Whether it’s due to age or limited mobility, access to transportation, location or a busy work and family schedule, getting needed medical care or examinations isn’t easy for everyone.
Mount Nittany Health’s 2016 Community Health Needs Assessment identified access to care as a prime concern of area residents for several years. Understanding that challenge, medical care providers and legislators are working on different methods to bring health services closer to those who need them.
Here’s some of what’s being done:
Opening more offices
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Through the data collection process of the 2016 CHNA, conducted every three years, Mount Nittany Health identified communities in its coverage area considered to be “medically underserved.”
As defined by the U.S. Department of Health and Human Services Health Resources and Services Administration, a medically underserved community is one that has too few primary care providers, high infant mortality rates, high poverty or a high elderly population. To help better serve those areas, Mount Nittany opened Physician Group offices that serve more than 100,000 patients, many who are located in rural areas.
“Access to quality health care has been a concern in our region for several years as evidenced in our most recent Community Health Needs Assessment,” Nichole Monica, communications and media relations director, said. “In the past five years, as part of our commitment to evolve to meet the changing needs of those we serve, Mount Nittany Health has opened Mount Nittany Physician Group offices in Mifflin County, Penns Valley and Philipsburg, totaling more than 18 locations in six counties, with 150 providers.”
With the Physician Group offices, Mount Nittany’s goal is to bring primary care services closer to people in more rural areas, to save them from having to drive into State College for medical care.
In addition to growing its primary care presence outside of State College, Mount Nittany is also adding more specialty care services, like cardiology, diabetes and general surgery to some of its primary care offices.
“We continue to recruit and attract providers who are committed to working in rural communities,” Monica said. “We are dedicated to educating and training medical students and family medicine residents with the intent of attracting them to practice in rural communities.”
Expanding specialty services
By recruiting more providers, Mount Nittany has been able to grow and expand the services it offers. By doing so, that saves people from having to take off work and drive an hour each direction to Danville or Hershey.
“We believe that advancing the scope of services and access to care at the medical center in areas like cardiac catheterization, electrophysiology, orthopedic, radiation therapy, and other services, enables convenient access in our rural environment,” Monica said.
Through the reinvestment of capital funds, Mount Nittany also opened the Lance and Ellen Shaner Cancer Pavilion, and an expanded emergency department facility. These services, along with adding orthopedics to the medical group and the new Cardiovascular Pavilion set to open in the fall, are intended to bring specialty care services right to Centre County.
“We have plans to continue investments in both our medical center and physician practice facilities to continue to grow services and increase access,” Monica said.
Bringing care to the homes
Barriers to accessing health services go beyond location and transportation. With advances in medicine, people are living longer with complex conditions, and often have trouble leaving their homes. For some people, the only way they can leave their homes is in an ambulance.
“What we’ve noticed over the past three to four years is that our population is aging pretty significantly, we have aged, higher chronic disease,” Janet Tomcavage, chief population health officer for Geisinger, said. “When we step back and look at the needs of individuals, patients, the community, what we’ve really just started to appreciate is maybe our current health care model isn’t meeting all the needs of our older, frailer patients.”
To answer the question of how to get people out of their homes and into a hospital who are really sick and have to travel an hour each way to see their doctor, Geisinger developed Geisinger at Home and enrolled its first patient in April.
As a personalized health care model, Geisinger at Home is not meant to replace a primary care physician, Tomcavage said, but rather to help integrate and coordinate among different health providers also from the perspective of the patient.
The home health team consists of a regional medical director, advanced practitioners, nurses, a community health assistant, pharmacists, dieticians and palliative care workers. The team visits the client, identified through Geisinger Health Plan, in their home, and conducts a physical assessment, as well as an assessment of the client’s social opportunities — whether there are any hazards in the home, and whether they’re getting the right kind of food.
The goal of the program is to develop an optimized treatment plan for the patient to help stay ahead of medical complications and ultimately reduce ER visits and hospital stays.
Since the program started in the spring, Geisinger has seen a 40-45 percent reduction in both ER visits and hospital admissions.
“It’s been pretty eye-opening to us and so rewarding and such a privilege to be able to go into patients’ homes and help them,” Tomcavage said.
Right now, Geisinger has about 450-500 patients enrolled in the program in the Centre/Mifflin county area, and has identified about 2,500 to 3,000 who could benefit from the program. Overall, about 2,100 clients are enrolled in the program, and they’re enrolling about 100 new clients per week. The goal is to get up to 150-200 per week.
Using telehealth and technology
The use of telehealth to help bring medical services to patients is still evolving in Pennsylvania.
State Sen. Elder Vogel, R-Sewickley Township, introduced Senate Bill 780 last year to better regulate and provide insurance coverage for telemedicince. The bill passed the Senate in June but ultimately failed in the House in October.
Senate Majority Leader Jake Corman, R- Benner Township, voted for the bill in June, and said Sen. Vogel is getting ready to re-introduce the bill in the coming months.
“Obviously, time and money, the ability to travel, get off work, that’s where telemediciine can be helpful,” Corman said. “That’s why a big component of this is broadband deployment and making sure everyone has access to broadband so they can do telemedicine.”
Access to broadband, particularly in rural areas, is a barrier to opening up telemedicine opportunities for everyone, Corman said. Although the General Assembly hasn’t yet introduced a broadband bill, Corman said it has a lot of interest, and he hopes legislation will get introduced on it soon.
Geisinger at Home is hoping to roll out its telemedicine component in March. Tomcavage said that the community health assistant would help the client get connected to an iPad, to connect with a doctor. The CHA can attach a stethoscope to the iPad, check the patient’s heartbeat, breathing, oxygen levels, weight and blood pressure all digitally from the home.
“What we think this will do is really extend the reach of our program,” Tomcavage said. “And also, if we have a patient who calls in and thinks ‘I’m not feeling really well,’ then maybe we can get our community health worker out quickly to do some telehealth connectivity with the docs, and maybe we can get sooner response times engaged.”