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Academy at Rensselaer Education Ctr: Delayed 2 HrsAcademy of the Holy Names: Delayed 2 HrsAchievements & Kids Express Mplwood: Delayed 2 Hrs, no before careAchievements St Kateri Tekakwitha: Delayed 2 HrsAchievements and Kids Express TBGC: Delayed 2 HrsAdirondack Enrichment: Delayed Until 12:30pAesthetic Science Institute: Delayed 2 Hrs, Classes begin at 11 amAlbany Leadership Charter High: Delayed 2 HrsAmbleside School: ClosedAmsterdam City SD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No BreakfastAmsterdam Head Start: Delayed 2 Hrs, Staff ReportAn Nur Islamic School: Delayed 2 HrsAndes CSD: Delayed 2 HrsArgyle CSD: Delayed 2 HrsArkville Head Start: ClosedAugustine Classical Academy: ClosedAustin's School of Spa Technology: Delayed 2 Hrs, Staff ReportAverill Park CSD: Delayed 2 Hrs, No AM BOCESAverill Park Pre School: Delayed 3 Hrs, No AM Pre-School, No AM PgmBallston Spa CSD: Delayed 2 HrsBattenkill Community Services: Closed, Hockey game still on, will call with timesBennington County Meals: Open, Home delivery delayed Cafe openBerkshire Country Day School: Delayed 2 HrsBerlin CSD: Delayed 2 HrsBerne-Knox-Westerlo CSD: Closed, Offices are closed.Best Fitness (Schenectady): Delayed, No Morning Classes, Club Open No morning classes classes resume 430pBethlehem CSD: Delayed 2 Hrs, No AM BOCESBethlehem Children's School: Delayed 2 HrsBishop Maginn HS: Delayed 2 HrsBluebirds' Nest Preschool: ClosedBroadalbin-Perth CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No Breakfast, No PTECH, AgTECH, TEC-SMARTBrown School: Delayed 2 Hrs, No Morning PLUS ProgramBrunswick (Brittonkill) CSD: Delayed 2 HrsBrunswick Children's Academy: Delayed 2 HrsBurnt Hills-Ballston Lake CSD: Delayed 2 Hrs, No AM BOCES, 2-hour delay (final)Butterfly Dreams Daycare: Delayed 2 Hrs, Opening at 9:30 amCOARC Adult Transportation: Delayed 2 HrsCairo-Durham CSD: ClosedCalvary Preschool: ClosedCanajoharie CSD: Closed, No PM ActivitiesCapital Reg Career & Tech (Albany): Delayed 2 Hrs, No AM BOCESCatholic Central HS: Delayed 2 HrsCatholic Schools Office: Delayed 2 Hrs, Principals Meeting at 10:30Catskill CSD: Delayed 2 Hrs, No AM Pre-KCatskill Mt. Christian Academy: ClosedCenter For Early Learning: ClosedChatham CSD: Delayed 2 HrsChatham Kids Club: Delayed 2 Hrs, Open at 8:30Childhood Friends Inc.: Delayed, We will open at 9:00am for All children today!Christ Our Light Catholic Church: Delayed 2 Hrs, Office opening & Adoration delayed 2 hrs. Morning services cancelledChrist the King Early Childhood Ctr: Delayed 2 Hrs, All programs open @ 9:30 AMChristian Brothers Academy: ClosedCircle Of Friends (Delmar): Delayed 2 Hrs, Wrap around delayed 2 hoursCircle of Friends (Ravena): Delayed 2 Hrs, 2.5 hour class is closed 5 hour classes delayedClifton Park Nursery School: Delayed 1 HrCobleskill Campus Child Care Center: Delayed 2 Hrs, Open at 9AMCobleskill-Richmondville CSD: Closed, Offices Open at 9 a.m.Cohoes City SD: Delayed 2 HrsColonie Youth Centers: Open, No BSPColumbia Christian Academy: Delayed 2 HrsCommunity Library Cobleskill, NY: ClosedCooperstown CSD: Closed, No AM BOCES, School is now CLOSED.Corinth CSD: Delayed 2 Hrs, No BreakfastCoxsackie-Athens CSD: Delayed 2 Hrs, No AM