Transitional care strategies can help rural hospitals manage care for medically and socially complex patients, or "super utilizers," panelists said yesterday at the AHA Rural Health Care Leadership Conference in Phoenix. AHA Board Member Jason Spring, chief strategic officer of Kalispell (MN) Regional Healthcare; Phillip Pandolph, CEO of Meadville (PA) Medical Center; and Tracy Meure, director of community care network & social service at Meadville Medical Center; explored how coordinating care, conserving resources and managing use of the emergency department enables them to improve the health and well-being of their patients. In addition, panelists said that by addressing the social determinants of health in their communities, such as coordinating community assets including housing, transportation, food and other safety-net resources, they were able to address the root causes that were driving super utilizers into their hospitals. Both hospitals champion pro-bono community engagement programs that have returned vast health benefits on behalf of patients and reduced readmissions. "It's not just health care; it's navigating complex socioeconomic issues," Pandolph said.  

More from the AHA Rural Health Care Leadership Conference: Pollack, Gragnolati Discuss Challenges, Opportunities for Rural Hospitals

On another panel, leaders from two rural hospitals — with vastly different populations — have seen positive impacts on their abilities to deliver care to their communities and recruit clinicians via telemedicine partnerships. Kayleen Lee, CEO of Sioux Center (IA) Health; Bryan Slaba, CEO of Wagner (SD) Community Memorial Hospital-Avera; and Darcy Litzen, client development officer, Avera eCare, discussed how a virtual health system model is transforming care delivery in their organizations. "Geographic isolation should not dictate the type of care people receive in their communities," Litzen said. Panelists cited clinician recruitment, workforce shortages, shrinking margins and a desire to stay independent as factors that prompted them to consider telemedicine programs. After doing so, they have saved more lives, reduced costs, improved their workforce and positively affected their communities, they said. Although Slaba said that his organization, which employs more virtual clinicians than in-house staff, is "as close to a virtual hospital that you will ever [find]," he acknowledges his vastly successful telemedicine program is "a supplement to what we can offer, not a substitute."
 
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