A Catholic Provider Reconnects With Its Communities By Offering Programs For Women And Children
Mr. Marinakos is president and chief executive officer, Mercy Health Corporation of Southeastern Pennsylvania, Bala Cynwyd.
Summary
To help persons in their communities, especially women and children, overcome barriers to healthcare, subsidiaries of Bala Cynwyd, PA—based Mercy Health Corporation of Southeastern Pennsylvania sponsor programs that reach out to area residents.
After a 1990 community needs assessment, Misericordia Hospital became more aware of the poor state of maternal and infant healthcare services in West Philadelphia. Today a revamped obstetrics/gynecology department offers a range of outpatient clinical and support services. The certified nurse midwife program, Misericordia on Motherhood, offers prenatal care, nutrition counseling, parenting classes, and social services. The WeeCare program, launched by Mercy Health Plan in 1991, is a perinatal risk-reduction program to help change the perception that pregnancy does not require medical intervention.
Misericordia Hospital is meeting children's healthcare needs through a school-based primary care center at the Samuel B. Huey Elementary School, West Philadelphia. Mercy Health Plan's Immunization Outreach Program ensures children receive necessary immunizations.
To prevent breast cancer, women can turn to Misericordia Hospital and Mercy Health Plan's Breast Cancer Screening and Outreach Program. The program's goal is to ensure that women recognize the importance of their own health and to educate them about early breast cancer detection.
Today many people, especially women and children, face economic and social barriers that prevent them from getting needed healthcare services. The mission of all subsidiaries of Bala Cynwyd, PA—based Mercy Health Corporation of Southeastern Pennsylvania is to break down these barriers to care and to support initiatives that will contribute to the well-being of their communities. To carry out this mission, the Mercy Health Corporation sponsors healthcare facilities in and around Philadelphia–Misericordia Hospital in West Philadelphia, Fitzgerald Mercy Hospital in Darby, and Mercy Haverford Hospital in Haverford. In addition, Mercy Health Plan is a hospital-sponsored, prepaid managed care plan that serves more than 75,000 Medicaid-eligible persons in the five-county Delaware Valley area.
Maternal and Infant Health
In 1990 Misericordia Hospital conducted a community needs assessment that brought to light the poor state of maternal and infant healthcare services in West Philadelphia. Until the mid-1970s, Misericordia Hospital had offered a full range of women's and children's healthcare services. Demographic changes during the 1960s and early 1970s caused the use of both maternity and pediatric services to decline markedly.
In 1975, when Misericordia merged with Fitzgerald Mercy (a suburban hospital about five miles away), obstetric and pediatric services were centralized at the Fitzgerald Mercy campus. Many physicians followed the consolidation of services, leaving a void in maternal and child health services in West Philadelphia.
After this move, the West Philadelphia infant mortality rate rose to 25 deaths per 1,000 births–more than three times the national average and on par with rates in developing countries. To reduce the infant mortality rate, Misericordia Hospital has been rebuilding its maternal and child healthcare program.
The hospital's obstetrics/gynecology department was fully staffed by May 1992 and now offers a range of outpatient pediatric clinical and support services, including referrals to on-site pediatricians for well-child care. Misericordia Hospital plans to expand routine outpatient obstetric, prenatal, and maternal care to provide full inpatient obstetric services in 1994. In addition, West Philadelphia has been designated a federal Healthy Start Initiative site because of its high rates of infant mortality and low-birthweight babies. Misericordia is now receiving funding for participation in this program to improve maternal and child health.
Through the community needs assessment, Misericordia Hospital administrators also found that women needed easily accessible gynecologic and obstetric care in a comfortable, nonthreatening environment. Misericordia offers two options–physician office-based care or certified nurse-midwife care. Both provide prenatal, maternal, and gynecologic services.
Misericordia on Motherhood
The nurse midwife program, Misericordia on Motherhood (MOM), offers prenatal care, nutrition counseling, parenting classes, and social services. The program, which is open to any woman regardless of her ability to pay, is funded by Misericordia Hospital and private grant monies.
In the program's first nine months, more than 40 healthy babies were born to women in the MOM program. MOM staff provide supportive medical care, counseling services, and perinatal follow-up assistance. Nurse midwives do follow-up home visits for several weeks to provide support and encouragement.
WeeCare
In 1991 Mercy Health Plan launched WeeCare, a perinatal risk-reduction program to help change members' perception that pregnancy does not require medical intervention. WeeCare helps Mercy Health Plan improve neonatal outcomes among its members through:
- Early identification of pregnant members
- An incentive program to encourage proper prenatal care
- Continual intervention and support by perinatal nurses working in conjunction with participating obstetricians
WeeCare perinatal care coordinators teach Mercy Health Plan members about the importance of prenatal care, tell them what services are available, help them participate in appropriate programs, and identify and coordinate care for special problems members may fare. Perinatal care coordinators form close relationships with WeeCare participants and help create a support system for them.
