Although EMHS has a footprint in about two-thirds of the state, there are still challenges, such as physician recruitment. Most physicians train in urban environments and prefer the urban lifestyle and professional environment, Sabbagh says. Out-of-state doctors don't have ties to Maine, and it's a cold place in the winter and a buggy place in summer. That means the system has had to rely on mid-level practitioners such as nurse practitioners and physician assistants to fill in the gaps.
In Kingsport, Tenn., Wellmont Health System is participating in a Medicare Shared Savings ACO, with 10,000 assigned beneficiaries. It plans later to add its own employees to the ACO program. Denny DeNarvaez, the system's president and CEO, says the six-hospital system serves a community with high rates of smoking, diabetes and obesity. “We have a very challenged market.”
Some of its care-coordination efforts include a nurse call program, where patients connect with a “navigator” who directs them to the most appropriate care setting so they don't just show up in the emergency department. It also will follow up with a home visit, if that's what a patient needs.
“By far the most significant (investment) is the people piece,” DeNarvaez says. High rates of obesity, for instance, are linked to depression and a lack of knowledge about nutrition. “It is by nature something that is more social work, (and) care managers are hard to come by.”
Wellmont also has spent $100 million transitioning from McKesson Corp. to Epic Systems Corp. for its EHR system.
The system reported $22.3 million in income on revenue of $789.7 million in fiscal 2012, according to a financial report. While those numbers were an improvement over fiscal 2011, inpatient admissions fell 6.3%, while emergency department visits fell 1.9%.
In October, Wellmont suspended operation of Lee Regional Medical Center, a 58-bed facility in Pennington Gap, Va., citing the federal budget sequestration cuts, other Medicare reimbursement cuts under the ACA and Virginia's decision not to expand Medicaid eligibility under the healthcare reform law.