GOSHEN — Finding ways to increase access to quality, affordable and comprehensive healthcare within the Goshen community and across the socioeconomic spectrum was the major topic of discussion during the “Wake Up, Goshen” event early Thursday morning at Maplecrest Country Club.
Hosted by the Goshen Chamber of Commerce, Thursday’s event “Creating a Healthier Goshen” featured guest speakers Randy Christophel, president and chief executive officer of IU Health Goshen, and Dr. James Nelson Gingerich of the Maple City Health Care Center.
Christophel noted that expanding and improving access to primary care services in the Goshen region is an ongoing strategy at IU Health Goshen Hospital.
Along those lines, Christophel provided attendees with a list of some of the major goals and priorities currently on the radar of IU Health Goshen over the next five years. A breakdown of that list is as follows:
• Lead the region in clinical integration and the management of population health;
• Deliver high value to the hospital’s patients, providers and colleagues by defining, demonstrating and delivering value;
• Developing destination of choice service lines in oncology, the cancer center and heart and vascular services;
• Working on aligning the hospital’s personal and professional missions with its colleagues; and
• Inspiring a spirit of partnership and generosity within area communities.
“So these are our five strategic priority areas over the next five years that we will be developing and pursuing,” Christophel said.
Community health challenges
In discussing some of the greatest health challenges currently facing the Goshen community, Christophel noted obesity, smoking cessation, diabetes, access to primary care and access to mental health services as some of the most pressing.
That said, Christophel was quick to note that dealing with these major health concerns is not as simple as just sending someone to their local doctor and having them pop a magic pill.
“Health isn’t only about healthcare,” Christophel said. “There are many factors that come into impacting a person’s health status. You’ve got social and economic factors, health behaviors, etc., and so how do we impact these other areas if we’re going to raise the health status of the communities we serve?”
Medical home models
According to Christophel, one of the best methods for getting a handle on that complex mix that is healthcare is what he called the medical home model.
“The foundation of how we’re going to get at this is creating primary care practices that are in the model of a medical home,” Christophel said. “We have lots of great primary care physicians, family practice physicians, internal medicine physicians, but we need to bring other services and other capabilities to them.”
Christophel noted that one significant benefit of the medical home model is the fact that such models really encourage people to access the healthcare system in the right way.
“We don’t want people coming into the emergency department unless you truly need that intensive level of service. We want you calling your primary care medical home practice, Christophel said. “They’re going to talk to you about what’s going on. They’re going to provide services 24/7 to you either on the phone or tell you how to access it. They’re going to enter you into the medical system. They’re going to help you access the system in the best way.”
Maple City Health Care
In attendance Thursday to provide an example of just how effective the medical home model can be was Gingerich, who has been at the helm of the successful Goshen healthcare facility for the past 25 years.
“Our vision is really not just about medical care,” Gingerich said of his organization. “It’s about how you foster a healthy community. And that’s not just about providing a whole series of individual services. It’s about building a relationship with folks and connecting with folks. It’s about relationship-based care.”
According to Gingerich, Maple City Health Care draws from three basic values when administering all of its care services: how does it foster long term relationships; how does it foster integration of care; and how does it empower patients in their own care.
“Those are at the heart of how we’re thinking about what we’re trying to do in the community,” Gingerich said.
Over the last 25 years, Maple City Health Care has been able to develop a wide range of services that are part and parcel of what Gingerich thinks of as primary care. Those services include: physicians; nurse practitioners; a psychologist; social workers; nutritionists; health coaches; diabetes care coordinators; prenatal care coordinators; lactations consultants; insurance navigators; interpreters, etc.
“Primary care is so much more than preventive stuff,” Gingerich said. “Primary care is also acute care and chronic disease management and bringing those all together in one place. So our goal is to build relationships with our patients, to do that over time, and to offer a range of services that keep them engaged in their own care in an integrative way.”
In addition to the multiple offerings available through the center, Gingerich also pointed to the fact that his model is capable of providing significant cost savings to his patients, particularly those who are low income or who have little or no insurance.
“All of our services, including dental services, are available at sliding fee discounts for all of our patients who don’t have insurance, or whose insurance doesn’t fully cover their services,” Gingerich said. “So anything that’s due to the patient gets slid up to 90 percent discounts.”
And for those who can’t afford healthcare even at such significant discounts, Gingerich said he and his staff came up with a plan where extremely low income patients can trade volunteer work for medical services.
“We came up with a program where the lowest income folks could volunteer anywhere in the community at not-for-profit organizations, and we’ll give $10 an hour credit for their volunteer activities,” Gingerich said. “That’s part of the relationship-based care that we’re trying to do. We didn’t start with all this stuff. It develops over time as we see what the needs are, as we see what our resources are, as we see what we can put together.”
And the results, he said, have far exceeded expectations.
“Consistently we’re in the top handful of providers in the entire state on all quality measures,” Gingerich said. “At the same time, for over 15 years, every single quarter of every single year, our Medicaid patients have cost the state 40 percent less than the state average. So it’s not about trading outcomes for money. We’re not about cheap. We’re about, first of all, quality... quality primary care, relationship based, data driven care.”
Capacity and cash
One area that Gingerich did note as a concern Thursday was capacity and an inability to take on more clients.
“We have been full to the gills at the healthcare center for a number of years,” Gingerich said. “We’ve been expanding the staff and expanding the services for a number of years, but we haven’t really been expanding patients. In the midst of all this, in primary care, the hospital has noticed that we have a capacity problem as well. We’ve got lots of patients that can’t find doctors, irrespective of insurance.”
As one way to try and remedy this situation, Gingerich pointed to the fact that Maple City Health Care recently partnered with IU Health Goshen to develop a second facility at the historic Abshire Mansion in Goshen which when completed should allow the clinic to serve an additional 5,000 patients.
According to Christophel, total cost of the project has been projected at $2.2 million, approximately $1.2 million of which will come directly from IU Health Goshen resources.
“We’re so interested in helping this project be successful and partnering with Maple City Healthcare Center, we’re putting $1.2 million of our resources into the project,” Christophel said, noting that another $1 million in funding is also in the works through various grants and community fundraising efforts.