Perinatal care coordinators make home visits to evaluate expectant mothers' nutritional, psychosocial, and environmental needs and to provide assistance such as transportation for physician visits; child care; and referral for smoking-cessation, exercise, and prenatal programs. Well-baby care and referral to other needed services are offered through postpartum home visits, which continue until the child is a year old.
Children's Health
Many American children do not receive the preventive care necessary for a healthy childhood. In Philadelphia more than 5,400 children have never been vaccinated against measles, mumps, and rubella. Some children go to school when they are ill because no one is home to care for them during the day. In addition, some children have no access to physicians when they need medical care.
Huey Family Health Center
Meeting the needs of the family, especially children, is a priority for Misericordia Hospital. One way it is reaching this goal is through a school-based primary care center, an innovative partnership with the Samuel B. Huey Elementary School, West Philadelphia. The school serves more than 900 children 5 to 12 years of age.
In spring 1992 school administrators expressed to hospital staff their concerns about the many students unable to reach their academic potential because of health problems. After meeting with school administrators, teachers, and members of the parents/grandparents organization, Misericordia Hospital staff researched the situation and submitted a proposal to the hospital's governing board, the Community Advisory Council, and the Philadelphia School Board.
With support from these groups, the Huey Family Health Center opened in November 1992, offering healthcare services to students. The school nurse handles referrals to the clinic, which is open year-round.
Mercy Health Corporation funded the start-up costs. Misericordia funds the daily expenses. The school provides space for the clinic and has contributed to the cost of the clinic's renovation. Misericordia is currently looking to state agencies and private foundations to help fund the center.
The center, staffed by a physician, professional nurse practitioner, medical assistant, and social worker, offers checkups, diagnosis and treatment of minor illnesses and injuries, immunizations, laboratory tests, early childhood screenings, and psychosocial and nutritional counseling. Today parents and guardians do not have to miss work to take their children to physician appointments.
Misericordia Hospital staff envision the program evolving to a managed care model linked to Mercy Health Plan. Hospital staff would also like to serve more school-age children in the neighborhood, provide care for preschoolers, and eventually offer a continuum of maternal and child health services.
Immunization Outreach
Preventing the spread of communicable childhood diseases is imperative. The Immunization Outreach Program administered and funded by Mercy Health Plan has entered the community to provide a much-needed free service, while increasing parents' and guardians' awareness of the importance of childhood immunizations.
The Immunization Outreach Program is an aggressive, multistaged initiative targeted at Mercy Health Plan member children to ensure they receive necessary immunizations. The program's goal is to eliminate the barriers to preventive care. Once parents and guardians become familiar with the Mercy Health Plan, they may be more likely to continue their children's preventive care.
The aggressive outreach activities that define this program, such as member incentives and home visits, help Mercy Health Plan physicians identify and engage hard-to-reach members who do not seek preventive healthcare on their own. For each immunization visit, Mercy Health Plan rewards parents and guardians with gift certificates for diapers or children's shoes. Home visitors contact members when records show they have not had their children immunized. They also confirm appointments.
Breast Cancer Screening
To help prevent breast cancer, women can turn to the Breast Cancer Screening and Outreach Program, sponsored by Misericordia Hospital and Mercy Health Plan, which also funds the program. The program, available to all women members 40 years of age and older, helps women recognize the importance of their own health and educates them about early breast cancer detection.
When the Breast Cancer Screening and Outreach Program was launched, Mercy Health Plan sent eligible women information about mammograms and encouraged them to contact their primary care physicians if they had not had a mammogram in the past 12 months. As a follow-up, Mercy Health Plan is sending women "birthday packets" that include information about mammograms, a breast cancer education brochure, a breast self-examination card for use in the shower, and a listing of all area mammogram facilities accredited by the American Cancer Society. In addition, the Breast Cancer Screening and Community Outreach Program contacts women on their birthdays to schedule breast examination and mammography appointments. To encourage participation, the program provides for child care and transportation costs.
Permanent Partnerships
The hospital's participation in the Huey Family Health Center has enhanced its position as a full-service provider and its attractiveness to managed care organizations. In addition, Misericordia Hospital has obtained some incremental volume and revenue, particularly in gynecologic services, although the hospital has committed to deficit funding until its women's and children's health programs are self-sustaining.
Healthcare services are now more accessible to and less costly for the women and children of West Philadelphia. These programs are providing the groundwork for more permanent partnerships among schools, hospitals, and community centers.
