Help wanted: Hospitals seek community partners

A continuum of care

Currently hospitals are paid on a fee-for-service basis, meaning hospitals are reimbursed by insurance or Medicare when a patient receives a treatment or procedure. Under the Affordable Care Act, commonly known as Obamacare, hospitals will be responsible for managing the health of entire populations. This means that instead of caring for patients during acute episodes—diabetic episodes and heart attacks, for example—health care providers will be responsible for managing the health of an entire area, such as Hays County, before patients enter the hospital, during their hospital visit and after being discharged.

In an effort to hold health care providers accountable, the legislation penalizes hospitals if a patient is readmitted within 30 days. In such instances, the hospital will essentially not be paid, Kelley said.

"We have to manage discharge and be good about making sure that patients get what they need after they leave the hospital: their prescriptions, their doctors appointments, nutrition—all the things that affect a patient's ability to get well," he said.

'Strange bedfellows'

Health care reform, along with a sluggish economy and a growing population, have caused health care providers such as CTMC and Seton to look for new partnerships with community organizations, said Clay DeStefano, director of public relations and marketing for CTMC.

"We're taking these shows on the road, so to speak," DeStefano said. "Part of our strategy has been establishing these more clearly defined and present entities in our community."

One of those entities is Live Oak Health Partners, CTMC's primary and specialty care provider. Live Oak offices have opened in Lockhart and Wimberley in the past year, giving CTMC a new presence in those communities in addition to offices in San Marcos and Kyle.

DeStefano said the economy, which has been slow in recovering from the downturn in the late-2000s, has forced many entities to seek creative or unorthodox partnerships to provide health care. One example is Hays County's community health clinic in San Marcos. In January 2013, Live Oak took over the clinic and began providing care for indigent populations in the county. That partnership was made possible because the county was looking for a more efficient way to deliver health care to residents.

The partnership allowed CTMC to provide medical services to an additional 2,482 patients in Hays County between May and August, according to the hospital's records.

"You couldn't have even had that conversation five years ago," DeStefano said. "It wouldn't have happened. Necessity makes for strange bedfellows."

Seton has formed alliances with CommuniCare, a federally qualified health clinic with locations in San Marcos and Kyle, as well as the Healthy Communities Collaborative, which seeks to improve access to nutritious food and safe places to exercise for residents of Hays County.

Healthy Communities Collaborative performed a needs assessment in 2008 and found that residents in Northeast Hays County were struggling to find safe places to exercise because leash laws were not being enforced and sidewalks were nonexistent.

In 2012 the group was awarded a $740,000 grant to address those two issues.

Education and outreach

In Hays County, diabetes is a particularly common problem, and it is growing. According to a community health needs assessment compiled by Seton and CommuniCare in 2013, the percentage of Hays County residents with diabetes increased from about 7.5 percent in 2004 to 8.5 percent in 2009.

To combat this trend and help people living with the disease manage their symptoms, Seton is proposing a simple solution: education.

Kelley said in his previous position as vice president and COO of Seton Edgar B. Davis Hospital in Luling, his staff discovered that if diabetics are educated about nutrition, blood sugar monitoring and prescriptions, their admissions to the hospital drop to "nearly zero."

"You don't even see them in the hospital because you're doing such a good job of keeping them well and managing their disease process in a cheaper environment," Kelley said.

According to a report Seton submitted to the American Hospital Association, the education and outreach efforts have saved the hospital $428,028 in cost avoidance and care coordination costs since 2009. During the same period, admissions to the emergency department for diabetics dropped by 33 percent.

CTMC has made similar findings, DeStefano said. The organization, which is part of the Adventist Health System, has adopted Creation Health Principles, a faith-based health program that educates patients on nutrition, activity, positive interpersonal relationships and more as the core of a healthy lifestyle.

"It's surprising how uneducated people are about nutrition," DeStefano said. "These are smart people, degreed people, people who should know better, but they really don't because our society and culture is fast food. It's hard to sort through what's good and what's not."

Partners in health

In the past five years, CTMC opened its $35 million Women's Center, a new second floor, a cardiac unit and new offices for Live Oak Health Partners.

Seton Hays' growth has been as dramatic as CTMC's. In July, Seton broke ground on a new 54,500-square-foot rehab facility. Kelley said there are plans to expand into the top floor of the tower at Seton Hays and add another medical office building to the hospital's 205-acre site.

CTMC is partnering with the Greenbelt Alliance and the city of San Marcos Healthy City Task Force to provide better access to safe places to exercise. The three entities are collaborating on a program that will give doctors the ability to prescribe exercise at specific areas throughout the city.

"A doctor will be able to say, 'I want you to do a 1-mile walk at Purgatory Creek Natural Area,'" Greenbelt Alliance board member Todd Derkacz said. "'Do a 1-mile walk the first week and a mile-and-a-half the second week.' It's going to be a collaborative effort with a lot of different moving parts and a lot of different people."

There will always be a need for care during major medical episodes such as heart attacks, CTMC CEO Sam Huenergardt said, but as health care providers work to address the root causes of health problems such as diabetes, the providers will have to figure out more effective ways of delivering care before major episodes occur.

"You're going to see us become less of a health care provider and more of a partner in health," Huenergardt said.