Home Business Blowing Rock ONE on TWO…with Alice Salthouse and Leigh Ann Byrd

Blowing Rock ONE on TWO…with Alice Salthouse and Leigh Ann Byrd

By David Rogers. July 7, 2020. BLOWING ROCK, NC – If this story was about fishing, Alice Salthouse would be talking about the big one that DIDN’T get away.

All photographic images by David Rogers for Blowing Rock News. Leigh Ann Byrd joined the conversation remotely, by telephone.

Blowing Rock News sat down with the Chief Executive Officer of High Country Community Health recently to talk about not only the impact of the COVID-19 pandemic on the region but also to learn about what is an entrepreneurial success story. Mid-conversation, we received a bonus: added input by telephone from Chief Operating Officer Leigh Ann Byrd.

Blowing Rock News (BRN): Alice, without question this is an interesting time to have this conversation about High Country Community Health because there are so many storylines, including the COVID-19 situation.

Alice Salthouse (AS): Yes, the pandemic has brought healthcare into focus and as you look around this nation, the state of North Carolina, as well as this community all have very different healthcare systems. That said, I truly believe that we are very blessed in the High Country because the healthcare system we have in place is exceptional. A lot of that has to do with the level of collaboration we share with all of the players, working together: neighbor to neighbor and business to business.

Here we have local people making local decisions about healthcare in our community.

BRN: Would you care to elaborate a little on those themes?

AS: Sure. If you look at Appalachian Regional Healthcare System it is quite different than systems in a lot of other places. More rural communities and smaller towns or distant suburbs often have a hospital that is run by a larger company in Charlotte or one of the other large cities. Here we have local people making local decisions about the healthcare in our community. I attribute a lot of that to the vision of former ARHS CEO Richard Sparks because his vision is being lived out today.

BRN: Are you speaking about his vision for a “continuum of care”, offering high quality professional services from birth to death?

AS: Yes, and even more. We have a lot to be grateful for when you think about the contributions of Richard and others who have impacted healthcare in this region, like Blowing Rock’s Dr. Bunky Davant and before him his father, Dr. Charles Davant. And there have been so many more. They have all had this dream about healthcare in the High Country and it is working right now.

BRN: You mentioned some of the more historical figures, but can you provide some examples from more recent times and maybe especially in the context of the COVID-19 crisis?

AS: If you look around at all of the different counties in Western North Carolina – and I don’t know exactly the reason for it – Watauga County is relatively very low in terms of the number of COVID-19 cases that we have had relative to the population. Jennifer Greene is the Public Health Director for AppHealthCare, which covers Watauga, Ashe, and Allegheny counties. She has done an amazing job of coordinating communication between all of the various agencies and leaders in High Country healthcare and the healthcare safety net. And that is not just in her three counties, but others in the region and across the state, too.

What you have are all of these community organizations working together instead of in silos — or in conflict.

BRN: What does that communication look like?

AS: Every Friday afternoon there is a conference call and it includes not just Appalachian Regional Healthcare and her health department, but representatives of Hunger & Health Coalition, Hospitality House, OASIS, the fire departments, law enforcement, and government officials like State Senator Deanna Ballard and Representative Ray Russell. Many others, too, all leaders with a stake in this community. On this call we all come together to talk about each other’s situation, our needs and the needs of the people we each serve.  What you have are all of these community organizations working together instead of working in silos – or in conflict.

One of my observations about this historic time is the level of collaboration that is taking place in this county and this community to keep people healthy.

BRN: Does that collaboration extend out into the other High Country counties, too?

AS: Yes, but the collaborations are somewhat different in every county.

BRN: Well, if my research serves me well, you are in a uniquely good position to understand what goes on in the larger region.

AS: That is probably accurate. High Country Community Health is now in four counties: Watauga, Avery, Surry, and Burke. Each one of those has a different set of county commissioners, different town councils, and different health directors. They all have different missions in that they all have different populations to serve. Some of the region’s other healthcare-type organizations have that perspective, too. OASIS, for example, has a presence in Watauga and Avery. Hospitality House serves people in five counties and they have really been overrun during this pandemic and economic crisis.

