LET US HELP YOU ENROLL.

Did you know that you may qualify for excellent medical, dental, and/or vision insurance? CHP staff can answer questions about the NEW Montana Medicaid and Affordable Care Act plans. If you qualify, we can help you enroll. Call ANY CHP site for an appointment.

Belgrade Medical: (406) 924-5754
Bozeman Medical: (406) 585-1360
Livingston Medical: (406) 222-1111
W. Yellowstone Medical: (406) 646-9441
Bozeman Dental: (406) 585-8701
Livingston Dental: (406) 946-4291
Downtown Livingston, Montana

CELEBRATING 20 YEARS
Community Health Partners Celebrates 20 Years Of Caring For Our Community

When a small band of concerned citizens decided to open a tiny clinic tailored to benefit medically underserved and uninsured people in Livingston, Montana in 1997, they could not have dreamed what their vision would become 20 years later. From one exam room in the emergency department of the old Livingston Memorial Hospital to an organization encompassing five separate sites spanning two counties with 140 staff, CHP is proof that humble roots sometimes know no boundaries.

“We wanted to do it right,” explained Ted Madden, former CFO and third staff member hired. “All hands were on deck; everyone helped out where they could. We were building the airplane while we flew it, but it gained elevation quickly.” Madden has seen many models of how the health system should work both across Montana and country in his new role as chief operating officer of the Montana Healthcare Foundation. CHP, he says, continues to embody all the right elements. “The community health center model is some of the best in the state,” he said. “Local hospital CEOs on the board, transparency and good professional development for staff. We learned so much from each other by letting the reigns loose which helped build autonomy and boldness in staff to create things that worked.”

Laurie Francis, founding CEO and now chief executive of Partnership Health Center in Missoula, remembers she had been working in the emergency department as a nurse and had been noticing that there was no place to help people to improve their health. To combat this, a “health wrap” group of community members gathered to meet monthly and performed a community needs assessment. The group considered a free clinic model first, but then learned about community health centers from the Montana Primary Care Association and CHP was conceived. Data from the assessment formed the basis of the original federal grant application to start a community health center. The new clinic opened four nights per week in the emergency department with Dr. Dennis Noteboom seeing patients.

Rie Hargraves, first hired as a case manager when the doors were opened, has worked in the organization’s Learning Partners program for many years helping to bridge the health literacy gap and assist parents to become better by providing valuable skills and mentorship.

“It has been really amazing to be a part of CHP since the beginning,” she said. “At first we were really overwhelmed when we realized how complex the lives of our patients were. We’ve grown as an organization by seeking out best practices for caring for patients and also caring for staff. I’m proud that we are continuing this approach even as we’ve gotten bigger.”

CHP has continued to build upon its roots championed by many dedicated founders and supporters along the way. Following an original tenet that patients come first – hence the word “partner” in the organization’s name – CHP works diligently within its communities to be an ever-evolving system of care that puts the patient at the center. “CHP has become a highly-respected fixture of the community,” says Brant Robey, a founder and current board member. “It is no longer a place for just poor people. We provide great care. We have forged some very powerful connections with other important groups in the community like the school systems. I’m so proud of how far we have come.”

Fast forwarding 20 years since those nights working out of cramped space in the emergency department, Laurie says she is most proud of what CHP is still known for and the decision to expand into Bozeman, Belgrade and West Yellowstone.

“CHP continues setting the standard for humanistic culture and respectful engagement with patients and the community,” she said. “There is a high bar for using actionable data as well as a very balanced way of looking at things. CHP enjoys a supportive board and really supportive hospital relationships which helps move the ball continually forward.” She also quips: “I would add that I’m really brilliant at hiring great people.”

While the US healthcare system seems to be in constant flux, some elements of how care is provided have not changed, like that procedural-based care still is the standard, according to Ted Madden. Yet CHP has tried to buck that paradigm from the beginning.

“The realization of what patients need has changed,” explained Madden. “Getting them to see a doctor isn’t enough anymore – we know so much more about things like the social determinants of health, adverse childhood experiences and other new information that is the foundation for why people are healthy or not. CHP adopted wrap-around services, like embedded behavioral health staff and resource coordinators early on. That makes a huge difference.”

Laurie Francis believes CHP continues to be in great hands and hopes that community health centers like CHP continue to be the voice for people who don’t have one.

