Five-hospital North Mississippi Health Services in Tupelo is one of a growing number of healthcare systems working with business and government to improve community health.
In the past, hospitals profited from illness because sick patients with insurance were viewed as money in the bank. But the growing influence of managed care and the concern over rising healthcare costs have caused multihospital healthcare systems to take another look at the purpose of their "cash cows."
"Our goal is to improve the health status of the (600,000) people we serve in a 22-county area of north Mississippi," said Jeff Barber, NMHS president and chief executive officer.
Maximizing admissions and revenues used to be a top goal of hospitals, before managed care began biting into patient stays and profit margins. Now executives believe keeping patients with preventable illnesses out of the hospital can keep fund balances beefy.
Barber said NMHS also realizes that by improving the health of its population, the system will ensure its future as a financially secure tax-exempt organization.
In 1995, NMHS generated net revenues of $312.3 million and provided $35.9 million in uncompensated care, or 11.4% of revenues. It earned $27.1 million in net income for a 8.7% total margin. The system has maintained an AA bond rating with Moody's Investors Service since 1993.
NMHS includes five hospitals with 895 beds. Its flagship hospital, 647-bed North Mississippi Medical Center, is the nation's largest rural referral center.
The system also operates 18 family medical clinics with 36 physicians, a home health agency with 365,000 visits, three freestanding nursing homes, and outpatient dialysis and rehabilitation services. NMHS has a 100,000-enrollee PPO and has just been licensed for an HMO.
To improve community health, the system is starting a program called Live Well, Barber said. It plans to work with schools, health departments, physicians, businesses and other private groups to support and encourage healthy lifestyles, health promotion and disease prevention.
Barber said Live Well also will complement NMHS' managed-care efforts by keeping potential members healthier and by reducing costs in the emergency departments.
"We do all the indigent care in the area without any tax support," Barber said. "Anything we do outside the hospital to improve community health will help us reduce our costs."
In June, NMHS plans to design Live Well by first choosing two to five health risk indicators. Those health indicators are among 12 that have been identified in Healthy People 2000, a report issued by HHS.
Some goals NMHS will review include reducing the number of low-birth-weight babies and improving prenatal care, Barber said.
Mississippi ranks 50th in the nation in the relative health of its population, according to ReliaStar State Health Rankings. The ranking is produced by ReliaStar Financial Group, formerly Northwestern National Life Insurance Co.
ReliaStar said Mississippi ranked in the bottom 10% on nine of 17 measures. For example, in prenatal care, Mississippi ranked 37th with 69% of expectant mothers receiving prenatal care. In addition, Mississippi ranked 34th in infant mortality rate.
To help fund Live Well, Barber said NMHS is discussing grants with an unnamed national foundation and a local foundation. Earlier this year, NMHS began discussing Live Well with the Create Foundation in Tupelo.
Create Foundation, a public charity that issues about $1 million a year in grants, was formed in 1972 by George McLean, former owner of the Tupelo Daily Journal. When McLean died in 1983, the ownership and assets of the newspaper were placed with the foundation.
"He had a strong belief in a locally owned paper doing good for the community," Parham said. "He had a fear it would be bought by an outside corporation. He wanted the foundation to be a place for the community to pool money."
As a result, Create receives nearly 33% of the Daily Journal's net income, Parham said. The foundation also solicits donations and issues grants for education, healthcare, community and human development in a 15-county area of north Mississippi, he said.
In 1989, Create collaborated with NMHS and the public school system in Tupelo on a project to improve health education in the schools, Parham said.
But Project Blueprint for Hope, as it was called, got bogged down on the issue of how best to reduce teen pregnancy, he said. A year later, however, participants created a community resource committee that still meets monthly to discuss community health issues, Parham said.
The committee, which includes more than 50 government and private agencies, has developed plans to reduce child abuse, cut school drop-outs and expand parental education, Parham said.
"We view NMHS' effort as an extension of our Hope project," he said.
Barber said he believes that health systems should be at the center of coordinating community health projects and services because of the medical resources and expertise the systems already have in place.
Besides financial support from business and coordination from other public health programs, Barber said physician involvement is the key to the program.
Last year, NMHS established a family medicine residency center in Tupelo. The residency program is affiliated with the University of Mississippi School of Medicine in Jackson. The residency center also houses the community outreach and school health nursing programs.
So far, one physician has enrolled in the program, with four more to join later this year, said J. Edward Hill, M.D., its director. Hill said six residents will enter the program each year.
"The residents will be a big help in promoting primary care in the area," Hill said.
In addition, Hill said the medical staff is highly motivated to become involved in public health issues. More than half NMHS' 275 physicians have volunteered to staff the system's free clinics, he said.
"We want to help people make informed decisions about their health and provide a place where they can get it," Barber said.