This article first appeared in the St. Louis Beacon, Sept. 12, 2011 - When the St. Louis Regional Health Commission was set up a decade ago, one of its priorities was to find ways to pump life into the area's imploding medical care system for the needy. Fragmented and underfunded, that system had just lost its last public hospital and had no effective way of delivering basic care to tens of thousands of vulnerable residents in St. Louis and St. Louis County.
As the commission prepares to mark its 10th anniversary, some acknowledge that the agency still has plenty of work to do. But they also point to strides made to improve health-care access for those least able to pay for the services.
The improvements have included:
- Expanding primary and specialty care to an additional 120,000 people annually since 2008
- Diverting an estimated 75,000 costly and needless emergency room visits each year
- Setting up the Integrated Health Network to boost coordination among community health centers
- Connecting an estimated 30,000 residents to a continuum of care through primary-care providers in health centers
- Opening a psychiatric stabilization center for short-term emergency care at the Metropolitan Psychiatric Center on Delmar Boulevard.
The problems in 2001 were hardly the first to afflict the city's health-care delivery. Over the years, declining resources had led to cutting services and eventually closing two public hospitals. Those moves triggered public friction. When the only remaining public hospital, Regional Medical Center, closed its doors in 2001, the unintended result was to move leaders to an effort that has helped to revive the system.
It happened this way: When Regional Medical Center was shut down, the city was set to lose millions of dollars each year in federal dollars earmarked for hospital care. That's when the commission, along with numerous other stakeholders, succeeded in getting a federal waiver to use the hospital money to strengthen and expand the area's system of community health centers. A second waiver has since extended the federal funding to 2014, the year that federal health reform -- and new revenue to pay for indigent care -- is expected to take full effect.
In football jargon, St. Louis had completed a very long and difficult pass, said Robert Fruend, CEO of the St. Louis Regional Health Commission.
"Many of the health centers wouldn't exist without this funding," Fruend said.
The system has grown dramatically in a decade with five major organizations running about 20 centers. The five are Family Care Health Centers, Grace Hill Health Centers, Jean Kerr People's Health Centers, Myrtle Hilliard Davis Comprehensive Health Centers and the St. Louis County Health Department. The system also includes ConnectCare, which operates out of the old Regional Hospital building on Delmar. That facility is an urgent care center, meaning it offers walk-in care for conditions requiring immediate attention but not serious enough for a visit to an emergency room.
Health centers were created to be medical homes for patients, giving them access to primary-care providers and offering a continuum of health services.
Fruend said some people are learning that community health centers aren't just for the uninsured, the underinsured and the poor. "I personally am a patient at one. Not because I'm making some grand statement but because I think it's really good health care."
One crucial player in the commission's work is the Integrated Health Network. Its job includes making sure collaboration among health centers runs smoothly. In addition to the St. Louis centers and ConnectCare, the Integrated Health Network includes Crider Health Center in St. Charles.
Changing mindsets
The new system has yet to change the thinking of all needy residents, many of whom were accustomed to seeking treatment at emergency rooms. After the public hospitals closed, many of the residents turned to ERs at private hospitals.
"We don't have a public hospital, but that mindset still exists," said Bethany Johnson-Javois, CEO of the Integrated Health Network.
She said the network has referral coordinators in local hospital ERs to work with patients and help find primary-care providers in health centers if the patient's medical conditions do not require ER care.
Because of these interventions, Johnson-Javois said, "We're seeing a dramatic increase in the number of people coming into community-based health-care centers as opposed to going to emergency rooms for their primary health-care needs."
In spite of the promise of her group's work, she said the entire health system still has a ways to go to "try to shape, shift and work with the community" on issues such as prevention.
"Some of the challenges in our community are environmental," she said. "We really need to begin working on having a healthier population of people. Obesity is an issue. Health disparities are still prevalent. There are pockets of poverty and pockets where there are only fast food outlets on the corner."
Addressing these, she feels, will require not just the health centers and the network but input from the larger community.
"The next step for us is to really start reaching out more to our community-based partners, our faith-based partners to address the issue of health in a holistic way," Johnson-Javois said. "That's what we're missing." She said another issue that needs to be addressed is the stigma of mental illness.
All this, she said, means that health reform extends beyond policies and the money to implement them. It will mean attacking "the more systemic social determinants of health. That's what's going to move the needle" toward a healthy St. Louis.
Impressive Water Tower health center
Alan Freeman, president and CEO of Grace Hill Health Centers, said health centers have had tremendous success providing medical homes for patients across the city. Last year, Grace Hill opened a new Water Tower Health Center at 4414 North Florissant Ave. to replace a facility destroyed by fire in 2009. The new facility covers 18,500 square feet and has 30 percent more space than the old site, Freeman said.
The interior of the Water Tower Health Center looks as impressive as most private hospitals. That may work to the advantage of health systems trying to convince patients that the treatment is as good as that offered in private settings.
Freeman called Grace Hill "a beacon in a community that has seen some stress from the difficult economic times. We're very pleased to have the Water Tower hub with our friends at the Grace Hill Settlement House. We think it's an important part of an attempt to revitalize that community."
The Regional Health Commission's Fruend said that ambience in the facilities is having as much of a positive impact as quality care. Mentioning the impressive Water Tower Health Center, he said, "I'd take my kid there. Absolutely. Without hesitation, I'd take him there to be treated. Now if you go back five years ago, I wouldn't have taken him there. Was it because they had bad doctors, bad people there? No. It just didn't look respectable."
But now, he said, the Water Tower Health Center "is something we all can be proud of."
Even so, nobody is doubting the challenges ahead. "We don't have seamless access for everyone. But we've come a long way," Fruend said.
The community is figuring out how to turn a broken system into a winner. And it's getting national attention for its work. The rebuilt system is one of six programs around the country that the Commonwealth Fund has singled out for a study being done by George Washington University, Fruend said. The others include health systems in Indianapolis, Austin, Texas and San Francisco.
"We were on the list of communities doing really bad 10 years ago," Fruend said.
He thinks again of his football metaphor. "Now we've gotten invited to the equivalent of our first Pro Bowl."
It's going to be a long game in which first-and-ten progress is measured in years rather than yards.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
