PROVIDENCE – On Monday morning, May 19, CODAC opened its new community integrated care center at 45 Royal Little Drive, featuring Sen. Sheldon Whitehouse and Sen. Jack Reed as the keynote speakers, introducing Rhode Island to a new, innovative concept of a medical home. The facility features suites of medical and social services, where patients’ needs define access.

For Linda Hurley, president and CEO of CODAC, the new facility seeks to change the culture of care. In an exclusive interview with ConvergenceRI the weekend before the official opening, Hurley spoke at length about the goals and intentions of the new community integrated care center. At a time when much of the state’s disrupted health care delivery system is in disarray, the vision articulated by Hurley and her team offers a positive pathway for recovery for the state’s health care future, one where the patients’ needs define access to services. Her enthusiasm for sharing plans for the new integrated care center was infectious.

ConvergenceRI: How does the new CODAC facility change the narrative around recovery and the delivery of health care in Rhode Island?    
HURLEY: I think what it truly represents is the change not just in the structure of providing care but in the culture of caring.

We are looking at providing care for people with substance use disorders and other mental health or behavioral health or psychiatric disorders, however you want to describe it, in a way that allows for the individual to define what their needs are versus a professional defining what those needs are.

What that then entails is a complete array of service availability. Someone may indeed have a substance use disorder and deep depression, but if they come to any of our doors, and their primary need is, “I don’t have food for my family tonight,” then that is going to be primary for that person.

And, that is what we have to shift. My voice isn’t: “Linda, when you come in for care, we know what you need. Please let us help you, dear.” It’s just a question: “What do you need?”

We are [launching] a community integrated care center. When someone comes to 45 Royal Little Drive, or hopefully, soon to be, any of our sites, they will be able to get their needs met in real time.

What we are doing here at Royal Little – and what it represents by having this integrated community care center – where if you have a need, you can simply come to our door.

If you are, say, a unionized construction worker, and you need help around the medicine for the pain, you can come to us.

If you are commercially insured, you can come to us. If you have no insurance, you can come to us [and connect] to our services.

We [will offer] comprehensive services for medical, for psychiatric, for psychological or behavioral health, however that is defined. We will provide [an entire] social services suite. For example, Neighborhood Health Plan of Rhode Island is renting space from us. They are the primary Medicaid managed care organization; Neighborhood will be there, five days a week, while individuals are there.

Again, the [emphasis is] on the word “integrated” – we will have a fully integrated peer recovery support center – the peers will come over to wherever you are, which ever suite you are in, and then bring you over to the Neighborhood Health Plan office,

If you come in, and say, “What I really need right now is a job,”  I just spoke with the director of the R.I. Department of Labor and Training, and they will be there a couple of days a week, and they will have an office for employment, [answering questions if you are having] trouble with your workers’ compensation. But also, and this is what I’m excited about, and they are most excited about, [offering services around] career path development.

That is going to be right there, under one roof. And we’ll be able to take you from Point A to Point B.  You’ll have the first step in your relationship developed, the first step in progress toward meeting your goal, right there, in real time, in one place.

The Social  Services suite is inclusive of the Rhode Island Department of Labor and Training and Neighborhood Health Plan. Blue Cross and Blue Shield of Rhode Island and UnitedHealthcare have also expressed an interest in being present on site, in different ways.

We will have the R.I. Department of Corrections on site; the Rhode Island Parole and Probation has an office with us, and they are already seeing people there. And they are providing group services for parolees at our site.

Brown University and UMass Chan medical schools will have office space there, because we are involved in some significant NIH research grants for both universities. So, that’s really cool, because they can not just recruit but really engage with individuals who have been recruited, in a safe and comfortable space.

The individuals can come to one spot, they know. The individuals who come to us for care know that this is their home, this is their medical home. So, they are not going into somebody else’s home, like the academic home at Brown, and the School of Public Health, where they can’t bring their family members upstairs.

This is their home, and they don’t have to adjust and travel to somebody else’s environment. It’s going to help with engagement and recruitment. But it is also a real gift to our patients, because many of them love participating in moving the care for their specific diseases forward.

CODAC has always, always worked closely with research, since at least 2000.  And, we are looking forward to having Health and Human Services there for WIC and SNAP and other entitlements for individuals. Of course, the HOPE initiative and other re-entry services will also be present in that area, in the Social Services suite.

In the Medical Services Suite, we will be providing primary care, and we are going to be expanding on that, we will also plan to be providing urgent care, which means, simply, if something is wrong and you need help, come here. Our docs will evaluate you and help you get where you need to go, if you need to go somewhere else. So, there will be those two types of services.

