Catholic Health World - March 1 by Catholic Health Association

Safety-net hospitals to combine 3 Executive changes 7 PERIODICAL RATE PUBLICATION

MARCH 1, 2020 VOLUME 36, NUMBER 4

HSHS preserves rural health care through hospital acquisitions Catholic system invests in services, spiritual care, leader formation By JULIE MINDA

SHELBYVILLE, Ill. — About six years ago the board of the 18-bed, nonprofit Shelby Memorial Hospital here reached the difficult determination that to secure its future, the stand-alone hospital needed to join a larger health system. Although the hospital had maintained its independence for almost a century and was in fairly good shape financially, rising operating costs — especially those associated with complying with Medicaid and Medicare regulations — were a growing concern. The hospital board came to the conclusion that its overarching priority had to be keeping the doors open and retaining health services in the rural community. Hospital Sisters Health System emerged as the board’s clear preference among the six systems that expressed initial interest in acquiring the hospital. Headquartered in Springfield, Illinois, about 50 miles away,

Ascension moves to expand nonhospital and digital services CEO says a central focus is improving services for those who are poor or otherwise vulnerable By JULIE MINDA

Dan Elbert, maintenance supervisor at HSHS Good Shepherd Hospital in Shelbyville, Illinois, hangs a crucifix in the hospital.

Rural connection HSHS has four hospitals within a 60-mile radius of Shelbyville, including its

HSHS was a known entity. It had serviceline level partnerships with Shelby Memorial. It had opened specialty and primary care medical practices in Shelbyville.

Continued on 4

St. Louis clinic provides immigrants affordable mental health care By LISA EISENHAUER

Sid Hastings/©CHA

tices or salaries to slice off a ST. LOUIS — When it became chunk of time clear that the same populato donate. tion coming to Casa de Salud So, Koch set for medical care also needed up a new probetter access to mental health gram called the care, the nonprofit’s operaMental Health Koch tors tried to stick with the care Collaborative model that had made the clinic that tapped the existing clinic’s a success. resources and added incentives Under that model, clinifor mental health providers — cians volunteer their services carrots that weren’t needed on and patients pay a flat fee that the medical side. Like the medihelps cover the cost of running cal clinic, the collaborative prothe primary care clinic seven Sr. Michelle Salois, RSM, left, a clinical social worker, supervises therapistsvides back-office support, transdays a week. While the clinic in-training Katie Killeen and David Chism, as part of her work at the Mental lators and case management for accepts anyone as a patient, it Health Collaborative in midtown St. Louis. Sr. Salois and other therapists in the clients. Unlike the medical clinic, was established in 2010 with collaborative get free office space courtesy of the Casa de Salud medical clinic it offers therapists and counsela mission of providing health in return for providing care pro bono to immigrants in the St. Louis metro area. ors free office space for use with care to foreign-born residents all their clients. In return, the of the St. Louis region. willing to volunteer at the clinic. That effort care providers agree to reserve at least 25% Kate Koch, the clinic’s vice president came up short and Koch suspects it was of their caseload for referrals from Casa de and chief operating officer, later sought out largely because the clinicians she contacted Salud. Those clients pay on a sliding-fee mental health therapists and counselors weren’t making enough through their pracContinued on 8

Ascension is several years into its “dual transformation strategy” that involves strengthening its core health care operations while also investing in new models and methods to help grow the health system’s footprint and impact. Joseph Impicciche, who has headed Ascension’s 150-hospital system since July 2019, has said Ascension is moving away from being a hospital-centric company. He’s tasked Ascension’s next generation of leaders with finding new ways to meet the health needs of patients and comImpicciche munities in a service area that spans 20 states and Washington, D.C. Impicciche joined Ascension in 2004 as executive vice president and general counsel, became its president and chief operating officer early in 2019, and was elevated to president and chief executive last summer. He spoke to Catholic Health World about Ascension’s “mission-inspired transformation” and the challenges the system faces in today’s complex health care environment. What are your early impressions as chief executive of a sprawling system with over 2,600 care sites and 150,000 employees? As I’ve traveled across our ministry and I’ve spoken to our associates, I’m really Continued on 6

Avera hospital’s land contribution opens door to affordable housing Nathan Johnson/Avera Health

By DALE SINGER

Tom Clark, regional president of Avera Health and chief executive of Avera Queen of Peace Hospital, shares plans for a land donation the health organization will make to the City of Mitchell for an affordable housing project. He spoke at a press conference and stakeholder announcement held Jan. 9 at the Mitchell, South Dakota, hospital. Seated behind him are Mayor Bob Everson, left, and Mitchell Area Development Corp. Executive Director Mark Vaux.

The situation was this: Mitchell, South Dakota, had a problem supplying affordable housing for the middle-income workers its employers need. Avera Queen of Peace Hospital, an anchor of the city’s economy, owned an undeveloped tract of 21.7 acres just east of its main campus — land that it no longer needed because future growth would be in a more visible spot along nearby Interstate 90. As a member of the Mitchell Area Development Corp., Tom Clark, regional president of Avera Health and the hospital’s chief executive, was aware of the housing chal-

lenge but he hadn’t really connected it to the surplus land before. Then, the proverbial light bulb lit up. “It just popped,” Clark said. “It just kind of clicked. We’ve got this land that we’re not going to use, and there’s a need for affordable housing. I wonder if there’s a way for the two to come together. “It was just fortuitous timing. I truly believe it was a God thing,” he said.

