Amid the turbulent ongoing statewide and national debates over health care policy and the implementation of the Affordable Care Act last year, Elaine Couture, CEO of Providence Health Care, remains optimistic that the complex law will push health care providers to focus on positive patient outcomes and operate more efficiently overall. 

Couture says Providence, the Spokane-based nonprofit network of hospitals, physician clinics, and other health care organizations and programs, is flourishing, at least in the initial stages of ACA implementation, in part because of the increasing number of insured patients the law has produced

Couture says Providence has seen an increase in the number of patients at its facilities, as well as a decrease in the number of uninsured patients.

It also has improved access by growing the number of Providence Medical Group physicians and advanced practice clinicians from about 50 five years ago to more than 550 today,  at more than 50 clinics in Spokane and Stevens counties. Providence, one of Spokane County’s largest employers, has nearly 7,400 employees in Spokane and Stevens counties. 

The health care network has seen a significant increase in its number of patient visits at Providence Medical Group clinics to nearly 625,000 in 2014 from 453,000 in 2013. 

The network includes three urgent-care locations in Spokane County that are part of its effort to shift care to locations outside of the hospital. 

With expanded urgent-care facilities, Providence nearly has tripled the number of patient visits to those facilities over two years. Nearly 62,000 patients visited its three urgent-care clinics in Spokane in 2014, up from about 23,000 patient visits at two clinics in 2013 when it added its third clinic, Couture says. 

Net operating revenue has increased as well during the past two years. In 2014, Providence Sacred Heart Medical Center & Children’s Hospital, the largest hospital in the network, had total net operating revenue of $790 million, up from $731 million in 2013. Providence Holy Family Hospital reported total net operating revenue of $186 million last year, up from $176 million in 2013. Providence Medical Group’s total net operating revenue was $159 million, up from $135 million in 2013.

As patient numbers have risen, the percentage of patients paying for care out of their own pockets has declined. At Sacred Heart, Couture says, 1.2 percent of all patients last year paid for their own care, down from 3.3 percent in 2013.

At Holy Family, the percentage of self-pay patients, fell to 2.5 percent last year from 6.7 percent the previous year. 

Couture, named CEO in late 2012, has made it clear in the past that she supports the ACA and the trend toward comprehensive outpatient centers as a replacement for hospitals as the center of the country’s medical system.  

Still, she says, that’s only a part of the equation.

“We have a triple aim of improving the health of the community through improved access, enhanced quality and patient experience, and lowering costs,” Couture says. 

She says another piece of the equation is lowering the total cost of health care for everyone as well as lowering the cost of insurance for employers. 

“Health care should not bankrupt families and individuals,” she says.

Couture says the impetus behind lowering health care costs is providing the right services in the most appropriate settings. In the past, hospitals were considered the center of the care delivery system, but that will change, she says. Hospitals will be in place for the most critically ill and injured, while many treatments and services will be available in other locations.

Couture says emergency departments provide acute care at a premium, compared with the cost in a clinic or urgent-care facility. “Emergency rooms are for people who need immediate treatment. Using an emergency department for nonemergency situations not only creates delays in service, but also comes with a high price tag,” she says. 

Insurance companies also will require a larger copay or out-of-pocket expense for an emergency room visit, as opposed to a trip to an urgent-care clinic or a physician’s office, she adds. 

She contends that people should use emergency rooms for sudden, unexpected medical conditions that could endanger a person’s life or seriously harm his or her health, if not treated immediately. Urgent care should be used for conditions that require prompt attention, but don’t pose an immediate, serious threat to life, she says. 

The Providence Medical Park, which Providence opened in 2014, is located at 16528 E. Desmet Court, near Interstate 90 and Sullivan Road, and offers urgent care, a surgery center, primary care, specialty clinics, an on-site pharmacy and laboratory services.  Couture says she’s excited about showing the Spokane community that Providence is serious about being part of the solution in making health care more affordable. 

She says she believes Providence has been leading change with innovative approaches and investments in facilities and physicians, to provide patients more access to care that’s the most appropriate, in the most cost-effective setting. 

Providence Health Care accepts every patient, regardless of their ability to pay, Couture notes. She adds that the goal is “moving patients appropriately from costly emergency departments to less costly urgent care settings where there is easy access to lower cost care, at locations throughout the community where the need is greatest.”

Another piece of the puzzle is Providence’s cultivation of new forms of collaboration, such as the one it has initiated with Group Health Cooperative, the Seattle-based, nonprofit health care system, Couture adds. 

Two years ago, Providence formed a partnership with Group Health to integrate delivery systems so the two could work together to coordinate patient care. That partnership and others have enabled Providence to shift its model from the traditional fee-for-service to value-based reimbursement, determined by evidence-based results and the ability to focus on prevention rather than intervention, she says.

“We are working to keep patients healthier and decrease health care costs,” she adds. “That goal includes keeping a close eye on key metrics,” she says. “We track the uses of emergency rooms, expensive imaging, management of cholesterol and diabetes, and we are still gathering data. As a result of hitting national targets, she says physicians and hospitals capture part of the savings, and insurers as well as patients keep part of those savings. 

Most recently, Providence joined forces with Kootenai Health and Cancer Care Northwest to create a regional cancer alliance called the InnerPacific Alliance for Cancer Care LLC. Couture says the alliance will provide comprehensive cancer care for patients in the region, with a full-range of treatment options and care to meet patients’ needs. 

Under the alliance, patients will receive radiation oncology services from a single provider that coordinates services at member locations throughout the Spokane-Coeur d’Alene area.

Couture says she expects telehealth, which refers to the use of electronic information and telecommunications to support clinical health care, to explode in coming years and to play a strong role in providing specialized medical expertise to rural areas.

“It keeps patients close to home when appropriate, which lowers cost, and it ensures prompt access to specialized care and physicians when necessary,” she says. 

Couture says the opportunities for technology combined with health care are without limits for future programs, including the use of telehealth in pediatric subspecialists and areas such as tele-psychology. 

“I think improvements (via telehealth) will be available in the very near future,” she says. “You know what they say … there’s always an app for that. I think the future is telehealth, and it will play a big role in the future of health care,” she says. “I think it will show up in different ways than we ever thought possible.”

Providence is conducting a health care community needs assessment this year to identify gaps and direct resources to address the most significant health issues in the community, Couture says. She also believes the social determinants of health, such as immunizations, housing and safety, must be addressed. 

“Access to dental care for those who are underinsured or uninsured continues to be a gap, and these patients end up in emergency departments seeking help,” she adds. Last year, she says, Providence also partnered with Better Health Together and Washington Dental Association to educate the community and medical providers on critical dental issues. 

Providence Health Care is a nonprofit Catholic health care ministry, part of Providence Health & Services based in Renton, Wash., which includes 34 hospitals, 475 physician clinics, senior services, supportive housing, and many other health and educational services. 

The health system and its affiliates employs more than 76,000 people across five states — Alaska, California, Montana, Oregon and Washington. In 2013, the latest year for which data is available. Providence says it provided more than $951 million in community benefits, including $313 million in free and discounted care for those who could not afford to pay for care.