BOCES, No BreakfastCrossFit Schenectady: Delayed, No Morning ClassesCrossroads Center for Children: Delayed 2 Hrs, Day Care open @ 9:00Crown Point CSD: Delayed 2 HrsDay Nursery (S Glens Falls): Delayed Until 12:35pDelaware Academy CSD at Delhi: Delayed 2 HrsDoane Stuart School: Delayed 2 HrsDolgeville CSD: Closed, No AM BOCES, No BreakfastDoors of Hope: Delayed 1 HrDuanesburg CSD: ClosedEarly Childhood Learning Ctr: ClosedEarly Childhood Education Center: Delayed 2 HrsEarly Childhood Education Ctr-Troy: Delayed 2 HrsEast Greenbush CSD: Delayed 2 HrsEco Baby Daycare & Preschool: Delayed 2 HrsEdinburg Common SD: Delayed 2 HrsExecutive Woods Childcare: Delayed 2 HrsFaith Bible Academy: Delayed 2 HrsFirst Friends Nursery School: Delayed, No AM Program, Enrichment program begins at 1130amFonda-Fultonville CSD: ClosedFoothills United Methodist Church: Closed, Building, Vision and Mission meeting cancelled for Wednesday 1/18Fort Plain CSD: Closed, Elem recognition breakfast moved to ThursdayFranklin County Technical SD: Delayed 2 HrsFulmont St Johnsville Head Start: Delayed 2 Hrs, Staff ReportFulton County Office for Aging: Open, No Transportation, No Social Adult Day Care No Home Delivered Meals Meal Sites ClosedFulton-Montgomery CC: Delayed 2 Hrs, Campus will open at 10 am.Gabriel Abbott Memorial School: Delayed 2 Hrs, No morning daycareGalway CSD: Delayed 2 HrsGeorge Washington School: Delayed 2 HrsGermantown CSD: Delayed 2 HrsGilboa-Conesville CSD: ClosedGlens Falls City SD: Delayed 2 Hrs, No AM Pre-K, No AM BOCESGlens Falls Common SD: Delayed 2 Hrs, No BreakfastGlens Falls Head Start Center: Delayed 2 HrsGloversville City SD: Delayed 2 HrsGood Ground Christian School: ClosedGrapeville Christian School: ClosedGreen Island UFSD: Delayed 2 Hrs, No BreakfastGreen Tech High Charter School: Delayed 2 HrsGreenberg Child Care Center: Delayed Until 9:30aGreenbush Child Caring: Open, No AM ProgramGreene County Nutrition Program: Closed, Athens, Catskill, Coxsackie Congregates & Homebound ClosedGreene County YMCA: Open, No Morning ClassesGreenfield Public Schools: Delayed 2 Hrs, No AM Pre-KGreenville CSD: ClosedGreenwich CSD: Delayed 2 Hrs, No AM BOCESGuilderland CSD: Delayed 2 Hrs, No AM BOCESHFM BOCES Adult Literacy: Delayed, ALZ opens @ 10am GLZ opens @ 10amHFM Career & Tech Center: Delayed 2 HrsHadley-Luzerne CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No BreakfastHansel & Gretel Nursery School: ClosedHappy Kids Day Care Center: Delayed 2 HrsHawthorne Valley School: Delayed 2 HrsHebrew Academy - Capital District: Delayed 2 HrsHelderberg Christian School: ClosedHelping Hands Pre-School: Delayed, No Morning ClassesHoly Spirit School (East G'Bush): Delayed 2 HrsHometown Health Center: Delayed 2 HrsHoosick Falls CSD: Delayed 2 HrsHope 7 Community Center: Open, 9am-6pm, Reg. After School Food Pantry Open9:30a-11:45Hudson City SD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No Breakfast, No tutoring centerHunter-Tannersville CSD: ClosedIchabod Crane (Kinderhook) CSD: Delayed 2 HrsImmaculate Conception (Glenville): Open, 9:00 am mass cancelledIndian Lake CSD: Delayed 2 Hrs, No AM Pre-K, No BreakfastInlet Common SD: Delayed 2 HrsJefferson CSD: ClosedJohnstown City SD: Delayed 2 Hrs, No AM Pre-K, No AM