Taking the train into downtown Chicago every morning, I sometimes feel as if there's a Presence Health clinic out the window every five minutes. I just had a conversation with my wife over the weekend about how the local health system seems to be everywhere.
Call it the Starbucks-ification of health care. Hospital leaders — looking to treat the health of populations, focus on wellness and pivot away from acute care — are building up convenient, less costly to operate locations around their communities. They're partnering with consumer-savvy organizations like Walgreens to add greater, um, presence in neighborhoods, and build brand awareness.
Presence Health, Illinois' largest Catholic system, with 11 hospitals, is no exception. Earlier this month, it announced plans to partner with urgent care provider Physicians Immediate Care to jointly manage 10 such clinics in the state, and build even more down the line. Those would be open seven days a week and into the evening, offering everything from X-rays to suturing. This is part of a larger strategy to expand the health system's ambulatory footprint, with 55 sites coming in the first phase, President and CEO Sandra Bruce told me by phone last week.
Bruce, who retires at the end of this month after more than 40 years in health care leadership, worries occasionally that she might be leaving just as things are really starting to get exciting. As a lifelong "do-gooder," she fell in love with the profession early on because of the chance to help the less fortunate, and the drive toward community health fits right into that mindset.
Pictured above: Presence Health's retiring CEO Sandra Bruce says Presence must seek out partnerships to improve population health.
"Sometimes, I think maybe I retired a day or two too early," Bruce says. "But, I think I've gotten this organization quite prepared for the move into population health. Lots of organizations don't yet have much infrastructure or concrete initiatives that they can measure at the end of a quarter or year to say, 'We've moved the needle further toward a focus on the health of our communities.' It's hard, and it's a big pivot for American health care."
Bruce believes an ability to broker such partnerships is the essential skill for the generation of leaders succeeding her. Being able to set egos aside to work closely with patients, providers, payers and a variety of others is crucial in today's environment. In the latest partnership, Physicians Immediate Care, the state's largest urgent care operator, will manage the day-to-day operations of each clinic and will refer patients who need higher-acuity services exclusively to Presence facilities within the regions where they partner. Bruce is excited, too, that they've agreed to accept the Medicaid population, which so sorely needs access to services.
Presence plans to hold a symposium on Sept. 25 with local board members of its hospitals that goes beyond the usual fiduciary concerns and focuses on how they can transition into becoming stewards of community health. Doing so will require pinpointing the social determinants that are impacting outcomes, Bruce says, and the partnerships Presence must seek out to improve population health.
"In some cases, it's going to be safer streets. It could be housing; it could be food. I'm not sure what we're going to find in every community," she says. "While we've all done these broad community needs assessments, we haven't really focused on what I call a 'true population health assessment,' and then determined what partnerships we need to begin to address those issues."
Bruce is concerned about the state's proposed cuts to Medicaid even as the system is stepping up efforts to help disadvantaged individuals. Reduced Medicaid payments would force the system to cut back hours of service and possibly close locations.
Presence has agreed with the state to take on capitation and establish a Medicaid managed care plan, which will happen sometime in 2016. Leaders are beginning to ramp up for that work, building the infrastructure to help identify high-risk patients, and provide interventions that enable them to avoid the ED. One example Bruce cited: A review of claims data of a 13-year-old girl revealed that she was living with her grandmother after losing both parents, and getting bullied by other youths. She coped by cutting herself. Presence put together an intervention plan with the grandmother to alleviate the bullying and stave off any greater harm that may have resulted in a ED visit.
"Those were all things that we were not used to doing. We've never had a patient before where we intervened in this manner and have never even seen or met the patient until then," Bruce says.
Hospital leaders and board members need to reshape how they think to thrive in tomorrow's health care, she believes.
"The role for health care workers and executives is going to be very, very different," Bruce says. "It's not necessarily about running the best cardiac program or the best orthopedic program, although those are important things, too, and have their place in a whole continuum of services. But health care I think is at, I don't know if it's a crossroads, but we have an opportunity to step up in this country and reframe what it means to be an American from the perspective of health. And if we step up and lead the revolution to work on some of these social determinants of care, in a decade or two, the country will look very different; our communities will look very different, and obviously health care itself will be delivered in a very, very different way. I'm pretty jacked about it. The question is will we step up and do it? What's your bet?"