. Case Study: A Tale of One Community with Two Hospitals The community of Greater

. Case Study: A Tale of One Community with Two Hospitals The community of Greater Manchester, New Hampshire, is served primarily by two hospitals: Catholic Medical Center (CMC) and Elliot Hospital. This case provides information about the two hospitals and a community health assessment for Greater Manchester. Once you have read the materials, answer the discussion questions. Catholic Medical Center The following is an excerpt from the CMC (2016b) website: In today’s turbulent healthcare environment, we … need to focus on evolving from volume-based (payments based on the number of patients we see) to value-based (payments based on the quality of care we provide to patients), and we are proud of our progress to date. We are participating in the Anthem Patient Centered Primary Care (PC2) program, Cigna shared savings, and the top 10 in the country for quality—NH Accountable Care Organization. CMC is a proud member of Granite Health—a partnership of five independent New Hampshire charitable community health systems (Catholic Medical Center, Concord Hospital, LRGHealthcare, Southern New Hampshire Health System, and Wentworth-Douglass Hospital) leading the transformation of healthcare delivery in the communities they serve…. Granite Health members are committed to sharing resources to provide better, more seamless, and less expensive care for their patients. CMC has also been focused on growing and enhancing our services. We have a Patient Transfer Center that large hospital systems are looking to model. We continue to expand our cardiac, vascular, and bariatric (weight loss) services throughout the state and announced our Telestroke and Teleneurologist program that complements our hospital-based neurologist (neurohospitalist) and award- winning Gold Plus stroke program. We are proud of our continued collaborative spirit with critical access hospitals throughout the state to focus on improving the quality of care available to their patients and the communities they serve. The CMC (2016a) mission statement is as follows: “The heart of Catholic Medical Center is to provide health, healing, and hope in a manner that offers innovative high-quality services, compassion, and respect for the human dignity of every individual who seeks or needs our care as part of Christ’s healing ministry through the Catholic Church.” Elliot Hospital The Elliott Hospital (2016) website offers the following description: Elliot Health System (EHS) is the largest provider of comprehensive healthcare services in Southern New Hampshire. The cornerstone of EHS is Elliot Hospital, a 296-bed acute care facility located in Manchester (New Hampshire’s largest city). Established in 1890, Elliot Hospital offers Southern New Hampshire communities caring, compassionate, and professional patient service regardless of race, religion, national origin, gender, age, disability, marital status, sexual preference, or ability to pay. EHS is home to Manchester’s designated Regional Trauma Center, Urgent Care Centers, a Level 3 Newborn Intensive Care Unit, Elliot Physician Network, Elliot Specialists, Elliot Regional Cancer Center, Elliot Senior Health Center, Visiting Nurse Association of Manchester and Southern New Hampshire, Elliot 1- Day Surgery Center, Elliot at River’s Edge, and Elliot Pediatrics. The EHS mission statement is as follows: “Elliot Health System strives to: INSPIRE wellness HEAL our patients SERVE with compassion in every interaction.” Greater Manchester Community Health Needs Assessment The following are excerpts from a community health needs assessment (CHNA) for Greater Manchester from June 2013. It was conducted jointly by CMC and EHS (2013), with assistance from the City of Manchester Health Department. Community. The 2013 Community Health Needs Assessment focused on the Health Service Area (HSA) of Greater Manchester, a market which is primarily served by Catholic Medical Center and Elliot Hospital. The Manchester HSA is home to approximately 180,000 residents and is comprised of the towns of Auburn, Bedford, Candia, Deerfield, Goffstown, Hooksett, New Boston, as well as the City of Manchester. These towns are located in three different counties (Hillsborough, Rockingham, and Merrimack) within the State of New Hampshire with 60% of the residents of the HSA living within the City of Manchester. (CMC and EHS 2013, 4) Demographics. The population of the Manchester HSA is changing; not only is it is aging, but it is also becoming increasingly multicultural with residents reflecting a variety of nationalities, languages, ethnic