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A new alliance aims to serve the underinsured

A newly formed partnership between Hoag Hospital Presbyterian and St. Joseph Health is setting its sights on O.C.’s at-risk population.

by Caitlin AdamsPublished: October 01, 2012

How can our county and companies thrive when so many of our citizens struggle to attain basic healthcare? This is a question that is not only being asked in clinics and in ERs, it’s discussed in the boardrooms of multibillion-dollar firms as well.
More than half a million Orange County residents are at risk when it comes to healthcare because they are uninsured, underinsured or low-income, and this population appears to be growing, officials say. It’s one big reason there is optimism that the partnership between Newport Beach’s Hoag Hospital Presbyterian and Orange-based St. Joseph Health, which was reported by OC METRO in August, may well prove to be an exciting development for the segment of Orange County’s population that falls under the healthcare radar.
In 2011, more than 550,000 Orange County residents did not have health 
insurance, and more than 10 percent of all residents were living below the poverty level, according to the latest census reports.
When the principals of both organizations – Deborah Proctor, president and CEO of St. Joseph Health, and Dr. Richard Afable, CEO of Hoag – decided to combine forces, one of their primary motivators was to create a more forward-thinking business model that is expected to deliver efficiencies of services and more options for insured patients. In concept, it will also offer more options for those at-risk residents who can’t afford or find care. Both faith-based hospital groups made it clear that serving this distressed population is a central tenet of this new “affiliation” between the two organizations.
“The power of delivering care in a different way and the power of our coming together is not focused in simply the strength of our hospitals, which we’re well known for. We do have very strong community-based clinics as well,” says Proctor, who notes that both organizations have a combined six hospitals and numerous healthcare centers. 
The combined target populations account for more than one fifth of the county’s residents and will benefit immensely from the more structured healthcare environment that the partnership aims to provide. Typically, many residents who fall into these categories must rely on hospital emergency rooms, frequently used for general medical concerns or primary care.
“[Emergency rooms] are not good places to receive care,” Afable says. “Not only is it not good for patients, because they get less-than-ideal care, it’s also expensive and inconvenient for all, and it takes up capacity.”
While the plan for the partnership between Hoag and St. Joseph Health 
was not formulated with any one socioeconomic group specifically in mind, both Proctor and Afable say that the ideas for its creation stem from their mutual concerns over how the current system is not effectively serving the population.
Likewise, Proctor and Afable emphasize that their ideas for the partnership did not grow out of the current debate over healthcare reform, but both are well aware of the nuances of the Affordable Care Act and are prepared to adapt to the dynamics of the ongoing changes in the industry.
“Our interest is in making sure that  once people have access to care [with insurance], they get the right care at the place that’s best for them, and ultimately at the lowest cost and with the best outcome,” says Proctor. “And so our work coming together is really focused around creating what people will access once they have access.”


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