Chief medical officer, Community Care Collaborative

Dr. Mark Hernandez is the chief medical officer for Community Care Collaborative. CCC is described as "a multi-institutional, multi-provider system of health care envisioned to provide a coordinated continuum of services to a defined patient population" for Travis County on its website, www.communitycarecollaborative.net.

The primary mission of CCC, Hernandez said, is to provide integrated delivery health care to uninsured and underinsured Travis County patients.

Hernandez graduated from the Baylor College of Medicine in 2003 and completed his residency in internal medicine at University Medical Center Brackenridge.

In 2011 he was appointed medical director for the UMCB hospitalist group and the hospital ambulatory clinics. Hernandez holds academic appointments with The University of Texas, Southwestern University and the UT Medical Branch.

What is integrated delivery?

Integrated delivery is simply taking into account all those other pieces of health care and making sure that to the consumer of health care, the system is seamless. What we don't want is more complexity in an already complex situation. What we want to do is create connections between all the various elements of health care—whether that's transportation, whether that's the facility, whether that's education for the patient—so that they can be empowered and able to care for themselves in a home or work environment. And we need to do all that in seamless fashion so that to the patient, it seems that they only engage in one health care system.

How does that occur?

... It's not necessary for consumers to know how much work is happening on the other side of the curtain to make the experience for them seamless. It only matters that it's seamless. So a lot of the work that we're doing in the collaborative is working on that back end.

Who are your primary patient groups?

We work inside a particular space, which is the unfunded and underfunded, but the lessons learned and the systems built will work just as well in commercial and Medicare populations. As we gain success with the work we're doing, I expect that that work will begin to bleed over into the commercial sector because those challenges are the same regardless.

How will integrated delivery work for commercial and Medicare populations?

Everything we're doing over here with the uninsured and underinsured holds true for those patients who have the same illnesses, the same afflictions, the same challenges in the underinsured population.

How is the Community Care Collaborative funded?

Frankly, we provide that care through organizations that provide charitable dollars and through tax funds. So Central Health taxes all property in Travis County and uses those tax dollars specifically to care for the uninsured and underinsured. Through the collaborative, those dollars are in a common bucket, and we use those dollars to purchase care for the uninsured and underinsured. We know that bucket of money will not grow infinitely; it's not going to grow to whatever the need is. And yet the need is huge—we had 211,000 uninsured people in Travis County in 2012. About 135,000 of those people were uninsured and living at 200 percent or less of the U.S. poverty level, so there's a lot of need.

How do you plan to change health care for the uninsured and underinsured populations?

We need to transform the care delivery system. ... We need to create a healthier population. The best way to transform health care delivery is to transform the population you're caring for. The demands on services are much less in a healthy population. And since we're dealing with limited dollars, we have a real incentive to make this population healthy and help them to be well.

Providers make a conscious choice to go work for organizations that care for the safety net. They do it because they like caring for individuals who wouldn't otherwise get care. But those providers know that there are limits placed on the system, and it's frustrating for providers sometimes. So if we don't create a system to where they feel rewarded and challenged and happy with the work they're doing, they'll vote with their feet to go work somewhere else.

How will integrated delivery affect providers?

We're beginning to change the way we pay our service providers. Instead of it being about 'How many patients did you see?', it's 'What kind of outcome did you get?' We believe that if [providers] achieve ... better quality of health care delivered, better experiences by the patients—that's what we care about. By experience I mean that the woman who had to ride two buses, wait an hour and then park her kids in a hallway so she could get her pelvis exam; that we change that so that we facilitate closer clinics so she doesn't have to ride so far and provide child care so that her kids have somewhere to be and play while she's getting her well-woman exam.

How does an integrated delivery model lower health care costs?

Health information is crucially important and needs to travel along with [patients] so that as they move through the system—geographically or virtually—every single [medical professional] they interact with has access to what we call the longitudinal record. ... That's integrated delivery, and when you do it that way, you make sure that the patient doesn't get lost in the system.