Executive Director, Redwood Community Health Coalition
Redwood Community Health Coalition (RCHC) is a network of 16 community health centers in the counties of Marin, Sonoma, Napa and Yolo. Collectively, RCHC health centers are the medical homes for 180,000 people (1 person in 6) in our region ... and 1 out of 5 in Sonoma County. Of these people, 69 percent live below 100 percent of the Federal Poverty Guidelines, which is just over $20,000 annual income for a family of four; 38 percent of our patients are uninsured. Through RCHC, our health centers leverage their resources to achieve economies of scale.
Here are three key initiatives. 1) A prime example of the collaboration among our health centers is the implementation of a shared electronic health record in 10 of them. This multi-million dollar investment allows sophisticated use of health information technology that improves quality of care and helps us toward our vision: "Every person in communities served by RCHC health centers has access to a patient-centered medical home." Soon our patients will be able to e-mail their doctor, schedule appointments electronically and review their labs and medical records from a home computer. 2) We also manage Healthy Kids, the program to enroll children in health insurance. Just in Sonoma County, it is estimated that 14,500 children are uninsured. Over the past 5 years, Healthy Kids has helped more than 25,000 children enroll in health coverage. 3) Also in Sonoma County our health centers contract with Partnership Health Plan through RCHC, providing data and other resources to better coordinate patient care and manage resources. This year's passage of the new health law ensures that thousands of community members who are currently uninsured will be eligible for health coverage in 2014. However, given the current economic downturn, until then the number of uninsured is growing. Our health centers in Santa Rosa and Petaluma are expanding into large new sites to meet the tremendous increase in demand.
Other communities around the country are taking bold steps to coordinate care, improve quality and contain costs. Grand Junction, Colo., El Paso, Texas, and Vermont, to name a few, have demonstrated quantifiable savings and improved health outcomes by investing in primary care " and particularly in patient-centered medical homes.
Two teams make this work. First within primary care, it's the care team, with the patient as an integral member. Many innovative practices around the country have adopted this model with great success. What makes these communities different is a community-wide team " employers, government, health plans, hospitals and primary care practices that have come together and decided they want a better system of care for their community " patient-centered, coordinated, comprehensive and integrated. Vermont, has realized an 11 percent savings in four years.
Our challenge is to build the same kind of coalition here, invest in primary care and take responsibility for healing our ailing health system ourselves. Sonoma County's Health Action has laid significant groundwork for community-wide improvements.
All of these initiatives are building a foundation for health reform. Improving quality and reducing costs through prevention and primary care are essential parts of the reform. Research demonstrates that investment made in primary care services reduces overall cost of care, improves health and reduces health disparities. Low-income populations are the greatest users of high-cost emergency room care for minor health care issues and the most likely to be hospitalized for preventable conditions. Taxpayers and hospitals bear the brunt of these unnecessary costs. Our health centers reduce these costs because every $1 spent in preventive and primary care saves $3 to $5 in future health care costs. Medi-Cal patients seen at community health centers are 19 percent less likely to use the emergency room for avoidable conditions, are less likely to be hospitalized and, when hospitalized, are sent home sooner. We are looking forward to working more closely with our hospitals and specialists to further coordinate their care.
President and CEO, Sutter Health West Bay Region
You will read about Sutter Health and its Sonoma County programs from Mike Purvis (See Page 11). In Marin, we offer acute hospital and outpatient services at Sutter Novato Medical Campus as well as urgent care and outpatient services at Sutter Terra Linda Health Plaza. Sutter Pacific Medical Foundation currently has 30 physicians in Marin located at care centers in Novato, San Rafael and Greenbrae. If the medically appropriate care is not available locally, patients also have access to Sutter Pacific's extensive network of highly specialized physicians.
We all need to do our fair share by reducing the cost of care and making sure that everyone has access to care. Affordability is a major emphasis throughout Sutter Health. Also, last year Sutter Health donated $10 million to the Marin Community Foundation, creating a partnership in which the Foundation will make grants to Marin's health care safety-net organizations.
We have recently expanded our services in Marin. The Kalmanovitz Child Development Center offers educational therapy, speech and language assessment, occupational therapy and psychological services. It is the only center of its kind in Marin. We have also expanded the Institute for Health and Healing, which provides integrative medicine services.
Several years ago, Sutter Health purchased property in San Rafael. Although we haven't yet determined the timeline or what specific services we will offer, the focus will be outpatient services and physician offices.
All North Bay residents need to feel secure that they will have access to high quality, affordable care. I have been practicing medicine for 44 years and know firsthand that when patients are ill, they are not interested in health care politics or who is competing with whom " they want to be cared for by highly skilled and compassionate physicians.