In 2010, North Carolina ranked 36th in the U.S. for the number of community health centers vs. the population numbers.

BRN: Let’s use those thoughts as a segue into the High Country Community Health mission and how you got this started.

AS: The idea and concept of High Country Community Health was started in 2010. That was when the federal government said that they would have 350 new community health centers across the whole country. They passed the law and got the money set up in the budget.

BRN: Did you see a need for one of those new community health centers here?

AS: It wasn’t just me. At that time, North Carolina ranked 36th out of the fifty U.S. states in the number of community health centers compared to the state’s population. So the Duke Endowment, the Kate B. Reynolds Charitable Trust, and the Office of Rural Health got together and provided some grant funds to help North Carolina’s more rural communities in applying for these federal grant funds more successfully.

BRN: I seem to remember that you were working for Appalachian Regional Healthcare before you started this.

AS: That’s right. In 2010, I was working as Community Outreach director for Appalachian Regional Healthcare and Watauga Medical Center. They supported us in writing this federal grant application in 2010. We worked together to come up with a plan of how our community health center was going to be developed, where it would be located and all of that.

BRN: With that kind of help, it seems like you would be shoo-in for federal funding.

AS: Well, shortly thereafter we got word that the federal budget was changed and  that they would not have the funding for all of those 350 new community health centers. Of course, there are 50 states and we were not the one that was funded in North Carolina in 2010.

So, we were thinking that all of our planning work was for naught. As a result, we kept doing what we were doing in Community Outreach, which was trying to bring access to care to underserved populations in the region. That is essentially what community health centers do, anyway: provide access to care.

…I looked down at my cell phone and saw an e-mail that said, “Notice of Grant Award.” After more than two years, we were funded.

BRN: Talk about pulling the proverbial rug out from under someone…that had to be disheartening, to have your vision go up in smoke before it even got started.

AS: As it turns out, they took all of those applications and put them on the back burner, so to speak. Fast forward to 2012. My colleague at Community Outreach, Brian Belcher, and I were in the car riding over to Avery County to meet with School Superintendent David Burleson. As Bryan drove, I looked down at my cell phone and saw an email that said, “Notice of Grant Award.”

I couldn’t believe it when I opened the email, but there it was: we were funded.

BRN: And you thought the opportunity had gone away.

AS: Yes. I thought it was over and done with, that the new program was dead in the water two years before that.

BRN: In your disbelief, who did you call to verify it?

AS: I called some of my connections at the state level and they said, “It’s for real. You are funded.”

We had to start all over, from scratch.

BRN: But with that passage of time, two years, didn’t that present some problems of its own?

AS (smiling): Well, after making all of those plans and the opportunity goes away, but then you get funded two years later, do you think those plans are still valid or appropriate? The doctor that was going to work with us had moved on. The space we were going to occupy was no longer vacant. The staff that we were going to hire…so many of those things weren’t available to us anymore. We essentially had to start the planning process all over again.

BRN: Most grants have a time constraint. Was that true in this case?

AS: Part of the rules for receiving the federal grant money was that you had to be up and running within 90 days, but we had to start all over from scratch. Well, we didn’t get up and running in that 90-day window, but given the circumstances they gave us an extension. We saw our very first patients on January 2, 2013.

BRN: That makes you about seven and a half years old.

AS: Yes!

BRN: Was there anything special about this area of Western North Carolina in which you operate that contributed to your funding success?

AS: One of the things that helped us, I think, is that we had planned for a migrant farm worker program. That was written into the grant. You know, the federal community health program was established around 1965, around the same time as Medicare. It was part of the “War on Poverty” under President Lyndon Baines Johnson.

BRN: Johnson’s “Great Society.”

AS: Yes, the War on Poverty was part of the Great Society. And all across this country the migrant farm workers represent an underserved and vulnerable population when it comes to healthcare. As we have seen during this pandemic, the health of underserved populations  can affect us all.

