How Sentara Healthcare moved managed Medicaid into the community

Photo courtesy Sentara Healthcare

Sentara Healthcare advanced its vision to reach vulnerable populations by moving care into the community.

Two months ago, the Norfolk, Virginia-based health system set up two neighborhood clinics – one within an emergency homeless shelter – and also went on the road with a mobile care van.

The Sentara Community Care model has enabled the Medicare- and Medicaid-heavy Norfolk, Virginia-based health system to start reaching its equity goals and put its community benefit dollars toward populations that have, out of necessity, put food and shelter concerns ahead of their healthcare needs.

Financially, the model is expected to save on uncompensated care costs by reducing the number of uninsured patients showing up for care. People who visit the clinics who qualify for Medicaid and who aren't already enrolled may sign up.

"Having people be healthier in a community is good business," said Dr. Jordan Asher, executive vice president and chief physician executive at Sentara.

People who don't have a medical home go to the emergency room, Asher said. 

"The sooner we get these folks into more preventative care it saves money for ourselves and the community and taxpayers," said Patricia Darnley, senior vice president of Government Programs. 

Last year, Sentara provided $254 million in uncompensated care, according to Darnley. The funds spent for the two clinics and the care van represent community dollars spent on preventative care. 

Beyond the financial, the move into the community is part of Sentara's mission, they said. The clinics were not a hard sell. Conversations on the health system's mission were held with the board, Asher said. The clinics became part of a five-year strategic direction.

"What we're finding and are very focused on, we're providing a trusted place and services, including for behavioral health and substance abuse," Asher said.

One clinic is in a shelter in Union Mission in Norfolk. It consists of three exam rooms and is staffed by nurses. Telemedicine is also available through the clinic. The second clinic is in the medically underserved neighborhood of Berkley, Virginia. The third program serves the Hampton Roads, Virginia, region through the Sentara Mobile Care bus. 

A grocery store is also available.

WHY THIS MATTERS

The model works in part because Sentara is an integrated system of 12 hospitals and two health plans.

Sentara is the Medicaid provider for 42% of all Medicaid lives in Virginia, Asher said. "And we're proud of that," he said.

All of the Medicaid population is in a managed care plan.

Before moving into the community, Sentara organizers researched areas of greatest need, which had a high number of people who were either uninsured or covered by Medicaid. They looked at the data and took a market-driven approach.

"The first thing is, what does the market need?" said Asher. "We looked at geographic mapping data, claims data. We interviewed people in the community." 

Darnley said, "Based on using that data, we pinpointed areas where there are gaps in care."

It's like the Walmart model, Asher said. People go into Walmart to buy food and see other things they need. Those who enter the Union Mission may be looking for shelter, but once inside may use the clinic's services because it's there.

One young child who had come in was given a toothbrush, Darnley said. He told the staff, "'I don't have one of my own, I have to share it with a family,'" Darnley said.

"The effort is about human dignity," Asher said. It simultaneously improves health equity, he said.

THE LARGER TREND

Health systems are incredibly good at taking care of people when they are sick and seek help, Asher said. 

The clinics are about preventing illness. Other health systems have taken similar steps to address clinical care through making improvements in the social determinants of health.

Montefiore Health System in the Bronx, for example, tackled the social determinants by investing in housing, a move that cut down on emergency room visits and unnecessary hospitalizations, for an annual 300% return on investment.

ON THE RECORD

"It definitely makes sense globally," Asher said. "We are a country that spends more on healthcare than any other country and also on social services.
From a business model standpoint, we are in the Medicaid business. Lowering the total of care, that's how managed care works."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org