“We were lucky early on to be surrounded by people who always wanted it to be better,” she said.

Looking ahead to the next 20 years, Brant Robey notes that it will be hard to know how healthcare may be provided, though she believes that CHP’s commitment to both patient-centered care and organizational excellence will never be out of style.

“CHP should take over the world,” she says. “I would also like to see more non-medical programming, like Learning Partners, to help break the cycle of poverty. Providing a greater range of these services will only strengthen our communities.”

Lander Cooney, current CEO, said the organization is fortunate to have been envisioned and cared for along the way by such dedicated and caring board members and staff.

“We are a strong organization with underpinnings of really committed people who were not afraid of working in the trenches to build something we can all be proud of today,” she said. “So many patients thank us each year for being here. It is humbling and I know that our staff feels that their hard work does not go unnoticed.”


Buffalo

OUR WEST YELLOWSTONE CLINIC
From 1,200 to 20,000 In The Glorious Days Of Summer

The staff in CHP’s West Yellowstone clinic recently completed a busy summer season with hordes of tourists from around the globe visiting Yellowstone Park through its most popular entrance using the small town as a jumping off point. In addition, the park is a “top 5 attraction” for visitors from China and Japan coming to the United States arriving daily in “West” on tour busses. These populations take this small town of roughly 1,200 for much of the year to more than 20,000 per night in the height of the summer.

And, it turns out, there are plenty of reasons for visitors to require healthcare during their trip. From cuts and falls to altitude sickness and abdominal pain, the CHP-West Yellowstone crew handles it all with grace and compassion. Adding to the complexity, sometimes patient visits must be accompanied by an interpreter at the end of a phone when the patient’s native language is not English.

“We see folks from all over the world for all kinds of reasons,” said Erin Bevan, RN, FNP, the clinic’s family nurse practitioner. “Since we are the only primary healthcare in town, everything and anything can walk through the door. We try to be ready and have great partners like the local fire department and Big Sky Medical Center close by to help us.”

As a patient-centered medical home for local residents, CHP-West Yellowstone takes care of individuals and families for their healthcare needs year-around. Complimenting Erin and her support staff, two behavioral health providers are in the clinic two days per week, commuting the 180 miles roundtrip from Bozeman to ensure that the residents of West have access to services usually not found in small communities.

One new service is the addition of a permanent nurse to CHP’s clinical staffing in West. Becky Goltz, the clinic’s lead medical assistant, recently completed her licensed practical nursing credential, which allows the clinic to have expanded services all the time. Becky also is the clinic’s limited permit holder x-ray technician. And with electronic health records connecting this small town to much larger healthcare infrastructure, patients at CHP-West Yellowstone can access many of the same services as patients of the other CHP clinical sites.

“Our array of services has been a large benefit to West,” said Lander Cooney, CHP’s CEO. “We have amazing staff who are committed to ensuring that locals in West have the best healthcare possible. They know everyone by name, can help refer to other providers as needed and are a trusted resource for everyone in town.”

Devising unique partnership arrangements is at the core of what community health centers like CHP do and the clinic in West is an illustrative example of this. The town council helps support the clinic financially and provides its building inexpensively, while Big Sky Medical Center provides its physicians on Tuesdays to allow the clinic to be open five days per week. Bozeman Health makes lab courier services available while also taking care of medical waste disposal, biomedical and radiological equipment servicing and other assistance.

“It really does take a village to work in small, remote communities, and CHP is proud to be the primary care provider for everyone in West Yellowstone – locals, with and without resources, as well as tourists,” Cooney said.


A Dental Profile

A DENTAL PROFILE

For veteran dental hygienist, Gregg Price, working with patients on preventive care is one of his most important jobs at CHP’s Bozeman Dental Practice. And after eight years in practice, Gregg has made a difference in many patients’ lives.

“The dental field in general seems to get overlooked as far as being pivotal to someone’s immediate health,” Gregg explained. “Dental hygiene even more so because good dental hygiene isn’t about having white teeth or necessarily even straight teeth. It’s about prevention of decay, gum disease and periodontal disease. These are issues that can affect any number of things such as heart disease to low birth weight babies. A lot of people aren’t aware of that.”

At CHP, however, Gregg has found that priorities are focused where they should be – on integrated care between dental, medical and behavioraal healthcare.

