by Jaron Terry, APR
Brought together by community leaders two years ago to address central Ohio’s most pressing health issues, the chief executive officers of Columbus’s four major hospital systems joined forces to create a healthier city and coordinate care for its most vulnerable populations. Along the way, they have also improved health outcomes and lowered costs for all. Is this a model for other cities? How about the nation?
Just as competitive siblings will close ranks to face down a bully, so the four major healthcare systems in Columbus have come together to address a growing problem in central Ohio: how to provide quality care for all persons in a community where the demand for charity care rose 163 percent in just five years — while the gap between the cost of care and government reimbursement widens.
This major issue poses significant challenges to Columbus’s not-for-profit healthcare systems’ ability to provide quality care. It also threatens the very fabric of the community as the quality of life for its citizens, the fiscal health of its businesses and the health of its most needy and vulnerable residents are in danger of unraveling.
In June 2008, the Central Ohio Hospital Council (COHC) was formed to address this unsustainable demand for unreimbursed care and to provide a forum for the four healthcare systems to collectively improve the health of the community. They are doing so by collaborating on high-impact initiatives, such as increasing access to health screenings and mental health services, improving the overall quality of care in key areas, enhancing patient safety and advocating to cost-effectively bring innovative new therapies to the citizens of central Ohio.
“We are very fortunate in Columbus to have a high quality healthcare system in place, led by truly great leaders who are willing to put collaboration before competition for the good of the community,” says John F. Wolfe, chairman and chief executive officer of the Dispatch Printing Company.
Wolfe serves as vice-chair of the Columbus Partnership, an organization of 30 top business and community leaders in central Ohio, which is studying problems raised by COHC members. With a mission to improve the economy and to be a catalyst for growth in the region, the Columbus Partnership focuses on five important issues: economic development, leadership and philanthropy, arts and culture, education, and health care.
With $4.5 billion in patient revenue generated by the four healthcare systems, which together account for approximately 31,000 jobs in the region, the looming crisis has moved to the forefront of the Partnership’s agenda. In 2008, the Partnership convened the Community Healthcare Task Force, which Wolfe chairs. Through it, the four Columbus healthcare systems’ chief executive officers began a more formal dialogue, replacing the ad hoc conversations of the past.
“Health care is a huge component of economic development,” Wolfe explains. “To attract people to our community – including top-flight executives and professionals – it is imperative to offer a high-quality lifestyle. Because having good health is central to quality of life, a healthcare system that makes a commitment to – and provides its citizens access to – high-quality health care is essential.”
In December 2009, COHC released its first report, “Connected to the Community” (available at http://www.centralohiohospitals.org/media.html), which details the nearly $400 million in community benefits (see box at right) the four systems collectively provided in 2008.
“Free care is not free,” says Jeff Klingler, president and chief executive officer (CEO) of COHC, which he joined after 17 years with the Ohio Hospital Association. “For every dollar of care that is unreimbursed, one or more of the community benefits other than charity care are put in jeopardy.”
Community benefits include health-improvement activities such as mobile mammography services taken to neighborhoods, strategies to reduce premature births, educational initiatives on chronic conditions and plans for reducing obesity rates (see sidebar story on next page: “What’s Next for COHC?”).
Many outcomes of these community benefits are intangible, such as healthier people who are not only good workers with low absentee rates but also more stable individuals able to raise healthier children. In addition, the better informed employers, community leaders and elected officials are about health issues, the more they will understand the need for quality healthcare services both for economic and humanitarian reasons.
“COHC is a valuable forum for bringing all of us together to discuss and address the major challenges we face in our ongoing efforts to continue to deliver high-quality, accessible and affordable health care to the citizens of central Ohio,” says David Blom, president and chief executive officer of OhioHealth. “Successful collaborations, such as the Solutions for Patient Safety initiative and our partnership to improve access to care for mental health patients, are making a real difference and improving the health of our community. We know there is much more we can do together. Ultimately, our not-for-profit healthcare systems belong to the community, and it is our responsibility to work together to be responsive to their healthcare needs.”
Steven G. Gabbe, MD, senior vice president for Health Sciences and chief executive officer of The Ohio State University Medical Center, notes that in many cities across the nation, healthcare systems are not as welcoming to patients who are uninsured or underinsured as those in central Ohio.
“The high cost of caring for such patients is a matter of tension in cities where hospitals try to shift the burden of uninsured care to one another with little regard for the patient,” Gabbe says. “Another significant difference between central Ohio and less cooperative communities is that this area does not have a ‘county hospital’ designated by county commissioners as the place where taxpayer-supported – but not fully covered – charity care is provided.