It all adds up With a three-pronged partnership of the hospital, the city and the development corporation, the project came together quickly. The vision has Avera donating Continued on 6

CATHOLIC HEALTH WORLD March 1, 2020

Insurers slow to expand Medicare Advantage benefits, study finds By LISA EISENHAUER

The addition of supplemental benefits such as adult day care and caregiver support for Medicare Advantage enrollees is off to a slow start, according to a recent study. The study was done in mid-2019 by David Meyers and others in the Department of Health Services, Policy, and Practice at the Brown University Meyers School of Public Health using data from the Centers for Medicare & Medicaid Services. Meyers discussed its findings Nov. 22 during a webinar called “Understanding Opportunities and Barriers to Launching Social Care Initiatives in Medicare Advantage Plans” hosted by the Social Interventions Research & Evaluation Network based at the University of California San Francisco. The private insurers that contract with the federal government to offer Medicare Advantage plans got the nod in 2018 from CMS to begin providing supplemental benefits starting the following year. Previously, all benefits had to directly prevent or treat an illness. The rule change makes it possible for the plans to cover nonmedical services that meet social needs related to health, such as adult day care and caregiver support. Under the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act passed in 2018, even more benefits can be added for enrollees who are chronically ill starting this year. Those benefits can include meals, pest control and transportation for nonmedical needs. Meyers said that of the 4,660 Medicare Advantage plans with 21.9 million enrollees in 2019, the CMS data showed the supplemental benefit most widely added was caregiver support, such as training or respite programs. The researchers found that 9.2% of plans added the benefit. The second most widely adopted program, added to 3.4% of plans, was in-home support, such as paying aides to help enrollees perform basic tasks like showering and preparing meals. Other benefits, including adult day care, home-based palliative care and non-opioid pain management, were added to less than 2% of the plans, according to the CMS data.

More insurers said they would offer supplemental benefits this year, although at least one of them that offers several Medicare Advantage plans said it would be dropping caregiver support, the study found. As to the wider benefits that could be offered this year under the CHRONIC Care Act, several insurers said they would offer transportation for nonmedical needs, but few said they would offer any of the other options, Meyers’ team found. Overall, the study found that the plans most likely to offer the supplemental benefits were those that were larger, older, forprofit and HMO-style and those with the higher performance ratings from Medicare. Meyers said the CMS data didn’t shed light on why plans were or weren’t expanding benefits; but, he speculated, “It may take plans additional time to be able to incorporate these into their benefit packages.” Researchers at Brown University did a separate survey of 38 managers with

17 Medicare Advantage plans offered in various parts of the country. Its goal was to understand plan representatives’ perspectives on the importance of addressing social needs and their views on the passage of the CHRONIC Care Act. The survey found that the managers thought “social needs are important and should be addressed.” But it also found that their approaches to addressing those needs are distinctly different. Some were interested in creating new, supplemental benefits while others preferred to support community-based organizations to address enrollees’ needs. The survey concluded that changes in Medicare Advantage plans’ benefit packages in response to the CHRONIC Care Act “will likely be modest.” The webinar presenters also discussed a second similar survey done by researchers at University of California San Francisco. The survey was of 25 members of execu-

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tive leadership teams with 14 Medicare Advantage plans, some of them nonprofit and some for-profit. It focused on how the executives were leveraging the new opportunities to provide social care benefits. The survey found that mission and values were a stronger driver among the executives than return on investment when it came to embracing the expanded benefits. Researcher Laura ShieldsZeeman said executives from for-profit and nonprofit plans shared similar views on the benefits. Each said, for example, they were happy about the flexibility the new CMS Shields-Zeeman rules provided but also found it challenging to expand their benefits because of limited resources.

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March 1, 2020 CATHOLIC HEALTH WORLD

Four competing south Chicago hospitals plan to merge into new system Building infrastructure and transforming the care model to address disparities could take a decade

All of the hospitals are losing money principally because they are not being adequately reimbursed by public insurers, Holland said. “We’re safety net hospitals and the majority of our patients have Medicaid as a source of payment and in Illinois Medicaid doesn’t cover the cost of care,” he said.

By LISA EISENHAUER

The presidents of four competing hospitals on the south side of Chicago that together are operating in the red by about $76 million a year have agreed to combine their hospitals’ assets and start a new system. They said that system will expand access to preventive care and quality services, reduce drastic health inequities and provide economic development, jobs and training programs in the region. “We really think we’ve envisioned something here that is pretty bold and is transformational and should help to get our residents the level of care and the kinds of care that they deserve,” said Carol Schneider Schneider, president and chief executive of Mercy Hospital & Medical Center, part of Trinity Health. The nonbinding agreement signed in January by Schneider and the presidents of Advocate Trinity Hospital, part of Advocate Health Care; South Shore Hospital; and St. Bernard Hospital & Health Care Center calls for building several community health centers and at least one new, state-of-theart inpatient acute care hospital to replace the four aging hospitals. Mercy Hospital and St. Bernard Hospital are Catholic. Charles Holland, president and chief executive of St. Bernard Hospital, Holland said that “individually the path forward was not sustainable” for the hospitals.

A new system Schneider said the new system will operate on its own. “It will be a new company and it will not be associated with the legacy organizations,” she said. The new system will have an indepen-

Mercy Hospital & Medical Center

St. Bernard Hospital

South Shore Hospital

Advocate Trinity Hospital

The four hospitals proposing a merger are in neighborhoods on the south side of Chicago. All of them are operating in the red.

dent board of directors including a voting member from each of the legacy hospitals. According to a press statement, after a definitive agreement is executed, a benchmark expected by midyear, a chief executive and leadership team will be named and “each provider will contribute or transfer existing hospital assets to and help capitalize the new system.” The estimated capital investment to create the new system and network of facilities is $1.1 billion. In addition to funding from the hospitals, the plan foresees funding from state and federal sources and private donations. “We started talking in September, so it’s been pretty quick, but we all have very aligned goals and missions and kind of the same urgency to do what is best,” Schneider said. Holland said combining the hospitals’ resources is a way to address “astounding”

health disparities in the section of Chicago they serve. He and Schneider pointed to statistics that show, for example, that the overall life expectancy for residents of some south side neighborhoods is as much as 30 years less than for residents of other parts of Chicago. Both executives stressed that the merger is a voluntary move by all four hospitals. “This is not being forced,” Holland said. He added: “Our commitment as the four presidents who’ve come together to put together this vision is that no facility that’s currently operating would close until a new community health center is built and open and serving patients. Nothing would close until something new is built.” Together, the hospitals have 973 licensed beds. Mercy Hospital has the most, with 402 licensed beds. No decisions have been made yet on how many beds the hospital or hospitals in the new system will have.

