Short stay turns to long health care career [The Post-Star, Glens Falls, N.Y.]

July 15--Dr. John Rugge's career developed in the reverse order of Luke, the New Testament physician who became a Christian apostle.

Rugge was a theological student at Harvard University before he earned his medical degree at Yale.

The turning point came about halfway through divinity school, when students did a required field rotation.

"In my case, I picked the Mass Mental Health Center, a psychiatric hospital in Boston, and I decided to go from one kind of study to another -- from divinity to medical," said Rugge, chief executive officer of Hudson Headwaters Health Network, headquartered in Queensbury.

His dual academic perspective, combined with a keen business sense, has helped Rugge develop a chain of 13 health centers in a 3,700-square-mile territory more than twice the size of Rhode Island, spanning five Adirondack counties and soon to enter a sixth.

The system employs 126 doctors, physician assistants and nurse practitioners.

"We didn't start a new religion, but we did have to work out some new ways of organizing a medical practice," Rugge said.

That practice continues to grow, geographically and numerically.

U.S. Sen. Charles Schumer, D-N.Y., recently announced funding for Hudson Headwaters' 14th health center in Champlain, near the Canadian border.

The joint venture with an established physician there will be Hudson Headwaters' first health center in Clinton County.

The other 13 are in Warren, Washington, Saratoga, Essex and Hamilton counties.

Rugge, early in his career, planned to become a medical specialist, but he didn't expect to specialize in keeping health care rooted in rural communities such as North Creek, Indian Lake, Bolton Landing or Moriah.

"You know the distances in the Adirondacks. ... It's a challenge to properly serve the health care of communities in general, to say nothing of when you have the distance problems," said Barbara Sweet, executive director of Tri-County United Way, and a member of the Hudson Headwaters Board of Directors.

"I just think he's been very visionary. He seems to do a good job of anticipating where there may be needs in the future," she said.

Rugge also has been influential in establishing various affiliations and groups focused on physician recruitment, medical education, transportation and enrolling the uninsured in government health plans.

Most recently, in 2009, he helped start the Adirondack Medical Home program, a consortium of health centers, hospitals and insurance companies in Clinton, Essex, Hamilton, Franklin and northern Warren counties.

The goal of the program is to maximize technology and collaboration in order to retain personalized treatment in the modern cost-conscious health care structure.

"I think the challenge is to become much more organized and in a sense more corporate, and at the same time become even more personal and more connected to the patient," Rugge said.

Features of the program include a shared database of health centers, hospitals and health insurance companies, along with a collaborative effort to remind patients via email or telephone when preventative or follow-up care is needed.

"Every day I have conversations by computer with my patients, who I no longer have to pull back into the office (as often) for some information," said Rugge, who still sees patients four afternoons a week at health centers in Chestertown and Warrensburg.

"I'm more connected, and sometimes that connection is personal not just with me directly, but through my nurse or PA rather than through me," he continued. "I think my patients are in a better place, a safer place, and have the advantages of many heads working together instead of just one person working at a time."

The premise is with better communication -- between medical providers as well as between providers and their patients -- overall health care costs will be less over time because patients have fewer chronic conditions.

The Adirondack Medical Home program has become a national model, and appears to be gaining the financial backing necessary to keep it solvent after state and federal grants run out, said U.S. Rep. Bill Owens, D-Plattsburgh.

"What we are hearing from insurance companies is that they are developing products that will take over medical homes, actually as an insurance product, when the medical home pilots expire," he said. "We think that really is evidence that these are potential money-saving as well as enhancing health care outcomes."

Owens, a lawyer who represented Champlain Valley Physicians Hospital before he was elected to Congress in 2009, said he has known and respected Rugge a long time.

"Our paths have crossed many times over about a 20-year period," Owens said. "My knowledge is that he was really a leader in community-based clinics, which are very important in the small communities in the Adirondacks."

Rugge said he has been one of many individuals responsible for Hudson Headwaters' success.

"I don't claim to be the originator of any of that," he said.

Rugge's local story began in 1974 when he came to the Adirondacks, originally planning to stay for six months while he co-wrote the canoeing book, "The Complete Wilderness Paddler," with James West Davidson, which Alfred A. Knopf published in 1976.

What was expected to be a temporary position for Rugge with a Glens Falls Hospital program setting up a health center in Chestertown after the last traditional physician retired there, lasted much longer.

Rugge ended up staying in the area, and the program evolved into Hudson Headwaters, a health center chain independent of the hospital.

"In medicine we call it a 'side effect,' " he said. "The intention was to come and see patients and tide the town of Chester -- the Chester Health Center -- over until physicians came along and really wanted to make it their long-term commitment."

Rugge, who in his mid-20s went by the nickname "Rug," wrote in the '70s with his co-writer about the disappointment when canoe trips didn't go as planned.

"If you feel unhappy because you predicted that some of those lower rapids might be runnable, think how we felt predicting the same thing -- the difference being that we were there and had to carry our mistakes all around all day in the bushes," they wrote.

Rugge, now a seasoned health care trailblazer, looks at changes in course as learning experiences.

"I see that we live in health care in a really fast-changing environment. And one has to understand that not everything is going to work to plan," he said.

Rugge, for example, was one of the key players in 1984 in forming Northcare, a now defunct Glens Falls-based health maintenance organization, a venture intended to give local physicians influence in the management of patient care.

Rugge said the dealings in that organization gave him insight into the thought process of insurance companies, which was valuable in setting up the Adirondack Medical Home program.

"Maybe more important than divinity school, that provided a perspective in terms of what are the demands on them, what are they looking for, how do we explain ourselves and how do we make a program that really has to be a partnership between payor and provider," he said.

Rugge said he's not quite sure if he fits the saintly image of "the beloved physician," as the Apostle Paul called Luke of the New Testament.

"Now, he wasn't crucified or anything, was he?" Rugge asked, with a grin.

Rugge is beloved by patients he has been treating for decades.

"All my patients are older now," he said.

In 2004, Bernice Malone, one of Rugge's patients in Chester, nominated Rugge for a "Volvo for Life Award," a Volvo Cars of North America program that recognizes community service.

Rugge was a semifinalist, and won a $10,000 grant which went toward health center construction projects.

Rugge, who is 67, is old enough to retire from health care and go back to writing books about canoeing, if he wanted to.

But he doesn't expect to retire any time soon.

"I've made it clear that I'll be looking to slow down in -- I don't know -- maybe 20 or 25 years," he said. "I feel like the plate gets fuller and fuller, and the team gets bigger and bigger."

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