“CHP realizes the importance of services like mine (and many others we provide) have on overall health and the organization makes it possible for anyone to be able to receive services regardless of their financial situation,” he said.

Gregg is known among his co-workers as being quiet, yet he exhibits a great sense of humor, easily relating to patients especially those nervous in the dental chair. Primarily home-schooled before heading off to the dental hygiene program at Loma Linda University, Gregg picked hygiene for the excellent job prospects. He acknowledges with a laugh that he may be the only male dental hygienist in Montana.

“Gregg makes all patients feel comfortable and connects with them on a personal level,” said Joanna Wales, DDS, CHP’s dental director. “He does a great job communicating oral hygiene instructions in a way that patients can understand. Gregg has been a true asset to CHP Dental and its patients since 2008.”

When not at work, Gregg can be found with his wife and three children getting outside and enjoying all Montana has to offer.

“CHP is just a great place to work,” Gregg said. “It’s a relaxed, non-threatening environment that also has high standards and provides me with everything I need to do my job to the best my abilities.”


Promotoras

PROMOTORAS

In comparison to much of the United States, Montana’s Latino population may seem tiny, however, of the roughly 12,000 patients who call Community Health Partners’ (CHP) their medical home, seven-percent identify as Hispanic.

Research has found that new immigrant populations in rural areas often experience social isolation which can lead to depression and anxiety as well as avoidance of routine healthcare. Confusion about where to go for care and help can be difficult to find leaving this population feeling vulnerable and alone.

In Gallatin County, where CHP has three medical sites, Latino families have settled in and around both the Belgrade and West Yellowstone areas where work in the agricultural and construction fields has drawn workers from across the country. To help outreach these families and deliver culturally and language appropriate preventive health information, CHP has teamed with the Montana Healthcare Foundation (MTHCF) and some Montana State University community health students to develop a health promoter – or promotoras in Spanish – program funded by a two-year grant from MTHCF. The grant completed its first-year in October and by all accounts has been quite successful.

The program recruited six Latina women – three in the Belgrade area and three in West Yellowstone – who have been trained in the prevalence and recognition of depression and anxiety, as well as nutrition practices that help lower high fat and carbohydrate foods. Women traditionally have been chosen for promotoras as they tend to make healthcare decisions for their families. The promotoras received training from CHP Spanish-speaking medical providers in addition to a volunteer nutritionist. Pre and post training surveys showed the promotoras felt they gained much knowledge from the trainings. After being trained, the expectation is that each promotora would be responsible for a certain number of “touches” to other members in their communities providing health information in a comfortable environment in someone’s kitchen or maybe while out for a walk.

Bridget Kevane, PhD, associate dean of MSU’s College of Letters and Sciences, has been leading the project. A native Spanish-speaker and professor of Spanish, Kevane has assisted the Latino community around Bozeman for many years.

“We are excited to have a formal program to bring health education to a hidden population in our communities,” Kevane said. “Our promotoras really have stepped up to try something that has not been done with Latinos in our state.”

During year two of the grant, the promotoras will be learning about the importance of preventive screenings such as mammograms and pap smears for women as well as vaccines for children. They also will continue expanding their knowledge base in mental health as this is a request they have received repeatedly from their community members.

“Our group was nervous at first about how we would give health information to people since none of us are experts,” one of the West Yellowstone promotoras, Yessika Vega, explained. “But people have been really happy and now keep asking us for more information.”

Promotoras programs have been in existence along the US/Mexico border for many years, though the concept is more recent in Montana. A successful program on the Crow reservation has provided some background, while some statewide work is underway to develop a community health worker curriculum that could be adopted by similar programs. The MTHCF is hopeful that CHP’s program can be replicated by other communities in the state with burgeoning Latino populations.


CHP Receives PCMH Again

CHP’s medical clinics in Belgrade, Bozeman, Livingston and West Yellowstone are recognized as Level 2 Patient-Centered Medical Homes by the National Committee on Quality Assurance (NCQA).

PCMH care focuses on the whole person and strives to deliver well-coordinated services and enhanced access to a clinical team. While evaluation results have been mixed, and many are still underway, outcome studies have documented improved quality and patient health outcomes, patient experience, practice efficiency, and provider and staff satisfaction. Primary care practices and their patients benefit from these transformation outcomes. PCMH care has also been shown to stabilize or reduce overall healthcare costs, primarily from reduced emergency department use, hospitalization, and hospital re-admission. Community Health Partners is committed to delivering care using the PCMH model because every single patient and family in our community deserves high-quality care, regardless of ability to pay.