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Shifting to outpatient care Schneider said the plan for the new south side system to open community health centers is in line with a state mandate to assist hospitals in “transforming their services and care models to better align with the needs of the communities they serve.” The mandate includes looking at whether more services in a community should be shifted from inpatient to outpatient sites. “We’re really looking at some behavioral changes (among patients) and offering access to care at the most appropriate level in an easy access way, instead of using emergency departments,” Schneider said. Community members and other stakeholders in the new system can share their thoughts on the plans at an upcoming series of community forums. The meetings “will help shape future hospital services, and the expansion of urgent care, ambulatory surgery, infusion therapy and behavioral health services at new community health centers, as well as specialty care, imaging and diagnostic services,” according to southsidetransformation.org, a website with information on the merger. The website also says the merger is expected “to take the better part of a decade.” Holland said the new system will be nonprofit and non-Catholic. He said he and other executives who are working on the planned merger have had conversations with the Archdiocese of Chicago and “they’re supportive of this effort to address disparities in health care and to really look community-wide at the need for a health care system on the south side of Chicago.” The executives are unaware of a similar merger anywhere else. “I’m under the impression that this is a very unique model in the nation, where four hospitals come together and contribute their assets, their property and say let’s create something new here,” Holland said.

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CATHOLIC HEALTH WORLD March 1, 2020

HSHS preserves rural health care From page 1

flagship, HSHS St. John’s Hospital, a tertiary care teaching hospital in Springfield. And HSHS was making investments in rural communities at a time when rural hospitals and health services are facing growing challenges to their viability. Kristy Gorden, a marketing specialist for the Shelbyville hospital, says its leadership was confident that HSHS had a good understanding of the hospital, its community and their needs, since HSHS and its founding congregation — the Hospital Sisters of St. Francis — “have been rural minded from day one. They understand rural health care.” Jean Hudson, executive assistant to the hospital’s chief executive, says HSHS stood out among suitors because it “wanted to partner to help maintain health care Hudson in Shelbyville. They truly wanted to serve the community and keep quality care here in the community, and that impressed the board so much.”

The unknowns But while HSHS’s January 2017 acquisition held the promise of providing long-term stability for Shelby Memorial, beyond the crosses that went up on the walls in every patient room, employees and members of this predominantly Protestant area were unclear about how the rechristened HSHS Good Shepherd Hospital would live out its identity as a Catholic ministry and a community anchor. Good Shepherd is a major employer in Shelbyville — population nearly 5,000 — and surrounding communities. Would the acquisition lead to job loses? What would change when the secular facility became a Catholic hospital? “With any change comes angst and anxiety,” says E.J. Kuiper, president and chief executive of HSHS’s Illinois Division. Kuiper About three years in, staff, board members and the community have their answers. HSHS has maintained staff count and invested in the hospital and the community, winning over any skeptics. “Shelbyville has really embraced this hospital being part of HSHS,” says Kuiper. System playbook Kuiper attributes this success to the

Employees of HSHS tour a cemetery on the grounds of the motherhouse of the Hospital Sisters of St. Francis in Springfield, Illinois, as they learn about the heritage of the women religious who founded the Hospital Sisters Health System. The visit was part of a formation program at the retreat house on the property.

“playbook” that HSHS developed as it acquired rural secular hospitals in Oconto Falls, Wisconsin, and Greenville, Illinois, converting them to Catholic ministries. The tactics are transparent and simple: HSHS is very intentional about developing and nurturing good relationships with stakeholders, getting their input and providing for their meaningful participation. For example, mission leaders from HSHS reached out to the local ministerial association to explain that Good Shepherd would be a welcoming place for patients of all faith traditions. Aaron Puchbauer, president and chief executive of Good Shepherd, says the ministerial association appreciates HSHS’s faith-based mission. The system and hospital also conducted a program for employees Puchbauer on the history and mission of HSHS and on what to expect with the transition to a Catholic facility. Hospital executives participated in the system’s leadership and formation training and all staff are invited to take part in formation activities including at the sisters’ Chiara Center, a spirituality center in Springfield. Fr. Nick Husain is employed as a chaplain at Good Shepherd and at an HSHS hospital in Decatur, Illinois, about 35 miles away. He celebrates Mass each week in Good Shepherd’s new chapel and provides spiritual care to patients. He has been mentoring staff who want to pray with patients. Staff volunteer to read a prayer over the intercom each morning and they’ve grown accustomed to starting meetings with prayerful reflection.

Rapid progress Puchbauer has led the facility through rapid improvements. Working with HSHS, the facility has been recruiting more clinicians to the hospital and community, and has added or expanded service lines,

including orthopedics, general surgery and primary care. The hospital recently completed a $2.3 million renovation and expansion of its emergency room. Next year Good Shepherd is going live with HSHS’s medical records system. Puchbauer says the hospital also has greatly expanded community benefit work, including through outreach and partnership with local schools, to improve students’ health care access and knowledge. Lorrie Hayden, a manager of the facility’s health information and patient registration departments who shares the mission leader role with a colleague, says HSHS welcomes open spiritual expressions, volunteerism and outreach. “Everyone can get involved,” she says. Hayden She is particularly fond of the “Mission Possible” program, which invites each hospital department to come up with outreach activities in line with the HSHS mission. Projects have included collecting school supplies for kids and food for local pantries; volunteering for bell ringing for

Mary Starmann-Harrison, Hospital Sisters Health System president and chief executive, and Brian Nall, then the hospital’s chief operating officer, unveil the HSHS Holy Family Hospital entrance sign. In the background is Bob Spencer, the facility’s supply chain facilitator.

