- In the city of McCook, Nebraska, paramedics visit the homes of patients recently released from the hospital, checking in on their health needs and making sure patients’ homes are suitable for recovery. This community health partnership was designed to address the needs of rural-dwelling patients, a social determinant of health that affects about one-third of all Nebraskans.
Patients in rural areas usually have trouble getting to the doctor, facing vast geographical limitations to hospital visits and follow-up care. McCook County Hospital serves nearly 30,000 patients, many of whom live well outside the city limits.
These long distances have many adverse healthcare effects; patients struggle to get to doctor’s appointments, if they decide attend at all. And as patients continue to delay care, their symptoms deteriorate, often leading to a costly ambulance ride and emergency department visit.
Patients needed a better option for receiving care – one that did not involve exhausting travel times or budget-busting ED costs.
In May of 2015, McCook County Hospital and city officials identified that solution. The Community Paramedicine program had been proven an effective strategy for meeting patient needs in areas with similar health needs.
The program allows experts from the community, McCook County Hospital, or the local primary care practice to identify patients who may need more home check-ins. This can include older patients, or patients with extreme circumstances keeping them from going to the doctor.
With patient consent, trained paramedics with the McCook fire department conduct home visits to enhance patient care, detect recovery issues, and ensure the patient’s home is safe for and conducive to recovery.
The program was up and running by January of 2016, and now, one and a half year later, has served 30 patients recovering from a hospital stay. Per patient costs average at about $85, and the group has plans to assess hospital readmissions and overall return on investment soon.
Community partnerships such as the McCook Community Paramedicine project are happening all over the country as healthcare organizations work to meet patients outside of the four walls of the hospital, according to Carol Friesen, MPH, FHFMA.
Friesen is the VP of Health Systems Services at Bryan Health, a Nebraska-based health system that recently published a compendium on successful regional community partnerships. The compendium includes case studies from all over Nebraska, listing best practices for supporting community healthcare.
“We wanted to harvest best practices about care being delivered outside the walls of the hospitals,” Friesen said in a recent interview with PatientEngagement.com. “We really wanted to demonstrate the mission of advancing the health of the community through collaboration, because we believe that's where we're going futuristically.”
Healthcare is becoming about a lot more than the medical interventions consumers traditionally think of, Friesen added.
“Patients don't want to necessarily think of their healthcare facility or provider as the place they go when they’re sick,” she said. “They want to see their providers as a partner in their health.”
Each of Bryan Health’s case studies are different. The health system highlighted one school system that created community partnerships to address mental health issues in high school students. Another made deals with the local hospital to support pharmacy services after the town’s last drug store shut down.
However, each of these stories had a few commonalities, Friesen said.
“The common theme we saw through all of the stories is shared a purpose between partners,” she pointed out. “They were invested in creating long-term solutions for the community, not just put a Band-Aid on it, but making a 20-year impact in the community.”
Successful community healthcare partnerships usually have three key stakeholders – the hospital and its partners within the community. This demonstrates strong collaboration within the community and highlights a shared vision to advance health of the community, Friesen explained.
Healthcare organizations can identify potential partnerships by conducting a community health needs assessment, which per the Affordable Care Act must be conducted at least once every three years for non-profit hospitals.
Organizations can also look at overall trends. These trends may not be revealed in a community health needs assessment, but still draw attention to gaps in care.
Such was the case in Fillmore Central Public Schools, the school system that noticed and addressed an uptick in behavioral health issues in its high school students.
Lastly, organizations might have an innovative idea that can be adapted from a different industry or community into their specific community situation efficiently and effectively.
The stakeholders in McCook adopted their idea from some neighboring communities who saw success with their paramedic teams. Although there was no pressing need for this service, the community partners decided the strategy could be of benefit for patients.
This overall drive for community health partnerships stems from the industry shift from volume to value-based healthcare, Friesen noted.
“Healthcare is changing, in that we traditionally have been focused on taking care of our community when they're ill and treating people that come to us,” she explained. “Now, the industry is moving from ill care focus to wellness and proactive chronic care.”
This is not just about a changing mindset, either. As payment models hinge on quality care metrics such as lowering hospital readmission rates, for example, hospitals see incentives for community outreach.
“Our prior reimbursement models weren't incenting hospitals to invest in these partnerships, or it wasn't something that they were paid for,” Friesen recollected of fee-for-service reimbursement models. “Now we're seeing with value-based care programs, that's coming into play. There are other incentives or disincentives in the system, if we align care and resources with community partnerships.”
Value-based payment models are also drawing attention to where hospitals and providers focus their attention. Most stakeholders are starting with the most at-risk patients, or the five percent of patients who account for nearly 50 percent of healthcare spending, Friesen said.
“Attribution heightens awareness to say, ‘When we identify who in our community is the top five percent of healthcare utilization, how do we create programs and solutions to help that population be as healthy as they can?’” Friesen posited. “And we’re also trying to work with the ‘walking healthy’ to prevent them from becoming individuals with chronic disease and high utilizers of health care.”
But this cannot be a solo endeavor, Friesen asserted. Healthcare is working with a scarcity of resources, and simply does not have the means to deliver both high quality care in the hospital and community services outside the hospital. Instead, cash-strapped hospitals need the help of community partners, like they received in McCook.
“As the scarcity of resources in communities occurs, a larger amount of collaboration is required to meet the needs of communities,” Friesen explained. “The scarcity of resources has had an unintended consequence which has been very positive. It fosters a lot of creative partnerships and collaborations.”
Even with the assist from community and government stakeholders, those looking out for community health are often left wanting for funding.
A lot of governments and communities are in the red, and rely on the philanthropy of private sponsors along with their hospital partners. In McCook, the Community Paramedics program has been bolstered by two $5,000 grants from the Community Hospital Health Foundation.
Getting this kind of funding is one of the prohibiting factors for community health partnerships. Caring for patients and conducting community outreach is something providers across the country want to do, Friesen suggested, but limited funds are keeping healthcare organizations from fully implementing programs.
Healthcare organizations and community stakeholders may continue to see this scarcity of resources, which Friesen said will lead to more collaboration. With more changemakers involved, hospitals and communities can see outreach efforts reach full scale.
But community health partnerships are just in their infancy, Friesen said. Nebraska is fortunate to be in the black, with plenty of financial means and incentive to drive strong patient outreach for quality care. It is important for the state to highlight its successes, demonstrating to other industry experts that community health is effective, she said.
By promoting this message, Friesen hopes to spark more community outreach and emphasize the return on investment these programs can have. As healthcare continues to mature, it will be imperative for hospitals to embrace community-oriented strategies and support patient wellness before issues escalate.