Mercy Health uses coalition as 'listening post' to hear concerns of the poor

October 15, 2011

Group helps underserved to access health services

Mercy Health Partners of Muskegon, Mich., has found that its acquisition of a community health coalition several years ago is returning strong results: The relationship has enabled Mercy to forge stronger links to its community and to improve the system's ability to assess and address community needs.

"We have shifted the concept of community benefit away from simply listing a hospital's good deeds to a much more expansive way of assessing and providing for community needs," said Vondie Woodbury, director and a founder of the Muskegon Community Health Project. "We already were doing those things at the Health Project, so it made sense to become a part of Mercy."

On-the-ground contact with community members is a signature of the Community Health Project, and an aspect that has benefited Mercy Health Partners through the merger, said Woodbury. The program is a coalition of Muskegon agencies that has built ties to the community so that it can address health care access problems and health care disparities. The coalition does this by educating people on prevention and wellness, helping them manage chronic diseases and assisting them with enrolling in insurance and getting the care they need.

Contact with the community
Begun in 1995 as an independent community coalition, the Community Health Project formally merged with the four-hospital Mercy Health Partners in 2008.

Woodbury's responsibilities now also include being director of community benefit for Mercy Health Partners and for Trinity Health, a 47-hospital system that includes the Mercy hospitals in Muskegon.

Woodbury said being part of Mercy Health Partners allows the Community Health Project to bring its community contacts and tradition of coalition-building directly into hospital management. She said it provides enhanced community benefit to Mercy Health Partners by linking the hospitals to a wealth of independent community health efforts, ranging from diabetes control education to a local health insurance system that provides coverage to low-income workers at small businesses.

Stronger together
Dan Hale, executive vice president of the Trinity Institute for Health and Community Benefits, and interim chief executive of Trinity's Loyola University Health System, said the merger of Mercy Health Partners and the Community Health Project can serve as a model throughout the Trinity system, and can be for the rest of the nation. He said the merging of Mercy Health Partners and the health project has expanded the capabilities of the health system's community benefit work in a time of changing public health laws and the hoped-for decrease in the number of uninsured people through the federal health reform act.

"Hospitals have a tendency to be somewhat paternalistic in their views of what the community needs," Hale said. "Traditional charity care isn't the way to manage the health of a community. Charity care helps those who are already sick. Vondie's program had contacts and services in the community that, frankly, were better than what the hospitals provided. It made sense to combine them."

Hale said the merger also provides a stable administrative budget for the Community Health Project, an issue that is a source of constant strain for most independent health coalitions.

Woodbury said the Community Health Project has not lost its ability to get out into the area's communities and neighborhoods with many health needs. What it gained, she said, is direct access to the area's main hospital system.

"I can walk the halls of the hospitals and sit down with the leadership," she said. "There is so much we can do in Catholic health care, with its wonderful legacy of mission inspired by God. This is a way to integrate mission and community benefit."

Good stewardship
The Community Health Project's connections to the community also have helped Mercy Health Partners to reestablish links to patients who may be avoiding the hospital due to nonpayment of bills. The system had a list of 92 patients with overdue bills who were proving almost impossible to reach. They hadn't filled out forms, left incomplete addresses or wouldn't answer their telephones.

"I can find them," said Mimi Rankin, a diabetes outreach worker for the Community Health Project.

The coalition already had good contacts with 40 percent of the people on the hospital's list of delinquent payers. Rankin and her coworkers hit the phones and streets, reaching many of the patients and helping them fill out Medicaid forms and other paperwork. The staff signed up three patients for Social Security disability.

Reestablishing contact with these patients and addressing financial concerns they may have could remove a barrier to their seeking care in the future. It also has a positive impact on the hospital's finances.

"In six weeks, Mercy was able to recover $250,000," said Woodbury. "One of the biggest barriers to health care is the inability of patients to pay for it. A goal of community benefit is to screen people for any help they can qualify for. This improves patient outcomes and community health and, ultimately, creates good stewardship."

'Communities Joined in Action'
Hale recommends that other hospitals consider mergers or close alignments with community health initiatives to enhance community benefit. After joking that the best way to improve a community benefit program is to "find your own Vondie," Hale said many communities already have independent organizations, such as the Community Health Project, that have numerous local contacts and health care initiatives.

In 1993, the W.K. Kellogg Foundation proposed establishing a community health planning project in Muskegon County, a community of 180,000 on Lake Michigan. Woodbury joined that effort two years later and helped to create the Community Health Project. She had worked 14 years on the staff of former Democratic U.S. Sen. Donald Riegle of Michigan and was looking for ways to provide health care to the growing population of uninsured Americans. The project later received additional funding from the Robert Wood Johnson Foundation. The Community Health Project is one of nearly 200 coalitions that is part of Communities Joined in Action. Woodbury helped to found this national, private, nonprofit membership organization representing community health programs.

Bringing people to the table
The Community Health Project has become a uniter of stakeholders. It has brought together hospital administrators, doctors, employers, political leaders and ordinary citizens. In 1999, the Community Health Project helped to create Access Health, a program in the Muskegon area that provides health insurance for about 1,200 employees of participating local businesses. Access Health does that through a combination of Medicaid and state programs, premiums paid by workers and employers and compensation agreements with local doctors.

"It was a challenging dynamic having all those groups at the table," Woodbury said. "Business said, 'Whatever it is, make it cheap.' Consumers wanted something like the Teamsters Union health plan. Providers said, 'We don't get paid enough.' We broke into teams and put this system together. Our goal was to give people true medical homes, and treat them like other patients."

The key, she said, was involving advocates in the discussion who could speak on behalf of patients and put forth their needs.

This drive to understand what is needed also is key to enhancing a hospital's community benefit, Woodbury said. "Federal policy is going in a direction that says a hospital must look at its community's prevailing needs. What something like the Health Project can do, and do better with a relationship to a hospital, is more actively engage the poor and the underserved."

The Community Health Project also works on such issues as child obesity, HIV/AIDS, drug abuse and asthma. Its direct services through Mercy include wellness education, chronic disease management and dental care for the uninsured.

Linda Bailey, director of Lakeshore Health Network, a physicians' group in Muskegon, said the merger has made the Community Health Project even more effective. Bailey called Community Health Project's presence within the hospital group a "strong voice of our community directly influencing how we deliver care."

Hale said the Community Health Project brings focus to Mercy Health Partner's desire to serve its community.

"Random acts of kindness are good things," he said. "But when you attack little individual needs without seeing a bigger picture, you lose a lot of effectiveness. Bringing this effort into our senior leadership group leads to a more organized and efficient approach to the good we seek to do."

 

Copyright © 2011 by the Catholic Health Association of the United States
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