Expanding state’s health care access

Providing access to health care can be a struggle for smaller rural communities across Nevada, and Renown Health is seeking opportunities for collaboration to help ease that struggle.

“Access to healthcare in general ranks very high among our strategic priorities,” said Larry Trilops, senior vice president and CEO of network development. “We want to maintain a strong, independent, not-for-profit health care system to support the needs of Northern Nevada; more than Washoe County,” added Kirk Gillis, vice president of accountable care.

As a not-for-profit health network, Renown Health considers helping rural communities find access to health care a responsibility. “Renown helps influence care and provide care throughout northern Nevada and the eastern Sierra crest. It is our role as a nonprofit to be here for the region,” said Trilops.

Those rural communities are growing along with the Reno-Sparks area. “Washoe County’s population is about 425,000. The population of our catchment area outside of Washoe County is 415,000 in surrounding communities,” Gillis explained. “We have virtually just as many patients that are dependent on Renown to provide high quality, cost effective tertiary health care services as we do in Washoe County.”

Access to care begins with insurance coverage. Hometown Health, Renown’s health insurance division, now offers coverage in Carson City, Lyon and Douglas counties and even in Clark County.

Next comes primary care, which has expanded into all of the Nevada counties near Washoe County. “Now we are in Fallon, Silver Springs, Carson Valley, Carson City and soon to be in other places,” said Trilops.

Providing care close to home for rural communities also means delivering laboratory and X-ray and imaging services as well as specialty care. This includes cardiologists traveling to those communities. Finally telemedicine can bring health care services to locations far from Reno without the need for the patient or the physician to travel long distances.

As one example of Renown’s reaching out to help a rural community, the health network is in negotiations with Nye County to offer services following the closure of Nye Regional Medical Center in Tonopah. Rather than opening a hospital, Renown plans to bring in telemedicine, primary care and possibly urgent care services. They have a physician who is interested in doing telemedicine services and might also visit Tonopah a couple of days a month for face-to-face care. Renown will continue to build a model that they hope will provide seven-day-a-week care in the future.

“The advantage that Renown brings to the equation is that providers may feel more comfortable knowing that there is a larger system involved in the delivery down there,” Trilops explained. The Tonopah hospital is “about to re-enter bankruptcy for a second time, so having a partner who is financially healthy … will make providers more comfortable to participate in Tonopah.”

Telemedicine offers a bridge over the distance from Reno to Tonopah and other rural communities. As Gillis explains, “Part of Accountable Care is population health management.… We started five years ago with our Telehealth telemedicine initiative, and we have been designing and operationalizing it in such a way that we can virtually execute our entire population health management strategy.”

Through this advanced technology, Renown can provide education for patients, families and providers, for example, diabetes education, smoking cessation classes and cancer survivor programs.

The next step is providing primary care. With “virtual visits” patients can use a smart phone, tablet, laptop or a PC anywhere, anytime to connect to a medical provider for common, urgent-care conditions. The provider in the virtual visit can order lab work or a prescription, if needed.

Renown also can use telemedicine with about 30 different specialties. “If you need to see a neurologist,” said Gillis, “you can be seen in a local clinic and be seen by a neurologist 200 miles away in Reno who can assist in the diagnosis and treatment and collaborate with your local provider on how to manage your care.”

With emergency telemedicine, an emergency room physician in a rural hospital can consult with an ER physician at Renown Regional Medical Center and determine whether to admit a patient at the local hospital or have the patient transferred to Renown Regional. This could prevent the expense and disruption of an unnecessary transfer.

Even patients in rehabilitation facilities, skilled nursing facilities, long term care facilities, even the home, could benefit from telemedicine. When a patient needs to see a provider outside the facility, “we can virtually connect them with the right provider, with the right specialty at the right time, and everyone’s resources are used more efficiently,” said Gillis.

As Renown has gained a greater presence in rural communities, they have learned lessons that could benefit other businesses seeking to expand. “You need to understand the needs of the community,” said Trilops. In Tonopah, he held extensive conversations with former board members, community stakeholders and commissioners. They came to a consensus that they needed to get primary care services going again alongside telemedicine and urgent care.

Trilops also learned that you can wind up working with partners whom you did not expect. In Tonopah he found many people who shared a concern that the town not be left without access to care. The state and companies who do business in and around a rural community also can prove to be allies.

Renown has made significant investments in health care technology and infrastructure, and Gillis notes that “There are ways that we can regionalize some of these … investments and enable the rural health care communities to keep up with modernizing those services that they provide without having to incur the expense as if they were doing it completely on their own.”

Trilops summed up the Renown Health commitment to expanding access to care across Nevada. “A lot of the families in rural Nevada are younger and are in mining and energy jobs, and they need to have these services, and we want to help with that.”