Insightful Discussions
Oct 21, 2019

Health Care: Where are We Now, Where are We Heading?

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With the possibility of New Hanover Regional Medical Center being sold, the subject of health care is a hot topic in the Cape Fear region. Always a destination for retirees with unique health care needs, New Hanover, Brunswick, and Pender counties are now seeing significant population growth in people of all ages. How will this — and other issues — impact health care in our area?

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The Cape Fear region’s population is growing; what impact does that have from a health care standpoint?

JASON CLAMME: The population of the greater Wilmington area is certainly growing … and aging. In addition to the large number of current residents considered part Baby Boom generation and beyond, the region is also a popular retirement destination, bringing in countless new friends and neighbors each year above the age of 65. This influx of people, many of which are Medicare-eligible, increases the need for a variety of health-related programs, services, and facilities, from home health, to long term care, to hospice and palliative care.

The Wilmington community is no doubt responding to these needs, making care accessible and convenient for those dealing with chronic and serious illnesses. For instance, the region is experiencing organizations aligning themselves to provide an improved continuum of care for their patients, clients, and residents. We also have a number of health care initiatives and programs that reach out into the community to provide critical information, resources, and access to care to seniors where they are. One example of such a program is the Cape Fear Elder Abuse Prevention Network, a coalition of community agencies and volunteers providing training and education on elder abuse and other aging issues.

TOM SIEMERS: The Cape Fear Region has always been a high-growth region for adults either retiring or preparing for retirement – typically from northern states.  In fact an April article in US News and World Report ranked Brunswick County as the fourth fastest growing county in the United States, and the pace of growth is accelerating. From a health care standpoint, it’s essential for the region to expand services that meet the specific needs of older adults, and attract clinicians with the training and expertise to work with this population. 

ELLEN TUCKER: A growing population will increase the need for primary care physicians. Having adequate access to primary care is important in keeping the population healthy, managing chronic conditions, and controlling the cost of care.

JEFF JAMES: From 2010 to 2018, the Wilmington metro area has seen a greater than 15 percent growth in its population. One of the bigger challenges associated with such rapid growth is access to health care services. As our population grows it will be incumbent on health care organizations to recruit and retain providers who perform well on quality and cost metrics to meet our community’s health care needs. In addition, we are constantly looking at the locations of growth within the Wilmington geography so we can place our providers in convenient locations for our patients.

How do our local health care systems stack-up to other metropolitan areas?

TUCKER: Wilmington has superior health care providers and facilities versus similar sized areas. Strong physician practices and a well-respected hospital enable most care to be provided locally. Care that must go out of the area can be provided at Duke or UNC, only a couple of hours away. This is an important factor in attracting employers and their employees to the Wilmington area.

JAMES: Metrics for evaluating the cost and quality of the care received by patients in our area are becoming more readily available, thanks to increased emphasis and scrutiny by the government, insurance carriers, and most importantly, the patient. Our community’s health care providers and organizations have been working hard to improve all aspects of the care delivery system.

Recent data on disease prevention and treatment, cost reduction and savings, and quality outcomes has several local organizations (including Wilmington Health) ranked extremely high on the national level, including outperforming many providers in other North Carolina metro areas. Our goal at Wilmington Health is to continue to improve on the work already done and lead the Wilmington area toward becoming a destination for the best that health care has to offer across the nation. 

CLAMME: One asset that Wilmington has that many other cities don’t is a beautiful, state-of-the-art in-patient hospice facility. The Dr. Robert M. Fales Hospice Pavilion offers patients and families a serene location when health care needs cannot be met at home. The center provides continuous medical care for hospice patients, but also support for family and friends. Though hospice is so much more than a facility, that particular building has served thousands of patients and families in the greater Wilmington area and has set the bar for other hospice inpatient facilities.

