Community hospitals were long viewed as a place to go only when you became ill or injured. But changing market forces are requiring these medical centers to embrace a new role that encompasses not just acute care but also overall prevention and wellness. Managed Care Partners sat down with Johns Hopkins Medicine’s three community hospital presidents to find out more.

_{What are some of the biggest challenges facing community hospitals today?}

_{Steven Snelgrove, Howard County General Hospital: One is the global revenue cap in Maryland, which clearly put us in the population health business overnight. We don’t think about ourselves as just hospital administrators worried about business coming into the hospital. We think about addressing the needs of the community we serve to ensure health and wellness. We partner with other community providers, such as physi­cians, skilled nursing facilities, assisted living facilities and home health agencies, to ensure that patients are not just cared for in the hospital but also when they’re discharged so they don’t have to be readmitted.}

_{We’re also now focused on the so­cial determinants of health that create disease or illness in the first place: pov­erty, transportation, access to afford­able housing, good nutrition, exercise, smoking status. We’re now partnering with the Health Department and other community agencies to improve access to services and help people do the right things for their health.}

_{Richard Davis, Sibley Memorial Hospital: One major challenge is maintaining the balance between continuing the high-quality, efficient care our community expects while also meeting the needs of community physicians in the midst of a rapidly shifting marketplace. One of the new models of care we must look at is providing patients a full continuum of care within and without the tradi­tional hospital walls. We’re preparing for population health, which requires that patients receive the right care in the right place and at the right time for the right cost. It’s a very service- oriented attitude.}

_{Gene Green, Suburban Hospital: We hear a lot about health care transformation, but most people don’t know exactly what that means. Fee for service is being replaced with value-based payments for safety, quality and the patient experience. Greater efficiencies are required in order to focus on those while decreas­ing costs. One of the answers is to identify ways to align with other organizations and with physicians, often through an employment model.}

_{What investments are you making, and what strategies are you employing to prepare for the future?}

_{Snelgrove: We’ve created a new senior-level position in Population Health and Community Relations; Elizabeth Edsall Kromm is helping us establish what population health looks like in Howard County. She’s doing so by collaborating with the medical director of the health department, the head of the Horizon Foundation (a funding agency unique to Howard County), the public school system and other providers.}

_{Davis: Let me give you one example here at Sibley. We have a large and thriving oncology service. One of the most significant improve­ments that has, and continues to have, a major positive impact on the patient experience is the hiring and then assigning of nurse navigators to patients so they’ll have a single point of continuity for their care. This navigator makes sure that appointments are followed up, information is provided, questions are answered and so on. We are well-positioned to provide the needed continuity of care for our patients: We have an acute care hospital, we have a rehab hospital, we have an assisted living facility, and we own a home care company. We have robust outpatient activities. We are making strategic investments in more prevention and wellness initiatives. The other area that we’re focusing on is creating a more robust ambulatory network. And we’re asking questions like, Should be we in pharmacy? Should we be in other locations?}

_{Green: At Suburban, it’s our role to be the hub of community wellness. A hospital’s main role used to be to take care of you when you were sick. Now our role is expanding to keeping the community healthy. So we are looking for partners, relationships and alignments to keep people healthy throughout all stages of their lives and, when they do become ill, to manage their health throughout the continuum of care—including primary and specialty care, skilled nursing facilities, and even fitness centers. Any relation­ship that helps build that, we’re seeking. I’m even talking to correc­tional facilities and to area businesses who want to keep their employees well. And we are also looking at ways to bring information technology into this to help us drive change.}

_{What must community hospitals do to reach clinical and financial success?}

_{Snelgrove: We have to embrace the mandate of accountable care and partner with physicians, elected officials and other providers. We need to help citizens understand the value of population health—what it means to the quality of life in our communi­ties—and create a strategy that everyone supports.}

_{Davis: We have to never waver in our focus on quality and safety as the number one priority. And provid­ing excellent service is a strategic priority as well. There’s a growing—and I would say appropriate—expecta­tion from patients and families that their experience needs to be “five-star.” We are recognizing that care needs to be designed around them, not the provider. For financial success, we have to look at our underlying cost struc­tures and see where there are opportu­nities to reduce those and have patients seen in the most appropriate care settings.}

_{Here at Sibley, we’ve introduced a number of more progressive perfor­mance-improvement tools for staff to help us redesign a more efficient and effective care delivery model. My particular focus is on investing in organizational development activities that will educate staff members to give them tools to help fingerprint where we’re headed. The other initiative we’re doing is having physicians visit patients at home after discharge. We believe it’s the right thing to do to make sure that patients are doing well and see if they have any questions. It helps reduce readmissions. But it also introduces a cultural dynamic where we can provide care that isn’t inside the traditional walls of the hospital.}

_{Green: We must embrace teamwork. That means everybody: physicians, nurses, patients and families. We have a very engaged Patient and Family Advisory Commit­tee that is guiding us toward an enhanced model for patient- and family-centered care.}