“We are very blessed, in that here we are willing to take off our individual ‘hospital hats’ and put on a ‘community hat’ that allows us to ask collaboratively how we can improve health care for the people of this community – especially those in need,” Gabbe adds.
Claus von Zychlin, president and chief executive officer of Mount Carmel Health System, agrees. “Our collaboration will allow us to keep local health care strong well into the next generation,” he says. “It’s by working together that we can reduce healthcare costs, improve quality and safety, and address other common challenges and opportunities to ensure the well-being of all central Ohioans.”
Steve Allen, MD, CEO of Nationwide Children’s Hospital, who refers to himself as the “newcomer” in the group, says he is not familiar with the waxing and waning of past competition and collaboration in Columbus, but he acknowledges that one of the major attractions to the city for him was the evident spirit of cooperation among the healthcare systems.
“Having arrived here only four years ago, I was very impressed with the marvelous collaboration among my peers, who always put the greater civic good ahead of their own interests,” Allen says. “That’s not only good for the community; it’s good for children, who are among our most vulnerable citizens.
“We are very proud to be part of a community where everyone not only wants to do their share, but where there is also a willingness to think beyond the boundaries to come up with innovative ways – such as Ohio Better Birth Outcomes – to ensure optimal health for the tiniest residents of our community,” he says.
The COHC and its members maintain a very delicate balance between competition and collaboration, and between providing healthcare services the community needs and others it wants, while keeping costs reasonable. Its past success and wise collaborations bode well for the equally uncertain times ahead.
What’s Next for The central ohio hospital council?
Investigation continues into the feasibility of bringing a proton-therapy cancer treatment facility to Ohio. Battelle, asked by COHC to assist in evaluating both the technology and the business case for the facility, also provides leadership for the effort. It has the potential to bring leading-edge medical technology and with it significant economic development to central Ohio. It is in place or in development in only nine other communities nationwide. Proton therapy delivers more targeted treatment for tumors than traditional approaches, and can spare more healthy tissue or organs.
Last year, COHC member hospitals received national recognition for development of HealthInfoTranslations.org, a Web site that provides free patient education materials to low-literacy and limited-English-speaking patients. The site includes more than 3,000 free resources in 17 languages. Some topics are available in multimedia format to assist low-literacy patients who are unable to read print documents.
With Franklin County’s rate of premature births continuing to rise — currently estimated at 13 percent, 20 percent if mothers with high-risk conditions are included — the four hospital systems are partnering with the Columbus Health Department, the physician community, local health centers and others to combat the problem.
The group is implementing several collaborative strategies, including educating mothers on nutrition and the safe spacing of pregnancies. This coordinated approach is designed to reduce premature births and the negative outcomes associated with them.
Cardinal Health Foundation invested $1.5 million to fund a partnership among the Ohio Business Roundtable, COHC, the Ohio Hospital Association and the Ohio Children’s Hospital Association. Hospitals represented by the partnership are implementing programs to reduce healthcare-associated infections and medication errorsby sharing information within and across institutions.
Every morning, admissions coordinators at the three COHC organizations that provide inpatient psychiatric care for adults collaborate with other community agencies to direct patients in need of mental health services to appropriate care in a timely manner. With the assistance of a secure intranet site, local providers share information such as the number of beds available at their respective hospitals. This initiative has drastically reduced the amount of time mentally ill patients spend in emergency departments before receiving the care they require.
With significant increases in the cost of blood products, COHC opened a dialog with the local chapter of the American Red Cross to form a Joint Commission on Local Accountability. Together, they have reached the goal of ensuring a safe, effective and cost-efficient blood supply for the central Ohio region.
The COHC healthcare systems are collaborating to explore the sharing of information among 11 emergency departments in central Ohio. The goal is to allow medical personnel to access patient data, including X-rays, laboratory results and medications, to ensure safety and reduce costly repeat tests that may also slow treatment.
• The Central Ohio Hospital Council is a unique collaboration among the chief executive officers of central Ohio’s four healthcare systems: The Ohio State University Medical Center, Nationwide Children’s Hospital, Mount Carmel Health, and OhioHealth.
• The Council was formed in June 2008 to address an increase in unreimbursed healthcare services in the region and to improve the overall health of its citizens.
• The Council has already reduced premature birth rates, improved health literacy, guaranteed a safe and adequate blood supply and simplified access to services for mentally ill patients
from left: John F. Wolfe; Jeff Klinger; David Blom; Steven G. Gabbe, MD; Claus von Zychlin; Steve Allen, MD