One of the lynchpins of Thundermist Health Center’s success has been the leadership of Maria Montanaro, who has served as the health center’s president and CEO since 1997.
Montanaro sees Thundermist as a kind of “super patient-centered medical home,” supporting community-based initiatives that promote prevention while making investments in quality, technology and innovation.
Thundermist is currently building a new health center in West Warwick’s historic mill district, which Montanaro says will add more than 100 new permanent professional jobs.
Providence Business News asked Montanaro to share her vision of the community health center’s future.
PBN: Thundermist Health Center currently serves about 30,000 patients, 30 percent of whom have no insurance and 80 percent are poor. With the pending sale of Landmark Medical Center, how will Thundermist’s role change? Some have said that you may be involved with managing the future hospital?
MONTANARO: We certainly are a large primary care provider in northern Rhode Island. In fact, we are the “pediatrician” for 70 percent of all Woonsocket children. Our patients represent two-thirds of all the births at Landmark. We care for one in four Woonsocket adults.
The considerable size of our primary care practice, coupled with 40 years of experience serving those most in need, should give us considerable influence in the discussion about the future of Landmark.
We have built a highly respectful, synergistic relationship with Lifespan, [a potential buyer of Landmark]. They understand and concur with our vision of an integrated health system that brings primary, specialty and tertiary care together in a coordinated effort to improve quality and lower costs.
We are working closely with them on the development of that model, and we hope to play a critical role in such a delivery system, both as a primary care provider and a managing partner. Only time will tell if we can bring such an idea to fruition. If we cannot, Thundermist will work to pursue a constructive relationship with whatever entity acquires Landmark. But our standards for partnership are high. If we do not believe the incoming partner will improve the hospital and create a stronger, more integrated delivery system, we are unlikely to support it.
PBN: U.S. Health and Human Services Secretary Kathleen Sebelius recently came to Thundermist to launch the Beacon Community grant for health information technology at your community health center. What kinds of improvements in quality and care will be the result of this technology upgrade?
MONTANARO: The Beacon Program is one of a number of highly innovative initiatives to advance quality in health care by focusing on the use of technology to transform medical practices into “medical homes.”
Thundermist has been an early pioneer in the use of health information technology to measure results by how well a patient is doing, instead of the amount and type of services we provide.
In other words, we look at meaningful outcomes – such as blood sugar levels for diabetics – for the entire population of chronically ill patients in our practice.
We look at this data proactively and collectively, rather than individually and episodically. In this way, we can raise quality by driving systemwide improvements and better manage the care of our chronically ill patients.
PBN: Thundermist runs a school-based health center at Woonsocket High School and at the West Warwick middle and high schools, geared toward adolescents – including nutritional education, family planning and behavioral health counseling. How has the school-based approach made a difference in better health outcomes?
MONTANARO: Adolescents have a notoriously poor record in accessing preventive health care. It makes a great deal of sense to meet and treat them where they are at – namely, in school. Our school-based centers have focused on prevention. We recently launched a ground-breaking obesity management program that targets overweight children and provides them with exercise classes, nutritional counseling and education for their parents.
Our mobile dental hygiene and treatment program is another example of a highly effective community program that brings dental care right to the school, greatly improving children’s oral health in our most needy neighborhoods.
The bottom line is that when we are in the schools, we have an opportunity not only to engage the student/patient, but the entire school community – teachers, counselors and parents. It also allows us to be more responsive to crises that emerge, whether it’s an outbreak of disease or a flood. We are still dealing with the effects of the West Warwick flooding among our school children there.
We also provide outreach visits to soup kitchens and shelters in all our communities to help deal with the unique problems that homeless people experience as they try to access health care. The remarkable thing is that their health outcome in chronic diseases is as good as it is for our general population. This is due to the effectiveness of our model.
PBN: In your efforts to provide comprehensive care, you have focused on trying to manage chronic diseases, such as diabetes, and eliminating health disparities among your patients. What kinds of community-based interventions have you undertaken?
MONTANARO: I like to say: “The best things we do in health care are free!” Community-based interventions, such as our obesity management program, make the biggest difference in eliminating health disparities and improving the health of individuals.
To enhance outcomes in managing diabetics, we have instituted group visits in Spanish and English. Diabetic patients can meet not only with their doctors, but nutritionists, exercise specialists and behavioral health counselors to learn how to take control of the management of their disease.
We use a similar strategy to get expecting mothers together for education and support when they are getting their prenatal medical exam.
To help our patients eat a healthy diet, we offer a farmer’s market in the lobby of our Woonsocket health center every Thursday.
PBN: Why has the financial business model for Thundermist proven to be successful?
MONTANARO: Many people may not realize that community health centers generate a great deal of revenue. We then leverage this revenue into millions of dollars of free and discounted care to thousands of low-income, uninsured patients every year. We believe this is health care as it should be.
The business model for Thundermist is really the ideal: efficient, effective delivery of care that produces revenue and reinvests that revenue by providing care to the most needy in our community, reducing their burden of disease and also the burden they create on society as a whole. We are like “investment bankers for the poor.” For every dollar invested in Thundermist, our goal has been to return that four-fold to the community.
We are now looking to the future, which means pioneering new models of health care reimbursement, where we are paid to manage care and produce good health outcomes instead of just produce patient visits. Thundermist has moved more revenue into pay-for-performance incentives than most health centers in the country. We believe that this is the business model of the future.
