Patient Flow Enewsletter
Volume 1, Issue 1
Thursday, December 11, 2003
Henry Ford Hospital in Detroit, MI is an Urgent Matters grantee. Detroit and Wayne County face many health care delivery challenges, including the need to assure adequate funding for safety net services. Detroit's population has higher rates of illness and chronic disease than other parts of the state, and there is a lack of primary care options and health professionals in the area. In addition, the city has higher rates of uninsured and low-income individuals than the rest of the state.
Economic factors have further undercut the local health care safety net, including reductions in Medicaid funding under the Balanced Budget Act of 1997, under-funding in the Medicaid program, and - as a result of the economic downturn - reductions in hospital investment income often used to subsidize the care of the uninsured.
In July, a workgroup appointed by Michigan Governor Jennifer Granholm presented a report outlining strategies to address health care needs in Detroit. In the report, the Detroit Health Care Stabilization Workgroup recommended the immediate establishment of a health authority for the City of Detroit and Wayne County. The health authority will seek to provide a seamless system of care through a more efficient delivery system aimed at improving the health of the public, decreasing the cost of care, and adding value to the areas of the health service delivery system.
Gail Warden, former president and CEO of Detroit's Henry Ford Health System, led the subcommittee on the health authority. He now serves as a special advisor to the Michigan Department of Community Health, helping it craft the formation of the authority.
Urgent Matters spoke with Mr. Warden to secure insights and perspectives on Detroit's health care crisis and the Workgroup's effort to provide workable solutions.
Interview: Gail Warden
Q: What, in your view, are the reasons for the health care crisis in Wayne County - and Detroit?
A: There are several reasons. We have about 700,000 people who are uninsured or underinsured. The health care structure is eroding. In recent years, 20 hospitals have closed, and we lost a lot of physicians who have left the city. The health and economic status of our patients are among the worst in the nation. In addition, there is a Medicaid crisis. The Medicaid program is under funded, and the decapitation rate for Medicaid health plans is the lowest in the country.
Q: Is this situation unique to Wayne County and Detroit or shared by other urban areas?
A: This is a problem shared by other urban areas, but I don't think the magnitude is as great as in Detroit. In some cities, such as Dallas, Chicago, Denver, there is a public hospital or public health system - an institution that provides support for health care.
Q: What led the Workgroup to decide that a Health Authority is the best solution to addressing Detroit's health care crisis?
A: We knew what our problems were and why we had a crisis, and we undertook an effort to understand how other cities have responded to similar challenges. We looked at models that might work for Wayne County and Detroit. The one that was most appropriate for us was an authority funded by an intergovernmental agreement that included the city of Detroit, County of Wayne, and the state of Michigan. That authority enables legislation for the state, county, and city to address all three governmental units.
Q: What is the overall aim of the Health Authority?
A: The goal of the Health Authority is two-fold - to find a way of designing the delivery system so that everybody has a medical home and to maximize the opportunities to attract dollars to care for our population through the matching of Medicaid funds, foundation dollars, federal appropriations, and grants. The Health Authority will pursue all possible funding sources to support the city's ability to deliver health care- including funds for federally qualified health centers and planning grants.
Q: Do you see this as an innovative approach that has been or might be adopted on a more widespread basis in other localities?
A: I think that many of the things that we are doing can be applied in other places. Some groups that might be interested in lessons learned include state governors, state Medicaid directors, and associations of public hospitals and community health centers.
Q: Are there plans to preserve services provided now by the major safety net hospitals in Wayne County and Detroit?
We hope to preserve what they are doing and provide better organization and coordination among institutions.
Q: Do you see the Urgent Matters Detroit site assessment as providing information that will be of use to the work of the Health Authority or to overall efforts to shore up Detroit's ailing health care safety net?
An outside assessment will be helpful, very useful. From the Urgent Matters assessment, we will find out what types of concerns the patients have and what they know and don't know about availability and access to health care. We can benchmark against other cities in terms of issues that are important - such as how long a patient must wait to be seen in an emergency room or a clinic or how much of the illness the patient presents can be attributed to a delay in health care because he or she lacks health insurance.
Q: Part of the Urgent Matters initiative involves working with hospitals to improve the flow of patients through the emergency department and enhance processes that contribute to quality care. Do you see this work as providing a timely contribution to the short- and long-term strength of Detroit's health care safety net?
A: It is going to have a major impact on how the population in urban communities uses local emergency rooms. It will help us know what kind of barriers patients encounter, how accessible the emergency department services are, what percentage of the time patients are visiting the ED for emergencies and what percentage they are using the emergency room as a de facto clinic. In our case, in Detroit, 50 percent of the visits to emergency rooms are preventable.
It is going to be very valuable as we seek to obtain better returns on the resources that we are putting into the health care system - our use of services, the organization of the emergency room for delivery of care, and the provision of high quality care. It will also tell us something about the relationship between patient care delivered on an inpatient basis versus care delivered in the emergency department - as they are often directly connected. In addition, we hope to learn more about bottlenecks in the emergency department and the length of time patients have to wait to be admitted to the hospital.
Q: What are the things that are going to improve the way emergency rooms operate?
A: Emergency departments will be improved through better information systems; changes in the approach to processing patients brought in by ambulance or car vs. those who come on foot; the identification of patients who are repeat visitors, what happens with him, the causes of their visits - such as the city transportation systems. Another piece is related to the shortage of personnel, the ability of emergency room to deliver care, and the use of various types of caregivers that may be available to take care of the patient population - for instance, using practitioners and clinical nurse professionals working aside emergency room physicians.
| Fast Facts - Detroit and Wayne County
Detroit's health care infrastructure is eroding.
Detroit Health Care Stabilization Workgroup, "Strengthening the Safety Net in Detroit and Wayne County," Michigan Department of Health, July 2003. |
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Gail Warden
Former President and CEO
Henry Ford Health System
Detroit, MI
