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 Environment Problems  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 Environment Strengths  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. UHC Downtown 123,000 visits UCCH 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

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 Uninsured The 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 Uninsured The 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 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????????????????