What’s in a name? For HSHS, connections to communities

hat’s in a hospital name? Heritage. Connection to place. Brand promise. Aware that names carry great weight, Hospital Sisters Health System wanted to use the process of renaming the secular hospitals it acquired to create goodwill in its new host communities. The process it followed recognized that successful relationships between hospitals and communities require respect, a willingness to listen and mutuality of interests. The names had to identify the hospitals as Catholic while acknowledging the community’s culture. As acquisition talks progressed in each community, HSHS leadership listened in meetings with the hospitals’ boards, other stakeholders and community groups for clues to names that would resonate with the communities. Two HSHS executives, one in charge of mission integration and the other over the system’s communications and marketing department, did additional research and came up with a list of suggested hospital names for the leadership of the Hospital Sisters of St. Francis to vet and winnow down. The sisters then signed off on three possibilities for each community, leav-

ing it up to the respective community hospital boards to make the final name selection. Community members in Oconto Falls, Wisconsin, wanted to retain the “Memorial” in the Community Memorial Hospital name. They saw it as a tribute to people who have served in the military. In introducing the community to the history of HSHS, system representatives described the special devotion the Hospital Sisters congregation that founded HSHS have for St. Clare, an aristocrat who turned her back on wealth to live a monastic life of prayer and service to the poor. When it came time to choose the hospital’s name, Oconto Falls residents and board coalesced around HSHS St. Clare Memorial Hospital. The residents of Greenville, Illinois, resonated with renaming Greenville Regional Hospital as HSHS Holy Family Hospital. HSHS Good Shepherd Hospital was the standout favorite in Shelbyville, a farming community where animal husbandry and agriculture are economic mainstays.

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Fr. David J. Hoefler, vicar general of the Diocese of Springfield, Illinois, blesses an entrance sign for HSHS Holy Family Hospital in Greenville after the hospital’s conversion to a Catholic facility. Vicki Kloeckner, the hospital’s human resources manager, is beside him during the May 2016 ceremony.

March 1, 2020 CATHOLIC HEALTH WORLD

the Salvation Army; and donating board games to nursing homes. Dave Cruitt, a Good Shepherd board member, says: “You can hardly open up the local newspaper or get out on Facebook without seeing something about a community garden, a Cruitt food truck or a holiday event that the hospital is involved in.” Former board member Randy Biehler says HSHS has delivered on its promises. “Everyone sees the improvements and that we’re offering more serBiehler vices and keeping treatments here locally. The community feeling overall is very positive.” Visit chausa.org/chworld for more information on the playbook HSHS follows when it instills Catholic identity into a newly acquired facility. jminda@chausa.org

Hospital Sisters Health System’s network of facilities

HSHS Hospitals Prevea Health (multi-speciality group)

Illinois

Strategic Affiliates/Joint Ventures

Wisconsin HSHS Hospitals HSHS Medical Group Prairie Cardiovascular

Relationship-building essential when bringing secular hospitals into ministry systems HSHS earned stakeholder buy-in for acquisitions By JULIE MINDA

When a secular hospital prepares to join a large Catholic system, the prospect of an ownership change can bring uncertainty for the hospital’s staff and the community. Trepidation can be heightened in rural communities where residents may have deep personal and philanthropic ties to a hospital, and where people who are not Catholic may have little knowledge of the tenets of Catholic health care. Recognizing this, before Hospital Sisters Health System of Springfield, Illinois, acquired rural hospitals in Oconto Falls, Wisconsin; Greenville, Illinois; and Shelbyville, Illinois, it courted the communities, building confidence and solid relationships with all key stakeholders. It engaged in transparent and forthcoming communication with hospital board members, administrators, admitting physicians, staff, patients, community clergy of all denominations, business and civic leaders and residents, says Sr. Monica Laws, OSF. As vice president of mission integration for HSHS at the time of the acquisitions, she helped to orchestrate the mission integration work connected with the Sr. Laws acquisitions. (Sr. Laws retired Nov. 8.) Peter Mannix, HSHS vice president of strategy development and implementation, says, “We wanted to ensure the communities would welcome us. We engaged with them Mannix to get their buy-in. We wanted to have them feel they were part of the process. We didn’t want to overwhelm them.” (Mannix retired Sept. 1.)

Getting to know you Mary Starmann-Harrison is president and chief executive of HSHS, which has 15 hospitals and a network of non-acute facilities in Illinois and Wisconsin. She says in seeking out potential acquisition prospects, HSHS looks at facilities within a 90-mile radius of its hospitals, evaluating Starmann- which ones have unmet Harrison health needs in their com-

munities that HSHS could help shore up. Mannix says HSHS determines how it can add value to the hospitals, including through the introduction of the system’s electronic health record, standardization of care processes and group buying opportunities. HSHS leaders keep local ordinaries, or bishops, in the information loop from the outset of acquisition talks. Sr. Laws says, “You never want a bishop to be surprised and read about something in the morning paper” that he has not been briefed on. Starmann-Harrison says bishops have been enthusiastic about adding a Catholic hospital ministry in their diocese. When HSHS and the hospital are ready to move forward with a letter of intent and to make their plans public, HSHS reaches out to more stakeholders. This can include hosting retreats with the community hospital’s board and administrators, making presentations to staff and to business leaders, convening community town hall meetings, and establishing a social media feed as well as outreach to traditional media outlets.