SIEMERS: The federal government has statistically rated Brunswick County as medically under served and a health care personnel shortage area. However, patients in the population centers of Brunswick and New Hanover Counties have excellent access to health care services. Three acute care hospitals serve the area: NHRMC, a tertiary facility, and two community hospitals, Dosher Memorial Hospital and Novant Brunswick Medical Center. All three are located in different areas and offer quality care and services. There’s an extensive network of primary care physicians and specialists to support clinic, outpatient and acute care medicine. There are also numerous urgent care, ancillary, rehabilitation and continuing care facilities.

What are major health care challenges unique to our region?

SIEMERS: Community health needs analysis for both counties are similar in many ways. Chronic diseases (diabetes, cancer, heart disease) are major health concerns for both counties. However, the opioid crisis has hit the Cape Fear Region hard.  Wilmington has the dubious distinction as being listed as the number one city in the United States for opioid abuse. For Brunswick County, drug overdose was listed as the third leading cause of death in 2018. Clearly, our region has significant challenges regarding dealing with the terrible destruction opioid abuse inflicts on our communities.

TUCKER: Growth and its effect on access to care. An aging population that will require different services.

Another seemingly intractable challenge in this area as well as this country is the mental health crisis. Mental health care is dramatically underfunded, understaffed, with few resources for inpatient and outpatient care. Every emergency room in the United States grapples with the daily challenge of trying to help mental health patients, or provide on-site care for patients awaiting transfer. It’s a major problem that we as a nation are going to have to address.

There are a lot of retirees in Wilmington and surrounding counties, how is the local health care community catering to their needs?

SIEMERS: Dosher Hospital has invested significant resources offering the services and expertise particularly needed by retirees:

* Access to Primary Care Providers and Clinic Locations. Dosher Hospital employs eight Family Practice/Internal Medicine physicians, six PAs, and offers convenient locations in Southport, Oak Island and surrounding areas.

* Wound Center. Dosher offers advanced wound healing therapies and techniques to include two hyperbaric treatment chambers. The Wound Center has earned the distinction of being a Center of Excellence each year it has been in operation for achieving top quartile scores in healing and patient satisfaction.

* Cardiac Rehab. State of the art facility, equipment and staff located at Dosher Wellness Center.

* Orthopedics and Joint replacement. Board Certified Orthopedic Surgeons offer a full complement of joint replacement and surgical intervention procedures for both outpatients and inpatients.

* Geriatric PT. Nationally certified Physical Therapist in geriatric physical therapy.

* Lymphedema Clinic. Dosher Hospital offers the only certified Lymphedema therapist in Brunswick County.

JAMES: The health care needs and concerns of an aging population are well documented and known. We take into careful consideration this population as we plan for the future. First, we continually evaluate the appropriate number and mix of providers and services to maintain the health and well-being of our aging population. This includes physician-led initiatives to improve quality outcomes and cost for many conditions prevalent in senior populations, such as diabetes and COPD. Second, we look to the placement of our locations to ensure convenient access to those providers and services. We continue to evaluate our training and technology to ensure we are on the cutting edge of care delivery. Finally, we are working with insurance carriers to provide lower-cost insurance options to a predominantly fixed-income population, including those now offered by many insurance carriers through the Medicare Advantage program.  

Would you rate the Cape Fear Region as having a healthy population or unhealthy? Why?

JAMES: I am inclined to say that we are both a healthy and unhealthy population. While our statistics in relation to other communities indicate that we are a very high-performing community in terms of health care quality, there are still so many things that need to be addressed. Now, those same high-performing providers are placing greater attention on aiding patients with issues that are beyond the time spent in the office or surgical suite, including: compliance in use of medication, diet, physical activity and continued concerns around substance abuse. If we determine that we are a “healthy population” I worry that it will lead to a reduced focus on helping each individual. And shouldn’t a “healthy population” include each of its citizens?