traditions, religious beliefs, and ideologies. The City of Manchester is home to 60% of the residents of the HSA and, in alignment with the State of New Hampshire, the population of the Manchester HSA is aging. The 65+ population within the HSA is projected to realize an 18% growth through 2018, and many other towns within the HSA will experience over 30% growth in the 65+ age group. . . . The City of Manchester’s pediatric population is projected to realize an increase of about 2% in children ages 0-17. (CMC and EHS 2013, 5) Access to Healthcare. Residents in the City of Manchester are much more likely not to have healthcare coverage than the rest of the State of New Hampshire. Residents earning less than $25,000 are more than twice as likely to not have health coverage as the rest of the city and almost three times as likely to not have coverage as the rest of the state. People who do not have healthcare coverage need to pay the entire costs for care themselves. The statistics are almost exactly the same for not being able to see a doctor because of cost. Residents earning less than $25,000 are more than twice as likely to not see a doctor because of cost than the rest of the city and almost three times as likely as the rest of the state. . . . Such barriers to accessing health services attribute to: unmet health needs, delays in receiving appropriate care, inability to get preventive services, as well as preventable hospitalizations. (CMC and EHS 2013, 38-39 Health Issues. The CHNA workgroup reviewed the data collected, the surveys, key leader interviews, and focus group minutes and after much discussion has identified the following needsto be addressed in the community: ï‚· Behavioral health issues: mental health services and access, substance abuse–specifically illicit drug use and tobacco use ï‚· Obesity: diabetes, poor eating habits, lack of physical activity ï‚· Aging issues: stroke, Alzheimer’s, pneumonia, transportation, medication coordination, caregiver support, inadequate out-of-home care ï‚· Chronic disease: heart disease, cancer, COPD ï‚· Ambulatory care sensitive conditions—marker for lack of adequate preventive care: need care coordination ï‚· Barriers to access of healthcare services related to poverty: lack of insurance, cost, transportation, lack of information on how to access care and what services are available if uninsured, language, lack of a medical home ï‚· Teen pregnancy ï‚· STDs: specifically, chlamydia ï‚· Dental services/access: specifically, for adults ï‚· Asthma ï‚· Violence and crime: neglect and abuse, safe neighborhoods, suicide, youth crime (CMC and EHS 2013, 50-51) Suggestions and Issues Raised by Community Members and Survey Respondents ï‚· More mental health providers ï‚· Coping skills for mentally ill ï‚· Additional substance abuse services ï‚· Coordination across agencies to promote better services and programs ï‚· Collaborate as a community with other like organizations and support each other—so all groups can share with people ï‚· More shelters ï‚· More homeless housing ï‚· Open a free/low-cost dental care facility ï‚· Low-cost dental clinics ï‚· Better dental care for Medicare/Medicaid people without insurance ï‚· Health providers giving inadequate time/attention to patients ï‚· Increase healthcare options for low-income/uninsured people ï‚· Expand medication bridge programs to help more people get access to patient assistance programs ï‚· Improved access for affordable health insurance to low-income/nondisabled ï‚· People should have enough food and access to more food pantries ï‚· More assistance for the elderly ï‚· Volunteers to visit nursing home residents ï‚· More gyms geared toward 65+ population ï‚· Improve housing conditions and options—hold landlords accountable for deplorable conditions, decrease wait list time ï‚· Clean out the lead-painted old multifamily units, especially the ones with poor heating systems ï‚· Clean up the run-down areas ï‚· Low-cost weight management programs outside of bariatric surgery ï‚· Make Manchester a smoke-free city ï‚· Affordable public transportation ï‚· Transportation for appointments ï‚· Increase funding for schools ï‚· Work for change in American beliefs and attitudes regarding how health is valued and what it means to be healthy (CMC and EHS 2013, 64) Questions: 4. Identify four health determinants that might be contributing to poor health for the community. 5. Research the amount of charitable care provided to the community from the two hospitals, and comment on the type of community benefit activities these hospitals provide.

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