People getting our care are the people making decisions about how the care is provided.

BRN: OK, I get that but you were working for the hospital’s Community Outreach initiative and you said you received Appalachian Regional Healthcare’s support for the community health center grant application. Since you received funding, how did that change your relationship with Appalachian Regional Healthcare?

AS: Simple. A community health center under the federal program cannot be owned by a hospital. High Country Community Health had to establish itself as a completely different entity, a separate  501(c)(3) non-profit agency, with its own board of directors.

BRN: Are there any guidelines as to the composition of your board?

AS: Yes. At least 51% of a federally-funded community health center’s board must be consumers of the services the center provides. That’s people who are actually being seen and cared for by the center.

BRN: That is interesting and I guess now it makes sense because I looked at your board of directors and I didn’t recognize hardly any of the names.

AS: We were proactive in getting people on our board who have different skills, such as a lawyer, a realtor, and a banker, but we are well over the 51% requirement of Board members that are consumers of our services. More accurately, I think, we are 70-80% people who use our services. What it boils down to is that people who get the care are the people making decisions about how the care is provided. Their #1 job is the hiring and firing of the CEO.

BRN: And they haven’t fired you yet, huh?

AS (laughing): Not yet and I hope they don’t because I love this work and still have lots more work to do!

We take anyone who walks through that front door: Medicaid, Medicare, uninsured, privately insured, self-insured.

BRN: I hope this isn’t an insensitive question, but because you are primarily serving low income, uninsured individuals, do those board members have the skill sets and knowledge to understand the business.

AS: That is actually a great question. Having the leadership of a board that is engaged and are recipients of the care that is provided gives them a unique ability to govern the organization. They serve and lead with a first-hand knowledge of the mission and the need for having High Country Community Health in this region. They are educated, compassionate people and provide wise leadership.  The model for a community health center is also unique. We are not a free clinic that relies upon donations, private grants, and fundraisers. If managed appropriately, the model is financially sustainable.

BRN: So, what is YOUR model?

AS: We see patients with health insurance, Medicaid, and Medicare patients. Then we have a sliding fee scale for patients who are low income and uninsured. And because we provide care for uninsured and other vulnerable populations, we also receive federal grant funds every year. It wasn’t just a one-time grant back in 2012. They provide support so that we can provide the best care possible for ALL of our patients.  That support allows us to accept anyone who walks through the door as our patient.

BRN: What kind of controls are imposed by the government? Are these community health centers regulated?

AS: We are held to a VERY high  standard and are required to report many quality measures for the care we provide. There are 26 measures that they monitor all the time. For instance, we have to regularly report on how well our diabetic patients are maintaining control of their diabetes.. We answer questions like: what percentage of our patients who have high blood pressure are effectively controlling their blood pressure? What percentage of our female patients are getting pap smears? We MUST report on most everything we do. These are called outcome-measures. They make sure that we are doing the jobs that we are supposed to be doing.

BRN: You mentioned four basic demographics receiving your services, including those with health insurance, Medicare patients, Medicaid patients, and uninsured. What proportion of each make up your total patient population?

AS: I’d say it is pretty balanced. About 25% for each category. This is really a good mix of the general population. High Country Community Health is not just a resource for the economically disadvantaged. It is a place where you can come and get primary care as good as anywhere.

We are now at about 110 employees working in nine locations across four counties.

BRN: Walking through your office, I noticed that you have a lot of employees. You have them in every nook and cranny. When you first started, it was just a dozen or so employees.. This is a lot different than when you were in the county health building. How big are you now? You seem to be bursting at the seams!

AS: We are now at about 110 employees. Boone isn’t even our biggest office. And, by the way, we are getting ready to move this Boone Medicaloffice over to where Boone Urology is now, on State Farm Rd. This medical office at 108 Doctors Drive will then be converted into a new dental office and the current dental office will move out of the health department into this space.

