Boosting access to care for underserved communities: 4 systems share their stories

As hospitals and health systems seek to create more access points to meet demand for healthcare, they are particularly focused on access to care for underserved communities. 

Becker's reached out to healthcare leaders to learn how they are addressing the issue.

Those efforts range from a Center for Health Equity to mobile clinics.

Here are their responses:

Note: Responses are lightly edited for length and clarity.

Mark Clement. President and CEO of TriHealth (Cincinnati): TriHealth is accelerating our efforts to proactively address health disparities, achieve greater health equity, and increase access to care throughout our community.

Last year, TriHealth announced the creation of its Center for Health Equity — Greater Cincinnati's first and only institute of its kind in an adult health care system dedicated to eliminating health disparities. The Center for Health Equity will leverage new and existing health system resources and competencies, ranging from analytics and data management to LEAN and performance improvement to care coordination and community organizing/advocacy. The Center for Health Equity will enable TriHealth to prioritize and proactively address social determinants of health and health disparities in order to achieve better health outcomes and greater health equity for ALL patients cared for at TriHealth and across the community.

And while we officially launched the Center for Health Equity last year, we've been finding ways to provide necessary health care for the underserved for even longer. Since opening in 2011, TriHealth's Good Samaritan Free Health Center has helped thousands of uninsured, non-Medicaid/Medicare-eligible adults find a medical home where they are able to receive regular primary health care.

All of this important work is foundational to our mission to serve the health needs of our entire community and our long-term vision of getting healthcare right by delivering the right care in the right way in the right place at the right cost to produce the right and equitable health outcomes, always.

David Jones. Market President, Critical Access Hospitals, CommonSpirit Health Central Region (Missouri Valley, Iowa): CommonSpirit Health is increasing access to care for underserved communities through providing the appropriate tools in order for our CHI critical access and rural hospitals to succeed.

Rural America has the oldest, aging and sickest population with the least amount of providers available. CommonSpirit recognizes this growing issue, and has created a critical access/rural market as one tool to combat the issue. This market has a committed leadership team, including myself. The market president's team has a devoted rural team with rural focus, including, but not limited to, a CFO, chief medical officer, chief nursing officer, strategist, mission, human resources, compliance, and a director of operations. This team's approach is to find ways to support CommonSpirit's critical access and rural hospitals.

In critical access, we ARE the community. If the hospital fails, so do our communities. One hundred percent of our time is dedicated toward ensuring our communities have every healthcare need met, including our most vulnerable, the oldest, aging and sickest.

This critical access team and resources listen to employees and patients located in the  communities we serve and, when tools are identified to increase access for underserved communities, CommonSpirit is able to adapt quickly, and provide any tool necessary. 

For example for our CAHs, the three main reasons for being unable to accept new patients included: Staff training, equipment and environment. Without these items, patients were turned away if they required bariatric care, dialysis or had large wounds.  

Within months of providing the CAH or rural hospital with the training, equipment and environmental upgrades necessary, census tripled, and, in some cases, even quadrupled. Again, the reason for the census influx is due to the staff now being prepared through education and connection of purpose to take patients they were unable to see before. 

Their working environment was processed through checklists which widened doors to ensure we had the correct equipment and training to accept  bariatric patients, which was not previously an option. To ensure staff was ready to manage larger wounds, CommonSpirit sent select nurses back to school for continuing education so they would be prepared to take care of these patients moving forward. 

This approach has not only increased access for the underserved communities, but our communities as a whole, which has helped lead us to meet and exceed in areas of employee engagement, patient experience, quality management, and financial stability.

This dedicated market has also given us the opportunity to share staff throughout our CAH and rural hospitals, and provides increased access for community members that might not require a full-time specialist. 

Another successful approach is for our 21 CAHs and rural hospitals to work with other healthcare systems to receive patients. This helps not only increase services for both healthcare organizations, but frees up beds throughout larger facilities. The result of this approach includes less time for patients in underserved communities not having to wait in the emergency room due to a lack of bed availability in more metropolitan hospitals who could potentially offer services CAHs and rural hospitals were previously unable to provide.  

CommonSpirit's dedicated critical access/rural market is able to wholly support our mission and result in increased access to care for our underserved communities.

Constance O'Malley. Regional COO at University of Michigan Health (Lansing): We are opening a new pain and rehab center in our Ionia, Mich., area. The pain center opened May 7, and the rehab center will be opening June 1. We're trying to increase access in some of our critical access areas like Ionia.