Consumers also want their caregivers, hospitals and clinics to work together to share responsibility for patient care. This concept of integrated care is essential to improving the patient experience and will undoubtedly be required in health care reform. At Sutter Health, our goal is to create a virtual "medical home" in which patients can receive the care they need.
Sutter Health fully supports health care reform. Transforming the health care system isn't just a "project." We need comprehensive change in the way health care is delivered.
Consumers want and deserve care that is more affordable and of the highest possible quality. We've been hearing this message for many years.
So, in many ways, we are not "preparing for reform," but are doing what we have needed to do for a long time. Health care reform is serving as a catalyst for change.
At Sutter Health, we have been taking steps in this direction even before legislation was passed. We have raised the bar on quality, expanded our physician network, invested billions of dollars in new facilities and contributed millions to vital community safety-net clinics. We have also made significant progress in delivering our services more efficiently and reducing costs.
Many decades ago, I entered what I believe is one of the most honorable professions " helping people remain healthy and taking care of them when they are ill. Health care should be a right, not a privilege, for every North Bay resident. For those of us who provide patient care, it is not a right, but a privilege that our patients have bestowed upon us.
Health care is going to become increasingly challenging. Regardless of the challenges " health care reform, the increased number of under- and uninsured, or the increase in the numbers of chronically ill " I am optimistic that we can face these challenges. The key for all health care providers is to consistently ask ourselves, "What is in the best interest of the patient?" If we apply this guiding principle, I believe we can create a better health care system for all.
Chief Administrative Officer, Sutter Medical Center of Santa Rosa
Sutter Health is one of the largest health care systems in the country and as such, has impacted the quality, affordability and accessibility of health care services in more than 100 communities in Northern California. Sutter Health's investment has strengthened and advanced the success of three local health care organizations: Sutter Pacific Medical Foundation, Sutter Medical Center of Santa Rosa, and Sutter VNA and Hospice.
Sutter Health supports health care reform and believes it represents a major step in the journey toward achieving access to high-quality affordable health care for all. Sutter Health began taking steps to enable the highest levels of quality, access and affordability for our patients well before Congress approved reform legislation in 2009.
In Sonoma County the building blocks are in place to manage health care reform with more than 100 local physicians and providers delivering comprehensive and personalized care through our integrated delivery network over a broad continuum " including surgery centers, physicians, outpatient care, general and specialty hospital care, and home health and hospice services. Sutter is strategically positioned to bring the value of health care reform together in our community.
Sutter Pacific Medical Foundation is a leading multi specialty practice model for physicians and providers in our local community. Access to Sutter quality care is provided in Sonoma County at 20 care centers with ambulatory services available in advanced imaging, laboratory services and outpatient surgery. Our plan is to continue to develop partnerships with physicians and expand services. In just a few years the organization's growth has been outstanding, increasing from 28 physicians and care providers in 2006, to 80 in 2008 and 102 in 2010. Our local doctors are part of the Sutter Medical Network " a group of more than 3,500 Northern California primary and specialist physicians. The network shares best practices and works together as an integrated team to handle even the most complex cases, resulting in the region's highest quality patient care.
Sutter Pacific Medical Foundation has embraced innovative technologies, like the electronic health record (EHR), enabling its caregivers to provide the best possible care to patients, ensuring patient safety and service affordability. For patients, Sutter Pacific Medical Foundation offers MySutterOnline, one of the most comprehensive sets of Web-based health services in the country.
Sutter Medical Center has broken ground and started construction on a 21st century hospital just off Highway 101 at the Mark West Springs/River Road exit. Construction of a new $284 million medical center has begun that will create 1,500 jobs and provide state-of-the-art health care. The new hospital was envisioned with the health of patients, the environment and the economy in mind. We have designed the hospital to optimize efficiency centered on patient needs. For example, the new facility will have all private patient rooms, which will provide superior patient care, privacy and comfort. Expected opening is fall 2014. Sutter has raised the bar and is positioned for health care reform by partnering with physicians and rebuilding and renewing outdated facilities " as well as contributed millions to support vital community safety-net clinics.
Sutter VNA & Hospice services will be a key component to health care reform as the need for home and community-based care increases. Sutter has developed the Advanced Illness Management (AIM) Program, which is an innovative treatment method designed to bridge the gap between home health and hospice care. AIM clinicians are trained in high level symptom management and seek to provide comfort for patients regardless of where they are in their course of treatment. The nonhospital services encouraged by the AIM program frequently result in better outcomes for patients and families than admission to the hospital. Home care and hospice services integrated with physicians and hospital care are vital to coordinating quality, affordable health care for our community.
a) A fragmented market
b) Provider imbalance with over-capacity of specialization and an under-balance of primary care
c) All providers do not share equally in the commitment to serve all demographics.