And then we have specialty medicines. We will have dentistry. We will have the opportunity to have podiatry [foot care] and audiology, which is huge for the people who come to us for care.

Honestly, they are the kind of overlooked medical conditions and life-changing conditions that are often seen when Medicaid is the primary, third party payer.

We are really excited to have those services available to us, because Richard, 93 percent of the patients who come to us for care are Medicaid members. We are excited to provide those services through our partnership with CareLink.

We are in discussion, active discussion – there has been verbal commitment with Open Door, [through which] Dr. Chan and Dr. Nunn [say they are] going to provide partner services with us. We are planning to engage with a physician whose specialty is in aging,

And we are also looking forward [to working with] the Department of Healthy Aging. We've already had discussion with them, so that they will be able to bring in educational services and physical enhancement services. We are looking to continue to develop a whole array for individuals who are aging.

We are not looking at terms “medical diagnostic” and “geriatric,” because we know that chronological age is not indicative of biological age. If I have had a really hard life, at 40, I might look like somebody else at 62, in terms the wear and tear on my body, whether it is my brain or my heart, my joints or my liver. We really want to specialize in the concept of healthy aging.

That’s exciting. We also made some offers; we are going to have a partnership that will work with pain management.

ConvergenceRI: What other specialty areas and services will the integrated care center focus on?    
HURLEY: Reproductive health and infectious disease. Infectious disease is inclusive of HIV, Hep-C, and any kind of STIs or STDs. Right now, we need a specialty in working with syphilis [epidemic] that is rampant right now in Rhode Island, that is tremendously harmful.

And, of course, one of our specialties is substance use disorders. In particular, opioid use disorders; we provide all the medicines and care for all the substances, not just opioid use disorder. This is my opportunity right now to let everyone know that we still continue to work with alcohol use disorder, stimulant use disorders – any substance use disorder. We have three ASAM [Addiction Society of Addiction Medicine] docs on staff. We have not been out front enough in terms of marketing the depth and competence of our medical providers.

We will have an onsite phlebotomist. One of the most intrusive and frightening and overlooked by providers, to the point where the sensitivity issue is overlooked by providers, which verges on being disrespectful, is phelobotomy.

I am thrilled that we now have at this site, in particular, a phlebotomy office, with a full-time phlebotomist and she is excellent.

ConvergenceRI: What does that mean?    
HURLEY: Someone to take a patient’s blood, if you need to have a lab done. I have had people treat me so disrespectfully. They just keep jamming and missing [the vein].

And when I can go somewhere else, and someone takes an additional five minutes, and just puts a warm towel on my arm, and I don’t even know that they’ve taken any blood. And they are kind. It makes a world of difference. I’m thrilled, because we can treat an individual with respect for all their needs.

And then, we have a specialty called “health home, ” which is special to opioid treatment. We have a full health home office inclusive of all the disciplines. And our home health  team is led by an RN. And so, when somebody comes to us for opioid treatment, we are required to have enhanced medical treatment for them, and referral services when it is needed. We do regular blood pressure, regular blood level levels testing, relative to diabetes and blood sugar

It is a whole comprehensive set that we have created, along with BHDDH, and was accepted by CMS, so now it is paid for by Medicaid, and that’s just a wonderful thing, and it is inclusive of the social service pieces [of care] as well.

So, if someone needs housing, right now, they can move from the Medical Services suite to the Social Services suite that they started with, because it is also inclusive of housing expertise, if you need housing, if you need transportation, do you need childcare, it’s all of these services. They call them “wrap-around” services, but, you know, I don’t think people actually understand how comprehensive that is in order for it to be effective.

That’s what we are doing here. And then, you put the umbrella over all of this, as a formal partnership with East Bay Recovery Center, so they have a suite. A real recovery center where anybody can be invited in by a peer; any patient that just needs to feel safe. feel calm, whatever. If you are cold, whatever, come in, watch some TV, get a cup of coffee, there’s couches…

We are now integrating CODAC’s peer recovery support services with East Bay’s recovery support services.

We have really good supervision. It’s just optimum services. If someone calls from the new re-entry office, over at the DOC, and an individual is being released early, two days early, we can go pick them up, as opposed to having a bus pass, and letting them crowd into that little bus stop out there on Reservoir Avenue, and bring them right over, and there will be all of these services here that they will be able to have access to, and not the least of which is, of course, connection to any kind of medical or behavioral health or substance use treatment, for whatever their needs are.

It really is absolutely developing according to what we dreamed, hoped and planned. The culmination of all of this is kind of astounding. I am still in awe. This integrated community care center, it is about the individual, it is about the family, and it is about the community.