Listen and learn Sr. Laws says HSHS and the hospitals had preexisting affiliations in place with the Oconto Falls and Shelbyville hospitals and that foundation reduced qualms. But HSHS was an unknown in Greenville when it moved to acquire the community’s only hospital. Jeannie Korte, an HSHS mission leader in Southern Illinois, says that in Greenville — which has a large Protestant population, but not a large Catholic presence — people didn’t understand Catholic health care’s ethic, and they “feared we’d try to proselytize or convert people. Korte … So, our task in part was to introduce what it means to be a Catholic facility.” The system built relationships with local clergy of all denominations, welcoming them to provide pastoral care for their respective hospitalized church members and has involved them in celebrations and rituals at the hospitals. Sr. Laws says in all of the meetings in and out of the hospital, HSHS representatives were there to listen as much as to talk, and they invited questions and ongoing follow-up communication. Salm Mary Salm, director of

HSHS’s recent acquisitions of stand-alone community hospitals 2014: the 22-bed nonprofit Community Memorial Hospital in Oconto Falls, Wisconsin, which is now HSHS St. Clare Memorial Hospital. 2016: the 42-bed nonprofit Greenville Regional Hospital in Greenville, Illinois, which is now HSHS Holy Family Hospital. 2017: the 18-bed nonprofit Shelby Memorial Hospital in Shelbyville, Illinois, which is now HSHS Good Shepherd Hospital.

spiritual care and mission integration for HSHS in Wisconsin, says system representatives also ensured “our messages were clear and consistent. We were intentional about presenting our mission” and being clear about the meaning and purpose of HSHS’s work. Korte says of the staff and communities, “We respected them, listened to them, we

identified barriers to the acquisition, and we reassured them.”

Intro to Catholic health care Sr. Laws, Salm and Korte were on mission integration subcommittees that made numerous presentations, especially for staff of acquired hospitals, on the history, legacy, mission and ministry of the Hospital Sisters of St. Francis, the health system they founded and what it means to be Catholic. The subcommittee members helped staff understand the meaning of — and reasons for — practices and protocols that would be put in place under HSHS’s ownership, including the placing of crucifixes in all patient rooms, the addition of religious art in common spaces, the hiring of mission personnel, the use of prayers to begin meetings, the celebration of certain feast days of saints and the addition of chapels. Korte says, “The more we shared, the more it resonated.” jminda@chausa.org

ould you be willing to sacrifice some personal privacy so that you or a loved one could live a longer, healthier life? That’s the main question explored in CHA’s latest podcast episode. Dr. Alan Pitt, a professor of neuroradiology at CommonSpirit Health’s Barrow Neurological Institute, is joined by CHA Director of Ethics Nathaniel Blanton Hibner for a discussion about the benefits, risks and ethical and practical considerations around the use of personal data in delivering health care. We invite you to subscribe to the podcast on your device store or download/listen to it using these players: chausa.org/newsroom/podcast

CATHOLIC HEALTH WORLD March 1, 2020

Affordable employee housing From page 1

land that will become the site of 94 singlefamily homes, to be built in two phases. Once the necessary government approvals win passage and the spring thaw arrives, work is set to begin. The first phase calls for eight homes to be completed by the end of this year and 55 to be built by the end of 2024. Target price for the homes is less than $200,000. The development is designed to solve cost hurdles that often can stymie efforts to build the kind of housing that communities like Mitchell need. “It works because of the land donation, keeping land costs out of the Clark total development costs,” Clark said. “It works because of the city and its willingness to use tax increment financing to fund infrastructure installation. And it works because of the development group bringing developers to the table. “We’re really excited. This is a huge project for this community. And it happens because of the partnership.”

Impicciche Q&A From page 1

impressed with the commitment to our mission and the compassionate, personalized and high-quality care. The commitment to the mission is very, very real and very deep within our organization. So that’s really where I have felt the most joy in the role, seeing that deep commitment and all the good that we’re doing in our communities. What is Ascension focusing on in the near term? Number one is building on our commitment to the mission — to the healing ministry of Jesus. In our last fiscal year we provided over $2 billion in care for persons living in poverty and other community benefits, and our community benefit programs are really designed to reach some of the most vulnerable people in our communities. That’s been our mission ever since Ascension was formed. I’ve challenged my team to open 50 clinics in our communities over the next three years. We think that will help align our efforts around solidarity with the poor in our communities. These clinics would be primarily aimed at meeting the health care needs of the poor and vulnerable in communities where they live. How is Ascension organizing how it does this work? We launched our “mission-inspired transformation” a little over two years ago, and it was primarily aimed to accelerate our advanced strategic direction. Its focus is on delivering compassionate, personalized, high-quality care in our communities where, when and how it’s needed. This work is being done in eight design teams. Each team is being led by one of our senior leaders and there are approximately 150 associates working across these design teams. (See sidebar.) How is Ascension ensuring improved care for the poor and vulnerable is part of its transformation? All this work is about providing better care to our patients, especially the poor and vulnerable. As an example, the 2025 consumer experience design team is building out our digital platform. We have someone on the team who’s focusing on access issues for the poor and vulnerable. We recognize that many folks that we care

Workforce recruitment tool That team will help solve a stubborn problem that the region and the state in general have faced for a while, according to Clark, Mitchell Mayor Bob Everson and Mark Vaux, executive director Everson of the area’s development corporation. In a number of fields, ranging from teachers to police officers, health care workers to IT professionals, jobs that pay in the $50,000-$70,000 range too often can go unfilled because potential employees can’t find the kind of housing that they need. The three principals in the Avera plan noted that Gov. Kristi Noem highlighted the situation in her recent State of the State address. “Workforce is a huge issue in the state of South Dakota,” Clark said. “We have more jobs than we have workers. The problem for normal development is that by the time a developer pays land costs and infrastructure costs, there is no way they can build a home in the price range that middleincome workers can afford. “The beauty of this project is that the land costs are taken out of the equation, and the infrastructure costs are taken out of the equation.” Everson said the project fits perfectly

with the goals of Forward 2040, Mitchell’s development plan. “This is one of the top items that came out of that,” he said. “We don’t have enough affordable housing. It’s tough for entrylevel workers to get into housing, without paying rent for a prolonged period of time. This will build a tax base for our city and our county.” The trio spearheading the plan were clearly excited about how Avera and Mitchell were able to come up with a forwardlooking project that could even inspire similar development elsewhere. “This is a brand-new model that has never been done before, to our knowledge, anywhere in the state of South Dakota, Vaux and I haven’t found it anywhere else,” Vaux said. “There have been other communities and economic development organizations that have worked on housing. But the difference that made this go is the tremendous gift from Avera. That is the element that completes this opportunity. “This is a model that can be replicated to scale in any other community. So, we’re excited about that opportunity. Others are starting to take notice and see the potential. We’re building a small town. That’s pretty cool.”

