Long-time, now-retired physician David Arnett and former Saguache County Commissioner Tim Lovato have a vision. It includes restoring a 100-year-old historical building in the town of Saguache to house dental, medical, pharmacy, physical therapy, veterans, and eventually behavioral health services to serve the town of Saguache and the surrounding county. Dr. Arnett, who worked as a physician for 38 years, is leading the renovation of the clinic where he used to work.
The idea of co-locating medical and dental services under one roof isn’t new. Delta Dental of Colorado Foundation (DDCOF) pioneered co-locating services through the Colorado Medical-Dental Integration Project as far back as 2007. However, there are unique challenges that arise in a highly rural setting. Originally, Dr. Arnett said, there were two “state-of-the-art” dental suites within the clinic that remained largely idle due to lack of dental hygienists in Saguache. Located in the northern San Luis Valley, Saguache is one of the most sparsely populated counties in the state. It’s also one of three persistent poverty counties in Colorado (all three are in the San Luis Valley). To get to services, residents must drive over a mountain pass to Salida or drive south to Alamosa — both almost an hour away.
Currently, Heart of the Rockies Regional Medical Center offers primary care medical services, physical therapy, pharmacy, pain clinic, orthopedic evaluation, and a veteran’s representative. Dr. Arnett hopes to add dental services to the clinic’s offerings once the dental suite renovation is completed. In 2019 and 2020, he and Lovato received a State Historical Fund Grant to evaluate the building’s structural integrity. The pair reached out to DDCOF in the summer of 2022 for support in locating a dental architect to redesign the two dental suites. They were awarded a one-year place-based grant of $80,000 to buy dental equipment for the two suites as well as contract a part-time coordinator to guide the project.
They also reached out to other partners including Regional Oral Health Specialist Julie Nutter who works in Saguache and Colorado Association of School-Based Health Care (CASBHC), both funded through DDCOF, to explore the possibility of a school-clinic link with their local school district, Mountain Valley. Nutter is helping to develop a scope of work and job description for a dental hygienist that can be circulated with potential partners, as well as continuing to integrate Cavity Free at Three and dental screenings into Mountain Valley School District. In addition, the group is coordinating with Heart of the Rockies Regional Medical Center and talking with Valley-Wide Health Systems (also an organization funded through DDCOF) as well as with private dental providers who accept Medicaid to further develop a scope of work for a dental hygienist and have them housed with a regional partner.
Both Project Coordinator Yvonne Morfitt and CASBHC Director of Community Engagement Mariana Ledezma-Amorosi say the project is moving forward. “We’ve found some challenges in the 137-year-old building with asbestos removal and lead-paint mitigation, but we hope to have the suites completed by the fall of 2023,” says Morfitt. They are drafting the dental suite layout and identifying dental equipment they will purchase with the help of a dental architect and dental equipment supplier. “We operate at the speed of the community,” adds Ledezma-Amorosi. “Sometimes we run, other times we walk.” Ledezma-Amorosi plans to present the results of CASBHC’s needs assessment to the Saguache County Commissioners within the next two months to look at the strengths, gaps, and recommendations for developing a strategic plan to move the school-clinic idea forward.
For Morfitt and Arnett, a combined medical and dental clinic is one piece of an overall puzzle. “We would like to eventually see behavioral health services integrated into the clinic,” says Dr. Arnett. And Morfitt adds, “the vision is to have everything — medical, dental, and mental health in one clinic setting with the addition of transportation for older adults, so they can get to their appointments.” Both see endless possibilities for their community. By providing quality care where people are, they can thrive in-place.