Transforming HealthcareIn Harnett County

www.harnetthealth.org

• 2 Hospitals• 6 Physician Practices• 7 Outpatient Centers• 1 Foundation

BETSY JOHNSON HOSPITALour flagship hospital in Dunn, established in 1937

• 101 beds• Emergency Medicine• Surgery• Medical Imaging• Labor & Delivery• Medical Nursing Unit• Pediatric Nursing Unit• Critical Care Unit• Rehab Services

CENTRAL HARNETT HOSPITALour new hospital in Lillington, opened January 18, 2013

• 50 Private Rooms• Emergency Medicine• Same Day Surgery• Outpatient Diagnostics• Medical Imaging• Medical Nursing Unit• Telemetry Rooms• Inpatient Rehab Services

$120 Million Investment in

Facility Improvements• New Hospital in Lillington• Inpatient Tower in Dunn• Women’s Center• Pediatrics• Emergency • Surgical Suite• Rehab Center• MRI• CT Scanner (64 slice)

• Nuclear Medicine • Digital Mammography• Wireless Cardiac Monitoring• Electronic Medical Record• Hematology/Chemistry

Analyzers• Medication Administration

Systems• Telepsychiatry

Harnett HealthPrimary Care Services

6 Primary Care Practices:Angier Medical ServicesCoats Medical ServicesDunn Medical Services

Lillington Medical ServicesHarnett OB/GYN

Premiere Pediatrics

1 Primary Care Partnership with Campbell University:

Campbell University Health Center

Harnett HealthOutpatient Centers

Benson Rehab & WellnessBreast Care Center

Cardiac Diagnostic CenterCardiac Rehab

Lillington RehabOutpatient Rehab

Wound Care Center

Harnett Health Foundation• County-wide philanthropic

entity for Harnett Health• Vehicle for channeling

community support into needed new facilities and services

• Healthcare foundations comparable to College and University foundations

• Means of promoting value proposition of Harnett Health; telling the story

• Council of Advisors

Our goal is to builda Top Tier Local

healthcare systemthat is affordablefor our patients

Investing in current facilitiesInvested $53 Million in Betsy Johnson Hospital:• New physicians • New inpatient tower• ER, OR, facility renovations• Technologies: CT, MRI, Nuclear Medicine

ResultsHighest to date:• Patient experience scores• Quality scores• Volume of admissions• ER volume • Number of physicians on staff• Financial outcomes• Number of employees

PHASE 1

Expanding facilities and services• Construct and open Central Harnett Hospital

($56 million investment)• Establish Electronic Medical Records (EMR)• Open new Business Center, downtown Dunn

ResultsFY2013 Budget Initiatives:• Hire 220 new employees to staff hospitals/services• Recruit 12 physician providers• Second Meditech upgrade• Computerized Physician Order Entry (CPOE)• Open new Wound Care Center, Dunn• Open 20,000 square foot Medical Office Building

in new medical office park, Dunn

PHASE 2

Growth• Strengthen educational partnerships to ensure

quality care providers are available in the future

• Continue building relationships with physician groups in key specialty areas that will be available in Harnett County

• Recruit 48 new physicians within the next 10 years

• Continue to evaluate additional primary care physician hubs throughout Harnett County

• Volumes in FY2013 are ahead of projections

PHASE 3

Population Growth• Total population in the service area is approximately 193,000 and is

expected to grow to 217,000 by 2015, representing a healthy 2.4% CAGR.• The fastest growing areas are those in/bordering Wake County.• Harnett County is one of the fasting growing counties in the state.

KeyServiceAreas

Harnett Health Stats

Harnett Health• Number of people getting a pay check: approximately 1,000• Average annual salary and benefits: $62,000 • Cleverly & Associates: Community Value Five-Star Hospital• Press Ganey Award: Most Improved Patient Satisfaction Scores• Joint Commission Accreditation 2013

Current Medical Staff

Total Medical Staff: 265+

Primary Care Providers: • Family Practice• Internal Medicine• OB/GYN• Pediatrics

Hospital Based Providers:• Anesthesiology• Emergency Medicine• Hospitalist Medicine• Pathology• Radiology

Current Medical Staff

Specialty Care Providers:• Cardiology• Dentistry• Gastroenterology (GI)• General Surgery• Infectious Disease• Nephrology

• Neurology• Oncology• Ophthalmology• Orthopedics• Podiatry• Urology

• Access to Care• Economic Development• Community Partnerships

Building a StrongCommunity

Partnerships with excellent physicians to provide care LOCALLY in Harnett County:

• Harnett Health Primary Care Network• Triangle Orthopaedic Associates• Cary Cardiology (WakeMed)• Cary Urology (dba Harnett Urology)• US Oncology• WakeMed Faculty and Specialty Physicians• Carolina Regional Radiology• Campbell University Faculty Physicians• Specialty Physicians for Telemedicine: Psychiatry• CommWell, First Choice FQHC’s

Access to Care: Building a Premier Medical Staff

Harnett Health has become a cornerstone inour communities:• $200 million economic impact ANNUALLY• Additional $700 million economic impact through 2022

with the opening of Central Harnett Hospital• County’s second largest employer – 1,000+ employees• New jobs now and in the future• 265+ Medical Staff Providers• $17 million annually in charity care, 17% of budget

Economic Development: Job Creation, Impact

Work with key organizations for strongercommunity and economic infrastructure:• Strategic Partnerships (WakeMed)• Campbell University School of Osteopathic Medicine• Campbell University PA Program and Pharmacy School• Central Carolina Community College• Partnering with Financial Institutions• Partnering with Governmental Institutions• Partnering with Community Leaders• Philanthropic Partnerships

We Must All Work Together!

Community Partnerships: Strengthen Relations

Harnett Health: Our Story

• Harnett Health is Harnett County; we are your friends and neighbors

• Strategic expansion; new footprints• Significant charity care commitment; our heritage• Increasing visibility wherever we can be• Huge local asset for a rural county• Building healthier communities• Local primary and secondary care access• Everyone needs a family doctor

Harnett Health: Our Challenges

• Need for greater transparency• Increasing cost of operation while maintaining

affordable cost of care and value• Greater access means greater capital investment• Understanding community needs• Unique and complex business model– competition drives cost up, not down– normal consumer psychology doesn’t apply– consumer prices not set by the hospital or the market– payment made by third parties, insurance or government – no one turned away; community “safety net”

• Preventive care vs. illness care• Preserving not-for-profit status

– margin reinvested, not directed to shareholders– no huge reserves, only what’s needed

• Political realities– continuing reimbursement cuts, federal and state– threatened loss of tax exemption– lack of Medicaid expansion– vulnerability of Certificate of Need– inadequate support for mental health care– perception of large, untapped cash reserves

Harnett Health: Our Challenges

• Focus on population health, healthier communities– means assuming financial risk, risk for health status

• Much greater transparency, community engagement– if Harnett Health assumes risk for diseases caused by social

issues, then we have to engage with the community on those issues

• Success is prevention/chronic care support• Achieving lower costs, higher quality, greater access,

better efficiency• New partnerships/collaboration will be necessary• Strengthen Campbell partnership

Harnett Health: Our Future

Harnett Health: Our Future

• Succeeding under reimbursement changes from the old fee-for-service model to pay-for-performance

• Adapting more of the traditional “public health practices” to health system design – large scale health intervention strategies– social psychology of health and health behaviors– predictive health analytics, large data sets– population health surveillance, assessment, evaluation

• Population Health Officer as senior-level executive?• “We want a health system that keeps people out of

the hospital” (D. Berwick, 2013).