JPS Health Network Long Range Planning Report
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Overall
Recommendations
June 6, 2017
Greg Vachon, MD, MPH, Principal
Lori Weiselberg, MPH, Principal
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In August 2016, the Tarrant County Commissioners
Court contracted with HMA to develop a “Long Range
Planning and Analysis for the Tarrant County Hospital
District d/b/a JPS Health Network.”
The charter established for HMA’s work:
“Tarrant County, with the assistance of JPS Health
Network, is looking into the future to anticipate
changes in population demographics/growth,
technology and how we provide healthcare
services. With this information, the Tarrant County
Commissioners Court will be able to make
informed decisions to improve the health status of
the County.”
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HMA conducted research, engaged stakeholders,
developed findings, and provided
recommendations for action organized in several
focus areas that form the chapters of this report:
1.
Voices of the Community: Stakeholder Engagement Process
2.
Macro Trends in United States Health Care Delivery
3.
Community Health Needs Assessment
4.
System Capacity and Population Needs
5.
Market Assessment: Medical Staff and Medical Education
6.
JPS Delivery System including major service lines, JPS strategic plans
7.
Tarrant County Public Health: Role and Relationship with JPS Health
Network
8.
Market Assessment: Financial Perspectives
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JPS Health Network is a strong, academic, public
hospital system that provides a very large
proportion of the safety net care in Tarrant County.
JPS is critical to the county and is recognized and
valued by residents, public health, social service
and other hospitals and health care providers.
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Demographics are changing.
The County’s population is expected to grow over 46% in
the next 20 years ‐ from 2M in 2017 to 2.95M in 2037.
The Medicare‐eligible population is expected to increase
sharply -- 41% between 2015 and 2021.
The population will grow increasingly diverse – highest
growth rates in Hispanic, Asian, and Black populations.
The rapid growth, aging and diversity of the Tarrant
County population in the coming decades, and
changes in the health care delivery system and
financing environment requires JPS and others to
focus on several priorities simultaneously.
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A key priority is ensuring an adequate future health
care workforce by expanding and strengthening
JPS’ health professions training programs; public
hospitals that do not have teaching programs or
properly invest in those programs are not
sustainable.
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Other critical priorities include:
expanding ambulatory care in communities of
greatest need including
primary care medical homes
diversion programs (inpatient and criminal justice), behavioral
health integration in existing and new medical homes, specialty
behavioral health and substance use services, and psychiatric
evaluation centers (PECs)
addressing anticipated shortages in specialty
care through strong recruitment programs and
partnerships with other provider organizations
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Replace and expand JPS’ acute medical inpatient
facilities.
Extrapolating from the JPS Connection population, HMA
estimates 594 beds will be needed for JPS to meet the
needs of current population percentage (34%) 20 years
in the future. This
includes an aggressive admission/LOS
reduction of 1% per year. This 185 additional beds with
this most conservative outlook.
When Blue Cottage report estimates of LOS reduction
are used, the estimate is adjusted to 664 beds needed.
Since the percentage of population need met is low and
an increase in the commercial/Medicare payer
component is recommended, an acceleration of the
shell space build out is reasonable.
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Replace/renovate and expand JPS’ psychiatric
inpatient facilities
HMA estimates 516 beds needed for JPS to meet 50% of
population need 20 years in the future. This is based on
35 public beds per 100,000 population which assumes
50% reduction of need (below the literature-supported
level of 70 beds per 100,000) through pursuing
investments in outpatient behavioral health services.
This degree of reduction assumed is not literature-
supported, but rather is expert opinion of the maximum
effect.
The 132 psychiatric beds will only fulfill 26% of the 516
beds defined above. To remain at current 37% of
calculated need would take an additional 59 beds.
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Other key priorities include preparing JPS, as an
integrated health system, for value-based
reimbursement and risk-based managed care in
part by:
optimizing primary care patient panels, and
using information technologies and data
analytics for population health management
and for identifying and enrolling high-risk
patients in a robust care management program.
