News Q and A: Kate Henderson Explains Seton's Health Equity Initiatives

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AUSTIN, Texas - (Aug. 11, 2014) - Kate Henderson, president of Seton Medical Center Austin and Seton Shoal Creek Hospital, now has a new, additional responsibility for Seton Healthcare Family's 'Health Equity Initiatives.'

What are Health Equity Initiatives?

It is our portfolio of activities and services focused on care for uninsured and otherwise underserved people.

Using a service-line perspective, we are studying what is and isn't working well, what is creating the health outcomes and experience that we strive for and what isn't, to ensure programs and services are value-based, not volume-based.

We're not just concerned with the amount of care; we want to provide quality care and positively impact the health of those we serve.

So they would align charity care with changes we see elsewhere in health care?

Absolutely. So many changes in health care delivery focus on insured patients. What about the uninsured and underinsured? We have different responsibilities here, and this population has unique needs and challenges, so we may have to meet them in different ways.

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Why does Seton need to change the way it does charity care?

As we think about the many changes in health care across the country and within our community, we know that health care transformation is under way. Re-evaluating and transforming, as we can, for underserved persons is an important component.

Our mission is to care for and improve the health of those we serve. We must take the long view on care - specifically consider the continuum - and work to keep people well and provide medical care when they are sick or injured.

Both our newly transformed relationship with Central Health via the Community Care Collaborative and our emerging partnership with Dell Medical School at The University of Texas are excellent opportunities to move the model from sick care to health care, and from volume to value.

What are the biggest challenges?

One certainly is that there's an influx of 150 new people coming into our community every day and 40 who leave. That creates not only a substantial net increase in population, but also a lot of churn.

Today, we have 200,000+ underserved individuals in Travis County and this population continues to increase. Another challenge - and opportunity - is that right now we don't have a well-coordinated medical system.

We certainly have several key components, including hospitals and outpatient services, and we are developing and/or partnering with others to build other components, including urgent care centers, stronger primary care and more navigation services.

The opportunity is to develop more of this collaboratively with key community partners, including Central Health and UT. As much of this is new in our community, we don't have to overcome historical precedents or a 'the way we've always done it' mindset.

The DSRIP (delivery system reform incentive payment) projects are both an opportunity and challenge. Using this federally funded health care delivery innovation vehicle, we have the opportunity to pilot expansions of unique primary care and specialty care services.

Development of the Seton Psychiatric Emergency Department is a shining example of this, as this is a significant and prominent DSRIP project and is, without question, adding tremendous value to the community at large.

The challenge with DSRIPs will be to rigorously evaluate their outcomes and then evolve successful projects into integrated and sustainable components of our health delivery system.

Who inside and outside Seton will be involved in these initiatives?

Key external collaborators will include Central Health and UT-Austin. Dell Medical School is committed to providing exceptional medical training consistent with traditional medical schools and also is committed to teaching population health management, social medicine and health care valuation. Specifically, the school will work with us to create new ways to provide high-quality, lower-cost health care and better keep well the people we serve.

Other schools within UT-Austin will be important partners as well, including Nursing, Social Work, Pharmacy, Business and Engineering.

Within Seton, via the Community Care Collaborative, we have expert clinicians working with Dr. Mark Hernandez to establish best practice protocols in key areas of medicine. These protocols will support best practice and evidence-based care throughout the delivery system and position us to drive quality up and variation out.

We know that access to care is critical to keeping people well and Seton Insurance Services in doing critical work to help connect our patients to Marketplace Exchange products to enable access to care. Via the Community Care Collaborative, Seton is working with other organizations to simplify the process for folks to apply for different coverage products - 'one-stop shopping,' so to speak, versus the current, disparate 'office to office' model.

Geographically, where do you start?

There are certainly opportunities to make an impact in all markets that Seton serves. Efforts are now focused on Travis County, given our unique partnerships with Central Health and UT-Austin.

Service-wise, where do you start?

Using data we have available, we have been studying the way in which underserved individuals use emergency departments and specialty care. The level of acuity in emergency care is scored on a five-point scale; one is high acuity and hospital care is necessary, while five is ambulatory-sensitive.

In reviewing data from University Medical Center Brackenridge, 99.2 percent of individuals scored as a 4 or 5 received primary care and required no inpatient hospital services, so we set out to learn why these patients choose to access the ED. An early hypothesis was that these people were using the ED during hours that primary care clinics are not typically open.

However, we found that most of these ED visit occurred Monday through Friday, 9 a.m. to 6 p.m. Patient focus groups were put together to investigate further. What our patients told us included:

  • Valuing 'one-stop shopping' at the ED; all services are provided and there is no need to come back for labs or imaging.
  • No appointment necessary, so same day service is guaranteed.
  • Access to specialists is easier.
  • Perception that ED providers and, hence, ED care is higher quality

We now are rethinking how we help folks opt to access and use primary care, as appropriate. This will better connect people to a continuum of care (versus an ED episode) and help Seton make more advanced, hospital-based services available to people who medically require them.

What about care for the homeless?

During our focus group, we learned that the existing clinic for the homeless was requiring appointment times.

Focus group members said that their challenge is balancing access to food with access to health care. Homeless individuals often must choose between standing in line for food or keeping a scheduled medical appointment. The alternative for many has been to stand in line for food, then seek medical care at an ED where no appointment is necessary. We've been working with the homeless clinic on this.

All of this is to say that we are starting with the data, to understand what people's habits are and talking to them about why they what they do - and then helping to create really meaningful alternatives.

When will these initiatives be launched?

Much discovery work continues. This portfolio includes evaluating how to best improve individuals' coverage, including enrolling more individuals in Marketplace Exchanges; aligning care protocols; evaluating access to and use of specialty care; consideration of urgent care centers instead of EDs; and creating new mechanisms to connect individuals with non-medical services they may need to stay well (transportation, food, clothing, housing options, etc.).

As the discovery work is completed, initiatives will be carefully planned and implemented.

What effect will this have on Seton financially?

Our focus is on producing better health outcomes using fewer resources - that is the definition of value. There's more people coming to town, more needs and we're unable to keep up with it. How can we better use the same resources and have greater impact?

We're not at all backing away from our mission. I believe we are strengthening our commitment. We are called to care for all members of our community while being exceptional stewards of the resources we have. We're asking ourselves: how do we keep up and improve the care for those we serve?

We need to do our work differently. We can't continue to do it the same way we've done it in the past. Health Equities is about transforming and improving the health of and care for our most vulnerable.

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