Sutter is relentless in the pursuit of quality, systematic efforts towards accountability and affordability. accountable care organizations, medical homes, provider integration, regional networks of care, development of integrated networks and innovation are at the forefront of our thinking as we implement our strategy for health care reform.
Assistant Physician in Chief for Health Promotion, Diversity and Service, Kaiser Permanente
Kaiser Permanente (KP) provides integrated, physician-led care to more than 250,000 members in Marin and Sonoma counties at eight locations. The Santa Rosa and San Rafael medical centers provide a broad range of hospital and outpatient medical services and specialties.
Kaiser Permanente members enjoy the technological advantages of KP HealthConnect, where they can e-mail their doctor, schedule routine appointments and view many lab results online. In addition to choosing their own personal physician, members receive care through an integrated medical team approach with their personal physician and with easy access to specialists and lab, X-ray and pharmacy services.
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.
The Kaiser Permanente Santa Rosa Medical Center opened a new five-story hospital tower that doubles the size of the Emergency Department and the Intensive Care Unit, and it includes a new interventional radiology suite. The original hospital also has numerous upgrades in progress.
At our San Rafael Medical Center, preliminary plans for a new emergency department and additional on-campus parking are in place. Replacement of the existing emergency department will better accommodate today's advanced medical technology and help ensure that patients continue to receive superior health care and service. Plans also include a seismic retrofit and addition to an existing parking structure on campus that will add 290 parking spaces. We are also in the midst of a hospital refresh.
All of these upgrades help Kaiser Permanente enhance a comfortable, healing and safe environment. Walls are colored with nontoxic paint that minimizes indoor air pollution, and floors are upgraded with vinyl-free products. This is just part of Kaiser Permanente's commitment to the health of our local environments.
Locally, disease prevention, access to care and a medical home remain challenges for many people. Kaiser Permanente supports our local safety-net clinics with grants, research and medical and technical expertise, and we also support many Healthy Eating Active Living programs in our community.
The North Bay faces many of the same challenges to our ability to advance medical care that we face nationally.
Much of medical care across the country is a 19th century cottage industry " paper records, fragmented care and unable to leverage technology to improve service, quality and affordability.
The national reimbursement system is still predominated by "fee-for-service," which drives utilization and does not reward quality, prevention and disease management. Reimbursement reform has just begun, and it will continue to be a challenge.
Hospitals, doctors and medical groups, insurance companies, pharmaceutical companies and device companies all have different self-interests and need to be better prepared to collaborate to improve the care for the patient.
In many ways we have been preparing for health care reform since our beginnings. Our focus on total health " prevention, empowerment and integration " and the investments we have made in electronic medical records and our physicians, staff and infrastructure all position Kaiser Permanente to efficiently and effectively care for our populations now and in the future. We will continue on our mission to improve the lives of others and the communities we serve. Our quality, service, affordability and ability to leverage 21st century technology are all part of our ongoing strategic plan as health care reform presents opportunities for Kaiser Permanente.
Kaiser Permanente supports universal coverage for health care and access to a primary care physician who can work together with patients to improve health via empowerment, integrated care and prevention.
Improving care delivery and controlling rising costs are our nation's greatest health care challenges moving forward. The new law is a good start, but it focuses primarily on health care financing. There are tremendous opportunities to reform how care is provided in our nation. Over 75 percent of all care costs in the United States come from services provided to people with chronic conditions " with 10 percent of all patients needing 80 percent of our total care resources "and America is getting care right for patients with chronic conditions barely 50 percent of the time. The lack of coordination prevalent in American health care results in poorer health and higher costs.
Redwood Regional Medical Group
Redwood Regional Medical Group is a physician-owned multi-specialty private practice. We have been serving patients in Sonoma County for over 50 years and now have offices throughout the North Bay. We began as a radiology practice but for several years have specialized in both radiology and cancer care. We have over 40 physicians and more than 300 in staff in 8 offices in four counties. We have state-of"the-art technology, and our radiologists read for all of the major hospitals in Sonoma County as well as for our own patients. We are particularly known for our integrated breast care program that offers all options for breast cancer care within one practice " breast imaging, breast surgery, radiation and medical oncology and a breast care coordinator to help the patient navigate.