Community Health Partners is committed to delivering care using the PCMH model because every single patient and family in our community deserves high-quality care, regardless of ability to pay.

Registered Nurse Rebecka Peacock takes a patient’s blood pressure Wednesday at the Bozeman Community Health Partners.

Registered Nurse Rebecka Peacock takes a patient’s blood pressure Wednesday at the Bozeman Community Health Partners.

IN THE NEWS
Medical providers say Congress’ inaction risks rural Montana’s health care safety nets

By Katheryn Houghton Chronicle Staff Writer Dec 23, 2017

Medical providers say the foundation of rural health care in Montana is unsteady as Congress delays pulling together a long-term federal budget.

A few patients sat in the waiting room of Community Health Partners in downtown Bozeman on a recent afternoon. Lander Cooney, CEO of the center, said they’re a sample of the 11,000 people who rely on their services which extend to Livingston, Belgrade and West Yellowstone.

Community health centers were designed to operate in vulnerable and underserved areas. In Montana — where 1 million people are scattered throughout 94 million acres — Cooney said “‘underserved’ means most of the state.”

As part of their mission, the centers offer care at a lower cost for people who qualify. And nationwide, 27 million people use the clinics’ services, from primary care to counseling. In September, 70 percent of the centers’ federal funding ended. And while Congress has said it should be reinstated, lawmakers haven’t agreed on where the money would come from. Last year, that federal funding brought more than $35.5 million to Montana’s 17 centers.

“One in 10 Montanans receive care at a community health center. This is not a little tiny program that you can forget about,” Cooney said. “I’m dismayed to find ourselves in this situation.”

The September deadline Congress passed also means funding ran dry for a health program known as CHIP, which covers 24,000 Montana kids. It was also an end to grants for programs that help recruit medical professionals to rural states like Montana, which has a shrinking provider-to-patient ratio largely outpacing the rest of the nation.

“When we talk about all of these programs as a package, were talking about creating this risk for completely undermining the health care safety net for Montana,” Cooney said. Health centers have historically been a nonpartisan issue. Cooney said that’s because access to services for people who can’t afford care keeps them out of emergency rooms, saving states and providers money.

On Thursday, Congress created it’s second short-term budget bill that keeps the government functioning into the new year. That pushed negotiations of where to pull money from to fund the centers and the list of other health programs through Jan. 19.

Cooney said that patch isn’t comforting. “It is extremely unnerving to continue this level of funding uncertainty,” she said. The individual federal grants to centers run on different schedules. Some are set to end in January. Community Health Partners’ grant runs dry in April.

Montana senators Republican Steve Daines and Democrat Jon Tester attached their signatures to a letter to the Senate Committee on Health, Education, Labor, and Pensions urging a “swift resolution to the funding cliff” the centers face. That letter went out Sept. 19.

In a statement this week, Daines said community health centers are “the first line of defense in Montana” and he’ll continue to fight to make sure they’re fully funded. Tester said it’s a “dirty rotten shame” the money hasn’t come through yet.

“It’s the reason we’re in single digits in popularity — people want Congress to work,” he said during a recent interview.

Stacey Anderson with the Montana Primary Care Association said whether a clinic can survive the possible federal cuts depends on their patient base.

“The question will be, ‘Will we be able to keep the small centers open? Will the big centers be able to keep their satellite sites?’” she said. “Could they afford to pay a dentist?” That’s all still up in the air, Anderson said.

Matt Kelley, the health officer for the Gallatin City-County Health Department, said if Congress doesn’t pull a plan together that includes the health service funding, the only thing that’s certain is that it would have a rippling effect in Montana.

“Community Health Partners provide core, quality services. When you chip away at the resources that are supposed to allow them to do that, you’re impacting other providers who may be asked to help pick up the pieces when somebody can’t access care,” he said. Cooney said roughly 25 percent of Community Health Partners’ funding relies on the federal grants. She said that would be a hole she’s not sure how the provider would fill. Roughly 20 percent of Community Health Partners’ patients are uninsured. Another 45 percent are on Medicaid.

If Congress doesn’t reactive the money, Cooney said the remaining small pool of federal funding would be sent out to centers on a monthly basis.

