With more potential changes in the wind for the health care industry in the wake of Donald Trump’s election as the nation’s president, Providence Health Care’s chief executive, Elaine Couture, says leading officials need to be prepared for new responsibilities, while maintaining an enthusiasm for research and innovation.

“Our focus in 2017 won’t be much different than this year,” she says. “We want to continue providing access to quality care regardless of insurance, looking at ways to keep that care affordable and eliminate duplications.”

 Couture herself has been adjusting to a new job title and additional responsibilities following Providence’s July merger with Irvine, Calif.-based St. Joseph Health. The two formed Providence St. Joseph Health, which is now the third largest nonprofit health care system in the country. 

Couture says that following the merger, Providence leadership reorganized responsibilities across the system’s seven states in a way that created eight market areas. 

While Couture still is chief executive for Spokane-based Providence Health Care, she now has the added titles of executive vice president and chief executive for the Providence network for Eastern Washington/Western Montana.

Her responsibilities still include health care facilities in Spokane and Stevens counties, but now also includes those in Walla Walla, the Tri-Cities, and Western Montana. 

While she has leadership responsibility over the large Eastern Washington/Montana region, she isn’t handling the day-to-day responsibilities of those hospitals and clinics.

Providence Health Care is the name for the Eastern Washington region of Renton, Wash.,-based Providence Health & Services. Its network here includes Providence Sacred Heart Medical Center & Children’s Hospital, St. Luke’s Rehabilitation Hospital, and Holy Family Hospital, all in Spokane; Mount Carmel Hospital, in Colville; and St. Joseph’s Hospital, in Chewelah; plus hospitals in the Tri-Cities and Walla Walla. 

Couture says the most difficult part of her new role has been adjusting to additional travel, as most facilities she visits are a two- to three-hour drive away. 

 “It’s important to me to be able to visit, and understand the unique needs of each facility and its surrounding communities,” she says. “Each has its own challenges, so we’re building relationships with local leadership so we can access and work together to meet those needs.” 

Following November’s presidential election, Couture says she has heard many in the industry speculating about possible changes to or the repeal of the Affordable Care Act. Trump had vowed repeatedly during the presidential campaign to repeal the health care law, but news reports since the election have suggested he might want to retain parts of it. That includes a provision that forces insurers to cover people with pre-existing health conditions and another that enables parents to cover children under their plan into their mid-20s.

Of his vows to readdress the law in some fashion, Couture says, “We have no real understanding yet of what those changes may be. We do know that the ACA has allowed many people to seek care who otherwise wouldn’t have been able to. We are seeing more people covered by the ACA that are very ill and require more services to get to a better state of health.”

Couture says that 2016 has been a challenging year for Providence financially, with reduced revenues and increasing expenses. 

 “Our income is the same or less than last year due to reduced payments and increasing costs. Meanwhile, the number of patients using our services has increased,” she says. “We’re still making money, but we’re not meeting our budget.” 

Couture attributes decreased revenues to reduced payments from Medicare and Medicaid, combined with increased enrollment in and use of Medicaid, and increased expenses for supplies, prescription drugs, and labor.

She says admissions volumes have remained consistent, while surgical, ambulatory, and urgent care visits are all up. 

Last month, Providence announced it will be eliminating 26 full-time positions in a further effort to reduce operating costs. Those employees whose jobs were cut will remain on staff through Jan. 6 and will be given priority consideration for open positions within Providence. 

Providence spokeswoman Liz DeRuyter says most of the 26 positions that are being eliminated are administrative. She says Providence employs just over 8,000 people in Spokane and Stevens counties and currently has 318 active open positions.  

Couture says the announced layoffs represent a small, but needed adjustment that will help to keep health care services affordable.  

“We’re continuing to grow, despite challenges,” she says. “We’re going to keep working to provide the best possible services we can, both here and regionally, while keeping care affordable.” 

If the ACA is repealed or altered dramatically, some people could be left without health insurance, but Couture says part of Providence’s mission is to try to continue to help them. 

