Progress 2020: Today's health care returns to its community-based roots

Feb. 26--In simpler times, your family doctor, black bag in hand, showed up at your doorstep to treat grippe, quinsy, dropsy, lumbago and consumption -- maladies better known today as flu, sore throat, edema, lower back pain and tuberculosis.

More than a century ago, if you were pregnant, your son broke his leg sliding into home plate, dad gashed his hand or grandpa got pneumonia, you hustled to a community hospital in Beaver County to birth a baby, set a fracture, stitch a wound or fight a lung infection.

If you lived in Rochester, you went to Rochester General Hospital. If you lived in Beaver Falls, you went to Providence Hospital. If you lived in New Brighton, you went to Beaver Valley General Hospital. And if you lived in Aliquippa in the late 1950s, you went to Aliquippa Hospital.

House calls made up 40 percent of doctors' visits in the 1930s, according to Forbes. Today, they represent only 1 percent. And none of the aforementioned hospitals exists today.

"One of our favorite phrases is 'health care is ever changing, ever challenging,'" said Norm Mitry, president and chief executive officer of Heritage Valley Health System, an integrated network that provides health care for residents in Allegheny, Beaver, Butler, and Lawrence counties in Pennsylvania, eastern Ohio and panhandle of West Virginia at three hospitals and numerous satellite facilities.

Economic volatility, legislative policy changes and continuous evolution of technology underscore those changes and challenges.

Health care, especially as it relates to its physical footprint, changed dramatically in Beaver County in the last century with hospital closings, mergers and acquisitions, and joint ventures.

Hospitals in Rochester, New Brighton and Beaver Falls joined in 1980 to form The Medical Center of Beaver County that was built on farmland off Dutch Ridge Road in Brighton Township.

"I can only imagine the articles in the paper and the community uprising," Mitry said, "when those three communities agreed to give up their community hospitals to build this new 'medical center' on a hill in a township that never had a hospital."

However, that visionary decision, Mitry said, was "so far ahead of its time" and started the hospital on a path of continued growth to support its mission of improving health and well being of people in communities it serves.

In the mid-'90s, The Medical Center merged with Sewickley Valley Hospital -- which opened in 1907 -- to form Heritage Valley Health System. And last year, Ohio Valley Hospital in Kennedy Township, Allegheny County, affiliated with Heritage Valley Health System to become Heritage Valley Kennedy.

That partnership brought a "very robust pain center and wound care center," Mitry said, along with an ambulance company and an assisted living, personal and memory care facility.

But maybe another phrase should be added: Everything old is new again, especially with the emergence of community based, convenient-care clinics and medical neighborhoods, and connected care via sophisticated digital tools that measure and monitor everything from blood pressure to blood glucose and relay results to physicians.

Today's health-care shift is community based -- health care that's available closer to home. That's what drove Heritage Valley Health System to develop new strategies to meet patient needs.

People don't think about health care until they need it, Mitry said, and the last place they want to go is a hospital.

"People want health care when and where they want it," he said -- fit into the routine of their busy days.

The vision wasn't to wait for people to come to the hospital, but take health care to the communities. And it came from four words, Mitry said: quality, cost, access and experience.

Seamless, convenient and accessible health care led Heritage Valley Health System to develop its "retail medical strategy" in 2009. That's when the first convenient-care, walk-in clinic opened in Beaver with a goal of providing high-quality, accessible care for minor illness and injury -- flu shots, stitches, sprains, antibiotics, for example.

Clinics, which have been very successful, Mitry said, are open 8 a.m. to 8 p.m. Monday through Saturday; 8 a.m. to 4 p.m. Sunday and require no appointments.

The Affordable Care Act helped shift health care to community based, too, prompting Heritage Valley Health System to develop medical neighborhoods that offer primary care, pediatrics, lab testing, physical rehabilitation, and diagnostic imaging -- including MRI and CT scans.

Previously, Mitry said support services like radiology, blood draw, and primary care sites were scattered, but medical neighborhoods bring them all together in one place with equivalent quality and less wait time than if one went to a hospital.

The first medical neighborhood opened in 2012 in Chippewa Township.

The eighth -- and largest at more than 60,000 square feet -- opened last March at Bluffs at Glade Path in Center Township behind Beaver Valley Mall. It also features an ambulatory surgery center and outpatient surgical services in orthopedics, ophthalmology, otolaryngology, general surgery, gynecology, podiatry and urology.

"We don't own any of the buildings," Mitry emphasized. "We either lease them or somebody builds them for us and we lease. We spend zero capital on brick and mortar for this. That's important for people to know."

The beauty of medical neighborhoods is efficiency.

If a physician puts a stethoscope to your chest and doesn't like what he hears, he'll direct you across the hall for an X-ray. Since all radiology readings are online, he can see results immediately and order whatever further treatment is necessary.