BOCESJubilee Child Day Care Center: Delayed 2 HrsKid Kampus: Delayed 2 Hrs, Opening at 8:30AMKidsFirst Childcare Center: Delayed 2 HrsKim's Kids Daycare: Delayed 2 Hrs, No BreakfastKingsbury Seventh-day Adventist Sch: Delayed 2 HrsKingston City SD: Delayed 2 Hrs, No AM BOCES, Kingston SD is on a 2 hr delay no AM BOCESLa Salle Institute (Troy): Delayed 2 HrsLakeside Nursery School: Delayed, No AM Pre-SchoolLansingburgh CSD: Delayed 2 Hrs, No Breakfast, Lansingburgh CSD is operating on a 2 hour delayLatham Christian Academy: Delayed 2 Hrs, No AM KLearning To Know Educational Center: Delayed 1-1/2 HrsLexington Center Fulton Co ARC: Open, No TransportationLiberty Ent/ Montgomery Co. ARC: Delayed 2 HrsLife Kids Before/ After School: Open, No AM ProgramLifeSong Inc (Saratoga): Delayed 1 HrLifeSong Inc (Schenectady): Delayed 1 HrLifeSong Inc. (Albany): Delayed 1 HrLifeSong Inc. (Rensselaer): Delayed 1 HrLil' Lambs Christian Daycare Inc.: Delayed 2 HrsLit'l Steps Pre-School: Closed, No AM Pre-KLittle Feet Daycare Center: Delayed 2 HrsLittle Tot Nursery School: Closed, No AM Pre-KLiving Res DCOP (Albany): Delayed 1 HrLiving Res DCOP (Rensselaer): Delayed 1 HrLiving Res DCOP (Saratoga): Delayed 1 HrLiving Res DCOP (Schenectady): Delayed 1 HrLong Lake CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No BreakfastLoudonville Christian School: Delayed 2 HrsMalta Montessori School: Delayed 2 Hrs, No Toddler Class, No Toddler ClassMargaretville CSD: ClosedMayfield CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No BreakfastMechanicville City SD: Delayed 2 Hrs, No BreakfastMekeel Christian Academy: Delayed 2 Hrs, No AM Pre-SchoolMenands UFSD: Delayed 2 Hrs, No BreakfastMiddleburgh CSD: ClosedMillbrook CSD: Delayed 2 HrsMohawk Trail Regional SD: Delayed 2 HrsMohonasen CSD: Delayed 2 Hrs, No AM BOCESMontessori School (Schenectady): Delayed, No AM Program, opens at noon, School will open at noon for PM programming.Montgomery County Office for Aging: Delayed 2 Hrs, Advisory Council cancelledMorning Star Learning Center: Delayed 2 Hrs, stay tuned, be safeMother Teresa Academy: Delayed 2 Hrs, No AM Pgm, No am nursery program, School opens at 9:45amMountain Road School: Delayed 2 Hrs, No Before School Care.Mt Moriah Academy: Delayed 2 HrsMyers Education Center: Delayed 2 Hrs, 12 month offices 2 hour delayN. Greenbush Little Red School: Delayed 2 HrsNew Lebanon CSD: Delayed 2 HrsNew Paltz CSD: Delayed 2 HrsNewmeadow at Malta: Delayed 2 HrsNewmeadow at Queensbury: Delayed 2 HrsNiskayuna CSD: Delayed 2 HrsNorth Colonie CSD: Delayed 2 HrsNorthville CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCES, No BreakfastNotre Dame-Bishop Gibbons: Delayed 2 HrsO.K. Kids, Inc.: Delayed 2 HrsOak Hill School: Delayed 2 HrsOhav Shalom Nursery School: Delayed, No AM Program, No am care for Ohav Shalom school starts at 930 staff report 900 amOnteora CSD: Closed, No AM BOCESOppenheim-Ephratah-St Johnsville SD: ClosedOur Lady Queen of Peace (Rotterdam): Open, Faith Formation classes cancelled dut to closing of Schalmont SchoolsOur Lady of Victory Early Childhood: Delayed 2 Hrs, No AM Pre-KOur Savior's Lutheran School: Delayed 2 Hrs, No AM K, No AM Pre-SchoolOur World Montessori: Delayed 2 Hrs, Open at 10:45 a.m.Owen D. Young CSD: Closed, No