“And it would run out. Fast,” she said. “If Congress does not commit to funding these basic safety net programs, they’re sending a strong message to people across the country that this is no longer a priority for them.”


CHP WINS AWARD

Community Health Partners receives the first annual Mignon Waterman Award for contributions to behavioral health in Montana.

Bozeman, Mont. – The Montana Healthcare Foundation (MHCF) is proud to announce that Community Health Partners will receive the first annual $10,000 Mignon Waterman Award. The award recognizes outstanding innovation, progress, and leadership in behavioral health in Montana. Mignon Waterman served as a founding trustee and secretary of MHCF from 2013 to 2017. Her vision, insight, and commitment helped shape the Foundation’s focus on the prevention and treatment of behavioral health disorders. MHCF created this award in honor of Waterman’s legacy of work to strengthen the system of care for Montanans with mental illness and substance use disorders.

Community Health Partners (CHP) is one of Montana’s early leaders in developing integrated medical, dental, and behavioral health services. A Federally Qualified Health Center, CHP operates four clinics and serves approximately 12,000 patients annually in Gallatin and Park Counties. Beyond their leadership in providing “whole-patient” care, CHP’s community-driven approach has allowed them to develop innovative partnerships and community-based services that address the upstream influences on health and well-being. CHP is dynamically engaged with community members and organizations throughout their service area, and is seen as a key partner in efforts to build healthier communities.

“We received more than 30 nominations for organizations and individuals doing amazing work around the state,” said Dr. Aaron Wernham, MHCF CEO. “CHP’s model exemplifies Mignon’s tireless work to integrate services and community supports for people coping with mental illness, medical conditions, and substance use disorders.”

“CHP is humbled and honored to receive the Mignon Waterman Award,” said Lander Cooney, CHP CEO. “Our staff works tirelessly to deliver integrated care across our clinic sites embracing models of care delivery that put patients in the driver’s seat partnering with their providers to improve their health. We thank the Montana Healthcare Foundation for its recognition of our efforts.”

About the Mignon Waterman Award

Each year MHCF will award $10,000 to a Montana-based non-profit organization, university, state or local agency, or tribal government that demonstrates exceptional leadership, innovation, and progress in improving behavioral health and health care in Montana. Additional information about the Mignon Waterman award can be found here.

About the Montana Healthcare Foundation

MHCF makes strategic investments to improve the health and well-being of all Montanans. Created in 2013, MHCF has approximately $150 million in assets making it Montana’s largest health-focused private foundation. MHCF contributes to a measurably healthier state by supporting access to quality and affordable health services, conducting evidence-driven research and analysis, and addressing the upstream influences on health and illness. To learn more about the Foundation and its focus areas, please visit www.mthcf.org.

EMBARGOED Until | December 1, 2017

Contact: Melinda Buchheit | 406-451-7060


IT’S GOING TO BE EPIC

An electronic health record (EHR) is the tool that medical providers, like CHP, use to systematically collect and store health information about you. Your EHR includes summaries of all your visits to CHP, your lab results over time, your vital signs like height, weight and blood pressure, and a list of all current and past medicines. An effective and efficient EHR software can help improve patient safety and care coordination.

On October 3rd, 2016, CHP implemented the Epic electronic health record software in partnership with Bozeman Health and Sanford Health. Epic is one of the highest-rated EHR software systems in the US and more than 190 million people currently have health records in Epic.

Changing from one EHR software to another required years of planning and preparing. A handful of CHP’s talented employees became Super Trainers (ST) and Super Users (SU). ST/SU’s received extra training, helped make decisions about new workflows to improve patient care and taught their co-workers how to use the new software.

Jane Mergy, FNP, CHP’s medical provider champion, poured countless hours of work into designing workflows and teaching her fellow nurse practitioners, physician’s assistants and physicians how to best use the new software to improve patient care.

“All too often you hear about EHRs being a source of frustration in healthcare,” Jane explained. “My goal with this whole project is to help foster a positive relationship with our EHR so that we can more effectively utilize the tools available to provide excellent patient care. Throughout this process, it has been fun for me to learn the ins and outs of the new EHR so I can share that knowledge with my coworkers.”

Now that the new software is installed, CHP employees are working hard to return to doing what they do best – providing compassionate, respectful care to all patients. And everyone is excited about some of the new tools available. With Epic, all CHP patients are connected to the Bozeman Health system – the hospitals, labs, specialty clinics and emergency departments – ensuring health information is shared seamlessly. And CHP patients now have access to MyChart, an electronic patient portal that includes secure electronic messaging for non-urgent medical questions, electronic retrieval of lab results and more.