Before, a doctor would write a prescription for blood work and chest X-ray for which you would have to schedule an appointment.

"Women are really good at that," Mitry said, while men tend to delay or ignore it.

At a medical neighborhood, everything can be done efficiently and effectively.

"That really helped to drive our mission," he said, making sure patients receive services they need to take better care of themselves.

And they are using those services.

Mitry referenced a site that opened Dec. 4, 2018, in Aliquippa as an example.

"From the day it opened through today, every day of the week it sees double-digit patients. Here's a city starved for health care. It has had double-digit activity from the very first day, which blew us away," he said.

Patients like the medical facilities because "it's convenient, it's high quality, it's cost effective," he said.

If one isn't feeling well and visits an emergency room, likely he'd face a co-payment of $100 to $150. But co-pay at a convenient care might be $30.

Still, emergency room visits haven't gone down, which surprises Mitry.

The Beaver campus sees 60,000 patients a year, he said. The Sewickley campus sees anywhere from 35,000 to 40,000 annually. And the Kennedy campus sees approximately 25,000.

At the end of last year, convenient-care sites treated 70,000 people.

"It's an incredible number," he said. "The good news is people are going for health care they probably need, but emergency rooms are just as busy as they've always been."

Over time, care has shifted -- 35 percent inpatient; 65 percent outpatient, he said.

Medical neighborhoods helped Heritage Valley Health System to "not only survive into the future, but help us thrive. Had we not done that, had our board not had that vision, I'm not sure the shape we'd be in today. Somebody else would be doing it."

Electronic health records keep physicians and neighborhoods connected.

For instance, if one visits the medical neighborhood in Aliquippa today, his primary care physician in Beaver knows he's been there. Whatever treatment was dispensed is logged into his electronic care chart. Likewise, treatment providers at the Aliquippa medical neighborhood can access that electronic record and see health history back to 1996 when Heritage Valley Health System started saving data electronically.

Similarly, if a patient's physician retires or relocates requiring the patient to find a new doctor, that doctor can review that electronic history to better know a patient.

"That's pretty incredible," Mitry said.

Today's technology -- things like apps and interactive portals -- keeps patients even more connected to care.

The Heritage Valley Health System App enables patients to identify physicians, locate services and in real time see patient volume at emergency departments, diagnostic centers and satellite sites.

Health Link -- a free, secure and interactive portal -- enables patients to view lab and test results, health records, request prescription renewals, schedule appointments online, and manage health.

More than 250,000 people have used the mobile app the past two years and this year it's on path toward 350,000. Quarterly, about 30,000 people use the patient health portal.

"Doctors are really encouraging people to get on and look up their numbers and take ownership of their health," said Suzanne Sakson, director of marketing and communications. "We do have that buy in from physicians and I think that has helped tremendously."

Heritage Valley Health System also offers community health and disease-management programs -- smoking cessation, pre-diabetes and diabetes education, and pregnancy classes, for example -- to improve patients' qualify of life and reduce use of medical resources.

And offers interactive community events like the upcoming "What's On Your Plate," a healthy food and wellness expo from 10 a.m. to 2 p.m. March 21 at Community College of Beaver County in Center Township.

It features exhibitors, speakers, fitness and cooking demonstrations, free health screenings, and free food and product samples.

More than 2,000 people -- many who queue at the door before the expo opens -- attend, Mitry said.

Over the years, joint ventures with 12 complementary health care organizations enabled Heritage Valley Health System to expand its services range.

One of the more recent is a partnership with Encompass Health Rehabilitation Hospital of Sewickley.

"It's a huge plus for this service area to have a specialized rehabilitation hospital in the Heritage Valley service area, but the average person has no clue that we're related to that," Mitry said. "But that's OK."

Other ventures include those with Concordia Visiting Nurses, Good Samaritan Hospice, and LIFE Beaver County.

What's in the future?

Mitry, understandably, can't reveal his cards.

"I've got to be careful what I say because health care is incredibly competitive," he said.

Other health providers have already encroached on Heritage Valley Health System's territory.

MedExpress has urgent care centers in Center, Chippewa and Moon townships.

Last spring, Allegheny Health Network opened a $20 million cancer center on Wagner Road Extension behind Beaver Valley Mall in Center Township -- the same street as Heritage Valley Health System's newest medical neighborhood.

A group of physicians from the North Hills is building an independent surgery center in Center Township and Weirton Medical Center in West Virginia is "encroaching on us," Mitry said.

But Heritage Valley Health System is "blessed," he said, to be "payer and provider neutral," which means it takes all insurers.

"As long as we can stay what we refer to as Switzerland, our future is much better off than not," he said.

And he complimented Heritage Valley Health System's board and senior management team for its vision and support in decisions affecting 2020 and beyond.

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