SIEMERS: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute partner together to rank County Health Rankings for each state. Out of 100 North Carolina counties, Brunswick County ranks #34 in health outcomes, and #25 in health factors, while New Hanover County ranks #19 and #13, respectively. Health outcomes include such factors as premature death, low birthweight, and overall health, whereas health factors include behaviors such as smoking, excessive drinking, teen births, etc.

TUCKER: There is a mixture of healthy and unhealthy people, similar to other areas. There are a lot of healthy people due to the climate and availability of outdoor activities. We do see obesity and diabetes at similar rates to other areas, however. 

There are a lot of outdoor recreational options for residents and visitors, what positive/negative impacts does that have from a health care standpoint?

SIEMERS: The more opportunities for exercise and being outdoors, the better! One of the main reasons our region is growing so rapidly is because of our location and weather. It’s just a great area for everyone to get outside and be active. Of course, inevitably there will be accidents (including automobile accidents traveling to and from activities), injuries, and even death. It’s particularly dangerous when alcohol is mixed with activities. However, considering the epidemic of obesity, diabetes and heart disease, anything that helps get us moving and increases our activity is a positive.

What new health care trends are taking hold? What are some you see on the horizon?

CLAMME: Maybe not a trend, but one emerging health care issue is the large number of patients and families dealing with the challenges of Alzheimer’s and dementia. Currently, in the United States, someone is diagnosed with some form of dementia every 65 seconds, with the total number of dementia-related cases projected to nearly triple by 2050. This fact will certainly drive health care providers in the Wilmington area, including both acute-care and long-term care facilities, to provide access to an array of services to meet their unique needs.

Furthermore, as the number of dementia and Alzheimer’s patients increases, so will the need for care and support for their caregivers and loved ones. Often, care falls on family members who lack information, understanding, and resources to be able to provide the level of care these patients require. Caregivers can suffer physical, emotional, and financial impacts, while also dealing with societal barriers and stigmas related to these challenging diseases. It will become vital for local organizations and health care providers to respond and help ensure these patients, caregivers, and families receive the care and support they need.

TUCKER: We are seeing a focus on making employees better consumers of health care. The goal is to receive quality care in the most cost-effective setting.

There will be a continued focus on managing pharmacy costs, especially the cost of specialty drugs, which is the largest increase that most employers experience in their health care costs.

There will be a continued focus on mental health, less stigma regarding receiving care, and more availability of services, including more tele-mental health.

Employers are moving from traditional wellness programs to ones that focus on  total well-being, including physical, financial, career, social/emotional, and community well-being. 

SIEMERS: One trend for improving health that is gaining much greater visibility is with diet and nutrition. Dosher Hospital offers a Guest Chef program that teaches members of the community how to prepare meals in a healthier way. Attendees at this program get to see — and taste — a healthy restaurant meal that is prepared with a modified ingredient list that reduces items such as sugar and fat, without sacrificing taste. Our dietitian also offers individual counseling and coaching.

JAMES: We will see more frequent and creative ways of partnering with the public and employers in improving the health and outcomes of the community at lower costs. New care delivery models will emerge that are much different than the traditional model. Technology will play an important role. The location of care is also evolving as we begin to partner with employers in developing on-site clinics. Access will be increased and the capabilities of organizations will improve to offer alternatives to high cost care. 

How healthy are the youth in our region, and how can parents help their children live healthier lifestyles?

SIEMERS: Childhood obesity continues to rise in the United States and is a serious problem. For children and adolescents, childhood obesity is estimated to be over 18 percent. This means almost 1 in 5 children are classified as obese.

According to the Centers for Disease Control and Prevention (CDC), factors to consider include nutritious snacks and school meals, time for lunch, physical activity, promoting good sleep, smart snacks and healthy eating.