AM BOCESPark Avenue Nursery School: ClosedParsons Early Head Start Day Care: Delayed 2 Hrs, Staff report at 9:00 AMParsons Early Learning Center: Delayed 2 Hrs, Staff report at 9:00 AMPerth Bible Christian Academy: Delayed 2 HrsPine Plains CSD: Delayed 2 Hrs, No AM BOCESPineview Comm Church Pre-School: Delayed 1 Hr, open at 8:30Princetown Evangelical Presbyterian: Closed, Potluck & Prayer cancelled RockLife cancelledProspect Center: Delayed 2 HrsPumpkin Patch (Albany): Delayed 2 HrsQueensbury UFSD: Delayed 2 Hrs, No AM BOCESQuestar III BOCES - Sarah's Sisters: Delayed 2 HrsQuestar III Catskill Academy: Delayed 2 HrsQuestar III Columbia-Green Ed Ctr: Delayed, No AM BOCES, 2 HR DelayQuestar III Rensselaer Academy: Delayed 2 HrsQuestar III Rensselaer Edu Ctr: Delayed 2 Hrs, Q3 New Vision is closedQuestar III Sackett Educational Ctr: Delayed 2 HrsRavena-Coeymans-Selkirk CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCESRed Hook CSD: Delayed 2 HrsRensselaer City SD: Delayed 2 HrsRhinebeck CSD: Delayed 2 HrsRiverRun Community Montessori: ClosedRoots and Wings Montessori: Delayed 2 Hrs, No before care. 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Action Prg.: ClosedSchoharie Cty Child Dvp Cobleskill: Closed, No AM Pre-K, No AM Head Start, HS & EHS closedSchoharie Cty HeadStart (Schoharie): Closed, HS & EHS closedSchool's Out, Inc.: Open, No AM ProgramSchuylerville CSD: Delayed 2 Hrs, No AM BOCES, No BreakfastScotia-Glenville CSD: Delayed 2 HrsSharon Springs CSD: ClosedShenendehowa CSD: Delayed 2 Hrs, No AM K, No AM BOCESShooting Stars Nursery & After Sch.: Delayed 2 Hrs, No AM Pre-School, Will open at 9amSkidmore Early Childhood Center: Delayed, No AM Pre-SchoolSouth Colonie CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCESSouth Glens Falls CSD: Delayed 2 Hrs, No AM Pre-K, No AM BOCESSouth Kortright CSD: Open, No PM ActivitiesSouthern Adirondack Edu Ctr: Delayed 2 Hrs, 12 month offices 2 hour delaySouthern Berkshire Regional SD: ClosedSpa Christian School: Delayed 2 Hrs, No AM K, No AM Pre-KSpotted Zebra Learning Center: Delayed 2 Hrs, SZ opens at 9:30 Program begins at 10:30 K Program begins at 11:00St Ambrose School: Delayed 2 Hrs, No AM PgmSt Anne Institute: Delayed 1-1/2 Hrs, Staff Report, No Trans, No school for day service StudentsSt Clement's Regional Catholic Sch: Delayed 2 Hrs, No AM Pre-K, No AM Pre-SchoolSt Edward's Church: Delayed 2 Hrs, No Mass and morning activitiesSt George's School: Delayed 2 Hrs, No AM Pre-School, AEP will begin at 11 amSt Gregory School: ClosedSt Jude the Apostle School: Delayed 2 HrsSt Kateri Tekakwitha School: Delayed 2 Hrs, No AM Pgm, No BreakfastSt Madeleine Sophie Pre-School: Delayed 2 HrsSt Madeleine Sophie School: Delayed 2 HrsSt Mary's Academy (Hoosick Falls): Delayed 2 HrsSt Mary's Church (Crescent): Delayed, No morning MassSt Mary's Institute ES (Amsterdam): Delayed 2 HrsSt Mary's School (Ballston Spa): Delayed 2 Hrs, No AM Pre-School, Before Care open at 8:00 amSt Mary's School (Waterford): Delayed 2 Hrs, No AM Pre-KSt Mary's-St Alphonsus Rgnl Cath: Delayed 2 Hrs, No Pre-K No AM Camp KerrySt Mary's/St Alphonsus Noah's Ark: Delayed 2 Hrs, Open at 9:45St Paul's Childhood Center: Open, No AM Pre-K, Part-day room closed only. 