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A clear need in the community as a whole is
behavioral health capacity; JPS is well positioned to
lead the development of a county-wide behavioral
health system of care with a focus on expanding
prevention and wellness programming, and
outpatient services.
HMA also recommends JPS designate cancer care
and geriatrics as high priority service line
developments supported by appropriate facilities.
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Hospital systems are shifting from focusing solely
on “sick care” to promoting health.
HMA encourages JPS to continue to build and
strengthen partnerships with diverse communities,
public health and social service organizations, as
well as other hospital systems to increase efforts in:
disease prevention, and
address social determinants of health -- through
health policy and other means -- including
public transit to improve access to its services.
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JPS serves a large proportion of individuals that are low-
income, uninsured, and covered by Medicaid.
Market share for Medicaid/Uninsured discharges combined is 55%
Only 13.7% commercially insured and 6.1% Medicare discharges
JPS has three major revenue streams:
Net Patient Service Revenues (NPSR): 43.7%
Property Tax Revenue: 37.9%
Supplemental Medicaid Funding: 18.4%
The long-term financial health of JPS Health Network would
be much improved if it were to increase its market share of
Medicare, Exchange, and private sector revenues.
This would allow JPS to develop and sustain a patient-based
revenue flow that is less dependent upon on property taxes
or on increasing Medicaid supplemental funding.
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Finally, facilities that meet today’s standards will
result not only in operational efficiencies, but an
improved patient care environment allowing JPS to
better serve the County’s residents now and in the
future.
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Question and Answer
Discussion
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The report prepared by HMA for the Tarrant County Hospital District outlines key findings and recommendations for the JPS Health Network's long-range planning. It highlights the importance of addressing changing demographics, expanding health professions training programs, and adapting to evolving healthcare delivery needs. The report emphasizes the critical role of JPS in providing safety net care and underscores the need for strategic planning to meet the future healthcare demands of Tarrant County.
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Presentation Transcript
Report to the Citizens Blue Ribbon Committee Report to the Citizens Blue Ribbon Committee on JPS Health Network Long Range Planning on JPS Health Network Long Range Planning Overall Recommendations June 6, 2017 Greg Vachon, MD, MPH, Principal Lori Weiselberg, MPH, Principal
INTRODUCTION In August 2016, the Tarrant County Commissioners Court contracted with HMA to develop a Long Range Planning and Analysis for the Tarrant County Hospital District d/b/a JPS Health Network. The charter established for HMA s work: Tarrant County, with the assistance of JPS Health Network, is looking into the future to anticipate changes in population demographics/growth, technology and how we provide healthcare services. With this information, the Tarrant County Commissioners Court will be able to make informed decisions to improve the health status of the County. 2
HMA APPROACH HMA conducted research, engaged stakeholders, developed findings, and provided recommendations for action organized in several focus areas that form the chapters of this report: 1. 2. 3. 4. 5. 6. 7. Voices of the Community: Stakeholder Engagement Process Macro Trends in United States Health Care Delivery Community Health Needs Assessment System Capacity and Population Needs Market Assessment: Medical Staff and Medical Education JPS Delivery System including major service lines, JPS strategic plans Tarrant County Public Health: Role and Relationship with JPS Health Network Market Assessment: Financial Perspectives 8. 3
KEY FINDINGS JPS Health Network is a strong, academic, public hospital system that provides a very large proportion of the safety net care in Tarrant County. JPS is critical to the county and is recognized and valued by residents, public health, social service and other hospitals and health care providers. 4
KEY FINDINGS Demographics are changing. The County s population is expected to grow over 46% in the next 20 years from 2M in 2017 to 2.95M in 2037. The Medicare eligible population is expected to increase sharply -- 41% between 2015 and 2021. The population will grow increasingly diverse highest growth rates in Hispanic, Asian, and Black populations. The rapid growth, aging and diversity of the Tarrant County population in the coming decades, and changes in the health care delivery system and financing environment requires JPS and others to focus on several priorities simultaneously. 5
