Improving the Improving the HealthHealth of of the Community in San the Community in San

Antonio & Bexar County:Antonio & Bexar County:

Realities, Challenges, & Realities, Challenges, & PossibilitiesPossibilities

Texas State UniversityTexas State UniversityHealth Administration ConferenceHealth Administration Conference

November 17, 2006November 17, 2006

San Antonio EnvironmentSan Antonio EnvironmentProblemsProblems

A relatively poor community; about 1 A relatively poor community; about 1 in 5 families in povertyin 5 families in poverty

High % of self employed or High % of self employed or employment in the service industriesemployment in the service industries

About 25% of the population is About 25% of the population is uninsureduninsured

High incidence of diabetes, heart High incidence of diabetes, heart disease, obesity, late prenatal caredisease, obesity, late prenatal care

San Antonio EnvironmentSan Antonio EnvironmentStrengthsStrengths

Economic growth (Toyota, AT&T, new Economic growth (Toyota, AT&T, new Texas A&M campus)Texas A&M campus)

Growing cooperation between City Growing cooperation between City and County leadersand County leaders

Growing cooperation between Growing cooperation between hospital system leadershiphospital system leadership

University Health System (Bexar University Health System (Bexar County Hospital District) is financially County Hospital District) is financially strong with no significant debtstrong with no significant debt

University Health SystemUniversity Health System

University Hospital (560 beds and University Hospital (560 beds and Level III Trauma Center)Level III Trauma Center)

Two large multi-specialty outpatient Two large multi-specialty outpatient centerscenters

Four primary care clinicsFour primary care clinics Airlife emergency air transport Airlife emergency air transport

system (co-owned with Baptist system (co-owned with Baptist Health System)Health System)

Community First Health Plans Community First Health Plans

UHC Downtown

123,000 visitsUCCH

90,000 visits

UH-EC

70,000 visits

Southwest

50,000 visits

Southeast

57,000 visits

UPG Diag.Pav.

62,000 visits

North

28,000 visits

UH Express Med

21,000 visits

CHCS-DT

14,000 visits

Outside PCPs

33,000 visits

Outside Specialists

7000 visits

Primary Care

329,000 visits

Specialty Care

239,000 visits

Emergency Care

70,000 visits

Hospital

Care

UH Clinics

73,000 visits

68%UHS;32%UTM

45%UHS;55%UTM

UHS Outpatient Network

By Level of Care &

Annual Volume of Activity

(based on 2006 YTD)

NW

10,000 visits

DT ExpressMed

37,000 visits

22,000 Admissions

ChallengesChallenges Financing Care for the UninsuredFinancing Care for the Uninsured The Impact of Mental The Impact of Mental

Illness/Substance Abuse and Lack of Illness/Substance Abuse and Lack of ResourcesResources

Moving Along the Continuum to the Moving Along the Continuum to the Prevention Model (from the Curative Prevention Model (from the Curative Model)Model)

Health Care Information/Technology Health Care Information/Technology ImplicationsImplications

Health Care Manpower NeedsHealth Care Manpower Needs Continued Growth of CollaborationContinued Growth of Collaboration

Financing Care for the UninsuredFinancing Care for the UninsuredThe Code Red ReportThe Code Red Report

Texas: “first in football; last in health care Texas: “first in football; last in health care funding for the uninsured”funding for the uninsured”

Texas Medicaid largely covers pregnant Texas Medicaid largely covers pregnant women and children; care for the women and children; care for the remainder of the poor largely falls to remainder of the poor largely falls to counties, where there are huge inequities counties, where there are huge inequities in coverage (urban v. rural); ex:Bexar at in coverage (urban v. rural); ex:Bexar at 200% poverty, rural counties at 21%200% poverty, rural counties at 21%

Texas does not take advantage of federal Texas does not take advantage of federal match to expand the Medicaid programmatch to expand the Medicaid program

Financing Care for the UninsuredFinancing Care for the UninsuredThe Code Red ReportThe Code Red Report

Inadequacies in funding for indigent Inadequacies in funding for indigent care drive these patients to care drive these patients to emergency centers for non-emergent emergency centers for non-emergent care; (ERs historically do not address care; (ERs historically do not address the need for management of chronic the need for management of chronic illnesses)illnesses)

See the Code Red Report at See the Code Red Report at www.utsystem.edu/hea/coderedwww.utsystem.edu/hea/codered

Mental Illness & Substance AbuseMental Illness & Substance Abuse

Estimated 135,000 adults in Bexar Co. Estimated 135,000 adults in Bexar Co. experience depression or other mental experience depression or other mental disorder; about 76,00 have a serious disorder; about 76,00 have a serious mental health problemmental health problem

Estimated 73,000 in Bexar County are Estimated 73,000 in Bexar County are dependent on alcohol or drugsdependent on alcohol or drugs

The effective treatment of physical The effective treatment of physical diseases and disorders is often diseases and disorders is often compromised by mental illness and/or compromised by mental illness and/or substance abusesubstance abuse

Major impact on ER overutilizationMajor impact on ER overutilization

Mental Health FundingMental Health Funding

Mental health services for the poor Mental health services for the poor remain significantly underfunded and remain significantly underfunded and are primarily available for only are primarily available for only severe mental illnesses of the severe mental illnesses of the uninsureduninsured

