The health care system for Davidson County’s medically underserved and indigent populations could look drastically different five years from now if Metro follows today’s report from consultancy John Snow Inc.
In a presentation to the Mayor’s Healthcare Community Advisory Group this morning, Snow representative Reesa Webb outlined the firm’s final recommendations for improving the county’s safety net health care system so it provides better care in a more financially viable business model.
In short, Snow thinks the county needs one “leading entity” that oversees not only the current Metro safety net facilities — Nashville General Hospital at Meharry, Bordeaux Long Term Care and Knowles Assisted Living — but also primary care physicians, clinics and any other safety net care providers. This entity, which could build upon the existing Hospital Authority structure, would be self-governing and have independent financial authority.
Advisory Group head Jack Bovender, retired chairman of local hospital giant HCA Inc., seemed optimistic about the potential effect of the recommendations. Having a leading authority, “maybe a Health Care Authority of Davidson County or something,” that encompasses hospitals, clinics, primary care and other parts of the system could allow for better-coordinated care that ultimately reduce incidences of acute illness, he said.
But Bovender stressed that the plan is still in the early stages. The advisory group will review today’s discussion and meet again before finalizing any recommendations it presents to Mayor Karl Dean.
Some of the details to be worked out in the interim include how much it would cost to fund an expected five year “transition period” for when the new leading entity would be created and implemented. Snow recommends Metro provide dedicated, predetermined funding to the Hospital Authority for that time so it can adequately define, plan and adopt the change, but it suggested no dollar amount.
Snow has been working with Metro since April 2009, studying the county’s health care delivery system and comparing it with successful safety net systems in similar cities.
Snow said Nashville’s safety net system lacks the predictable public funding stream and integrated planning and resource allocation of more successful systems. It also identified an insufficient physician workforce, limited access to specialists and services such as adult dental care and mental-health care.
During the suggested five-year transition period, Snow recommends the leading entity identify a dedicated funding stream to help support its revenues. Some communities use a dedicated tax or city funding, Webb said.
Plus, with an independent financial authority and structure, the entity would be able to float bonds, raise capital and enhance revenues streams of its facilities through new or expanded services to meet the safety net’s financial goals. Snow also thinks the entity should be more aggressive in seeking grant funding.
An overall focus on primary care, however, should help with the safety net’s financial standing. Patients receiving more cost-effective preventive and primary care should be able to avoid more costly, emergent care.
Beyond a financial focus, the entity would also have committees to address human resources, community relations and quality of care.
As of this morning, no timeline was set for the Advisory Group to send preliminary recommendations to the mayor.