Revamping an old hospital in rural Illinois

After Streator, Ill., lost its only hospital in 2016, residents were rattled. The town of just over 13,000 is still without a traditional hospital, technically, but it's now home to an outpatient center with a slew of services, including emergency care, rehab and links to resources that address social determinants of health.

As rural hospitals across the country continue to close and healthcare disparities persist, health systems are rethinking how they provide care, including in rural areas. They're bringing healthcare to places outside traditional hospitals—where in rural areas, the occupancy rate hovers around 50%—and they're encouraging patients and providers to work together to maintain health and stave off problems.

In Streator, The Center for Health, run by OSF HealthCare, is intended to support new care paradigms that include social determinants of health. “We want to transform the primary-care model and enhance it with technology,” said Ken Beutke, president of the OSF Center for Health-Streator. “This is no longer a hospital. It's a place you come to get healthy and 
stay healthy.”

To make that change, OSF is operating the center while renovating the 55-year-old hospital and building 
an addition; the plan is to finish the $30.5 million project in the summer of 2019.

OSF will revamp the entrance and lobby, adding kiosks for digital registration. It will have spaces for community health education and offer a technology bar, so people can come in to get help with digital health tools, like wearables.

Alongside the renovations, it will also add software, including the digital guts behind a program that helps connect people to community organizations to address social determinants of health. Through the Pieces Iris software, Center for Health providers will direct patients to resources for transportation, housing and food insecurity, as well as other social issues they have.

“We want to interact with patients and assist them and meet them where they are,” OSF HealthCare CEO Robert Sehring said. “It's clear that the current care model of a primary-care physician and a panel of patients is not sufficient.”

Right now, during a pilot of the Pieces program, the software is not connected to the health system's Epic electronic health record. But that will eventually happen, and providers can already see whether patients have followed through on recommendations.

So far, thanks to the program, some of the eight organizations included in the pilot have moved from paper to digital customer management.

“It's giving them really good insight into who's coming in, what services they're providing, how often and what kind of dollars are going out,” said Kip McCoy, director of the Office of Innovation Management for OSF HealthCare. What's more, he said, these organizations can now more directly communicate with one another.

That capability in particular makes what OSF is doing unique, said Anita Cattrell, chief innovation officer for technology at consulting firm Evolent Health. “Care management and trying to link patients to these types of social services have been in existence for a while,” she said. “To be able to document and communicate electronically is pretty exceptional. You don't see that happening a lot.”

As OSF pushes the project ahead, leaders will have to make sure providers are ready to makes changes, both to workflow and to thinking.

“It's about viewing a healthcare model differently, broadening it to look at those social determinants and getting people to think about the differences in how we care for people,” Beutke said. “That shift in thinking is a challenge.”

By directing people to resources outside the health system, OSF providers and leadership are admitting that they can't necessarily do it all themselves.

“We, as the healthcare industry, especially in rural markets, need to recognize that we need partnerships,” Beutke said. “We can't be the answer to everyone's health issues,” he said. “If we're going to be sustainable in rural markets, we can't compete—we really need to work together.”

That requires a shift in financial thinking too. The Pieces-driven program is just a part of a broader rethinking of how care is delivered. If it were just a single program, executives might be able to aim for a return on investment in just a few years. But with this greater project, they're looking at a longer timeline—eight to 10 years—before they can really see changes in outcomes, Beutke said.

OSF may use Streator as a model for other projects, Sehring said. “How does rural healthcare change over time?” he said.

“We all worry about how that healthcare delivery is negatively impacting communities. A lot of what is being learned and developed in Streator is where the opportunity is for us.”