“I’m very proud of how every CHP employee buckled down and worked extremely hard to prepare for a successful transition,” CHP’s CEO, Lander Cooney, said. “Employees made time for extra training and practice, helped transfer data from our old system to the new one, and supported each other remarkably well through the stress of learning a new system.”

CHP is excited to have new tools at our fingertips to enhance its ability to provide evidence-based and coordinated care in our patient-centered medical home model.


Medical Assistant

A MEDICAL PROFILE

Many patients at CHP’s Belgrade medical clinic panic a little bit if medical assistant, Kaleena Uber, is not the one greeting them in the waiting room inviting them back for their provider visit. A staple at the clinic for the past four years, Kaleena’s warm smile and caring demeanor are like having a family member on the healthcare team.

“I truly enjoy the relationships I have with both my co-workers and patients and I love helping people,” Kaleena said. “I get to do that here every day. I make it a priority to get to know our patients; it helps make them comfortable and not dread coming to see their provider. Providing a safe and friendly environment for them is an important part of their healthcare.”

Kaleena started with CHP in 2005 in an administrative role in Bozeman. After a three-year stint she left but returned in 2012 as a medical assistant. As a professional goal, she challenged the national certifying exam for medical assistants this past summer – while on maternity leave with her second daughter – and passed with flying colors! She also serves as a “Super User” on CHP’s new electronic health record helping others with questions and training tips.

“I came back to CHP because I knew it was a place that I loved to work,” Kaleena said. “No matter your position, you are treated with respect and integrity. The work that we do every day is rewarding and selfless. CHP is like a family, and I love families!”

And as an enrolled member of the Kickapoo tribe in Horton, Kansas, Kaleena has a large extended family, having also lived just off the Fort Peck reservation in northeastern Montana. Her father is the Native American Studies department head at Montana State University.

“I am very proud of my heritage,” she said. “I am so passionate about changing the way Natives are viewed and fighting the stereotypes that are out there. Racism is very much alive and a reality for both me and my kids. I never want my girls to experience this and I want them to be just as proud of who they are as I am, so I fight every day to break down these views and educate the best I can.”

CHP is fortunate to have Kaleena’s leadership, passion and commitment in the Belgrade clinic giving her best each day to make every patient’s experience better.

“Kaleena always works her hardest to help the patients whatever their needs might be that day, often going above and beyond what is expected,” said Jane Mergy, FNP, the nurse practitioner on Kaleena’s team. “She always brings a positive attitude to work and I feel very fortunate to work with Kaleena. I know patients feel the same way!”


20 under 40

CHP’s CEO is honored

Congratulations goes out to our CEO Lander Cooney for being recognized as a standout in the 20 under 40 spotlight as one of Southwest Montana’s top young business professionals.

Prior to joining the Community Health Partners team in 20xx, Lander lived and taught in Ecuador, Peru and Bolivia. The following is an excerpt from the interview conducted.

How has your travel informed the work you do now? I have had the privilege of working for a lot of high-quality nonprofits that have really strong missions. I spent a lot of time at The Traveling School (in Bozeman) and spent the better part of three years traveling with them. Any time you spend time in developing countries, you see disparities everywhere. It took me a little time to realize that that same stuff exists in the United States and that there are people working on that here.

What would you like people to know about CHP? What I’m most proud of with CHP is our perspective to approaching people. We don’t treat people as numbers to process through a system. We recognize that people are complex, have complex needs and have their own priorities. Our job is to partner with people and ask them what is important to them. In health care we are so pressured to look at data, but increasingly the research says that we should just ask them what is important to (people).

Did you ever see yourself in this position? No, I definitely did not. I’ve had some really powerful mentors who gave me some great lessons early on. I also developed a connection to this organization, and I felt this obligation that if I have the skills to help make this place better, I have to try. If you have skills you should be using them to help your community.

Would you say the health care landscape in Gallatin County is unique? In some ways, definitely. We have really community-minded hospitals, and that is really unique. They both are committed in language and practice to serving the whole community. Not that it isn’t imperfect, but I think it’s unique. We’re also small enough that you can build effective partnerships and trust, and that helps us get things done.