While Americans usually debate health care expenses and who will pay, industry leaders are trying new ideas to improve patient results at lower cost.

Gazette readers can see great examples of health care innovation right here in Billings. Two have been in the local news this month: The expansion of the RiverStone Health clinic on South 27th Street and the addition of a 24-hour psychiatric stabilization unit at Billings Clinic.

Last week, RiverStone staff and medical residents started seeing primary care patients in 48 new exam rooms. The clinic, which serves 16,000 patients who make about 80,000 visits a year, was designed with research that actually tracked how staff walked around in the old space. The new space is configured to locate equipment and services for privacy, convenience and efficiency. There’s new also new teaching space for the Montana Family Medicine Residency, a nationally recognized physician training program that has been preparing doctors to take care of Montanans since 1991.

The result is an attractive, patient-centered, family-friendly clinic. Now that the clinic has moved into the new addition, the old clinic space will be remodeled into a wellness center.

Community health centers, such as RiverStone, have a great track record of delivering high quality care at lower cost than other clinics. RiverStone estimated that it saved Montana Medicaid $33 million last year.

Considering that most RiverStone Health patients have low incomes and that much of its reimbursement for services is limited by Medicaid and Medicare, there’s no way the $11 million clinic expansion and renovation would have happened without community support. The RiverStone Foundation has raised all but $1.75 million of its $5.5 million philanthropy goal. The building is named for the Bill and Merilyn Ballard family, who made a lead gift of $1 million. The M.J. Murdock Charitable Trust donated $350,000. RiverStone staff members contributed $510,000.

Change at Billings Clinic

Community support is integral to developing the Billings Clinic psychiatric stabilization unit. The 2016 Billings Clinic Classic raised $750,000 for an endowment to support the new unit into the future. The Leona M. and Harry B. Helmsley Charitable Trust made a grant of $784,271 toward remodeling an area of the psychiatric center into separate treatment areas for youth and adults who need stabilization, but may not need hospitalization. The Fortin Foundation, Charles M. Bair Family Trust and Stillwater Mining Co. made significant donations.

Money invested in the new psychiatric unit is expected to deliver faster, more appropriate patient care while also saving money. The model Billings Clinic will use was developed a few years ago in Alameda County, California. There Dr. Scott Zeller, a psychiatrist, devised a solution to mental health patients filling up hospital emergency rooms and waiting many hours to get a psychiatric hospital bed. Zellar found that the majority of mental health patients could be stabilized quickly in special units staffed round the clock by psychiatrists, nurses and other mental health professionals. Research showed that the new units reduced emergency room waiting times up to 80 percent for these patients and that only about 25 percent of them ended up needing a hospital bed after they spent less than 24 hours getting evaluated, receiving appropriate medication and referral to community services.

The new Billings unit won’t replace community services, such as the Community Crisis Center or the Mental Health Center, said Dr. Eric Arzubi, chairman of the Billings Clinic psychiatric department. The stabilization staff, including social workers, will connect patients with community services.

Last year, Billings Clinic emergency department saw 4,909 mental health cases, averaging 14 a day. About a third were children or teens. For these adults and youth, the emergency department provided a medical evaluation and triage — either admitting the patients to the psychiatric center or discharging them.

“Now it’s all or nothing,” Arzubi said. With the psychiatric stabilization unit “we hope patients will get access to more appropriate care more quickly.”

Getting the right care at the right time: That’s what all of us want for ourselves, our families and neighbors. Achieving that goal takes excellent planning by leaders who recognize that they are part of a system that must work for the entire community. Congratulations to RiverStone Health for meeting growing demand for primary care. Kudos to Billings Clinic for staying on the leading edge of psychiatric care.