Detox and substance abuse Detox and substance abuse treatment programs are largely treatment programs are largely unavailable for the indigentunavailable for the indigent

Mental Health ServicesMental Health Services In Bexar County, an evolving In Bexar County, an evolving

integration between the University integration between the University Health System and the local mental Health System and the local mental health authority (Ctr. for Health Care health authority (Ctr. for Health Care Svcs.) may maximize use of available Svcs.) may maximize use of available resources and accessresources and access

Intended is an eventual integration of Intended is an eventual integration of mental health services into the mental health services into the medical model (instead of separate medical model (instead of separate systems)systems)

Moving Toward PreventionMoving Toward Prevention

The curative model is not sustainableThe curative model is not sustainable Root cause analysis: put $$$ in Root cause analysis: put $$$ in

prevention and health promotion & prevention and health promotion & educationeducation

Example: less than half of the over Example: less than half of the over 50 population get colonoscopies 50 population get colonoscopies (could save 30,000 lives per year and (could save 30,000 lives per year and associated costs)*associated costs)*

*Colon Cancer Alliance

Integration of Health System with Integration of Health System with S.A. Metro Health DistrictS.A. Metro Health District

New agreement just signed to jointly New agreement just signed to jointly plan to better align and plan to better align and collaboratively provide servicescollaboratively provide services

Eventual consolidation of the two Eventual consolidation of the two entities (endorsed by Mayor & entities (endorsed by Mayor & County Judge)County Judge)

Goal: push preventive model and Goal: push preventive model and health promotion activities further health promotion activities further into the community (to change into the community (to change behaviors & lifestyles)behaviors & lifestyles)

Health Information & TechnologyHealth Information & Technology

Will the single PCP for each patient Will the single PCP for each patient model become obsolete??model become obsolete??

Sharing of clinical information to Sharing of clinical information to reduce duplication and maximize reduce duplication and maximize effectiveness of the visiteffectiveness of the visit

EMRs to improve patient safety & EMRs to improve patient safety & implement evidence-based disease implement evidence-based disease protocols (UHS has just implemented protocols (UHS has just implemented EMR)EMR)

Health Information & TechnologyHealth Information & Technology

Increased reliance on information Increased reliance on information systems to bring the right treatment systems to bring the right treatment to the right patient (extension of the to the right patient (extension of the physician)physician)

Beginnings: Austin’s ICC and San Beginnings: Austin’s ICC and San Antonio’s ACU will provide basic Antonio’s ACU will provide basic patient information across traditional patient information across traditional provider boundaries to decrease provider boundaries to decrease duplication and improve quality of duplication and improve quality of carecare

Health Care ManpowerHealth Care Manpower

Physician, nursing, and technical Physician, nursing, and technical staff requirements are growing with staff requirements are growing with no organized plan for where these no organized plan for where these staff will come fromstaff will come from

Health systems will need to partner Health systems will need to partner with local school districts, community with local school districts, community colleges, and universities to assure colleges, and universities to assure an adequate number of students in an adequate number of students in the pipelinethe pipeline

Need for Increased CollaborationNeed for Increased Collaboration

We must maximize use of existing We must maximize use of existing resources and eliminate duplicationresources and eliminate duplication

University Health System Partners: SA University Health System Partners: SA Metro Health, Community Primary Care & Metro Health, Community Primary Care & Specialty Physicians, O/P Surgicenters; Specialty Physicians, O/P Surgicenters; Center for Health Care Services (mental Center for Health Care Services (mental health); educational institutionshealth); educational institutions

TrendsTrendsKeep pushing prevention, health Keep pushing prevention, health

promotion, and primary care into promotion, and primary care into the homes, churches, schools, the homes, churches, schools, and communitiesand communities

Change the funding models to Change the funding models to pay for these activitiespay for these activities

Incorporate mental health and Incorporate mental health and substance abuse treatment into substance abuse treatment into the primary care modelthe primary care model

Trends (cont.)Trends (cont.) Attempt to address the inequities of Attempt to address the inequities of

indigent care funding across county indigent care funding across county lines in Texas; maximize use of lines in Texas; maximize use of available federal fundsavailable federal funds

Develop hospital/health care system Develop hospital/health care system partnerships with educational partnerships with educational institutions (start at middle & high institutions (start at middle & high school levels)school levels)

Collaborate with other local systems Collaborate with other local systems to begin developing regional health to begin developing regional health information organizations and information organizations and systemssystems

A Nexus of Collaboration:A Nexus of Collaboration:Plans for the University Health Plans for the University Health

Center-DowntownCenter-Downtown Mental Health Authority services Mental Health Authority services

already presentalready present SA Metro Health offices to relocateSA Metro Health offices to relocate UT School of Public HealthUT School of Public Health Connection to a central city health Connection to a central city health

careers high school under discussioncareers high school under discussion Continuation of primary care and Continuation of primary care and

outpatient diagnostic & specialty outpatient diagnostic & specialty servicesservices

Keep planning, keep “visioning”, Keep planning, keep “visioning”, keep keep TALKINGTALKING

Questions????????????????Questions????????????????