"There is something new going on, and it is called "population health" said Yessenia Longoria, Registered Nurse and Population Health Care Coordinator at Moore County Hospital District (MCHD). Longoria was at the Hampton Inn Friday morning speaking to a breakfast meeting of the adult, men's Sunday school class of the Calvary Baptist Church known as the "Prime Timers" about some of the new ways the Moore County Hospital District is delivering health care to Medicare patients, JBS employees, and others.
Under the pressure of rising health care costs, governments, private corporations, and health care providers have been searching for innovative ways to control costs while, at the same time, meeting a growing demand for health care services. "The cost of health care is outrageously growing in the United States," said Longoria. "Health care in Texas alone costs more than running the entire government of France, and our quality here is not necessarily better. We have to figure out how can we have better care and not make it so expensive." According to Longoria, more than 20 Texas hospitals, mostly in rural areas, have been forced to close in recent years due to financial pressures.
One solution that the Moore County Hospital District and other health care providers around the country have recently tried, with some initial success, has been a concept known as population health. According to Longoria, who is in charge of the effort for the district, population health shifts the focus from just treating individual illnesses to seeking ways of improving the health of whole groups of similar people. The concept stresses education, preventative medicine, and coordinating care among providers to achieve the best long-term outcomes. "Sometimes we have sick care instead of health care, and we really need to have health care, which means being healthy -- not just seeing you when you are sick," she said. One big goal of population health is to get patients to access care at clinics and from primary care physicians, rather than in emergency rooms, where care is more expensive and less effective for non-emergency patients. Under population health, nurse care coordinators help steer patients through the various stages of their care. They can insure patients have transportation to appointments and keep the lines of communication between the patient and doctors -- and among doctors -- open. Beyond medical services, the care coordinator can help patients gain access to the social and other services, like Meals on Wheels, they need to complete their recovery and remain healthy.
"Sometimes it is just figuring out what a group of people need to understand," said Longoria. She talked about a patient who had had orthopedic surgery and was sent home with the instruction to keep his leg up and keep an ice pack on it. The man, a recent refugee, did not know how to make ice. He had never had a refrigerator. Had the care coordinator not been there to tell him what to do, his leg would not have healed properly, and he would have probably had to return to the hospital for more treatment -- at additional cost to the system and discomfort for him.
"You always know that when you send someone home (from the hospital), they still need something," said Longoria, who recently received a Master of Science Degree in Nursing from Texas Tech University and had an article she had written about health care delivery to refugee populations in rural areas published in the national nursing journal "Nursing Management. "As the nurse at the bedside, I always wanted a little more time to educate the patient and find out what was going on once they left the hospital, and we didn't have that time."
At present, the Moore County Hospital District is applying population health concepts to Medicare patients through membership in an Accountable Care Organization (ACO) with Northwest Texas Hospital and other hospitals and physicians called the Texas Panhandle Clinical Partners. The main benefit of these organizations is that members agree to accept each other's tests, reducing expensive duplication and letting patients avoid having to endure the same procedures over and over again. Members also have to maintain a high quality of care to continue membership. A big incentive for remaining a member is that, at the end of the year, the members divide up any savings.
The 3500 employees of JBS also participate through membership in a Physicians Hospital Organization with the hospital district. The district provides education and care coordination, among other things, for the employees, many of whom are refugees and recent immigrants. Some have not had health care before. JBS pays for their employees to receive care in MCHD clinics and from participating local physicians.
Longoria says other organizations have expressed interest, but, "Medicare patients and JBS employees are the two (groups) we have right now."
According to Longoria, population health is showing results. Visits to the emergency room for non-emergency cases are down 24 percent over last year and visits to clinics are up by 25 percent. There has been improvement in the health of the many diabetic patients among JBS employees, thanks to a MCHD diabetic educator who helps them with diet and blood sugar monitoring, among other things.
Longoria also talked about the new telehealth program that gives patients at MCHD access to out-of-town specialists and a Chronic Care Management program that brings care coordination to patients diagnosed with two chronic illnesses.
"There are resources available," she said. "Visit with your doctor. Reach out to one of us. Don't feel like you are alone in handling your health care."
Milton Pax, leader of the Sunday school group said, "I have always felt like communities are judged on how they take care of their residents. We have a lot to be proud of ... Dumas is one of the few towns that has grown ... I think it is because we take care of those in need."