Addressing heritage, mission Plans call for the development to be known as Ridge View on Foster, after the street that is near the land that currently is prairie or pasture. Street names submitted for approval would reflect Avera’s donation and its heritage, including: Nagle Lane — after the Venerable Nano Nagle, founder of the Sisters of the Presentation of the Blessed Virgin Mary. The Sisters of the Presentation of Aberdeen, South Dakota, are a co-sponsor of Avera. Nursia Drive, after Saint Benedict of Nursia, founder of the Benedictine monastery. The Benedictine Sisters of Yankton Sacred Heart Monastery in Yankton, South Dakota, are a co-sponsor of Avera. Peace Place, a reference to the virtue of peace that is a key value of both orders as well as a part of the hospital’s name. Also present in the project, Clark said, will be Avera’s commitment to the mission that guides the hospital every day. “It allows us to be a good steward of the resources God has blessed us with,” he said. “It allows us to work in partnership with others to achieve something that none of us would be able to do on our own. And, it allows us to live our value of hospitality by creating homes and opportunities for the families that will inhabit them. “This really is the mission of our organization. That is one of the things that makes this so exciting.”

for may not have access to the technology, and may not be comfortable with the technology we’re offering to patients to ease their access to medical services. So even as we deliver that experience, we are paying close attention to how we can provide better access to those who may not be able to access our system in that manner.

poorly organized records, and trying to distill those records together. It’s a very frustrating experience. For us it’s even more acute because we are a system of legacy systems — we have five different electronic health records systems within Ascension that don’t talk to each other. We’ve had hundreds of clinicians working with Google over the last several months, to provide a solution to this complex problem. And we believe the solution will empower our caregivers to provide better, safer care to our patients. The one thing that I also want to highlight is that patient data will be protected just as it is today. And under no circumstances is Google allowed to use this data for other purposes or to combine it with Google consumer data. We take our responsibilities seriously. Of course the interoperability challenge isn’t Ascension’s alone; it’s true for all health care participants. Across the board, health records are very fragmented, which is why Ascension very much supports the U.S. Department of Health and Human Services initiative to

promote interoperability and we are doing our best in our work with Google to do just that. We think this will be a game changer for clinicians and patients alike in a secure and safe way.

What’s the purpose and goal of Ascension’s collaboration with Google and how will it impact patient care? Were you surprised by the criticism related to the sharing of patients’ private medical information with Google? First of all, I’m very excited and proud of the work that we’re doing with Google. The health care environment is rapidly evolving, and we have to adapt; we have to find better ways to meet the needs and expectations of our patients and caregivers. The simple truth today is that electronic health records systems don’t talk to one another, and that adds unnecessary challenges to providing patient care. Today caregivers are spending too much time hunting through fragmented,

Ascension design teams undertake transformation work

scension has tasked eight cross-disciplinary design teams with ideation and development of its “mission-inspired transformation.” The system describes the teams this way:

Building socially integrated systems of human flourishing is focused on building socially integrated systems of care with primary attention to addressing the underlying social determinants of health — such as housing instability, education, access to healthy foods — that lead to disparities of health outcomes. Delivering the 2025 consumer experience aims to expand Ascension’s reach through technology that is aimed at improving convenience and access to health care akin to the consumer convenience offered by Uber, Amazon and online banking.

Bringing health and healing to the home is developing the hospital at home model and other services to improve the access, quality and experience of patients by caring for them in their homes. Redesigning the front door to Ascension’s health system is addressing traditional, telehealth and other new “front doors” or entry points for those seeking care. Designing the caregiver experience of the future is focused on redefining how caregivers operate as an interdisciplinary team and find joy in their work. Redefining excellence in surgical care will design a proactive surgical services growth strategy in key service lines and explore innovative approaches to supporting surgical efficiency, consistency and data transparency.

Reimagining our presence and capacity is planning the repurposing of some facilities in a way that improves health care access while addressing social determinants of health. It is doing this by congregating such services as education, job training, transportation, retail and social services. Ascension is using this “Healthy Village” concept in the reset of one of its facilities in Washington, D.C. Growing covered individuals through strategic purchaser contracting is expanding Ascension’s population health models and capabilities to address the needs of self-insured employers and other strategic purchasers of value-based care.

How is Ascension planning for the increase in care needs of the growing population of senior adults? What innovative services are being considered? There are a number of things. We’ve been looking at home care for example. As part of this work, we’re beginning to “admit” patients to their home: We’re providing that same hospital care within the home in a much more comfortable environment, in a very safe environment. We think this could have a major impact on the care of many in our communities. What are top challenges Ascension expects to navigate in achieving its priorities? One is that there’s still a lot of uncertainty with respect to health care reform. Providers are caught in the middle right now as we move from a fee-for-service to a fee-for-value platform — many providers have a foot in both worlds, which is very difficult. I think the uncertainty around health care financing continues to be a major issue and I think health care policy is going to continue to be a robust debate. Rising consumerism is another major factor. People are used to the type of convenience that they have with the Amazons, the Ubers, online banking and so forth and they are beginning to demand the same access and convenience in their health care system. The consumer experience team is focused on delivering that integrated, seamless, branded experience. Six months ago we made some changes in our senior leadership team and brought in next generation leaders with various backgrounds and talents. We flattened the organization and, I think, that’s enabled us to make decisions more quickly and to be more aligned throughout the organization. Finally, we’re facing a lot of nontraditional players entering the health care space, including big box retailers, technology companies, retail urgent care and so forth. These nontraditional players are forcing all health systems to change and adapt and become more consumer centric. Visit chausa.org/chworld, for more of this interview. jminda@chausa.org

March 1, 2020 CATHOLIC HEALTH WORLD

KEEPING UP PRESIDENTS/CEOS Dr. Kenneth E. Berkovitz to senior vice president, Ascension, and ministry market executive, Ascension Michigan. He was president of Ascension Medical Group in Michigan. Organizations within Chicago-based CommonSpirit Health have made these changes: William “Bill” Ermann to president of CHI St. Alexius Health Dickinson in Dickinson, North Dakota. He was chief executive and president of the Southwest Medical Center in Liberal, Kansas. He succeeds Reed Reyman, who moved to a new role at Altru Health System in Grand Forks, North Dakota, in the fall. Scott Taylor plans to retire July 1 as chief executive of two CommonSpirit Health hospitals: Centura Health – St. Catherine Hospital of Garden City, Kansas, and Centura Health – Bob Wilson Memorial Grant County Hospital in Ulysses, Kansas. Medrice Coluccio is retiring this month as chief executive of the Southwest Service Area of Providence, which includes Providence St. Peter Hospital in Olympia, Washington, and Providence Centralia Hospital in Centralia, Washington, and the Medical Group.

