What They’re Saying: Integrated Care Models are Addressing Current Healthcare Challenges

Hospitals, especially those in rural communities, are faced with figuring out how to maintain operations with rising costs. As a result, rural hospitals are closing at an alarming rate throughout the United States.

“'Costs in almost all industries are steadily rising, but rural hospitals are also faced with challenges on the reimbursement side because of their disproportionate share of Medi-Cal and Medicare funding,’ said Peggy Wheeler, vice president of the Rural Healthcare Center of the California Hospital Association. Wheeler, a national expert in rural health care, represents all the rural hospitals in California. ‘Their patient population is disproportionately weighted toward government payers, Medicare and Medi-Cal, which don’t pay the full cost of that care,’ Wheeler said. ‘So, if costs continue to go up, but 70 percent of your population is government payers, you can see what the struggle is,' Wheeler said. ‘You are trying to stay up with the cost of care, which steadily rises, but you are weighted with patients who don’t pay the full cost of care.’”

- North Bay Business Journal,
California North Cost rural hospitals shift tactics to survive national, local financial challenges,
Jan, 28, 2019

“Hospitals are often the economic drivers of rural communities. Per capita income falls 4% and the unemployment rate rises 1.6 percentage points when a hospital closes, a related study found…Many large systems support community hospitals that can share some of the lower-acuity workload, evidenced by systems like the University of Alabama at Birmingham that are taking on administrative tasks and sharing specialists with their rural neighbors. This can often be more effective than an acquisition, DeBehnke said. When DeBehnke was at Nebraska Medicine, he convened a rural hospital consortium. They shared best practices, revealed each facility's challenges and opportunities, and discussed how to streamline redundant services, he said.”

- Modern Healthcare,
Nearly a quarter of rural hospitals are on the brink of closure,
February 20, 2019

“'Options are dwindling for many rural families, and remote communities are hardest hit,’ said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota…Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so. In its June report to Congress, the Medicare Payment Advisory Commission found that of the 67 rural hospitals that closed since 2013, about one-third were more than 20 miles from the next closest hospital. A study published last year in Health Affairs by researchers from the University of Minnesota found that over half of rural counties now lack obstetric services. Another study, published in Health Services Research, showed that such closures increase the distance pregnant women must travel for delivery. And another published earlier this year in JAMA found that higher-risk, preterm births are more likely in counties without obstetric units.”

- New York Times,
A Sense of Alarm as Rural Hospitals Keep Closing,
Oct. 29, 2018

Doctor and woman talking seriously.

Integrated models of care help ensure rural communities have access to quality healthcare.

“On the second path, Inda said, the nonprofit Health Trust could work together with potential partners such as Salud Para la Gente, Kaiser Permanente and Sutter Health to help it manage and fund operations. ‘Where you see hospitals in small areas succeed is where there are affiliations,’ she said. ‘From my lens – Salud serves 27,000 people in the community – it is our mission to assure access to healthcare for them, and there is a very clear path to success that will benefit the community and sustain healthcare.’”

- The Register Pajaronian,
Watsonville hospital buyer to be known soon,
July 17, 2019

“Like many small, rural hospitals, Allen said, Mendocino Coast gets most of its revenue from Medicare and Medi-Cal, but those two government programs don’t pay enough to cover the total cost of providing care, and it does not receive enough revenue from commercial insurers to make up the gap. A large, integrated health care system often can realize economies of scale that reduce their costs, he said.”

- The Sacramento Bee,
Why tiny Fort Bragg hospital is looking to Sacramento-area giants for lifeline,
April 24, 2019

Doctor offering education to older female patient.

“Even generally speaking, obstetric services compared to other healthcare services that we value, is generally unreimbursed, which is why across rural United States, and even in urban areas, OB services are going away. Hospitals can’t afford to keep the lights on because relative to their high fixed costs, OB services are just not very well reimbursed…The question is, women deserve options on every level, they deserve options on where they want to get care, who they want to get care from, and then what type of care they want to receive. And then we should figure out then, not to have silly debates about home versus birth center versus hospital, or midwife versus physician, but how we provide people the access to all of those options safely in an integrated way.” Neel Shah, MD, obstetrician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School.

- WBUR (Boston NPR),
How Empowering Midwives Could Improve Health Care For Mothers,
March 8, 2018

“California hospitals received $1.5 million. Sierra Nevada Memorial Hospital in Grass Valley and Sutter Amador Hospital in Jackson each received $750,000 in Rural Residency Planning and Development Program grants to spend over a three-year period. ‘[HHS Secretary Alex Azar] Supporting the training of healthcare providers in rural areas through grants like these is a key way to help expand rural access to care, and is part of an overall effort to support rural healthcare in sustainable, innovative, and flexible ways.’”

- The Sacramento Bee,
As rural hospitals and health care struggle, California hospitals are fighting back,
July 10, 2019

Integrated models of care produce greater quality and patient outcomes.

Young girl hugging woman.

The “simplest explanation of how California decreased maternal mortality while the rest of the nation increased? ability to coordinate efforts towards aligned goal...regional health systems with the right leaders absolutely a part of the story.” - Neel Shah, MD, obstetrician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School

- Twitter,
December 19, 2018

Through its integrated network, Sutter Health provides innovative solutions that deliver quality and affordable care to more than 3 million Northern Californians.

“Jeff Cornelius, director of strategic initiatives with Fresno-based CVT, echoed that sentiment. He said that when it comes to adding new health plans, CVT is ‘judicious’ and ‘very cautious’ about choosing which plans to offer its members. The organization chose to add Sutter Health | Aetna because of its strong ties between its provider system and the health plan, Cornelius said. Under the agreement, Sutter Health | Aetna will offer five different provider organization health plans, which largely steer patients toward in-network providers like Sutter Health and Stanford Health Care. ‘We’re the first school pool to be able to offer this. We think it can help with the cost challenge in California,’ Cornelius told the Business Journal.”

- Sacramento Business Journal,
Sutter Health | Aetna lands deal with large education benefits group,
July 18, 2019

“The clinic, a service of Palo Alto Medical Foundation, is the 11th one to open in the Bay Area. The first Sutter Walk-In Care opened in April 2016 in Sacramento. The Sacramento area now has seven clinics and four more are expected to open by the end of the year. Having a clinic in Aptos is not just convenient, but necessary, according to 2nd District County Supervisor Zach Friend, who attended the ribbon cutting. ‘I see this more about health equity and health access issues for really the outcast area,’ he said. ‘There’s nothing between 41st and Airport. …To not have to drive is going to be a remarkable difference I think for this community like I said, not just one of convenience. Because there’s a lot of people here, elderly and Rio Del Mar, Seacliff and such that I can see this becoming really an essential clinic for them more than just a convenience clinic.’”

- Santa Cruz Sentinel,
County’s first Sutter Walk-In Care opens in Aptos,
June 21, 2019

Elder and younger woman smiling and touching heads.