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After school enrichments are on until further notice.St Thomas the Apostle School: Delayed 2 Hrs, No AM Pre-KStepping Stone Pre & DCC (Albany): Delayed 2 HrsStillwater CSD: Delayed 2 HrsStory Place Preschool: Delayed, Open at 10, before care closedStorybook Academy: ClosedSullivan BOCES: Closed, Offices will open at 10 amSunshine Kids Corner: Delayed 2 Hrs, Opening at 9AMSusan Odell Taylor School: Delayed 2 Hrs, No coffee hourTLC Christian Day Care: Delayed 2 Hrs, No BreakfastTaconic Hills CSD: Delayed 2 HrsTech Valley High School: Closed, Staff report at 10 AM.Temple Israel Nursery and Day Care: Open, No early drop off School starts at 9:00The Albany Academies (AA & AAG): ClosedThe Beagle School: Delayed, No AM Pre-K, No AM Pre-School, All AM programs closedThe Downtown School: Delayed 2 HrsThe Hyde Collection: Delayed 2 HrsThe Kid's Place Preschool: Delayed 1 HrThe King's School: ClosedTiny Tots Early Learning Center: Closed, No AM Pre-School, No AM Preschool PM TBDTri-Village Nursery School: ClosedTroy City SD: Delayed 2 HrsTroy Prep: Delayed 2 HrsTwin Valley Elementary School: Delayed 2 HrsTwin Valley Middle High School: Delayed 2 HrsUMC Daycare Norton Hill: Delayed 1 Hr, No AM Pre-KUnlimited Potential, Inc: Delayed 1 HrUpstate Transit: Delayed 2 HrsVictory Christian Academy: ClosedVoorheesville CSD: Delayed 2 Hrs, No AM BOCES, No BreakfastWSWHE BOCES - Gick Road: Delayed 2 Hrs, 12 moth offices 2 hour delayWWAARC—Albany & Queensbury: Delayed 1 Hr, Staff Report Regular TimeWaldorf School (Saratoga Springs): Delayed 2 Hrs, No 2 day PreKWarren Street Academy - The Bridge: Delayed 2 Hrs, No BreakfastWashington County Nutrition Program: Closed, No Senior Meal Sites ; No Home Delivered MealsWaterford-Halfmoon UFSD: Delayed 2 Hrs, No BreakfastWatervliet City SD: Delayed 2 HrsWebutuck (Northeast) CSD: Delayed 2 HrsWesley Evergreen Adult Day Program: Delayed 2 HrsWest Canada Valley CSD: ClosedWheelerville UFSD: ClosedWhispering Pines (Cobleskill): ClosedWhispering Pines - Schoharie UPK: ClosedWhispering Pines Pre Sc (Amsterdam): Delayed 2 Hrs, No AM Pre-KWhispering Pines Pre-sch (Delanson): ClosedWhispering Pines Presch - Boulevard: Delayed 2 Hrs, No AM Pre-KWhispering Pines Preschool at Meco: Delayed 2 Hrs, No AM Pre-KWilton Baptist Academy: Delayed 2 Hrs, No AM KWindham-Ashland-Jewett CSD: ClosedWonderland Nursery School: ClosedWoodland Hill Montessori School: Delayed 2 Hrs, Delayed 2 hours . No early care. No toddler AM session, delayed 2 hours. No early care. No toddler AM sessionWorcester CSD: ClosedWynantskill UFSD: Delayed 2 HrsYMCA (Bethlehem): Open, No Morning ClassesYMCA (East Greenbush): Open, No Morning Classes, Child Watch opens at 9am, Before School Care 6:45amYMCA (Greater Glenville): Open, No AM classes before noon.. No babysitting before noon.YMCA (Guilderland): Open, No AM Pre-School, No Morning Classes, No AM branch childcareYMCA (Schenectady): Open, No Morning Classes, Child Watch Closed for AMYMCA (Troy): Open, No Morning Classes, Child Watch opens at 9amYMCA Southern Saratoga: Open, No Morning ClassesYWCA of Schenectady Children's Ctrs: Delayed, YWCA child care @SCCC delay Until 8am. WA site delayed Until 9amYWCA of the Greater Capital Region: Delayed 2 Hrs

