Many can't see the forest for the trees. And some construction workers can't see the drywall for the building. So it shouldn't have come as a big surprise when, one recent morning in May, a builder looked up from his work at a construction site on the Boise Bench and asked, "Can you tell me what this will be when we're done building it?"
Heidi Traylor, executive director of Terry Reilly Health Service, smiled and assured the builder she would explain the end result just as soon as she was done giving Boise Weekly a tour of what will be a new health center.
Every time we meet with Traylor, it's at a new TRHS site under construction. In November 2014, it was at what would be a new health care facility in Nampa. In July 2015, it was when she was helping break ground in Caldwell for Hope Plaza, a campus of health care, daycare and shelter for victims of domestic abuse. Our most recent visit with Traylor was at the corner of Cassia and Latah streets at what will become the newest TRHS medical facility, joining a dozen dental and behavioral health clinics across the Treasure Valley. While health care has become one of the most deconstructed, debated and politicized issues of the 21st century, the people at TRHS have little time to participate in that debate. They're too busy serving tens of thousands of patients every year.
Terry Reilly himself wouldn't have had it any other way. A conscientious objector of the Vietnam War, Reilly and wife Rosie began a tutoring service in their Nampa home for children of Canyon County farmworkers. The Reillys soon noticed some of the children were suffering from severe ear infections. With the help of physicians, the Reillys began offering health care, and their living room clinic moved to a revamped Nampa grocery store. More clinics followed and the Terry Reilly legacy was in motion. In 1986, Reilly died in a plane crash while campaigning to become Idaho lieutenant governor. Not long after, in 1992, Traylor joined the Terry Reilly organization as an intern. Over the years, she served as a therapist, program director of SANE Solutions, administrator of Allumbaugh House and eventually the executive director of the organization in 2012. While Traylor inspected the progress of the newest TRHS clinic, she peered out the window to survey the neighborhood.
"We really like this neighborhood: a lot of hard-working young families but a good many seniors, too. There's a good number of single heads of households, refugee families, you name it," Traylor said. "It's not an affluent part of town by any means. People here are doing their best to get by. That's why we love this—truly, a neighborhood clinic."
Decision-makers at Boise City Hall couldn't be more pleased.
"We can't say enough good things about Terry Reilly," said Diana Lachiondo, director of Community Partnerships at the city of Boise. "They're always stepping up on matters that are challenging, yet they always seem to find a way to make things work that add value to the community. The fact that this clinic addresses physical and behavioral health as well as dental in one clinic, that's tremendous."
The new Boise Bench clinic will offer primary care, such as physical exams, prenatal and pediatric care, immunizations, health screenings and treatment of chronic diseases. Under the same roof will also be dental care, behavioral health services and overall case management.
"People ask me all the time, 'Why do you integrate those services so much instead of spreading them out to different clinics?'" said Traylor. "But we see examples every day that remind us that this is the way to go. Just yesterday, we saw a patient come into a Caldwell dental clinic for oral surgery, but her vital signs indicated elevated blood pressure and heart issues," she said.
Traylor also said a number of patients who come in for physical or dental care also disclose depression.
"This way, we can have them talk to behavioral health just a few steps away. The alternative would be that those people might drift away or get lost in the cracks," she said.
The location of the new health center lies close to two Boise neighborhoods: the Central Bench and Vista. City officials say the availability of community services, particularly health care, was identified as a prime need for the area.
"It came out early, and it was loud and clear, that residents of that area said they needed better access to health services," said Lachiondo. "It's fair to say that it's a neighborhood of challenges and opportunities. Yes, we have a lot of working families there, a fair amount of seniors, new Americans and even young professionals who work downtown. There just hasn't been as much access to health services."
According to 2009-2013 U.S. Census five-year estimates, almost 28 percent of families living in the Bench area do not have health insurance and another 27 percent have public coverage such as Medicaid or Medicare. For those families with children under 18, the percentage living in poverty is as high as 28 percent; with children under 5 years of age, it reaches 40 percent.
The new health center is not a free clinic. The TRHS economic model does provide low- to no-cost care on a sliding scale, but just as much care is billed to traditional insurance carriers. Unfortunately, the growing number of Idahoans who have secured coverage through Obamacare are learning the term "Affordable Care Act" may be a misnomer. In a March 2 investigation, we learned 37 percent of individual market plans offered on the Idaho health care exchange earlier this year had deductibles of $5,000 or higher, and out of pocket maximums were more than $10,000.
"The Affordable Care Act has changed quite a bit, some of it positive, some of it misleading," said Traylor. "Yes, on paper those people are insured, but then they see their deductibles. In fact they're underinsured."
Perhaps the unseen silver lining of the Affordable Care Act is something called the Health Infrastructure Investment Program, which made the Boise Bench health center possible.
"We were awarded $767,000 for the buildout of this location," said Traylor, pointing to the construction of medical and dental exam rooms, counseling offices, behavioral health space all framing a central workspace where physicians, dentists, nurse practitioners, psychiatric nurse practitioners, nursing staff and dental hygienists will work in what is called a Patient Centered Medical Home.
"The layout design minimizes the number of steps for a patient," said Traylor, adding that if all goes as planned, she'll take the keys to the building in the first few days of June, hold an open house for the community two weeks later and open for business on Monday, June 20.
True to form, Traylor already has her sights set on her next project: a new mental health crisis center for Boise. Earlier this year, the Idaho Legislature earmarked enough funds to create two mental health crisis centers: one in Twin Falls and another in Boise. Centers have already been established in Idaho Falls and Coeur d'Alene.
"That funding becomes official on July 1," said Traylor. "And caring for a mental health crisis is something that Terry Reilly knows about."
The Allumbaugh House in Boise, which is run by TRHS, has been operating for six years, focusing on mental health and addiction issues for citizens without means. The facility opened its doors through a unique coalition the city of Boise, the Idaho Department of Health and Welfare, Ada County, the city of Meridian, Saint Alphonsus and St. Luke's hospitals, the Boise City/Ada County Housing Authority and the United Way of Treasure Valley.
"We're having those conversations right now," said Lachiondo. "We still need to make some decisions on who will be the operators and where that new crisis center might be located. And yes, there is some potential at Allumbaugh House," she said, adding that the City of Boise is serving as the fiscal agent for the process. She said Boise could see the new mental health crisis center as early as this December.
"So, that might keep us busy in the coming six months," said Traylor. "Right now, we're just excited to get this Boise Bench health center completed."
Construction workers at the site could be forgiven for eavesdropping a bit, listening to Traylor detail exactly what they were working on. All of a sudden, it wasn't about hammers, nails or drywall. They were building a place where people care.