In addition to that, we just opened a new school-based clinic in Grand Ledge on April 22. That was to increase access for young people from ages 5-21. That's for well visits, potentially behavioral health visits, immunizations, also non-well visits. That clinic is open to the community as well as being attached to the school so if there are any children who need immediate access to healthcare, we have that clinic on-site at Grand Ledge High School. 

We have three critical access hospitals in Eaton, Ionia and Clinton, and these are really critical to communities they serve. Those are 25-bed hospitals but also have full outpatient services for the community. We're trying to deploy our specialists out to those community areas. Specialists like interventional radiologists, our pulmonary team, our ENT and dermatology team. Some of those are going to be rolling out this fall, and some are already in place.

We have a mobile health clinic, and we have ramped that up over the last year. That mobile clinic is moving four to five days a week now and going to multiple areas within the state where we know there is a need for access to patients. That clinic is staffed by a physician assistant and a medical assistant and is providing healthcare to the communities it's moving to. We're trying to reach out to the community directly so we can provide that service to them in their home community.

We're working on a food bank. Eaton Community Health partnered with University of Michigan Health-Sparrow Eaton Hospital. We're in the process of setting that up right now at the hospital.

Our home care team here is open to underinsured as well as Medicare, Medicaid and all other insurances. So we really are filling the gap for the community with regard to Medicaid and underinsured for home care services. We are one of the few in Lansing and the greater area to provide home care services for those who need it. We do in-home care as well as virtual.

Also, we're serving the Carson City community. That is the kind of rural area sometimes lacking in health care resources and accessibility. We're adding services to that area as well specialists and other services people might be trying to access from very far away. 

The communities have responded very positively to the changes we're making, and they are accessing those services. They're happy, and we're trying to allow people to get care close to home, and only come to the larger hospitals when they need to, so we can get that access to care out in the community.

Kirsten Riggs, BSN, RN. Interim president of UNC Health Rex (Raleigh, N.C.): We have worked hard with the North Carolina Department of Health and Human Services to enroll patients who are newly eligible for Medicaid. We created a campaign and will have one of the first enrollment events on May 18 in our Smithfield area, which is in Johnston County. It's a county within our system service area that UNC Rex supports through outreach. The hope is that we'll drive eligible patients in, help them apply for Medicaid, and then follow the process. We believe that will have a positive impact in the community by helping patients navigate an important, but complicated process.

The other thing we're expanding is using mobile clinics to improve care and certain services in the rural parts of our state, or where we know there's a healthcare desert. One example is our mobile mammography. We travel to employers, churches and public health clinics to provide those important screening services to women, and then introduce them to other options while they're there if they're in need of other services. We also do that for heart and vascular screenings for peripheral vascular disease and have a standing support circuit at one of our Federally Qualified Health Centers. This organization treats patients who aren't eligible or haven't traditionally been eligible for Medicaid. Now with the Medicaid expansion, we're partnering with them to figure out how best to support their ability to navigate their patient population. 

One thing that's exciting that's coming up is a new hearing and speech mobile clinic for children. That will increase access to important hearing and speech care for children across our state, especially in underserved rural areas that lack appropriate resources.

Additionally, we just had a ribbon cutting at our new Beacon Point clinic in southeast Raleigh. It's one of the poorer areas within the county, and there is a lot less access to primary care, specialty care, pediatric care and more. We're partnering with Advance Community Health, one of those FQHCs, to co-locate primary and specialty care in adjacent clinics. Our specialty services include gastroenterology, heart and vascular and sickle cell services. Part of what we're doing in that space is they kicked off their obstetrics platform, and we'll be the group that delivers for them. Patients will come to our hospital for delivery and immediate postpartum care. Then the hope, in partnership with this FQHC, is that the patients who are supported can return to their primary care and we will ensure that the child and the mother are cared for quickly. Previously, it was challenging for new moms to navigate those resources. We're hopeful it will be a model for the future. 

At UNC Rex, we've also partnered with Food Lion to open a food pantry in the hospital. The patient or their family gets a prescription, and based on the diet or the needs they have, we will make sure they go home with food to help them continue to heal. That's been successful in helping patients before they are discharged from the hospital.

One other example is having social workers in our emergency department provide support and access to patients who don't have primary care, or are uninsured. It's a great way to ensure they get follow-up visits before they leave the hospital. Then post-discharge, those social workers follow up and partner in hopes of helping that patient get care necessary to keep them out of the hospital. We're trying to better understand if we can get them tied in, have all the resources, make it easy for the patient, then maybe they won't use the ED as much as they have in the past. From a mission perspective, we're driven to provide care to everyone, and this is a great way to do it. 

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