Delivery in a Rural Setting
February 12, 2013

Please note that the views expressed by the conference speakers do not necessarily reflect the views of the
American Hospital Association and Health Forum.

Lori Williams,
Illinois Hospital Association
Vice President, Small & Rural Hospital Affairs

Illinois Hospital Association
• Offices in Naperville,
Springfield and
Washington, D.C., an advocate for 200 hospitals and health systems
• 88 are considered
Small & Rural
• 51 are Critical Access
Hospitals
4

Hospitals as Leaders in Rural
Communities
Small & Rural Hospitals in Illinois:
• Provide 65,380 direct and indirect jobs
• 1 of the top 3 employers in most rural counties
• Contribute $9.9 billion to rural economies
• Leading health care transformation
5

Adopted by the Centers for Medicare and Medicaid
(CMS), the goals of the Triple Aim are defined as:
• Improving Health Care
• Patient Experience
• Quality
• Improving Health & Wellness
• Reducing cost
6

Building Value Based Systems in rural communities
Rural Hospitals:
• Expanding access to primary care
• Focusing on Prevention & Wellness
• Developing care coordination services
• Using technology in new ways
• Moving from inpatient to outpatient services
• Partnering with other health providers
7

Health Screening
& Assessment
Value-Based Care
Health
Coaching Medical Home
Disease
Management
Compliance and
Community
Support Services
Better Health!
Lower Costs!
Stephanie McCutcheson and Associates, 2011

9
®
Advocating for Superior Healthcare
Harry Wolin, Administrator/CEO
Mason District Hospital
Havana, Illinois

®
IHAP is a disease management program that allows employers to reduce their healthcare costs, reduce future liabilities, and maximize the health of the highest utilizers in an organization.
10

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We exist to serve the health care needs of the community in a cost effective manner with a constant striving for the highest quality care, to maintain a strict standard of professional and ethical behavior, and to always place the patient at the center of our activities.

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Mason County
• With 14,666 people, Mason County is the 77 counties.
th most populated county in the state of Illinois out of 102
• In 2010, the median household income of Mason County Residents was $42,461.
• 15.5% of Mason County residents live in poverty.
• The median age for Mason County residents is 44.0 years young.
• The largest Mason County racial/ethnic groups are White
(97.5%) followed by two or more races (0.9 %) and Hispanic (0.8%).
US Census Bureau, 2010 Census

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– 269 Employees:
• 9 active medical staff members/physicians
• 198 total physicians/allied health care providers
• 55 volunteers
– $24,068,598 Annual Budget
– 1,466 Annual Admissions
– 14,370 Annual Ambulatory Clinic Visits
– 24,338 Annual Hospital Outpatient Visits
– Serves more than 18,000 people in west-central IL

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• Healthcare is the largest component of employee benefit costs
• 80% of healthcare dollars are used by 20% of benefit plan participants
• The largest amount of healthcare dollars are spent by those with multiple chronic illnesses or about 5% of people
• This 5% spends half of the healthcare dollars and incurs the largest claims each year

Anderson, G. (2010) Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation.

Anderson, G. (2010) Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation.

Anderson, G. (2010) Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation.

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Unique Solution To A Growing Problem
Lowers risk future liabilities
Tested
Strategy with Sustained
Outcomes
Improves
Participants’
Health
Reduces
Healthcare
Costs
Educates and
Supports
Employees

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®
Primary
Advocate
Psychosocial
Advocate
Medical
Advocate
Primary Advocate /
Registered Nurse
Psychosocial Advocate/
Counselor, Psychologist or
Social Worker
Medical Advocate /
Medical Doctor/Mid Level

Participant and Advocate Responsibilities
• Productive
Participation
• Calendars/ Diaries
• Regular Instruments
Participant
Team to
Participant
• Confidentiality
• Education
• Empowerment
• Cost Effectiveness
• Documented
Progress
• Outcomes Reporting
Team to
Plan
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• Risk assumes the average of the minimum and maximum potential claims liability of an identified group of high-risk individuals
• Cost is a calculation of Company ABC’s historical claims data (2008-2010) plus the cost for 36 months of the IHAP program (assuming 100% participation)
Risk
Cost + IHAP Costs for 36 Months
=
Projected
Return on Investment
22

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Mason District Hospital participant health care costs 2009-2011

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 Data supports the money saved:
• Every $1 spend saved $4 o Reinvested the money into preventative care
 Positive Outcomes
• Decreased Absenteeism
• Self Directive Testing
• Patients feel better

®
Length of employment
Number of current health problems
2 to 36 years
1 to 13
Current medications
Hours of sleep per night
Chronic health issues/conditions reported by IHAP Team
2 to 17
3 to 12
14 to 27
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“ A focus on a small population of intensive users could have the potential for improving care for all.
”
R. Blendon (Harvard School of Public Health),
C. Shoen (The Commonwealth Fund), et. al.; Project Hope,
The People-to-People Health Foundation, Inc., 2003

