HCA Healthcare
March 06, 2019

SOURCE: NashvillePost.com

AUTHORS: Kara Hartnett

Meharry President James Hildreth discussing the safety net system proposal Tuesday

A team of stakeholders led by Meharry Medical College has unveiled a proposal to launch a safety net health care system which aims to better connect many of Nashville’s biggest health care providers to the underinsured community.

The proposed system comprises two components: a network of hospitals and health care providers and an indigent care management program. The model combines the resources of area providers, and will allow the hospitals to split patient care according to their area of specialty. As proposed, the Metro-backed Nashville General Hospital will serve as the hub of the network.

The management program, called BetterHealth Nashville, will establish interoperability between the hospitals by coordinating care for all patients under one electronic health record — establishing a communication line between major providers that isn't there now. The program will be managed by Meharry’s recently launched data science institute, which will provide each eligible patient a care coordinator to help navigate the system.

With Nashville General as the hub, the proposal also calls for the development of programs focused on oral and systemic health, diabetes and hypertension. NGH will send more patients needing specialized treatments to Nashville’s three major hospital systems — HCA Healthcare's TriStar Health, Ascension Saint Thomas and Vanderbilt University Medical Center — while taking in more of the low-acuity patients now going to those facilities. The system could possibly aid overcrowded hospital emergency departments by diverting uninsured patients from emergency departments to a clinic setting better suited to their needs.

Although funding for the system has yet to be determined, documents suggest the network will be supported by public and social service agencies, and reallocating some of the hundreds of millions of dollars per year Nashville hospitals already spend to treat uninsured patients. In fact, many members involved in making the proposal said that the plan, if properly implemented, could save money for the city.

The massive data set that comes with a built-out system will bring other benefits. Meharry President Dr. James Hildreth said the electronic health records set built under the plan will be one of the largest on indigent communities in the country — about 100,000 people, or 15 percent of the Nashville population, are considered underinsured. The data set would enable future health IT initiatives linked to Nashville’s growing health care tech sector as well as research collaborations on underserved communities.

The proposal was drafted by the Indigent Care Stakeholder Work team, which was created by Hildreth about 14 months ago in response to the announcement by then-Mayor Megan Barry that she was looking at ending inpatient services at Nashville General. The group comprises local government officials, church groups and representatives of private hospitals, along with officials from Meharry and Nashville General.

"This is a historic day for the city of Nashville, especially for the most vulnerable among us," Hildreth said. "Today we unveil a shared vision that for the first time involves Nashville's entire health care community in the care of the underserved. As the center of the system is the patient, who will become the focus of our renewed energy, effort and responsibility. As a city today, we resolve to leave no one behind."

The three major private hospital systems, along with Nashville General, responded to the proposal:

TriStar: “We remain supportive of efforts to effectively improve access to healthcare for the underserved in our community. We also believe it is important for all hospital systems in Nashville to be involved in discussions about any indigent care funding model which may ultimately be put in place.”

Saint Thomas: “As Nashville's only faith based, nonprofit health system, Ascension Saint Thomas Health has always cared for its poor and vulnerable. It is a key component of our mission as evidenced through the data shared by the group today. Behind Nashville General, we provide the second and third highest levels of uncompensated care as a percentage of revenue. Our actual cost of care for the poor is approaching $11 million per month. While we would need more details around the plan, we are open to solutions that enhance access and share this responsibility with our other health system partners.”

VUMC: “Already, Vanderbilt University Medical Center plays a significant role in caring for uninsured patients from across the region while our adult and pediatric hospitals consistently operate at a high capacity. The proposal from leaders with Meharry Medical College and Metro Nashville General Hospital is creative and could result in a way forward to address the needs of Nashville's uninsured. As a longtime member of the Safety Net Consortium of Middle Tennessee we continue to seek solutions to help the medically uninsured, and look forward to further discussions with Meharry and Metro General leaders regarding this proposal."

Nashville General: “We acknowledge and appreciate the efforts of Meharry Medical College and the Stakeholder Team to provide healthcare for the indigent population of Nashville. Nashville General Hospital provides care to all Nashvillians through our integrated healthcare delivery system. As the City’s original community hospital, Nashville General Hospital remains committed to ensuring that, together with Meharry Medical College and other physician providers, we continue to provide the highest quality of health care to the citizens of Nashville and Davidson County in the most cost-efficient manner … We wish to thank Mr. Richard Manson and Ms. Dawn Alexander who served as Hospital Authority Board and Nashville General Hospital leadership representatives. At this time, the Hospital Authority Board is awaiting the opportunity to have a formal review of the Stakeholder proposal.”