Community health is about more than just giving back to the public, says Renee Romberger, vice president of community health policy and strategy at Spartanburg (S.C.) Regional Healthcare System, it's a critical business strategy for any hospital system. Romberger — a speaker at the 2013 Health Forum-AHA Leadership Summit later this month in San Diego — tells H&HN about her organization's population health strategy, and how the integrated provider pared down its uncompensated care by more than $20 million. | Interviewed by Marty Stempniak

Tell me about the Spartanburg, S.C., market.

Romberger: Spartanburg Regional is not much different from most hospitals across the country that are plodding along, focusing on our mission of caring for everybody in the community. We were very proud of that mission. We were founded in 1921 and quite often we would say to people in the community, 'We never close our doors to anybody. It's part of our responsibility as a community-based hospital.' We felt as though we were meeting our mission by making sure that we kept our doors open for anyone who needed us. But in 2008, we started looking at the numbers and found that we were providing more than $100 million of uncompensated care a year. Unfortunately, we were spending a tremendous amount of money and we had some of the poorest outcomes in the nation.

How have you approached population health?

Romberger: Our community health strategy is focused in three areas. The first is identifying and addressing public health concerns. For our county, we've identified five areas of concern: childhood obesity, birth outcomes, access to care, decreasing tobacco use and behavioral health. The second priority is to ensure that care is available and accessible. If we don't have adequate resources to care for people, then we're going to end up with people utilizing the hospital for nonemergent care or crisis care and, either way is very costly. The third area is around re-engineering our delivery system so that care is delivered in an efficient and coordinated manner. It's not enough to have an adequate delivery system. You have to make sure the delivery system is being utilized appropriately.

How did you develop that strategy?

Romberger: When we started this journey, one of the most effective things we did to start us on the right foot was our leader-to-leader commitment. We committed leadership resources at the hospital and then we talked one-on-one with others in the community because, if you're going to develop a comprehensive community health strategy, you've got to have commitment from the top. And it's not easy. We don't really understand each other's businesses. The biggest mistake that folks make is having front-line staff, people who are involved in day-to-day activities, trying to lead the process. And if you don't have commitment from the top, and you don't have decision-makers in the room, you're not going to be able to develop strategies. So, the first is having leader-to-leader commitment.

Secondly, it focuses on shared decision-making. You have to believe that we as a group can be more effective in identifying the issues and solving problems if we share in the discussion and in decision-making — reaching consensus on issues and solutions.

The only way that you can accomplish No. 2 is through No. 3, and that is with a commitment to partnerships. We have a role at our hospital in community health, and that role is we do nothing if not in partnership with others. That's probably the hardest piece of this puzzle: How do you build partnerships with organizations that you typically don't work with? Those partnerships have to be built on two things: One is trust and the other is transparency. If you have partnerships built on trust and transparency, you can pretty much effectively solve any issue in front of you. But trust is probably the hardest part of all.

Why a community-based approach?

Romberger: Even though we're all independent agencies, when you look at that whole patient care path, a patient's journey is what we follow together. As much as we sometimes think of ourselves in silos and hospital-to-hospital and there is no connection with other community agencies, the reality is that what we do affects other agencies, and what they do affects us. If one component of the whole delivery system is broken, we all feel the impact. All too often, it's not really glaringly apparent ... but once you identify what those issues are, you realize the impact that they have on the entire system.

What results have you seen thus far?

Romberger: When we started out, our uncompensated care was at $106 million. Over the past five years, since we've been working on this strategy, we're now down to $81 million in uncompensated care. It's not because we're closing our doors; it's because we've spent the time to say, 'How can we invest those dollars in a different way that will produce better outcomes and reduce costs of care?' Also, we identified five health priorities to which more than 40 agencies in the community are committed. These are the areas where we have the greatest weaknesses and the greatest opportunities; and since that time, we've developed dozens of those public health community initiatives. We've also implemented at least a half-dozen delivery system redesign strategies. Most importantly, over the past five years, we've learned that we have to commit to testing new models of care and measuring the outcomes; if one works, then we're going to hardwire it, and if it doesn't work, if it doesn't improve health and reduce costs of care, we're going to eliminate it.

What have been some of the biggest roadblocks?

Romberger: The first hurdle for most hospitals, and what I see in talking with others about our strategy, is getting buy-in around the philosophy that you have to invest to reduce costs and improve outcomes. Many of the strategies we've implemented, we didn't know, walking into it, that they were going to make an impact. Some of it is: 'We've got to try something. Let's invest some money. If it doesn't work, we'll stop the program. If it does work, then we'll hardwire it.' But getting folks to believe that we've got to spend money to make money, or spend money to reduce our costs, that's a really tough hurdle.

And then, the second hurdle that I've encountered is when you say the terms community health or population health, people immediately jump to, 'Oh yeah, community health.' That's what we do to 'give back to the community.' And what I try so hard to say to people is, 'Community health is not about giving back.' Community health really needs to be one of the critical, strategic imperatives for any successful hospital system.


C.V.: I have 25 years' experience in health care administration and have been at Spartanburg Regional for the past 19 years. Oddly enough, I've changed careers five times in my years at Regional: marketing, business development, managed care, operations and now community health. I have a master's degree in health science from the Medical University of South Carolina.

What are you reading right now?: Rereading my favorite book, The Art of Possibility by Benjamin and Rosamund Zander. It speaks to the power of opening up the mind to see the possibilities.

Any hobbies?: I like to exercise, play golf, travel and spend time with loved ones, especially at Edisto Beach, S.C.