“This is it,” said Heidi Traylor, putting on her hard hat. While the scene on Nampa’s First Street South is a series of metal and wooden frames crafted by a few dozen architects and builders, Traylor, executive director of Terry Reilly, could see something in her mind’s eye: a $6.2 million, state-of-the-art 30,600-square-foot facility that will house multiple patient care teams, a laboratory, full pharmacy, X-ray, mental health services and medical administration.
“It’s ahead of schedule and on-budget,” Traylor said, as Boise-based Jordan-Wilcomb Construction teams filled the air with a cacophony of ear-piercing noise. “We’re hoping to be operational the first of March. What can I say? I’m an optimist.”
If only Terry Reilly were here to see it all. What began as a makeshift clinic in May 1971, in his Nampa living room, has become one of the national models for community health caregiving. Reilly’s “clinic” was soon moved into the old Square Deal Market grocery store at the corner of 16h Avenue North and Third Street North and was dubbed the “Nampa Clinic.” Soon thereafter, other clinics appeared in Garden City, Parma and Homedale.
But that’s only the beginning of a story that has tremendous relevance in today’s robust conversation about the cost of health care. Through a series of visits to Terry Reilly clinics in Ada and Canyon counties, BW busted a few myths about the people who walk through those clinic doors and some sobering truths about how desperately Idaho depends on the community health center model.
Traylor first walked through the doors of the clinic in 1993 as an intern. She served as a therapist; program director for SANE Solutions, working with abuse victims and offenders; director of behavioral health programs; administrator of Allumbaugh House; and ultimately taking over as executive director of the organization in 2012.
“That’s me,” she said, pointing to a younger version of herself, part of a giant five-panel mural that hangs in the existing Nampa clinic—which still sits on the site of the original grocery store. “There’s me and many of the caregivers and a lot of our patients. And over there is Bob LeBow.”
A graduate of Harvard and the Johns Hopkins School of Medicine, LeBow was recruited to come to Idaho by Terry Reilly in 1972 to oversee the Nampa clinic. Through the years, LeBow would care for untold thousands of patients, many of them without financial means. LeBow was the caregiver; Reilly was the advocate. Sadly, they’re both gone: Reilly was killed in an Eastern Idaho plane crash in 1986 while campaigning to become Idaho lieutenant governor. LeBow died in 2003, 15 months after a bicycle accident left him quadriplegic. Yet the very mention of either name elicits instant smiles on everyone we spoke with. They talked in glowing terms about the past, but they had plenty to say about the present—and even more to say about the future of Terry Reilly Health Services.
By the Numbers: Truths and Myths
Approximately 30,000 patients walk through the doors of Treasure Valley Terry Reilly clinics each year. If you haven’t visited any of the 18 clinics in Boise, Caldwell, Homedale, Marsing, Melba, Middleton and Nampa, you might be hard-pressed to paint a word picture of who those clients are, though. For instance, a common myth is that the poorest of the poor are the only people who access Terry Reilly services. While its mission insists on “affordable, comprehensive health care to everyone in our community,” Terry Reilly serves almost as many clients who are insured.
“Right now, about 45 percent of our patients are insured—private insurance, Medicaid and Medicare,” said Traylor, who added that at the height of the recession, the insured rate dropped to about 28 percent. “And that says more about what our patients went through rather than what our organization went through.”
“It’s not really treating people with integrity to say, ‘Prove to me how much money you have.'” –Heidi Traylor, Terry Reilly executive director
The overriding factor is that, quite simply, Terry Reilly clinics don’t turn anyone away. If people can’t pay, the organization writes off the charge. If people are insured, great. If not, they may pay on a sliding scale. Clinics use a rather standard chart that has a row at the top indicating how many members are in a household; on the side column is the household income. Where the two intersect will determine how much of the bill the clinic will write off, in increments of 25 percent.
But here’s a bit of a stunner: Terry Reilly no longer asks for proof of household income.
“We made that decision about a year ago,” said Traylor. “And you know what? Nothing changed. I think people are generally honest. I think it can be very shaming or embarrassing to ask for somebody to prove how much they do or don’t earn. It’s not really treating people with integrity to say, ‘Prove to me how much money you have.'”
The organization has concluded that if a patient is intent on scamming the system to get free care, they’ll probably get away with it anyway. And so far, Terry Reilly has found little, if any, evidence of that.
The reason for the change? That might be tied to another stunner. Boise Weekly learned that at least 51 percent of Terry Reilly board of directors must also be clients.
“Right now, I think about 75 percent of our board are people who access services at one of our clinics,” said Traylor.
Mental Health Services
Terry Reilly clinics have expanded—as have their patients’ needs—through the decades. LeBow famously labelled the early days, in the 1970s, as “seat-of-the-pants”: operations with patchwork funding; laboratory and X-ray work followed in the late 1970s; exercise and “healthwise” programs came soon after, as did more work with local schools. In the 1980s, clinics set up the so-called SANE (Sexual Abuse Now Ended) Program, dealing with both the victims and offenders of sexual abuse. Programs to care for an increasing number of teen pregnancies came in the mid-1980s and more focus on prenatal care was introduced to the clinic.
Throughout the history of Terry Reilly, there has been a steady, sustained level of care for behavioral health issues, but while that care has remained steadfast, the national debate about mental illness has ebbed and flowed over time.
“I think it’s heartening and disheartening all at the same time,” said Traylor, who spent her early professional years caring for people struggling with mental illness. “It seems that the community conversation only starts when there has been a tragedy. All of a sudden, it feels like anyone who has some form of mental illness is brushed with the paint from that tragedy. Everything is about the extreme.”
As a result, Traylor said, the larger conversation distorts the real picture of what it’s like to live with mental illness.
“There are many people who struggle with some form of mental illness that are loving, hard-working members of society who want to do right,” she said. “So here comes the optimist in me: The heartening piece is that perhaps we can talk about mental illness a little more. I hope we can get to the point where we say that mental illness is a chronic health condition; and we can treat it with the same stigma, or lack of stigma, as diabetes, Crohn’s or hypertension.”
Telling the Story
“I would love to be able to tell our story the same way that the Treasure Valley YMCA tells their story. They’re so good at that,” said Traylor, who pointed to Tami Fife, Terry Reilly’s new development and outreach director. “Not only does Tami have a heart and passion for what we do, she has the understanding of telling our story.”
A big part of that story is the community health model.
“I’m not sure if people really know what that model is,” said Fife. “It’s really transforming health care. I promise you that it’s reducing cost and putting more services in one place. That’s something that we really want to share.”
Over the years, Terry Reilly has told donors, supporters and grantors about the health service organization’s zero-pay program, its indigent services and homeless programs.
“But we haven’t told our full story,” said Traylor. “We want to honor our past, but we want to tell the whole story.”
A big piece of that will be when they take the keys to their under-construction clinic in Nampa.
“It was really important that we stay close to downtown Nampa, giving our clients easy access and plenty of parking,” said Traylor, wearing a hard hat. “We like what’s going on in downtown Nampa.”
She also stressed that Terry Reilly would be keeping its current Nampa clinic on 16th Avenue North (the original grocery store location) open as a neighborhood care center.
“Oh yes, we’ll maintain a presence here,” said Traylor referring to the original site.
As for that five-panel mural that shows a very young Traylor and Bob LeBow in earlier years?
“These pieces of art…” Traylor took a pause. “These walls are our legacy.”