CLAMME: Being in a field that focuses more on the aging population, I don’t have a “professional” response as to the basic health issues of the area’s youth. However, as a parent myself, I can speak to some of the challenges my family, and families we know, face on a regular basis. First, many kids struggle to keep balance in their diets, where they often include too many sweets, too many fats, and too many processed foods. For instance, my own kids argue that a dessert should be part of every meal; it’s some kind of reward for eating their meal. Another challenge for our family and many others is that we are so busy in the evenings that it is just easier to pick something up at the local fast food joint. In other words, we teach them that it is okay to make less healthy choices if it is more convenient.

Another area of concern for my kids and their peers is related to exercise, but it can be on both extremes. For some youth, they are so active in sports and other physical programs, they don’t have adequate opportunities to rest and just be a kid. Furthermore, the intensity of these activities can often lead to burnout and/or injury. On the other side, with the tremendous popularity of video games, television shows, and other screen-time activities, it can be easy for some youth to never step outside and get any sort of physical exercise. For all these items, the secret is for the young people to maintain moderation and balance.

What are some simple things individuals can do to live healthy lives from a diet, exercise, and mental health standpoint?

TUCKER: Move more, sit less; get enough sleep; reduce the amount of processed foods eaten; eliminate soda, even diet soda; and manage stress through yoga, a walk, or whatever works.

SIEMERS: Here are some tips from the CDC:

• Wash hands often to prevent the spread of germs.

• Manage stress.

• Don’t drink and drive or let others drink and drive.

• Be smoke-free.

• Fasten seat belts while driving or riding in motor vehicles.

• Get exams and screenings.

• Prepare food safely.

• Eat healthy, stay active.

The CDC website has a whole section of their website devoted to Healthy Living:

CLAMME: A study from the Johns Hopkins Bloomberg School of Public Health found that two-thirds of respondents did not have health care plans in place nor were they comfortable having critical health care-related conversations. However, most people did have preferences about the kind of medical care they wanted if faced with decisions around serious and advanced illness. Research has shown that there are tangible benefits to health care planning and communicating of choices, in future health care outcomes and in patient/family satisfaction. Additionally, programs like Begin the Conversation, a local advance care planning initiative, can help provide personal peace of mind and emotional confidence that patients will receive the kind of care they want and deserve.

Regardless of when you engage in pre-planning, make sure that you involve the important people in your life like spouses, children, parents, brothers and sisters, doctors and caregivers, business partners, friends, and, if appropriate, spiritual leaders. 

What area resources are available to residents to improve their health?

CLAMME: In addition to the area’s traditional health care facilities, Wilmington boasts some wonderful nonprofit and social service agencies that offer additional care and support for individuals dealing with health issues, including organizations like Cape Fear Clinic and Wilmington Health Access for Teens (part of Coastal Horizons). Other local agencies/groups focus on particular health issues, such as poor nutrition (Nourish NC) or mental health concerns (NAMI). Several organizations in Wilmington also feature support groups for patients and/or caregivers dealing with particular diseases and conditions. 

One particular nonprofit I have had the pleasure to work with is Hope Abounds, an organization that is doing amazing work with patients and families actively undergoing cancer treatments. This small, yet passionate, team of individuals provides critical navigation, education, and advocacy services to help meet the health care and personal needs of those affected by this terrible disease. For those that rely on them, Hope Abounds is a true life-saver.

SIEMERS: The Brunswick Wellness Coalition (BWC) is a united group of individuals and health-minded leaders with the mission to improve the health of the Brunswick community, and the vision of becoming the healthiest county in North Carolina. BWC is made possible by Healthy People, Healthy Carolinas, an initiative of The Duke Endowment. Dosher Hospital, New Hope Clinic, the YMCA, and Brunswick Health Department joined together and received a very generous $450,000 grant from the Duke Endowment. Some BWC initiatives include Walk with a Doc, Health Hacks, and Diabetes Prevention Program.

Brunswick County was one of only ten counties that the Duke Endowment selected to be part of this initiative which enables each county to invest in community partners and system changes that promote healthy eating habits and active lifestyles to ultimately prevent and/or delay the onset of disease and poor quality of life. Thirty-four organizations are partnering with BWC to include all three hospitals, YMCA of Southeastern NC, New Hope Clinic, Brunswick County Health Services and many other health and health-related organizations.