Editor’s Note: At this point in the conversation, Leigh Ann Byrd, operating officer of High Country Community Health joined the conversation by telephone. On this day, she was in the Morganton office.

AS: Thanks for joining us by telephone, Leigh Ann. We’ve been talking about our history, as well as what the COVID-19 situation means to us. I’ve spoken about the wonderful collaboration we have seen between the various organizations and community leaders we have in the High Country. You know, we have a pretty low count of COVID cases. Maybe it is because the region is largely rural but it might also be because as a community we got out in front of the pandemic.

Leigh Ann Byrd (LB): A lot of times I think the general public doesn’t always know what goes on behind the scenes. With all of the agencies and departments, we meet at least once a week to talk about what is happening and how to keep the community safe. It has been a joy to see that collaboration happen. Jennifer Greene at the Health Department has done a phenomenal job of coordinating us and keeping us informed about the CDC guidelines.

AS: Yes, if we had to pick one shining star in this community in dealing with this crisis, it would be Jennifer Greene.

LB: Absolutely!

BRN: It just occurs to me that one of the focal points or hotspots for COVID-19 has been nursing homes. So where they have been critical areas in other parts of the country, why is it that places like Appalachian Brian Estates, Glenbridge, and Deerfield Ridge Assisted Living here in Boone have not seen similar kinds of impact. And we should also include The Foley Center in Blowing Rock.

AS: They stay clean, of course, but it also comes back to the fact that we have not had as much in the community to begin with. And we don’t have places like a meat-packing plant or a prison where people work or live in close quarters.

BRN: Yeah, but we do have a lot of tourists and seasonal residents coming to us from all of those other areas where the infection rates are higher.

AS: That’s true. I don’t necessarily know the answer, but I am grateful. I also think that good leadership from people like Jennifer Greene and the Appalachian Regional Healthcare CEO, Chuck Mantooth, makes a difference, too.

LB: I think it has been this community’s proactive leadership. For instance, I have a friend at The Foley Center and they locked the place down in terms of visitation early on when there was any discussion about COVID-19 being in North Carolina. While similar places in Charlotte and other major metropolitan areas continued to permit visitation for quite a while, The Foley Center restricted it.

BRN: That’s a good point. I know it was a source of consternation because we have friends with family members at The Foley Center. While it has been frustrating for them not to be able to see their loved ones, to give them smiles and hugs, they understand. And their understanding has become increasingly acute as all of the other nursing home problems have come to light.

LB: Yes. I think we took those kinds of extreme measures a lot quicker than other places did.

There are many smaller counties out there with less population than Watauga but they have many more cases.

BRN: I’m sure you two are more familiar with the staffing practices at our local nursing and assisted living facilities. One of the reports that we have seen about those other places around the U.S. is that the spread from nursing home to nursing home is because staff members are so low paid that they have to hold down two or three jobs. They work at multiple nursing homes in their town or city. Where they are carriers, even without symptoms, they end up spreading the virus in the different facilities to the most at-risk segment of the population. Do we not have that circumstance here? What is it that makes the High Country facilities different? Or is it just that we haven’t had a Patient Zero yet?

AS: Frankly, I don’t really know the answer to that.

LB: I think it just re-affirms the benefit of being proactive. Our Health Department was really quick to put out all of the information, to everyone in the healthcare community, including other agencies like the police and fire departments and schools. They were probably much faster than some of the other towns and cities. We were all just more aware of what must be worn, the emphasis on handwashing, social distancing, masks…All of those things were put in place more proactively and promptly in response to reports of the looming pandemic.

AS: You know, there are a good number of counties out there that have smaller populations than Watauga, but they have many more cases. So what Leigh Ann is suggesting probably hits the mark.

BRN: How much has COVID-19 attacked the population more than say a regular flu, which some variation seems to come every year.

AS: Yes, well people die from the flu and most often it seems to have the most devasting impact in the same vulnerable populations, including those who are elderly and have health issues to start with.

Compared to the flu, the death rate from COVID-19 is more than twice as bad in roughly half the time.

