Excela bolsters system’s health with focus on primary care
When officials at the Excela Health System were looking to leverage their impact in Westmoreland County, it didn’t take long to target diabetes care.
“There’s no shortage of diabetics in Western Pennsylvania, and we’re here to help,” Dr. David S. Richards said.
Richards, a Westmoreland County native, is executive medical director at Excela. He oversees the health system’s 220 doctors and 130 advanced care providers and knows the patients they serve. That allowed the system to target diabetic care and management as a top priority and set its staff working to turn the tide on the epidemic of type 2 diabetes with the goal of becoming one of the top 10 percent of centers in the nation providing such care.
Given that the disease is among the leading causes of kidney failure, heart disease, blindness and amputation, it was a natural fit for Excela’s goal of promoting better health across its service area.
Although keeping patients out of the hospital might seem a counter-intuitive goal for a system built on hospitals and fighting for its share of local health care dollars, that’s not the case, Excela CEO Robert Rogalski said.
Officials say it is one of the keys to the local health system’s future.
“The chassis here is built on primary care and population health with an emphasis on value,” Rogalski said.
The strength of that chassis has been tested in recent years as first UPMC — with its UPMC East in Monroeville — and then AHN — with its outpatient facility in Hempfield and a micro hospital under construction just outside of Jeannette — began aggressively moving into Excela territory.
The two massive Pittsburgh-based health systems that boast multiple hospitals and large research and academic medicine programs as well as their own insurance plans, have taken over many community hospitals as they battle for dominance across the region.
Just last month, Somerset Hospital, a community hospital just east of Excela’s service area, announced it was merging with UPMC.
But officials at Excela, a community-based health system that grew out of the merger of hospitals in Greensburg, Latrobe, Mt. Pleasant and Jeannette, insist it will continue to go it alone and focus on the needs of the communities it serves, even as others edge in along Route 30.
“A micro hospital is not going to provide a safety net,” Rogalski said, adding that Excela will continue to provide services such as its costly, but much-needed inpatient behavioral health unit.
Open to all
The Hospital and Healthsystem Association of Pennsylvania, which tracks hospital mergers, said they represent a sea change in the health care landscape in Pennsylvania.
“Since 2000, the number of hospitals affiliated with health systems has risen by 88 percent,” said Jeff Bechtel, senior vice president of health economics and policy for the association.
According to association records, 22.4 percent of the general acute care and specialty hospitals in the state were not affiliated with a health system. A year later, that number had declined to 20.4 percent.
Bechtel stressed that each hospital is unique and local boards of trustees are looking out for the best interests of the communities they serve when faced with decisions on how to move forward.
At Excela, Rogalski said that has meant remaining a local option, open to everyone.
Unlike the big players whose physicians and facilities may place restrictions on access based on who has what insurance, Rogalski said Excela accepts all health insurance.
And it has partnered with the big players when that is advantageous.
For instance, Excela patients can access cutting-edge cancer care in central Westmoreland County at the Arnold Palmer Cancer Center thanks to Excela’s partnership with the UPMC Hillman Cancer Center. Another UPMC-Excela partnership provides state- of-the-art telemedicine consultations for stroke victims.
Officials point to women’s health care, as Excela’s commitment to providing a full continuum of care has fostered an obstetrics and gynecology department that handles about 1,250 births a year while providing a link to UPMC Children’s Hospital of Pittsburgh for neonatal intensive care services.
Moreover, Excela has invested in state-of-the-art outpatient centers throughout the region, including Excela Square facilities in Latrobe, North Huntingdon and Mt. Pleasant, which provide a host of services that once required a hospital stay.
And when Excela officials determined they had underutilized space at Excela’s Frick Hospital in Mt. Pleasant, they leased part of the facility to Gateway Rehabilitation Center, which now operates a desperately needed 32-bed inpatient drug treatment center there.
“I think people would be surprised to know that 90 percent of the health care they need can be provided here, outside of an academic medical center,” Rogalski said.
He said Excela will partner with others when it means delivering top-notch care to patients. On the other hand, it is working to maintain and expand its cardiac care and orthopedics departments.
Richards said that not only means providing surgical options, but working with the whole patient to ensure they are receiving appropriate care. Weight management, for instance, figures into orthopedics and cardiac care.
“It’s a matter of value and appropriateness,” he said.
Challenges of aging
That kind of care is taking on growing importance as the population here ages and requires such services. And being able to access it close to home is a plus.
Rogalski said the aging population — central Westmoreland County is growing grayer by the year — has presented a challenge in terms of the bottom line as a larger portion of the patient mix comes to rely on Medicare.
Hospitals have long complained that Medicare, the government insurance program for those 65 and older, falls short of covering costs. And financial reports for 2017 showed Excela relied on Medicare payments for more than 45 percent of its revenues — 47.5 percent at Frick, 46.6 percent at Westmoreland and 44.2 percent at Latrobe — compared to an average of 38.6 percent elsewhere across the region.
He conceded it took strong stock market returns on investments to boost the health system into the black last year.
But he said an emphasis on wellness and appropriate care is paying off as Excela approaches the break-even point on Medicare.
Recruiting pool deepens
At the same time, as the work force ages, Excela has had to up its game on recruiting.
Richards said it is important to find a cultural fit for highly sought-after specialists, but he’s been able to fill those slots and the family practice residency program at Latrobe has been key to keeping physicians trained here in the community.
Two new nursing programs, one each at Seton Hill University and Saint Vincent College, may well prove yet another pipeline to employment for the health system that already provides clinical rotations for nursing students from Westmoreland County Community College, Indiana University of Pennsylvania and the two-year-old nursing program at the University of Pittsburgh at Greensburg.
“We were really excited to hear about those,” Rogalski said of the new programs at Seton Hill and Saint Vincent, which will admit their first students this fall.
As for keeping costs down, Rogalski predicted Excela’s success in that area will become increasingly important as employers, especially those who are self-insured, begin taking a closer look at costs and turning to the local alternative.
“The key to it all is taking care of patients with high quality care at a low cost,” he said.
Deb Erdley is a Tribune-Review staff writer. You can contact Deb at 724-850-1209, [email protected] or via Twitter .