JAMES: The number one resource for any Wilmington resident to improve their health is a positive and proactive relationship with their health care provider. Your health care provider cannot only explain the “why’s” to improving your health, but can also point you in the right direction for wellness. Sometimes that might require a medication or procedure, while others strategies might include a recommendation for food or exercise. Providers really do focus on the health of the whole person. If the patient can look to their doctor as a resource for complete health, rather than another avenue to receive a treatment, they will undoubtedly see improvement in their overall well-being.

What concerns or potential opportunities do you see for our health care community with New Hanover Regional Medical Center exploring a sale or other options?

JAMES: Our concerns are always with the patient population in our community. I’d suggest that there are some key things that every patient should be watching and asking as the process proceeds. Will our community be given transparency regarding the transaction itself? What impact has the potential new owner had on the overall patient population in communities where they have previously purchased a health system? Does the transaction encourage competition to the benefit of the patient or discourage it leading to less access to care, higher costs for services, and lower quality of care received?

The issues around a potential sale are those faced throughout our nation as consolidation of services within the health care industry can lead to adverse outcomes at a time when we need to diligently work to improve both the quality and cost of care. Overwhelmingly, research show this type of transaction increases cost and, in many cases, decreases quality to the public; as highlighted by recent articles published by Modern Healthcare and The New York Times. The reasons for the potential sale need to be examined in detail and evaluated against other alternatives. Any transaction needs to benefit the health and well being of the community it serves without increasing the cost of care. We will be watching the process closely and stand ready to assist in assessing all the options. 

SIEMERS: Anytime there is change and uncertainty, people can become anxious. So it’s understandable that people are concerned about the ownership of New Hanover Regional Medical Center. After all, for many years it has provided the region with comprehensive quality tertiary level care. 

And yet, this is a transition that is happening throughout the United States. There is massive consolidation trend among hospitals. Acquisitions, mergers, and innovative partnerships are the norm. In 2018, there were almost 1,200 mergers and acquisitions totally over $120 billion. Examples of mergers and acquisitions in North Carolina include HCA acquiring Mission Health for $1.5 billion; Atrium announcing it will be merging its 42 hospitals with the seven comprising Wake Forest Baptist; Atrium and the University of North Carolina calling-off their merger last year; and UNC Health Care acquiring Morehead Memorial Hospital.

Consolidation among hospitals and hospital systems is a national trend. Whereas the New Hanover County Commissioners voted to allow the hospital to seek proposals and information, they did not vote to sell the hospital. This will be a long process with opportunities for community input and discussion.

TUCKER: The hospital is the largest employer in New Hanover County, so a change would affect the many hospital employees as well as patients. The goal should be to provide top quality health care that is sustainable for the future. Consolidation in health care seems to be the norm, with Mission Health in Asheville being purchased by HCA Healthcare, and Atrium Health merging with Wake Forest Baptist as two recent examples in our state. The theory is that a larger system will lower costs through economies of scale and have more leverage to negotiate with insurance companies, while also improving quality. That is not necessarily the result, however. A valid concern is that health care costs will increase, without improving quality or efficiency.

CLAMME: We partner with many health care systems, facilities and providers in our service area, providing hospice and palliative care to their patients who need inpatient care, care at home, or care at one of our hospice care centers. Expert in-service programs for continuing education and referral assistance from our team is also available to local health care professionals.

We have a long and treasured partnership with New Hanover Regional Medical Center. Our palliative care team has been on-site for many years serving the needs of patients in the hospital. In addition, we have an established palliative care clinic within the Zimmer Cancer Center to provide pain management and symptom relief that improves the lives of oncology patients and their families. Lower Cape Fear Hospice is positive it can continue to add valuable services to New Hanover Regional’s patients and team no matter what the organization’s future holds.

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