Outlook 2013: Ellis CEO’s aim: Keep people out of the hospital

Outlook 2013: Ellis CEO’s aim: Keep people out of the hospital

Jim Connolly is actively trying to reduce business for Ellis Medicine. He doesn’t want people coming

Jim Connolly is actively trying to reduce business for Ellis Medicine. He doesn’t want people coming into his hospital. He doesn’t want people taking up beds in his emergency rooms.

If he had it his way, Ellis would be leaner and more specialized. It would send hernia patients to Canada’s Hernia Hospital and kids with broken bones to the Bone and Joint Center in Albany and old men who need colonoscopies to the Endoscopy Center in Burnt Hills.

“I’m cannibalizing myself,” said Connolly, on a Friday afternoon in his office, just a few weeks into 2013.

As president and CEO of Ellis Medicine, Connolly is in charge of steering a hospital system through the complex, financially precarious world of modern-day health care. But really, he’s no longer just in charge of a hospital. He’s in charge of an entire community’s health.

He’ll tell you, and state Health Commissioner Nirav Shah has publicly agreed: Ellis Medicine is ahead of the pack in implementing health care reform. But for a hospital to be successful at health care reform, it has to encourage activities that keep people out of the hospital.

“The problem here is if I’m successful, I’m engaging in an activity that people generally don’t pay for,” said Connolly. “And when I’m successful, I’m reducing the cost of things they do pay me for.”

And what first helped the Schenectady-based hospital system get ahead was a much-begrudged 2007 mandate — the Berger Commission recommendations.

BERGER

“When people say, ‘Berger? Oh, that was terrible,’ I say, ‘Berger was the best thing that happened to this community,’ ” said Connolly. “We were blessed to have Berger, because it was a hammer. It didn’t give you any choice and it backed you up with cash. And it provided us cover to do what we had to do.”

The Berger Commission’s job was to independently review the state’s health care resources and offer recommendations on how best to use them to offer high-quality, affordable and accessible care. The commission’s recommendations were to consolidate, close, convert and restructure health care institutions across the state. And they became law Jan. 1, 2007.

Orders were handed down across the state to close a longtime hospital or to merge two or more redundant facilities. Some regions took it well. Others didn’t.

In Schenectady, the reaction was visceral. Bellevue Woman’s Center was ordered to close. Connolly recalls “sheer panic” setting in amidst women in the community. And when Ellis Hospital and St. Clare’s Hospital were ordered to merge, he recalls hesitancy to change on both sides. But years later, the region has emerged as the poster child of the Berger recommendations.

Connolly showed up two months after the recommendations became law and just over a year later, while some regions of the state were still quibbling over the changes, Ellis used state Department of Health funds to implement Berger in the community. As other regions began to catch up, the pool of available state money had nearly run dry.

Because of its head start, Ellis Medicine is on the fast track to achieving the so-called Triple Aim — better care, better health and lower costs.

Inside Connolly’s office on a January day, the gray-haired, distinctly mustached man mulled over the next big shifts in health care.

“One is under way,” he said, slowly, as if the ideas were just taking shape in his head. “And one is partially under way.”

Sitting up straight, the thought fully formed, he added with a sad smirk: “And one is still a pipe dream.”

CHRONIC CARE

Health care is shifting toward population management. Ellis has had a foot in this door for about the last three years, first unveiling its medical home in 2009 and then expanding the concept even further with the creation of Care Central.

Both developments are designed to accomplish the same thing: the successful management of a population’s health. It replaces the traditional one doctor, one patient model by putting all of the health care players (primary care physicians, specialists, nurses, insurance companies, nursing homes, etc.) in charge of a community’s health. So when an elderly man is discharged from the hospital, everyone works together to ensure he doesn’t end up back in the emergency room.

“It’s figuring out a way to keep people in the community healthy enough so they don’t have to use the ER, they don’t have to come to the hospital for their care, and when they do come, to make sure that care is well-managed,” said Connolly.

The kind of coordination and payment reform this model requires isn’t free, though. So the federal government and individual states are calling on the health care community to go after the low-hanging fruit first.