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®
“ The program DOES change people ’ s lives and has proven to be replicable across teams/organizations.
”
“ The program is helping people and the spirit of the program is aligned with our values as an organization.
”
“ The philosophy, principles, and impact of the program make me proud to sponsor these teams.
”

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McDonough District Hospital in Macomb, IL
Kenneth Boyd,
Chief Executive Officer

McDonough District Hospital
Mission Statement
The mission of McDonough
District Hospital, in partnership with its Medical Staff, is to provide health services with a personal approach to care that enhances the quality of life.
Vision Statement
To be your First Choice for First Class
Health Services
Core Values
Honesty and Integrity, Respect,
Exceptional Service, Commitment to
Excellence and Teamwork

 72 Staffed Bed General Medical Surgical Hospital
 Hospital services include: behavioral health, cancer care, cardiopulmonary, diabetes education, home health, hospice, dialysis, laboratory, radiology, transitional care, food nutrition, emergency room, surgery, and wound management.
 Outpatient rehab services include Physical Therapy,
Speech-Language Pathology, Cardiac, Pulmonary,
Industrial & Sports Rehab. Inpatient rehab services include physical, occupational & speech therapy.

 620 Total Employees:
• 38 active medical staff members/physicians,
• 85 consulting medical staff, 48 telemed staff, 35 allied health providers for a total of 206 “providers” on staff
• 150 active volunteers
 Annual Budget - $143M gross/$71.8M Net
 2,350 Annual Admissions
 30,000 Visits to employed physician offices & 7,300 to our Convenient Care Clinic
 48,000 Annual Hospital Outpatient Visits

The PSA has an estimated total population of 31,998 (2011) which has the following demographic characteristics:
 Median age: 24.7 years
 Median household income: $34,990
 Racial and ethnic distribution: 88% Caucasian, 5% African American, 3%
Asian, 2% Hispanic of any race, 2% all other
The SSA has an estimated population of 16,769 (2011) which has the following demographic characteristics:
 Median age: 44.0 years
 Median household income: $41,694
 Racial and ethnic distribution: 97% Caucasian, 1% Hispanic of any race, 2% all other

MDH has identified 68 zip codes surrounding the primary and secondary service areas as potential growth opportunities.
Residents of this expanded service area (ESA) contribute 8% of the hospital’s inpatient admissions and 5% of its ER visits.
 The ESA has an estimated population of 104,356 (2011) which has the following demographic characteristics:
• Median age: 40.7
• Median household income: $41,081
• Racial and ethnic distribution: 90% Caucasian, 5% Hispanic of any race, 4% African American, 1% all other

Voluntary Program rolled out to McDonough District
Hospital Employees in August, 2012
Core components of MDH LifeSteps© Program:
1. Biometric Screening; Full Gamut of Laboratory Tests then 6 month screenings thereafter
2. Online Health Risk Assessment; Software Program

Purchased with partnership

Identifies top risk factors of population

Participants receive access to patient portal
3. Online health resource library, monthly newsletters and challenges, and wellness activities
4. 3 Mayo Certified Wellness Coaches

Summary Findings of First Cohort:
 301 Active participants
 Overall, participation rate of 53%; 65% of management staff
 98% “Very Satisfied”
 Top three modifiable risk factors; Physical activity, Weight
Management; Osteoporosis risk
 Goal: Reduction of top 3 modifiable by 30%; over three years

 Focusing on Life Style Choices – Health Improvement –
Personal Responsibility
 Cash Incentives for:
• Annual Health Screenings
• Flu Shots
• Exercise Programs
• Wellness Challenges
• Full participation in MDH LifeSteps© program = zero increase in employee out of pocket cost in health premium responsibility

Trial partnerships with small to medium sized employers within MDH service area
 McDonough Telephone Cooperative: secured
 Other identified partners for approach: City of Macomb, McDonough
County (Board and employees), McDonough County YMCA.
 Allowing Business Partners reduced cost for trial as well as choice of program components
 Analyzing Data Collection
 Development of company wellness plan specific to Business Partner’s employee population & business model
 Opportunity to integrate MDH LifeSteps© with Business Partner’s insurance carrier and health plan design

Contact Information:
Harry Wolin,
Administrator & CEO
Mason District Hospital h-wolin@masondistricthospital.org
(309) 543-8575
Kenneth Boyd,
Chief Executive Officer
McDonough District Hospital kdboyd@mdh.org
(309) 833-4101
Lori Williams
V.P. Small & Rural Hospital Affairs
Illinois Hospital Association lwilliams@ihastaff.org
(217) 541-1164