Southeast Iowa Care Network Secures Grant to Transform Rural Healthcare

posted on 8/29/23

The Southeast Iowa Complex Care Network is pleased to announce that it has been awarded a generous grant from Iowa’s Centers of Excellence Program, totaling $250,000 per year for three years. The primary objective of this grant is to support healthcare providers in enhancing access to specialty care in rural communities while ensuring the sustainability of these crucial programs in the long term.

This grant is a beacon of hope for patients like Shirley, illustrating the profound impact that a proactive, coordinated approach to healthcare can have. This story of Shirley, a fictional representation is inspired by real patient interactions that healthcare teams encounter daily.

Shirley’s Experience: Current Reactive Model of Care

Shirley, a 70-year-old, grapples with diabetes, hypertension, and COPD, living alone on a fixed income. Over the past nine months, Shirley has become a frequent visitor to the Emergency Room, arriving almost monthly via ambulance due to severe health crises. On three distressing occasions, she required air ambulance transportation to the University of Iowa Hospital. Shirley’s post-hospitalization follow-up with her primary care provider is sporadic, compounding her health challenges.

However, thanks to the generosity of Iowa’s Center’s of Excellence Program, the Southeast Iowa Complex Care Network is now implementing a transformative proactive approach to healthcare, ensuring patients like Shirley receive comprehensive support.

Shirley’s Experience: Proactive Model of Care

Upon an initial hospital stay, Shirley is assigned a dedicated Patient Care Coordinator, who will provide continuous support and guidance throughout her healthcare journey.  Beth, the Patient Care Coordinator, will actively work to identify determinants that adversely affect Shirley’s prolonged care and identify resources to improve Shirley’s care journey including:

  • Medication Management: Upon meeting with Shirley, Beth realized Shirley was not regularly filling her prescriptions due to cost. Beth assisted Shirley to meet with a representative to better determine a Medicare plan to find suitable coverage, ensuring Shirley would receive medications without additional financial strain. Beth also assisted in setting Shirley’s prescriptions up to be filled automatically each month by the pharmacy and delivered to Shirley.
  • Regular Clinic Visits: Beth discussed the importance of regular check-ups with her primary care provider for ongoing assessment and treatment adjustments.  Before Shirley was discharged, Beth had assisted her in setting up a routine clinic visit schedule.
  • Home Visits & Enhanced Living Conditions: After being discharged, Beth conducted a home visit with Shirley and determined several additional determinants including lack of food and air conditioning to be impacting Shirley’s ability to improve her health. After the visit, Beth was able to help Shirley meet with a dietitian to better understand to better understand how food choices affect health. Beth, with the help of a social worker, also set up a weekly delivery from the local food bank. In addition, hospital staff were able to provide access to local resources to find a donor to provide a window air conditioning unit to be installed at Shirley’s home.
  • Specialized Care Programs: With the help of a Patient Care Coordinator, additional assessments such as a Pulmonary Function Test can be arranged to better determine tailored health programs. After Beth scheduled testing for Shirley was able to enroll her in a smoking cessation program.
  • Mental Health Support: Beth, knowing local programs and support groups was able to encourage Shirley to partake in the Senior Life Solutions program, bolstering her mental health support network. 

All these measures are coupled with consistent, weekly check-ins with dedicated Patient Care Coordinators, like Beth, providing a vital lifeline of care and support.

“The Southeast Iowa Complex Care Network represents a critical milestone in our region’s healthcare landscape,” stated Garen Carpenter, CEO of Van Buren County Hospital. “By collaborating and sharing resources, we can address the unique challenges faced by patients in our rural communities, and ensure they receive the specialized care they deserve.”

This collaborative care model, funded by the Centers of Excellence Program grant, is centered on three fundamental principles:

  1. Improving the Patient Experience of Care: enhancing the quality and satisfaction of healthcare services.
  2. Improving Health of Populations: focusing on proactive measures to enhance the overall health of the geriatric population.
  3. Reducing the Per Capita Cost of Healthcare: striving for cost-effectiveness in healthcare delivery.

Aligned with its mission of care, coordination, and connection, the Southeast Iowa Complex Care Network has adopted these principles as the cornerstone of the program. This framework will enable the network to effectively coordinate complex clinical care and connect patients to social resources that can potentially improve health determinants and elevate the quality of care provided.

“Collaborating is essential to achieve improved patient experience, improved health outcomes, and reduce healthcare costs for elderly populations,” stated Veronica Fuhs, CEO of Davis County Hospital and Clinics. “This partnership empowers us to make a meaningful difference in the lives of our patients and fulfill our mission of delivering exceptional experiences.”

The overarching goal of this initiative is to pool resources, allowing all network partners to serve patients more effectively in their respective communities. Rather than competing, the Southeast Iowa Complex Care Network is fostering open communication and resource-sharing among its member organizations, while also promoting the unique specialties of each participating institution.

Bryan Hunger, CEO of Jefferson County Health Center, expressed appreciation for the grant stating, “We are sincerely grateful for the support provided by this grant, which underscores our unwavering dedication to delivering exceptional healthcare services in our region. This funding enables us to transcend obstacles and provide comprehensive care that genuinely benefits our community’s senior citizens.”

With the generous support of the Centers of Excellence Grant, the Southeast Iowa Complex Care Network is poised to address the unique healthcare needs of the elderly, including limited mobility and transportation challenges. The network’s ultimate vision is to ensure that specialized, high-quality, and preventative services are readily accessible to geriatric residents while increasing their utilization.

About Southeast Iowa Care Network

The Southeast Iowa Care Network is a groundbreaking collaboration comprising of Van Buren County Hospital, Davis County Hospital and Clinics, Jefferson County Health Center, and other dedicated local partners. To enhance healthcare accessibility and quality of care for residents in Van Buren, Davis, Jefferson and Lee counties, these institutions work together to foster communication, share resources, and expand clinical capacity. This innovative collaboration aims to streamline patient care, simplify access to services, and ultimately enhance health outcomes for the region’s population.

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This content was printed from the Van Buren County Hospital website at vbch.org on June 15, 2024.

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