“We can’t predict what changes will come, but I believe those changes will continue to be consumer driven,” she says. “Things like our new urgent care facilities helped open up access, and we’ll continue to offer access through those facilities, as well as phone apps and retail clinics, because it’s the right thing to do.”

She says Providence’s focus continues to be on access and affordability, providing local care when possible—and a seamless transfer of care otherwise.

 “That kind of seamless transfer is easier than ever now because of Epic,” she says. 

Epic is the electronic medical record software used at all Providence facilities, having been introduced gradually to each in 2012 and 2013. Through Epic and its web portal version My Chart, patients have access to their health records, with the ability to manage appointments, pay bills, and email nonemergency questions to their providers.

“What we’re seeing now is a desire for a different system of health care delivery,” says Couture. “Young people especially have little patience with waiting on forms and schedules. If they’re sick today, they want to be seen today.” 

While there always will be a need for hospitals, Couture says new venues of access are being explored that include urgent care facilities, retail clinics, virtual care phone apps, and community projects.  

“A lot of these new things work in part because of Epic,” she says. “It’s a very efficient tool that allows for some exciting possibilities.” 

She says Providence now has three urgent care facilities in the area, which enable patients to be seen more quickly and with less expense than hospital emergency room visits. 

“We also plan to open several retail clinics in the area soon, where patients can check things like blood pressure and other minor tests,” she says. 

She says those retail clinics are the next phase of Providence’s Express Care Virtual, an online application launched last year that connects consumers to a provider via a smartphone or other device with a camera and enables providers to treat patients with minor health concerns. 

Providence is set to open its first such retail clinic, called Express Care, at 2923 E. 29th in the Lincoln Heights Shopping Center, late this month, and plans to open several more next year. 

Adding to its repertoire of online offerings, Couture says Providence also currently is testing a new phone app in the Seattle area that would give users the ability to request an in-home visit. 

She says the app would function similarly to the Uber ride share app. 

 “When you’re really sick and would prefer not to leave home, this would allow you to request a doctor or nurse to come visit you at home,” says Couture. “We’ve gotten some very positive feedback on that so far.” 

Couture says researchers at Providence’s Seattle-based Institute for Systems Biology also are working on developing an exam system that would use biomarkers in blood to determine individual treatment options and likely outcomes. 

“This kind of system would be able to tailor health care to meet an individual’s needs,” she says. “If we could use your blood to determine your risk, and what medications would work best, we could treat more effectively and save on costs. It’s some exciting stuff.”

In addition to improving access and affordability, Couture says Providence continues to work within the community on projects that will engage and educate. 

One such project is Sqord, in which Providence partners with schools to provide fifth graders with fitness tracking wristbands that encourage them to stay active. 

Last year, the project included schools in Stevens and Spokane counties, and this year it was implemented in Kootenai County.

“Our researchers are starting to look ahead at some of the social determinants of health. This includes issues like childhood obesity, poverty, homelessness, and drug addiction,” says Couture. 

She notes that following the merger with St. Joseph, Providence has created a new program called the Institute for Mental Health and Wellness, as it announced it planned to do. 

The program is supported by an initial $100 million investment that will be used to identify and advance innovative solutions in mental health.

“This program will be working to change how we think about mental health issues, and how to treat them,” says Couture. 

Further efforts toward providing better mental health care include Providence’s partnership with Kirkland, Wash.-based Fairfax Behavioral Health to build and operate a planned-100 bed psychiatric hospital here.

The facility will be located at 104 W. Fifth, where the Fifth & Browne Medical Building has stood. Demolition of the existing building there is expected to start next month, with construction of the hospital to begin next spring. The building is expected to be completed and open for patients in the summer of 2018.

“As we go forward, we remain committed to community partnership projects, and growing services in our region to meet patient needs,” says Couture. 

She has worked in the health care sector for 39 years in various advancing leadership roles, most recently as chief executive for Providence Sacred Heart and Holy Family hospitals.