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BY: STEPHANIE MANSON AND PETE GUARISCO

Mark Pernice

At Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, our Catholic heritage calls us to extend our healing ministry to those most in need. But, in a state where a majority of those most in need were served by a state-run public hospital system, we answered this call, like most hospitals, by providing our fair share of free care and community service. In 2005, when Hurricane Katrina made landfall in New Orleans, temporarily shuttered that city's public hospital and caused thousands of its patients and medical students to relocate to Baton Rouge, there was a great challenge to our ministry.

There was an even greater opportunity for us to bring our mission into the lives of many others.

This is a story of a state with a long history of providing care to the uninsured or underinsured through a system of public hospitals. It is a story of one of our country's costliest natural disasters and the monumental consequences, and it is a story of the Franciscan Missionaries of Our Lady Health System and its Catholic heritage. These stories collided when Katrina's waters toppled the levees and put New Orleans underwater. The result has been a series of innovative partnerships creating new models of health care, providing graduate-level medical education and developing community health outreach to some of Louisiana's most vulnerable residents.

In the chaotic days after the hurricane, Louisiana's capital city, Baton Rouge, received thousands of people from flooded New Orleans. Among the displaced were Louisiana State University medical students and residents who had been working in the New Orleans Charity Hospital, part of the state's health care safety net of 10 public hospitals administered by LSU. This public hospital system — unique to Louisiana — provided care to our state's uninsured, estimated to be about 22 percent of our population. Charity Hospital, which had served the poor in New Orleans since its founding in 1736, was shut down after the storm. The rebuilt $1.2 billion hospital is poised to reopen later in 2015.

LSU temporarily moved its medical school to its Pennington Biomedical Research Center near Our Lady of the Lake Regional Medical Center, one of the Franciscan Missionaries' five Louisiana hospitals. The proximity of the temporary medical school to Our Lady of the Lake — which now was experiencing a great influx of patients displaced from New Orleans — offered a natural fit for an academic partnership between the two institutions.

A deal was struck. Overnight, Our Lady of the Lake welcomed approximately 70 residents, who were able to continue their training. Today, this academic medical program has grown to about 500 students and residents combined.

Meanwhile, talk was swirling about what would happen with Baton Rouge's public hospital, the Earl K. Long Medical Center. This acute care facility primarily served the uninsured in Baton Rouge and several surrounding parishes, but it was in poor physical condition: It was estimated to require more than $400 million in rebuilding or renovation costs or face the loss of its accreditation. As the state looked for solutions, including the possibility of closing the Earl K. Long hospital, it sought Our Lady of the Lake as a key contributor in the discussion.

CREATING A PARTNERSHIP
Our Lady of the Lake already had a long-term goal of evolving into an independent academic medical center. The confluence of forces wrought by Katrina, combined with the anticipated cost of repairing or replacing Earl K. Long, brought the state and Our Lady of the Lake together to consider a formal partnership that included graduate medical education and inpatient care for public hospital patients in Baton Rouge.

State health officials also wanted to make a fundamental change to Louisiana's approach to caring for its poor and uninsured citizens by partnering with private organizations such as Our Lady of the Lake. With high rates of chronic disease in that population, the goal was to improve access and better coordinate care. The result was a cooperative endeavor agreement among the State of Louisiana, LSU and Our Lady of the Lake, the first such agreement in the state. The agreement provided funding to Our Lady of the Lake to expand its role as a teaching hospital — funds to pay residents and to pay for their training. Because of the historic link between graduate medical education and state health care services, the crucial addition of state funding would allow the hospital to absorb some of Earl K. Long's inpatients.

However, as discussions and planning progressed during a more than three-year period, the collaboration grew to include shifting the responsibility of providing inpatient care for the patients of the public hospital system to Our Lady of the Lake and other private partners. The go-live date was to be in November 2013, giving Our Lady of the Lake time to make a smooth transition — completing construction to ensure the physical capacity to care for the added patients, and bringing new team members onboard. But circumstances changed.

Uncertain about the new direction, some LSU physicians and team members began to leave Earl K. Long, the soon-to-be-shuttered public hospital. Simultaneously, budget shortfalls were reducing state dollars across the board, further compounding the challenges to operations. In late 2012, LSU asked Our Lady of the Lake to consider moving up the go-live date from the fall of 2013 to the spring. In addition to assuming responsibility for LSU's inpatient and graduate medical education components, Our Lady of the Lake was asked to add a Level II trauma center; take responsibility for all of LSU's outpatient and ambulatory clinics; and create an urgent care clinic in the Earl K. Long neighborhood.

SPEEDING UP THE TRANSITION
Between Jan. 2, 2013, and the official new transition date, Our Lady of the Lake put together a team that included employees from Earl K. Long and concentrated on filling key roles and identifying leaders who could help recruit, interview and hire the right staff for the new undertaking. In all, Our Lady of the Lake successfully brought on board 368 new team members, and hospital leadership will always be grateful for their professionalism and perseverance as they made the transition from Earl K. Long operations.

The partnership went into effect on April 15, 2013. Graduate medical education programs shifted to Our Lady of the Lake's campus, and the medical center assumed operation of five LSU outpatient community clinics, LSU's pharmacy and surgery center. It also opened a new urgent care center.