RECOMMENDATIONS: HEALTH PROFESSIONS TRAINING A key priority is ensuring an adequate future health care workforce by expanding and strengthening JPS health professions training programs; public hospitals that do not have teaching programs or properly invest in those programs are not sustainable. 6
RECOMMENDATIONS: AMBULATORY CARE Other critical priorities include: expanding ambulatory care in communities of greatest need including primary care medical homes diversion programs (inpatient and criminal justice), behavioral health integration in existing and new medical homes, specialty behavioral health and substance use services, and psychiatric evaluation centers (PECs) addressing anticipated shortages in specialty care through strong recruitment programs and partnerships with other provider organizations 7
RECOMMENDATIONS: MEDICAL INPATIENT FACILITIES EXPANSION Replace and expand JPS acute medical inpatient facilities. Extrapolating from the JPS Connection population, HMA estimates 594 beds will be needed for JPS to meet the needs of current population percentage (34%) 20 years in the future. This includes an aggressive admission/LOS reduction of 1% per year. This 185 additional beds with this most conservative outlook. When Blue Cottage report estimates of LOS reduction are used, the estimate is adjusted to 664 beds needed. Since the percentage of population need met is low and an increase in the commercial/Medicare payer component is recommended, an acceleration of the shell space build out is reasonable. 8
RECOMMENDATIONS: PSYCHIATRIC INPATIENT FACILITIES EXPANSION Replace/renovate and expand JPS psychiatric inpatient facilities HMA estimates 516 beds needed for JPS to meet 50% of population need 20 years in the future. This is based on 35 public beds per 100,000 population which assumes 50% reduction of need (below the literature-supported level of 70 beds per 100,000) through pursuing investments in outpatient behavioral health services. This degree of reduction assumed is not literature- supported, but rather is expert opinion of the maximum effect. The 132 psychiatric beds will only fulfill 26% of the 516 beds defined above. To remain at current 37% of calculated need would take an additional 59 beds. 9
RECOMMENDATIONS: POSITION FOR VALUE-BASED REIMBURSEMENT Other key priorities include preparing JPS, as an integrated health system, for value-based reimbursement and risk-based managed care in part by: optimizing primary care patient panels, and using information technologies and data analytics for population health management and for identifying and enrolling high-risk patients in a robust care management program. 10
RECOMMENDATIONS: SERVICE LINE DEVELOPMENTS A clear need in the community as a whole is behavioral health capacity; JPS is well positioned to lead the development of a county-wide behavioral health system of care with a focus on expanding prevention and wellness programming, and outpatient services. HMA also recommends JPS designate cancer care and geriatrics as high priority service line developments supported by appropriate facilities. 11
RECOMMENDATIONS: PROMOTING HEALTH Hospital systems are shifting from focusing solely on sick care to promoting health. HMA encourages JPS to continue to build and strengthen partnerships with diverse communities, public health and social service organizations, as well as other hospital systems to increase efforts in: disease prevention, and address social determinants of health -- through health policy and other means -- including public transit to improve access to its services. 12
RECOMMENDATIONS: PAYOR MIX JPS serves a large proportion of individuals that are low- income, uninsured, and covered by Medicaid. Market share for Medicaid/Uninsured discharges combined is 55% Only 13.7% commercially insured and 6.1% Medicare discharges JPS has three major revenue streams: Net Patient Service Revenues (NPSR): 43.7% Property Tax Revenue: 37.9% Supplemental Medicaid Funding: 18.4% The long-term financial health of JPS Health Network would be much improved if it were to increase its market share of Medicare, Exchange, and private sector revenues. This would allow JPS to develop and sustain a patient-based revenue flow that is less dependent upon on property taxes or on increasing Medicaid supplemental funding. 13
RECOMMENDATIONS: FACILITIES Finally, facilities that meet today s standards will result not only in operational efficiencies, but an improved patient care environment allowing JPS to better serve the County s residents now and in the future. 14
DISCUSSION Question and Answer Discussion 15
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