The chronically ill — those with chronic heart failure, chronic obstructive pulmonary disease, diabetes, obesity, mental illness, alcoholism and drug abuse — account for only about five to 10 percent of the nation’s population, but drive 50 to 60 percent of the nation’s health care costs.

To drive down those costs, Connolly and others in the health care community are hiring people to coordinate their care. They’re paying “navigators” to check in on them after discharge, to make sure they understand how to take their medication and to make sure they have transportation for medical needs. They ask patients about the shortness of breath they’ve been feeling lately, keeping an ear tuned to any red flags that could send the patient back to the emergency department.

“The problem with chronic illnesses is they’re, for the most part, the result of behaviors,” said Connolly. “We drink too much, smoke too much and eat too much. So if I’m going to bend that cost curve, I’ve got to change behavior. So I said, I’ve got to get a chronic care team, I’ve got to have people out there that are doing nothing but managing that population.”

Ellis has also jumped on a national trend that steers people away from hospitals and into urgent care centers. Urgent care centers are part of a growth strategy for some hospital chains, according to an NPR report last year. Hospitals own more than a quarter of the nearly 9,000 urgent care clinics in the U.S., the report said, with the goal of drawing patients away from emergency rooms.

In October, Ellis Medicine debuted a brand new urgent care center to serve the population of southern Saratoga County. The Medical Center of Clifton Park, a 38,000-square-foot facility just off of Northway Exit 9, has already seen robust attendance in its first three months with an average of 70 to 80 visits a day. During the holiday season when the flu had hit the region and the rest of the nation hard, the center was over capacity at more than 100 visits a day, said Ellis Medicine Executive Vice President and COO Paul Milton.

“Volume there has been good,” he said. “We’ve been hearing anecdotally that activity and service there is very good, and soon we will have formal results of a survey.”

ECONOMIC ALIGNMENT

“Why should a hospital change when all the economics of health care pay you for doing more?”

What Connolly is referring to is the industry’s longtime reliance on a fee-for-service payment model, where physicians are paid separately for each office visit, lab test, procedure and other services.

The industry is now shifting toward a pay-for-performance model, which drives down cost by rewarding physicians for keeping patients healthy and out of the hospital.

Since 2005, the federal Centers for Medicare and Medicaid Services has poured money into pilot programs and initiatives designed to avoid unnecessary health care costs, and the Capital Region is a frequent recipient of these funds.

The reason the government stepped in with the funds now was to avoid driving up the deficit later, said Connolly.

“The deficit is going to drive the demand for reduced spending in health care,” he said. “And if most spending in health care is driven by chronic illness then I’ve got two choices. I can sit here and I can wait until the feds and the states say, ‘OK. Enough. We’re cutting everybody 20 percent across the board. Here’s the ax. Whack.’ In which case, we all go into freefall and who the hell knows what happens then. Or, I can be proactive and invest in this kind of a population management program that keeps people out of the hospitals and ERs.”

THE PIPE DREAM

The best thing that could happen to the health care industry (in Connolly’s pipe dream at least) is for hospitals to stop trying to be everything to everyone.

Institutions need to get smaller, he said, and they need to specialize.

“Why don’t we start moving resources around so that one institution concentrates on neuroscience and one institution on cardiac care?” he said. “There are some things you cannot strip way from hospitals. You still need a basic cardiologist, because so many people come into your ERs with cardiac problems. You still need neurologists because so many people come into your ERs with strokes. But not every hospital needs to have a pediatrics unit, not every hospital has to do OB. Not every hospital has to do intensive neurosurgery.”

After Berger, Ellis Medicine actually restructured its campuses following a similar, specialized format.

It moved all of its women’s and maternity care to Bellevue. It transferred all of the inpatient care services from St. Clare’s to the hospital on Nott Street. And right now, construction crews are putting in the foundation for an expanded emergency room at the main campus so that the emergency room at the old St. Clare’s can close.

“The problem with Schenectady was not operating three campuses,” said Connolly. “It was not operating Bellevue and St. Clare’s and Ellis Nott Street. It was operating three full-service hospitals. As soon as we gave that up, the economics changed dramatically. Now that’s what we need to do in a broader region.”

To read all the stories from the 2013 Outlook special report, click here.

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