BRN: Is this just a much more aggressive virus?

AS: If you go back and look at the data…and I am not going to know the answer to your question exactly…but in the United States of America we have had the COVID-19 for some four or five months now. And during that time we have now exceeded 133,000 deaths. If you look at the number of people who died last year from flu, I think for the whole year it was something like 67,000. So just looking at it in those terms, the death rate from COVID-19 is more than twice as bad in roughly half the time.

LB: Pardon me for interrupting, but I think what you also have to look at are the vaccines. A lot of people don’t get the flu because they had the vaccine. On the other hand, there are a number of people who get the vaccine – but who still get the flu.

The thing about COVID-19 that is so hard for practitioners and scientists is that it presents itself in so many different ways. Some people test positive that have no symptoms. Others get really, really ill. I think there is just so much unknown about this virus and because it is novel (a new virus) where there is no immunity in the general population. There is much to learn about this virus.

AS: And while the most vulnerable population might be the elderly and people with other major health issues, there are instances of physically fit and otherwise healthy people who get it. Maybe 24 years old and they die from it.

LB: Yes. We just haven’t had the research on it yet, to understand the actual DNA of the virus.

BRN: Leigh Ann, while I think about it, you are not excused for interrupting our dialogue. You are INVITED to interrupt!

LB (laughing): Thank-you!

AS (smiling): Anyway, in a county that has only had a limited number of cases (104 with 0 deaths) as of this writing), we have not been touched by it as much as other areas of North Carolina and the U.S. as a whole. You look down the mountain at neighboring Burke County, they have more than 1,124 now, with 20 deaths. They also have a meatpacking plant that has contributed to half of those numbers.

One of our biggest challenges is figuring out the safest way to see non-Covid patients, to still get them the care they need even under these unusual circumstances.

BRN: I guess Watauga’s initial hotspot, if you can call it that, was Samaritan’s Purse and a couple of their international travelers.

AS: Yes, and they got on top of it really fast. And they put those individuals under quarantine, with contact tracing really quickly. That helped a lot.

BRN: Leigh Ann, while we have you on this call, I understand that your role with High Country Community Health is as its chief operating officer. What do you see as the major challenges for overseeing an operation like this? I understand that the practice is in eight or nine locations now, in four counties.

LB: Right. So, one of our biggest challenges — and really because of COVID-19 — is figuring out the safest way to see non-Covid patients, to still get them the care that they need under these unusual circumstances. Just because there is a global pandemic with this virus doesn’t mean that you don’t have people with hypertension, diabetes, broken bones, COPD, heart disease and so many other chronic as well as sudden health issues. As their healthcare provider, we need to see them.

BRN: Can you share some special steps you have taken?

LB: We have a doctor on staff who has developed extensive skills in tele-health and tele-medicine. At the same time, our behavioral health division is also very busy. They are probably seeing 50% more cases than would be seeing normally on a weekly or monthly basis. Because of the economic lockdown, we have higher levels of unemployment and food insecurity in this region, so the work of our behavioral health team in terms of counseling and such has been essential, now more than ever.

That said, it has been really difficult to get patients in for health visits. They often need preventative care, such as an annual physical. It is especially difficult because in rural areas you have a lot of people who still don’t have access to the Internet. And some who are over a certain age just don’t want to be online. So, it has been important for us to have measures in place that help people understand how to have a tele-health visit, for example. We offer those services in our parking lot if they don’t want to come into the clinic.

AS: It is important to understand that we take every patient who walks through that front door. We screen everyone, patients and staff, that comes through the door for Covid, too, and if you have a fever we will come out to the car and the doctor will see you out there in the parking lot. We don’t turn people away.

BRN: Tele-health has become a big buzzword, of course. But putting on your business hats, how much has providing tele-health or tele-med services increased or decreased your operating costs?

LB: Tele-health itself is not that expensive. There are some methods that are essentially free. We chose to buy a special software package because it is more user friendly for our patients. They just click a link on our website. If there is a larger capital investment, it was buying some iPads to have at each location. If patients don’t have access to the Internet and don’t feel comfortable coming inside the clinic, we can take an iPad out to the parking lot and connect them with a provider.