Mercy Health Corporation will continue its commitment to restructuring healthcare delivery at the local level, on the basis of what the community says it needs, not what hospital leaders believe is necessary. Through commitment to their communities, Mercy Health Corporation and its subsidiaries have a firsthand view of the needs of the people they serve. These efforts will help eliminate barriers to healthcare and help the communities flourish.
A Positive Turnaround
In the late 1980s Misericordia Hospital, a 249-bed community hospital in West Philadelphia, was feeling the effects of community decline, poor economic conditions, years of operational drift, and large and formidable competitors.
Located in a medically underserved community, Misericordia Hospital was providing $8 million in charity care each year. Declining market share, eroding financial performance, outdated facilities, and an aging medical staff seemed to indicate the hospital was on a downward trend. Today, however, Misericordia Hospital is healthy, having experienced a positive turnaround.
A large part of Misericordia's turnaround is credited to the synergy that has resulted from reconnecting the hospital with the community. Although Misericordia Hospital had been an important member of its community since 1918, in the 1980s the hospital's sponsor, the Sisters of Mercy, and administrators realized that the community believed Misericordia was not responsive to residents' needs. Most residents went elsewhere for care; others waited until their illnesses were life-threatening before coming to Misericordia.
Planning for Change
Misericordia's first step to address the situation was an aggressive strategic planning process that included a community needs assessment. Administrators learned that despite concern about the hospital's viability, the community wanted it to continue to operate
In 1989 hospital administrators had decided on a variety of short-term operational improvements to stabilize Misericordia Hospital while initiating strategic planning activities. New operational policies and controls emphasize both productivity and quality. Selective program refocusing and development were also key elements of the short-term plan. A community advisory council was convened in October 1991 to facilitate community input and oversee the hospital's community healthcare initiatives.
Community-based Care
As a result of the community needs assessment, Misericordia Hospital committed itself to providing community-based care and integrating this commitment into the hospital's financial framework–a task completed with the 1991 budget. In addition, the hospital has a renewed responsiveness to the need for emergency services and programs for elderly persons in the community.
Emergency Services
Misericordia's emergency department is three units in one, treating critical care cases, urgent care cases, and walk-in primary care cases. The system works well, but those seeking primary care often have to wait a long time before seeing a physician. Until the hospital is able to establish geographically dispersed family healthcare centers, it is important that the emergency department continue serving all three types of patients.
Misericordia is reconfiguring its emergency department to expand its primary care services. After being treated in the department, patients will be referred back to their primary care physician or to a network of local family practitioners.
To facilitate this process, Misericordia is constructing a patient care building that will house a new emergency department, a primary care center, a 46-bed medical-surgical unit, and an intensive care unit. Scheduling, preadmission, and preoperative testing will be centralized.
Eldercare
In Misericordia Hospital's service area, 15 percent of the population is older than 65. Through an outreach program at senior centers and churches, hospital staff are providing screenings and evaluations for blood pressure, diabetes, cancer, glaucoma, hearing loss, cholesterol, and foot problems. They also provide educational programs on cardiopulmonary resuscitation techniques, diseases of aging, and stroke.
Misericordia Hospital has also allocated resources to improve its services for patients with cancer and cardiovascular disease, two of the most prevalent diseases of elderly persons in the hospital's service area. Efforts include enhancing preventive approaches and diagnostic and treatment services; developing a program to target, screen, and identify patients who have major modifiable risk factors; pilot testing an educational program to help control risk factors; and conducting seminars to encourage the elderly to use what they have learned through health education in conjunction with physician treatment.
To address the shortage of nursing home beds in Misericordia's service area, Mercy Health Corporation of Southeastern Pennsylvania, Bala Cynwyd, recently purchased a nursing home near the hospital. The site is large enough to add 250 beds and possibly some assisted-living and residential apartments.
Finally, Mercy Health Corporation has entered into a partnership with a home healthcare provider to strengthen the continuum of services for elderly persons in Misericordia's service area.
Building Community Relationships
In addition to improved emergency and eldercare services, Misericordia Hospital sponsors a healthcare van that travels to various locations, educational health programs, and other outreach initiatives. These programs have not only enhanced community well-being but also strengthened the hospital.
Between 1991 and 1992, Misericordia's capital expenditures increased by more than $7 million, and admissions increased by more than 500 persons. Profitability has also improved. In 1988 the hospital lost $1.35 million, but for the past two years Misericordia's combined net income has been more than $1.5 million.
Now that the planning process has been integrated into Misericordia's management practices, planning is continuous rather than periodic. The critical strategic planning element remains Misericordia's renewed relationship with the community.
Alan M. Zuckerman
Executive Vice President
Chi Systems, Inc.
Philadelphia
JoAnn Mower
Executive Vice President for Acute and Ambulatory Care
Mercy Health Corporation of Southeastern Pennsylvania
Bala Cynwyd