By Thanksgiving Day, the old emergency room at the former St. Joseph’s Hospital in downtown St. Paul will store boxes of non-perishables floor-to-ceiling for Second Harvest Heartland, the food relief organization. Nearby ambulance bays will serve as a food bank distribution center. The hospital parking lot will host a reoccurring pop-up food shelf for those in need.
By next summer, at least a handful of primary care doctors will once again walk the halls of an institution that was once synonymous with medical care.
Nearly a year after St. Joe’s shuttered its E.R. and ended most of its major medical services, M Health Fairview has announced preventative care and wellness offerings to be housed at “St. Joseph’s Campus,” including a day program for seniors and a primary care community clinic targeted to low-income and uninsured or underinsured patients.
The clinic will be a new expansion site for Minnesota Community Care, the largest federally-qualified health center in the state, and will play a leading role in the new Fairview Community Health and Wellness Hub.
“We know that 80 percent of the factors that impact health aren’t really dealt with within the walls of the hospital. It’s food, it’s challenges of seniors, it’s our ability to provide mental health and addiction services,” said Fairview President and Chief Executive Officer James Hereford on Tuesday. “If you tell me your ZIP code, I can tell you a lot about how healthy you are, and how that’s going to impact your future health and wellness. St. Paul, and the east metro, offers a great testing ground for this, but that’s not unique to St. Paul. Almost every community in the country sees those disparities.”
Clinic construction is scheduled to begin in January, with primary care visits starting up by July. Fairview will provide medical imaging and other ancillary services on-site for some 10 providers — among them dentists, nurses, mental health counselors, social workers and at least a couple doctors as well as 20 support and administrative staff. They expect 8,000 patients annually.
“We haven’t done all the demand analytics yet, but we anticipate there will be more than one MD,” said Reuben Moore, president and executive officer of Minnesota Community Care. “There’s huge demand. Losing St. Joe’s created a huge gap in care for 10,000 or 20,000 folks who were receiving care there.”
Moore said that the location — referred to in early planning meetings as the “10th Street Wellness Hub” — will be the 18th clinic for the health center, opening around the same time as locations in Frogtown and Farmington. All services will be offered on a sliding scale, meaning they’ll be free of charge for many.
“Anyone who wants to access healthcare can come to us for a broader range of primary care services you just can’t get in a hospital,” Moore said. “If you want to come in and get your COVID vaccine, we do that. If you want to bring your grandchild for a wellness visit, we do that. Chiropractic visit, mental health visit, dental care, we do that, no matter how much you make. What’s re-emerged is something better and more realigned with the community. The ‘sick care’ model is just not working. Our goal is to keep people out of the hospital.”
EBENEZER SENIOR LIVING, SECOND HARVEST HEARTLAND
Other partners in the Fairview Community Health and Wellness Hub include Second Harvest Heartland, a Brooklyn Park-based food bank network and Ebenezer Senior Living, which will provide daily on-site senior care and activities.
To host pop-up events and on-the-ground food distribution, Second Harvest Heartland is in discussions with direct-service agencies such as the Sanneh Foundation, Keystone Community Services and Christian Cupboard Emergency Food Shelf.
“I’m not sure three years ago I would have thought about using an ambulance bay as an opportunity for food distribution, but this whole pandemic, we’ve been able to innovate and think differently everyday,” said Allison O’Toole, chief executive officer of Second Harvest Heartland. “The circumstances have required it.”
O’Toole noted that one in 10 kids in Minnesota faces hunger, and those rates are at least twice as high in communities of color. The pandemic hasn’t helped, especially in a diverse, high-poverty city like St. Paul.
“It took more than a decade to undo the harm from the Great Recession 10 years ago,” she said. “It’s been really hard for people to recover. At the same time, supply chains are tightening again, which makes food more expensive. We’re hearing this year’s Thanksgiving dinner will be the most expensive in history. … We’re in a tough stretch again.”
Moore said his clinic also will host a USDA-approved “Food is Medicine” program focused on healthy eating, which would go beyond the bags of food his clinics often distribute to patients.
St. Joseph’s Campus will continue to host long-term acute care services, which were transferred to the hospital in March 2020. Intensive outpatient substance abuse addiction and mental health services will be relocated to a different corner of the former hospital.
Inpatient mental health services will continue until at least July 2022 as M Health Fairview assembles a new mental health facility to serve the east metro, location to be determined. Under the new model, a transitional care program intended to serve as a stopgap between emergency hospitalization and outpatient counseling services is expected to expand.
NEW CENTER FOR COMMUNITY HEALTH EQUITY
More partners for the Fairview Community Health and Wellness Hub are expected to be announced in coming months. The goal is to provide preventative services for vulnerable populations, including those impacted by health disparities related to “social determinants of health” such as income, educational attainment and access to healthy food. A growing body of research in public health circles is focused on the outsized role that factors like race, poverty and ZIP code have on a person being healthy.
A survey of St. Paul residents conducted in June found that more than half of respondents felt that existing healthcare services do not meet the needs of the surrounding communities, especially for low-income people, racial or ethnic populations and refugees. And 61 percent of respondents said they were more of aware of unmet health needs now than before the pandemic. Among non-white respondents, 57 percent said they face a barrier to staying healthy, even when they aren’t managing an illness.
In the same vein, the downtown campus will host the new M Health Fairview Center for Community Health Equity, which is described in written materials as a foundation-like effort to back “the next generation of community-based health and wellness programs focused on prevention and addressing the social determinants of health.”
Led by Diane Tran, the center will expand upon the work of the Fairview Foundation, which had funded public health outreach such as diabetes clinics, COVID testing and other “mini-clinics” in ethnic and low-income areas. The University of Minnesota Foundation took over major fundraising for M Health Fairview’s hospitals, clinics and community programs in November 2020.
A triennial community health needs assessment will be published by the end of December, Tran said, and the center will rely on that and other “community insights, data and analysis to determine how to take action in systems and communities. … We’re still at the beginning of it.”
The Center for Community Health Equity will include community education space as well as room for mobile vaccination clinics and food access programs.
Fairview hasn’t released a price tag for the overall transformation of St. Joe’s, but the health network reported last year making a $14 million investment in community-building activities and health improvement outreach systemwide. It’s turning to philanthropic donors for additional investment.
“We’ve talked to other healthcare organizations across the country,” Hereford said. “I think it’s unique. There’s nothing quite like it. … I think this is going to be a busy place.”
Founded in 1853 by the Sisters of St. Joseph of Carondelet following a cholera outbreak, St. Joseph’s served generations of St. Paul residents until its closure as a full-service hospital over the past year, a move blamed on money losses. The 400-bed hospital shed its maternity ward in 2017, soon after M Health Fairview acquired the cash-strapped HealthEast network.
Despite community backlash against cutting services during a pandemic, its emergency room closed in December, and a COVID unit created during the pandemic hosted its last patient in April.
Fairview Health Services rebranded its shared services with the University of Minnesota and University of Minnesota Physicians as M Health Fairview in October 2019.