An annual report on the state of health care in the region traditionally highlights hospital expansions, expensive technology and the newest leading-edge medical programs.
While area hospitals are reporting all those things, the overall vision has begun to change. Driven by pending changes under health care reform, hospitals are gearing up prevention efforts through what is called “population health management.”
The shifting paradigm is long overdue, said Dr. Matthew Masiello, director of the Center for Health Promotion and Disease Prevention at Windber Research Institute.
“Our immediate reaction when we think ‘health care’ in the United States is: We go to the hospital,” Masiello said.
“That is the problem. They are not necessarily designed to keep people healthy or prevent disease. They are designed to treat sick people.”
The chief medical officer for Conemaugh Health System says hospitals are ready to take on the prevention challenge, but financial incentives are still lagging.
“We want to begin to be more focused on health promotion and chronic disease management,” Dr. David Carlson said.
Conemaugh’s unified system is paving the way for population health management, Carlson said. The system includes Memorial, Miners and Meyersdale medical centers and a myriad of ancillary clinics and programs. By coordinating care across multiple providers, Conemaugh can help track patients’ screenings and progress on health improvement efforts.
The health system’s employee wellness program has been well received and can serve as a model for other companies and groups striving to improve health and reduce health care costs, he said.
System facilities include employee fitness centers and a tobacco-free environment to encourage healthy living. There are incentives for employees and friendly competition between departments.
Windber Medical Center is also preparing for changing payment structures, President and CEO Barbara Cliff said. The hospital is about to unveil results of its community health assessment showing how to target wellness programs through population health management.
Adult obesity rates stood out in the Windber study, she said.
“That was really No. 1 on the list,” Cliff said. “It is one area we will be looking at further in community outreach for prevention.”
Change will begin with primary care doctors, Carlson stressed.
That’s why most systems have heightened focus on those front-line providers.
Conemaugh’s newest facility is an example. Conemaugh Physician Group–St. Benedict opened in August near Carrolltown and will soon add another primary care doctor, Carlson said.
Somerset Hospital’s expanded primary care network and new wellness center illustrate the organization’s commitment to prevention, President and CEO Ron Park said from Somerset.
“We view primary care as being essential to the future of our organization,” Park said, explaining that a seventh physician and another medical professional will help Somerset Family Practice expand its hours to meet community needs.
By directing patients to an appropriate screening regimen and encouraging healthy diet and active lifestyle choices, family doctors can help patients stave off many diseases, even if they run in the family, Carlson said.
“Even if it’s inevitable, it can be delayed 15 or 20 years,” Carlson said.
“But it takes information technology and partnerships to do all that,” he continued. “We can’t go there until the payment system shifts.”
Indiana Regional Medical Center is gearing up for the change as well, President and CEO Stephen A. Wolfe said, noting that the ultimate effect is still not known.
“We are clearly seeing the industry leaving the fee-for-service model and going on a journey,” Wolfe said.
He echoed Carlson’s observation that a system approach partnering hospitals with physician networks will be the strongest approach under a reimbursement structure that bundles all payments for each patient.
But better health is not very complicated, Masiello said. The primary focus for all doctors should be encouraging and enabling patients to address a few key areas.
“It is a short list: Sleep eight hours a day; adopt a Mediterranean diet, exercise at least 30 minutes a day and stop smoking,” he said.
“Nowhere on that list is anything related to the health care industry.”
Masiello has been the region’s leading voice for preventive medicine and public health for more than a decade. Arriving in Johnstown in 1997 as a pediatrician, Masiello founded the Child/Adoles-cent Health & Wellness Council of Cambria County and went on to lead Conemaugh’s Office of Community Health before joining the Windber institute in 2008.
Although best known for his work in bullying prevention and childhood obesity, Masiello and Windber’s program has embarked on other community health initiatives, including a work site wellness program for employers.
“With growing awareness and recognition of the issues, we continue to promote evidence-based health promotion and disease prevention in large populations,” Masiello said. “It is slow and tedious, but more people are enrolling in our work site wellness programs than ever before. It is slowly working.”
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