Over the next four to five years, RRMG will be proceeding down a path that will lead to the creation of a regional integrated multi-specialty group that is physician-owned and governed. To reach this goal, not only will we be adding physicians to our practice from our region, but we will also be making a significant investment in infrastructure, such as electronic medical records (EMR), new imaging equipment and other similar types of investments. The goal is to provide the highest quality of care at the most affordable price point.
Two major challenges face our communities in the near future that will have a significant impact on the delivery and availability of health service. The first is the current economic downturn; the longer it persists, the fewer resources will be available for health care. Even with "Obamacare," if there are no additional economic resources, significant cuts will still need to be made in health care. This leads us into the other major issue, which is the lack of providers in our community. As resources are squeezed, the weakest link in the chain is the physicians and their ability to weather any reduction in economic resources. So the future could present us with a picture of fewer providers and, therefore, fewer health care services.
This is the basis for the plans as outlined in question two. We feel that if Redwood can accomplish its vision, not only will our organization survive but also the community will benefit from our initiatives.
President and CEO, St. Joseph Health System, Sonoma County
Founded by the Sisters of St. Joseph of Orange, St. Joseph Health System-Sonoma County has been serving the health needs of a multi-county region in the North Bay for 60 years. As Sonoma County's largest nonprofit employer, we employ 2,314 individuals. Our integrated health care delivery organization is sponsored by the St. Joseph Health Ministry. Its mission is to extend the healing ministry of Jesus Christ in the tradition of the Sisters of St. Joseph of Orange by improving the health and quality of life of the communities we serve. Entities include 278-bed Santa Rosa Memorial Hospital " which serves as the regional Level II Trauma Center " as well as the 80-bed Petaluma Valley Hospital, Memorial Hospice, Hospice of Petaluma, North County Hospice, St. Joseph Urgent Care clinics in Santa Rosa, Rohnert Park and Windsor, and St. Joseph Home Care Network.
Our employees offer residents of the Redwood Empire a spectrum of health care services including general acute care hospital services, trauma services, urgent care services, health prevention and promotion, outpatient behavioral health care, palliative care, rehabilitation, home care and community benefit programs that improve the health of our communities and the quality of life in Sonoma County and our region.
Santa Rosa Memorial Hospital was honored this fall to receive our 14th annual Consumer Choice award from the National Research Corp., which surveys consumers across the United States to determine the most preferred hospitals in their markets. This followed our re-designation in the spring of 2010 as a Level II trauma center serving the multi-county North Coast region of California. We look forward this year to the opening of our third urgent care clinic, in Windsor at the Shiloh Center shopping complex of Highway 101, and to the introduction of digital mammography at Petaluma Valley Hospital. At Santa Rosa Memorial, this month we became the first Bay Area hospital to offer free Skype video calling capabilities to bridge distances between newborns in our intensive care nursery and their families.
Santa Rosa Memorial recently became the second hospital in Sonoma County, along with its sister hospital, Petaluma Valley, to offer endoscopic ultrasound for the diagnosis and treatment of gastrointestinal tract cancers and other conditions. Santa Rosa Memorial also received a Joint Commission survey and site visit required for Primary Stroke Center certification, and we are now in the final stages of receiving Joint Commission certification for our stroke program. Our initiatives in workforce wellness promotion and the prevention of childhood obesity and childhood dental decay continue to grow in scope and impact throughout Sonoma County.
National health care reform will bring unprecedented changes to the field of health care. We welcome the opportunity to serve a larger number of people who will have increased access to health care services as a result of reform. Reform will incentivize all health care providers to work together more collaboratively and to integrate the delivery of care in a manner that transforms the industry as we have known it. In the midst of responding to these systemic changes, we will continue to work to close gaps in access " whether on behalf of underinsured families who lack access to oral health care and basic medical services, or whether it is working to prevent widespread conditions such as childhood obesity, heart disease, stroke and other serious illness.
We are focused on providing the highest quality, easy-to-access care at the greatest value to consumers; on delivering more value-added for health care consumers' dollars; on emphasizing prevention and management of chronic disease to reduce the need for hospitalizations; and on building and reinforcing partnerships among providers that help us to seamlessly coordinate care for the betterment of all the people we serve.
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Topics: Kaiser Permanente , Kevin Klockenga , Kirk Pappas , Martin Brotman , Mike Purvis , Nancy Oswald , Redwood Community Health Clincs , Redwood Regional Medical Group , St. Joseph Health System"Sonoma County , Sutter Health , Wayne Fairchild Categories: Conference Reports , Events , Featured List , Health Care and Senior Living , Industry News
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