Even with those steps, I will also tell you that our medical patient encounters are down about 40% since the COVID-19 crisis materialized. “Encounters” are defined as patient visits.

AS: The dental patient encounters are down about 85%.

LB: Yes. So, we have taken a pretty big hit because of the pandemic and the lockdown, but we don’t want anything to be a barrier to patient care. We are all about creating care options for everyone.

I was going to go back and get my Master’s degree and life happened.

BRN: So if I were to sum it up from a business perspective, your operating costs have not increased so much while having to deal with these new challenges, but your revenue sources have been hurt, except of course for your government support.

While we are on that subject, hospitals pay for a lot of what I will call charity care, particularly through the Emergency Room, and they typically absorb those expenses. I recall hearing that those costs might be to the tune of $9 million to $12 million each year at Watauga Medical Center. Well, maybe in normal times they can afford those losses because of the elective procedures for the insured, but now many people are choosing not to do elective procedures because of the lockdown processes in place, as well as the risk of exposure to Covid-19.

AS: That is true, they were not doing those elective procedures for a while, but I will tell you that hospitals, as well as organizations like High Country Community Health have gotten grant monies from the federal government to help us get through these times. And we are extremely grateful for that support.

BRN: Leigh Ann, I know you from your previous work at Watauga High School – as well as being the mother of one of my favorite high school women’s basketball, volleyball and track stars – so I have to ask what enticed you to jump over to this role in healthcare from the education field?

LB: My first degree was in medical technology, as was Alice’s. So, I was actually working toward a health science career for a long time. To make a long story short, I was going back to get my Master’s degree and life happened. I ended up teaching at the community college and high school level.

BRN: This isn’t your typical health science job, though. A good percentage of your patient population served comes from vulnerable or at-risk demographics.

LB: It has always been in my heart to help out in health care disparities. I had a long conversation with Alice and she talked to me about community health centers. She convinced me that every day through High Country Community Health we are helping to narrow those disparities in health care access. I just fell in love with this concept and the opportunity. With my background and my 32 years in medicine, I am blessed by this job and its opportunities. It is a mission for me.

BRN: Did you know Alice before?

LB: I met Alice two and a half years ago when I came over to speak with her about a job.

BRN: That means, I guess, that you met her simply as a job applicant.

LB: And, really, the open position at the time was about quality (assurance). A lot of medical technology is about maintaining high standards for quality and quality control. So that is how I started the conversation and it just evolved into the chief operating officer role.

BRN (smiling): Well, I admire your courage for jumping over to work with Alice without even knowing what a monster she is!

AS (laughing): Oh, if she would have known she wouldn’t have!

Seriously, though, Leigh Ann and I work really well together. Both of us see the work we do as our ministry. We feel like this is work that God has called us to do.

That classroom experience really prepared me for THIS job.

BRN: Well, Alice, when you told me that Leigh Ann was working as your chief operating officer and I started thinking about the two personalities and the two women that I know, I immediately thought, “This is a perfect fit. They are two peas in a pod!”

LB: That is so nice of you to say.

There is one other thing that I wanted to mention on this topic, though. As an educator, I taught health occupations and medical law. I remember thinking that I was going to teach my students how to be great caregivers and if that was not for them, I wanted to make sure they knew that before walking out of my classroom. That classroom experience really prepared me for THIS job.

BRN: A couple of final questions and the first one is for Alice. Is the size and scope of your organization today what you had in mind when you first envisioned it 10 years ago.

LB: Oh gosh, great question!

