not have the opportunity to speak with the RACHC about Rio Arriba’s water resources, I realize that the issue is important to your membership. I would like to share some of my thoughts with you now.