ADMINISTRATIVE CHANGES Facilities within Livonia, Michigan-based

Macholz

McCormick-Boyle

Trinity Health have made these changes: Dr. Justin Grill to chief medical officer of Mercy Health Muskegon of Muskegon, Michigan. Dr. Steven Nemerson to chief clinical officer of Saint Alphonsus Health System of Boise, Idaho. Cheryl Taylor to chief nursing officer and Dr. Alon Weizer to chief medical officer, both of St. Joseph Mercy Chelsea in Chelsea, Michigan. Sheri Rodriguez to director of payer strategies for St. Joseph’s Health of Syracuse, New York. Catholic Health of Buffalo, New York, has made these changes: David Macholz to chief financial officer and Rebecca J. McCormick-Boyle to chief integration officer. Facilities within St. Louis-based Ascension have made these changes: Scott Furniss to chief financial officer, Ascension Saint Thomas Rutherford Hospital in Murfreesboro, Tennessee; and Latriece Prince-

Fadden

Sr. Gottemoeller

Wheeler to executive director for Providence Health System in Washington, D.C. Mayank Jain to group vice president of workforce strategy and analytics for Providence of Renton, Washington. Dr. Kyle Ulveling to the newly created, part-time position of chief medical officer of St. Anthony Regional Hospital of Carroll, Iowa. Sean Fadden to vice president of finance at Lutheran Medical Center in Wheat Ridge, Colorado, part of SCL Health of Broomfield, Colorado.

ANNIVERSARY Saint Alphonsus Regional Medical Center in Boise, Idaho, 125 years.

HONOR At an awards dinner March 18, the Cincinnati Business Courier will award

Sr. Doris Gottemoeller, RSM, the “2020 Health Care Heroes Lifetime Achievement Award.” She is a member of the board of Cincinnati-based Bon Secours Mercy Health and vice chairperson of that system’s public juridic person, Bon Secours Mercy Ministries. Sr. Gottemoeller is among the trailblazers of the movement in the 1980s to begin consolidating independent Catholic hospitals and small systems into larger organizations. She also played a key role in helping form lay leaders to assume leadership in such organizations. In 2008, CHA recognized her with its Sr. Concilia Moran Award, for her creativity, leadership and breakthrough thinking.

CHRISTUS to acquire Central Texas Medical Center CHRISTUS Health of Irving, Texas, plans to acquire Central Texas Medical Center in San Marcos, from the AdventHealth system in the spring. CHRISTUS and AdventHealth have signed a binding definitive agreement under which the 170-bed hospital and its subsidiaries would become part of the CHRISTUS system. The hospital has 700-plus employees and more than 300 active and consulting physicians. Thirty of them are employed physicians. CHRISTUS has 36 hospitals and a network of other facilities in four states. The hospital will be part of the CHRISTUS Santa Rosa Health System of San Antonio — based about 50 miles from San Marcos. That subsystem has five hospitals in and around San Antonio. A CHRISTUS Santa Rosa hospital in New Braunfels, Texas, is about 20 miles from San Marcos. Katy Kiser, CHRISTUS director of external communications, said CHRISTUS is acquiring Central Texas Medical as part of its effort to strengthen its health care presence across Central Texas. AdventHealth, a nonprofit system based in Altamonte Springs, Florida, has 50 hospitals in nine states. Under the deal with CHRISTUS, Central Texas Medical would become a Catholic facility, adhering to the Ethical and Religious Directives for Catholic Health Care Services. It also would get a new name that would reflect that it is part of the CHRISTUS Santa Rosa subsystem.

Dignity Health hospital in Santa Cruz to expand Dignity Health Dominican Hospital in Santa Cruz, California, plans to undertake a $360 million renovation and expansion that will convert all of the 222-bed facility’s semiprivate rooms to private, create a new surgery department, upgrade technology and add new energy-saving features. The facility’s bed count will not change. Hospital spokesperson Claire Henry says the building project will help to ensure that “the growing Santa Cruz County community can access world-class health care for generations to come.” Statistics from the Federal Reserve Bank of St. Louis show the county’s population has been growing steadily for more than a decade. Last year, the county’s population was 274,255, according to the reserve bank. San Francisco-based Dignity Health, part of CommonSpirit Health, is providing most of the funding for the project, but the Dominican Hospital Foundation plans to raise some funds through a community campaign. Henry says the start date of the construction has yet to be determined; the project is pending county approvals. The project will take several years, according to a press release.

CATHOLIC HEALTH WORLD March 1, 2020

Mental health care for immigrants scale of up to $20 per session. The collaborative launched in February 2018. It now has partnerships with 17 mental health clinicians. In fiscal year 2019, those partners delivered 3,207 hours of therapy to clients referred by Casa de Salud. The average wait time for appointments for Casa de Salud clients, who had previously been referred to outside providers, was reduced from 18 months to 18 days. “It’s still a referral,” Koch said of the program. “We just facilitate the access. That’s our mission.”

From page 1

Sr. Michelle Salois, RSM, counsels a client in her office at Casa de Salud in St. Louis. Sr. Salois operates Mercy Professional Services, one of 17 provider partners in the clinic’s Mental Health Collaborative.