AS: It is far greater today than what I anticipated back then. The fact that we have medical, dental, and have integrated behavioral health just  to start with…well, that is more than we envisioned. And then we have the medication assisted therapy program for those that have substance disorders. Add to it that High Country Community Health has helped diagnose and provide a cure for more than 350 people in our community with Hepatitis-C, which is the leading cause of liver cancer in the United States. We have a 340-B program for people who need access to their medicines at a cost they can afford. And then there is the migrant farm worker program that I mentioned earlier. Especially with this COVID-19 situation, people are talking about low-income and other vulnerable populations. Well, we are going out to those people and providing care that reduces their vulnerability. We are closing the gap on those access disparities that Leigh Ann was talking about.

We have more than doubled in size since Leigh Ann has been here.

BRN: With migrant farm workers, you are speaking a lot about the Christmas tree farms, I guess.

AS: Yes, the Christmas tree farms, agriculture in general, construction, and even in the hospitality industry.

BRN: I imagine that one of your challenges is language and communication.

AS: That’s right, but we have addressed those challenges. Ten percent (10%) of our employees speak both Spanish and English. If someone needs help communicating, we are able to provide it.

To your point, I cannot believe that High Country Community Health has grown to the point that it has in just these seven years of its existence.

BRN: I’m thinking back to when I visited with you and Bryan in your early months, in your temporary office at the County health department building. It was just the two of you and maybe another staff member and a physician, I think. Now you have added all of these disciplines (medical, dental, behavioral health) and initiatives like migrant farm workers and Hepatitis-C, and you are providing these services in eight or nine physical locations across four counties. Growing to 110 employees over that time frame, well that is big.

Another question for Alice…. when I mentioned I was going to do this interview to a couple of friends of mine, they asked how you are different than, say, an agency like Community Care Clinic?

AS: Well, it is different because we care for people that have insurance, Medicare and Medicaid, too. In my mind, that helps make us a little more self-sufficient. Community Care Clinic does excellent work, but they are a free clinic and there is an important  place for that in the healthcare arena. We are not a free clinic, even though we provide free care to a lot of people. In a final analysis, our model is sustainable because our revenue sources are more varied.

We pay millions of dollars in salaries each year — in this region.

BRN: Leigh Ann, I want to focus for just a bit on your role in the growth of High Country Community Health as an organization and the size and scope that Alice was talking about. How long have you been with the agency?

LB: Right at two and a half years now. When I started, there were almost 50 employees.

AS: We have more than doubled in size and scope since Leigh Ann has been here.

LB: Yes, and to that point I want to share another great thing about High Country Community Health.  We are doing a pretty good job with employee retention.

AS: Before Leigh Ann got here, our turnover rate was not the best.

LB: When I got here, I couldn’t understand why the turnover rate was so terrible because it is such a great place to work with a great mission. Now our turnover rate is about seven percent (7%).

Some of the people we might lose, of course, get married and move away. I am so proud of the way our whole team works well together.

AS: We do have great employee benefits.

LB: And competitive salaries.

AS: Yes, and competitive salaries. And that leads me to the thought that when you bring something that was previously non-existent, in this case seven years ago, and now it has grown to this size and scope of High Country Community Health, that is a significant economic impact on the region. The jobs that we have in our organization are NOT low-paying jobs. We pay millions of dollars in salaries every year in this region.

BRN: I guess I have to ask….would a Boone Urology, Boone Dermatology, AppOrtho or, say, a dentist like Dr. Lee Warren in Boone or Dr. Adam Hill in Blowing Rock look at you as competition?

AS: I suspect that they are glad we are here because a lot them are not able to take the Medicaid patients because the reimbursement is below what it costs them to provide the care.

BRN: Why is that?

AS: Medicaid’s reimbursements do not cover their costs. But we appreciate getting Medicaid patients because the federal government and our multi-sourced revenue sources are helping pay for the costs of providing care. Realistically, I don’t think we are a threat to anyone. In fact, I think those other providers appreciate our presence because instead of telling those Medicaid or uninsured patients that they cannot see them, they can refer them to us.

There are so many things that High Country Community Health has brought to this community when you think about the underserved and vulnerable populations, providing them with access to care, and then there is the economic impact of our organization on the region.

Both Leigh Ann and I and our whole HCCH team are pleased and honored to have been a part of this.





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