Improving the Health of the Community in San Antonio & Bexar County: Realities, Challenges, & Possibilities

1. Improving the Health of the Community in San Antonio & Bexar County:Realities, Challenges, & Possibilities Texas State University Health Administration Conference November 17, 2006

2. San Antonio EnvironmentProblems • A relatively poor community; about 1 in 5 families in poverty • High % of self employed or employment in the service industries • About 25% of the population is uninsured • High incidence of diabetes, heart disease, obesity, late prenatal care

3. San Antonio EnvironmentStrengths • Economic growth (Toyota, AT&T, new Texas A&M campus) • Growing cooperation between City and County leaders • Growing cooperation between hospital system leadership • University Health System (Bexar County Hospital District) is financially strong with no significant debt

4. University Health System • University Hospital (560 beds and Level III Trauma Center) • Two large multi-specialty outpatient centers • Four primary care clinics • Airlife emergency air transport system (co-owned with Baptist Health System) • Community First Health Plans

5. UH Express Med 21,000 visits NW 10,000 visits North 28,000 visits Southeast 57,000 visits Outside PCPs 33,000 visits Southwest 50,000 visits Primary Care 329,000 visits DT ExpressMed 37,000 visits UPG Diag.Pav. 62,000 visits UHC Downtown 123,000 visits UCCH 90,000 visits Specialty Care 239,000 visits CHCS-DT 14,000 visits UH Clinics 73,000 visits 68%UHS;32%UTM Outside Specialists 7000 visits 45%UHS;55%UTM UH-EC 70,000 visits Emergency Care 70,000 visits UHS Outpatient Network By Level of Care & Annual Volume of Activity Hospital Care 22,000 Admissions (based on 2006 YTD)

6. Challenges • Financing Care for the Uninsured • The Impact of Mental Illness/Substance Abuse and Lack of Resources • Moving Along the Continuum to the Prevention Model (from the Curative Model) • Health Care Information/Technology Implications • Health Care Manpower Needs • Continued Growth of Collaboration

7. Financing Care for the UninsuredThe Code Red Report • Texas: “first in football; last in health care funding for the uninsured” • Texas Medicaid largely covers pregnant women and children; care for the remainder of the poor largely falls to counties, where there are huge inequities in coverage (urban v. rural); ex:Bexar at 200% poverty, rural counties at 21% • Texas does not take advantage of federal match to expand the Medicaid program

8. Financing Care for the UninsuredThe Code Red Report • Inadequacies in funding for indigent care drive these patients to emergency centers for non-emergent care; (ERs historically do not address the need for management of chronic illnesses) • See the Code Red Report at www.utsystem.edu/hea/codered

9. Mental Illness & Substance Abuse • Estimated 135,000 adults in Bexar Co. experience depression or other mental disorder; about 76,00 have a serious mental health problem • Estimated 73,000 in Bexar County are dependent on alcohol or drugs • The effective treatment of physical diseases and disorders is often compromised by mental illness and/or substance abuse • Major impact on ER overutilization

10. Mental Health Funding • Mental health services for the poor remain significantly underfunded and are primarily available for only severe mental illnesses of the uninsured • Detox and substance abuse treatment programs are largely unavailable for the indigent

11. Mental Health Services • In Bexar County, an evolving integration between the University Health System and the local mental health authority (Ctr. for Health Care Svcs.) may maximize use of available resources and access • Intended is an eventual integration of mental health services into the medical model (instead of separate systems)

12. Moving Toward Prevention • The curative model is not sustainable • Root cause analysis: put $$$ in prevention and health promotion & education • Example: less than half of the over 50 population get colonoscopies (could save 30,000 lives per year and associated costs)* *Colon Cancer Alliance

13. Integration of Health System with S.A. Metro Health District • New agreement just signed to jointly plan to better align and collaboratively provide services • Eventual consolidation of the two entities (endorsed by Mayor & County Judge) • Goal: push preventive model and health promotion activities further into the community (to change behaviors & lifestyles)

14. Health Information & Technology • Will the single PCP for each patient model become obsolete?? • Sharing of clinical information to reduce duplication and maximize effectiveness of the visit • EMRs to improve patient safety & implement evidence-based disease protocols (UHS has just implemented EMR)

15. Health Information & Technology • Increased reliance on information systems to bring the right treatment to the right patient (extension of the physician) • Beginnings: Austin’s ICC and San Antonio’s ACU will provide basic patient information across traditional provider boundaries to decrease duplication and improve quality of care

16. Health Care Manpower • Physician, nursing, and technical staff requirements are growing with no organized plan for where these staff will come from • Health systems will need to partner with local school districts, community colleges, and universities to assure an adequate number of students in the pipeline

17. Need for Increased Collaboration • We must maximize use of existing resources and eliminate duplication • University Health System Partners: SA Metro Health, Community Primary Care & Specialty Physicians, O/P Surgicenters; Center for Health Care Services (mental health); educational institutions

18. Trends • Keep pushing prevention, health promotion, and primary care into the homes, churches, schools, and communities • Change the funding models to pay for these activities • Incorporate mental health and substance abuse treatment into the primary care model

19. Trends (cont.) • Attempt to address the inequities of indigent care funding across county lines in Texas; maximize use of available federal funds • Develop hospital/health care system partnerships with educational institutions (start at middle & high school levels) • Collaborate with other local systems to begin developing regional health information organizations and systems

20. A Nexus of Collaboration:Plans for the University Health Center-Downtown • Mental Health Authority services already present • SA Metro Health offices to relocate • UT School of Public Health • Connection to a central city health careers high school under discussion • Continuation of primary care and outpatient diagnostic & specialty services

21. Keep planning, keep “visioning”, keep TALKING • Questions????????????????