Overall, the partnership both ensures the presence of graduate medical education in Baton Rouge and improves the state's safety net health care system for the uninsured. The collaboration is perhaps one of the most important efforts ever undertaken in our community. Since the partnership's launch in 2013, Our Lady of the Lake has maintained critical access to care for many in Baton Rouge after Earl K. Long closed. It also has met the original goal of helping meet the need for training the next generation of physicians.

The innovative collaboration's planning and success set the benchmark for similar partnerships in other Louisiana cities.

MEETING GOALS
The partnership's initial results were very encouraging, with all metrics trending upward. Our Lady of the Lake implemented a grassroots outreach and education program to alert the community to this new model of care. The hospital added 20,000 square feet of clinic space and transformed the facilities and operations of the existing LSU clinics and surgery center to continue operations under the name LSU Health Baton Rouge.

In December 2013, as an obligation of the agreement, Our Lady of the Lake opened the new Medical Education and Innovation Center for graduate medical education on its main campus. The facility houses the first simulation center for resident training in Baton Rouge, where residents can simulate real-life procedures, similar to how airline pilots and astronauts are trained. There are now more than 200 medical residents in the program gaining valuable training experience and contributing to improved patient care. Another 300 medical students are training within the hospital.

Historically, the emergency room at Earl K. Long served as the main point of care for the majority of its patients. Our data showed that 70 percent of patients who relied on the emergency room for minor illnesses or their primary care could receive more convenient and more cost-effective care in an urgent care setting. We opened an urgent care clinic in April 2013 and added a second clinic in late 2014, creating a full continuum of care and began changing our community's health care structure and the culture of accessing care. Here are some key measures of success:

• Improved outpatient care by treating more than 121,000 patients in the LSU Health Baton Rouge clinics between July 1, 2013, and Nov. 30, 2014. This represents a 139 percent increase in patient visits prior to the partnership.
• Treated almost 42,000 patients in the newly created, 6,965-square-foot urgent care center between July 1, 2013, and Nov. 30, 2014, an average increase of 43 percent for daily visits. Located in proximity to the old Earl K. Long site, the new facility serves as an alternative to emergency room care for non-emergency conditions.

CREATING A HEALTHIER COMMUNITY
Achieving our vision of a healthier community required a new approach to how care and services were delivered through the network of community clinics. Our Lady of the Lake applied a population health management program that identified patients with chronic conditions or who were at risk of developing a chronic illness. Our goal has been to improve the health of these patients, lower the cost of care and prevent catastrophic events. To date, Our Lady of the Lake has:

• Partnered with our organization's population health experts to use analytics to identify patients that are at high or moderate risk for suffering a complication and becoming hospitalized. The goal is to identify patients with costly conditions, help manage their care, stabilize their conditions and avoid serious complications.
• Our Lady of the Lake focused on ensuring that our patients have quick and easy access to their medications. In the first 100 days of the partnership, a backlog of 1,200 unfilled prescriptions was eliminated. Over the following 18 months, the pharmacy filled more than 91,500 prescriptions.

IMPROVED ACCESS TO CARE
This partnership has resulted in a vast improvement of inpatient care. In the old public hospital model, Earl K. Long could not provide all of the services its patients needed. Whether because of a lack of technology, antiquated treatment facilities or lack of some surgical specialties, many patients had to travel more than 75 miles away to New Orleans or other communities for surgery. Now most inpatient surgeries are done at Our Lady of the Lake. Ambulatory surgeries are done at the LSU Health Perkins Surgical Center. Patient surgery volume has steadily increased from 400 surgeries annually to 3,400 between July 1, 2013, and November 30, 2014.

The partnership between the Franciscan Missionaries of Our Lady Health System took another step forward in March 2014 when it welcomed Our Lady of the Angels Hospital, located in Bogalusa, Louisiana, near the Mississippi border, as the newest organization of the health system. Our organization assumed the management and operations of the 98-bed hospital, formerly known as LSU Bogalusa Medical Center, to continue health care services and graduate medical education in that community.

The partnership in Bogalusa is similar to the successful Baton Rouge model but involved bringing the LSU hospital under the management of our health system. This made for a relatively easy transition of more than 500 team members, 125 physicians and two graduate medical education training programs to our health system. The partnership ensures the continuation of important health care services and medical education in the community.

The Franciscan Missionaries of Our Lady Health System is pleased to have taken on the challenge to improve health care in both Baton Rouge and Bogalusa. These two innovative approaches have resulted in more people than ever before getting quality care in the most convenient and cost-effective setting. Our health system continues to educate and train future physicians, many of whom are choosing to stay in communities throughout Louisiana and to establish their own practices in the state's large cities and small towns.

This work — this story of a successful partnership — has occurred in no small part because of our Catholic heritage. Our mission of caring for those most in need aligned perfectly with desire in Louisiana to fix a two-tiered, broken system and create a true continuum of care for everyone. Combining each partner's complementary missions of education and care has created a newly sustainable health care system and improved access for patients in the communities we serve.

STEPHANIE MANSON is vice president of operations, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana. She is a 2011 recipient of CHA's Tomorrow's Leaders award.

PETE GUARISCO is vice president, mission effectiveness, Franciscan Missionaries of Our Lady Health System, Baton Rouge, Louisiana.