Caring for immigrants The mental health offices are in a building next to Casa de Salud’s medical clinic. The clinics are on the medical school campus of Saint Louis University, which pro- counties in Missouri and Southern Illinois. vides the space as an in-kind donation. The Casa de Salud is Spanish for House of location is within walking distance of SSM Health and early on its patient population Health Saint Louis University had been overwhelmingly Hospital. Casa de Salud’s case Hispanic. But that has been management program refers changing; although still patients to that and other SSM mostly Hispanic, its patients Health hospitals as well as to now come from about 70 some hospitals that are part of nations. At the collaborative’s the Mercy system. offices, signs are in Spanish, Casa de Salud’s budget Signs inside the Mental Care Arabic — the second-most of about $1.3 million covers Collaborative’s offices are in used language for clients — care for a largely uninsured English, Spanish, Arabic and and braille. or underinsured and mostly braille. Koch said studies have immigrant clientele. Patients come from St. found that the immigrant and refugee popuLouis city and county as well as several other lation is particularly at risk of having suffered

trauma. One study published in the July 19, 2018, International Migration Review and done by a researcher at the University of North Carolina and a researcher at the University of Washington pointed to rates of post-traumatic stress disorder of 19-54% among children and 14-19% among adults from war-torn areas, compared to 2-9% for the general population. The researchers found when “pre-migration poverty” combined with the stress of clandestine entry into the U.S., there also was an increased risk of PTSD. Language is not the only barrier for immigrants and refugees seeking mental health care. The immigrant population also tends to have uninsured rates that are much higher than for the general population, according to the Kaiser Family Foundation. Casa de Salud’s sliding scale fee structure addresses that hurdle and the agency contracts with and pays for interpreters who have training on mental health issues. It offers vouchers for reduced cost rides through Uber Health for both medical and mental health patients for whom transportation is a barrier.

Expanding the therapist pool Sr. Michelle Salois, RSM, is a licensed clinical social worker and one of the Mental Health Collaborative’s care providers. In fall 2018, Sr. Salois moved her practice, Mercy Professional Services, where she offers therapy as well as supervision for therapists-intraining, to the collaborative’s office. The collaborative’s partners have access to seven counseling rooms with comfortable furnishings for therapists, clients and translators. The scheduling of appointments is done by Casa de Salud staff.

Get the Basics at CHA’s Community Benefit 101 Program! Oct. 27–28, 2020 Chase Park Plaza Royal Sonesta St. Louis The Catholic Health Association, the leader in the community benefit field for over 20 years, offers a one-and-a-half-day seminar that covers the basics of community benefit programming. What you will learn •

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ow community benefit H demonstrates the organizational mission. e latest news on tax exemption/ Th community benefit issues at the federal and state levels.

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S teps for developing and implementing community benefit programs.

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olicies needed to support P community benefit programs.

• What

counts and doesn’t count as community benefit.

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ommunity benefit C accounting principles.

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Staff in mission, finance, strategic planning and compliance should consider attending to learn how federal requirements for tax-exempt hospitals could impact their organization’s community benefit efforts.

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Before her move, Sr. Salois had tried to accept referrals to provide therapy to the immigrant community. Her efforts were stymied by logistics, particularly the need for a translator. “We could never get this to work, that the therapist and the interpreter would reach the client at the same time, to be able to schedule even a first session,” she said. Most of the therapists-in-training who Sr. Salois supervises are graduate students in need of clinical hours for professional certification. The collaborative lets Sr. Salois meet her pro bono requirement by offering therapy sessions from her trainees, which she tapes and then uses for instruction. The collaborative also functions as an incubator space for licensed therapists and counselors who don’t yet have the resources to start a practice on their own. “Casa is trying to promote the capacity in the community at large of therapists who know how to work with immigrants and non-Englishspeaking clients,” Sr. Salois said.

Simplified access to care Anne Hagen said the collaborative’s setup makes it possible for her to maintain a practice where she also treats patients insured by Medicare and Medicaid. Like Sr. Salois, Hagen is a licensed clinical social worker and is happy to have her own practice yet be able to help Casa de Salud with its charitable mission. “I love that Casa saw a need and said how do we fill this,” Hagen said. The matching of a client to a therapist who they see for the duration of their care is handled by Ben Zeno, Casa de Salud’s mental health coordinator. His job also includes recruiting and working with the therapists. Zeno said that Casa de Salud surveys show that patients are grateful to have access to mental health care. “We have heard from people that, unfortunately, they have had a lot of difficulty accessing mental health care elsewhere but they’ve had an easier time here in part because we just have one central intake line that they call and that gets them connected to up to 25 different therapists depending on their needs and their schedule,” Zeno said. Life stressors without borders One of the clients who has gotten counseling through the Mental Health Collaborative called Casa de Salud for help shortly after graduating from college in 2017 with a degree in mechanical engineering. Just as he was struggling to sort out his career options while working in a high-stress restaurant job, his immigrant parents lost their jobs and abruptly decided to divorce, and one of his grandparents died. “I was in a situation where I was in a bad mental health state and I was doing everything I could to look for support and therapy,” said the 24-year-old, who was uninsured at the time. Through Casa de Salud, he was matched with a therapist whom he met with regularly for about three months. “The visits to Casa were pretty key in bringing some structure to just me figuring out where I was and setting some concrete goals and working towards landing myself in a new situation,” said the man, who asked to remain anonymous. For Sr. Salois, the problems she sees among her Casa de Salud-referred clients are largely the same as those of her other clients, such as anxiety, depression and relationship issues. But the immigrant population she treats at the collaborative also struggles with high rates of trauma from situations in both the countries they left and in their new homeland as well as from social isolation and separation from families. Without the Mental Health Collaborative, she said many of those immigrants might have no access to mental health care. “As a Sister of Mercy, one of our critical concerns is to care for migrants and the poor,” she said. “This has really leveraged our role in being able to do that.” leisenhauer@chausa.org