Statesman reporter gets Heart Saver CT scan to look at heart attack risk
Austin Statesman Health Reporter Nicole Villalpando receives a Calcium CT scan to look at risk for heart attack at Heart Hospital of Austin.
Sara Diggins, Austin American-Statesman
“Trust is the first step to health.”
“Whole person care is one size fits one.”
Health care in Travis County is like a tree: “one trunk, many branches.”
Dr. Patrick Lee, the new head of Central Health — the hospital district of Austin and Travis County created by voters in 2004 — repeats these phrases often and with enthusiasm. He is spreading the gospel of hope and health care around the county to the people who live at or below 200% of the poverty level served by Central Health as well as to the medical community in which it operates.
“What I’ve learned about Austin and Travis County is that it is a really special place,” Lee said. “It is a small, big town that is deeply relational. … People deeply care.”
Lee arrived in Austin six months ago to lead a hospital district that recently turned 20 and is unique in that it is the only hospital district in Texas without its own hospital. He replaced Mike Geeslin, who served a planned six years as the head of Central Health and announced his decision to leave at the end of 2023 that April.
This year is a pivotal year in Central Health’s history. It launched a seven-year health equity plan, which includes pivoting from being mainly a payer of health care through its Medical Assistance Program and MAP Basic programs (similar to insurance), to becoming a provider of health care by opening up its own clinics as well as starting respite services for people leaving the hospital.
A career based on health equity
Lee, 46, describes himself as a “physician executive” with a “lifelong commitment to health equity.”
Lee spent the past two years as the system chairman of medicine for One Brooklyn Health in New York, which works in three hospitals and 27 ambulatory centers.
Before Brooklyn, he was in the Boston area as an assistant professor at Harvard Medical School, the chair of medicine at Salem Hospital, the chief performance improvement officer at Lynn Community Health Center and the medical director at the Cambridge Primary Care Center.
He leans on the work he did early in his career in Liberia, where he picked up this “one trunk, many branches” idea of creating a unified health system.
“One trunk many branches is more than a metaphor for me,” Lee said in May. “It is a daily practice. What we are doing is building trust in every direction so we can create partnerships in every direction so we can really advance our mission.”
A complicated system
In Central Texas, there are many players in providing care for people who make less than $30,120 for an individual, and $62,400 for a family of four, which is considered 200% of federal poverty level.
- CommUnity Care, which grew out of the city and county clinics, provides the direct care for many in this population as a federally qualified health center.
- Ascension Texas’ Dell Seton Medical Center at the University of Texas is the safety net hospital for the county in all things except women’s services, which are at Ascension Seton Medical Center.
- Mental health is provided by Integral Care as well as by the Austin State Hospital.
- Health care for incarcerated people is provided by the Travis County Jail and the sheriff’s office that operates the jail.
- Other clinics and hospitals also do charity work.
Central Health was created in 2004 to help create a cohesive health care system to serve the people who are at or below the federal poverty level. It has used its 10.0692 cents per $100 valuation property tax to fund these services by enrolling people in its MAP and MAP Basic programs, based on their incomes. It’s also subsidized premiums for its Sendero insurance on the health care exchange, also known as Obama Care.
Lee sees that in this small, big town, “there is space at the table. They have been waiting for Central Health to show up.”
Finding unity after years of fighting
The Central Health that Lee inherited has a 20-year public relations problem: It is often unknown or misunderstood by both the community it serves and the county’s medical and political actors it needs for collaboration.
Lee has met with Ascension Texas head Andy Davis and his team even while discovery is ongoing in these lawsuits. “These are good people,” Lee said of the Ascension Texas team. “We have the same values.”
“I very much appreciate how much people care,” Lee said. “You’ve been holding us to account for a long time,” he said of the community, and for good reason. Lee cited facts such as a 10- to 20-year shorter lifespan for people living east of Interstate 35 than west.
In the meantime, Lee has been meeting with Dell Medical School Dean Dr. Claudia Lucchinetti to build more connections between the school and Central Health. “Many of their physicians are working with us,” he said.
The medical school allows Central Health to recruit more specialists who want to work with its population but also want to teach at a medical school, he said. The connection also has allowed for research to be conducted, including a program between Central Health, CommUnity Care and Dell Medical School to get more patients screened for colon cancer.
A lot of what Lee has done in this first six months is meet with people in leadership across the county. That’s part of his vision of creating “one trunk, many branches” of a united health care front in the county.
“It has felt very organized, very on target and I think very much what we in the community need,” said Dr. Cynthia Brinson, the vice chair for Central Health, at a recent board meeting. “This bringing together of the whole structure as cohesively as this has been done has been appreciated and admired.”
For the Travis County Commissioners Court, that has meant having regular meetings with Central Health and also one-on-one meetings with commissioners and Lee. The commissioners are responsible for approving Central Health’s budget because the commissioners are elected officials, as opposed to the Central Health board of managers, which are appointed by the Austin City Council and the Commissioners Court.
In recent years, Central Health has had to appear multiple times each year at Commissioners Court to get its budget approved. Concerns about the amount of money in its reserved funds and the number of people Central Health serves, as well as the community lawsuit, have led to a performance audit being done. That audit is expected to be completed and released this summer.
Central Health is also more responsive to some of what the commissioners and City Council members have wanted. It is beginning to provide some care, starting with podiatry in the jail, as well as signing up people for MAP coverage while incarcerated. It will then add more in-jail services such as cardiology, substance use disorder treatments, psychiatric emergency services and HIV and Hepatitis C care.
Care for people who are incarcerated as well as keeping people out of jail and into mental health care has been a passion of Travis County Judge Andy Brown. One of his criticisms has been that Central Health was not doing enough for that population.
“I think Dr. Lee is heading in the direction for more services to keep people out of the justice system and into housing,” Brown said.
“Working with Central Health, I’m very optimistic we are going to get to a place where people are not cycling in and out of jail,” Brown said.
What to expect in this first year
Unified branding: Already, under Lee’s tenure, Central Health, CommUnity Care and Sendero have rebranded themselves with a unified logo to play up the interconnectivity of the three parties. The hope is that having similar logos will enable patients at CommUnity Care to see themselves as being part of the Central Health umbrella; people served by Sendero as having a connection to Central Health; and people who receive MAP from Central Health to see a partnership in CommUnity Care clinics.
New clinics opening: Central Health’s Hornsby Bend Health & Wellness and the East Austin Specialty Clinic opened in October. Dell Valle Health & Wellness and Rosewood-Zaragosa Specialty Clinic are expected to open this summer.
More care: This fiscal year, Central Health has started:
- Specialty care in the jail.
- Added a mobile bridge team/street team for people experiencing homelessness.
- Added clinicians at Dell Seton and Ascension Seton hospitals to help transition people from hospital to home.
- Added its providers in skilled nursing facilities where it has respite beds and added respite beds.
- Added more mental health services with Integral Care.
- Started a mental health diversion services pilot to keep people out of jail.
- Added medical respite beds.
- Added providers in gastroenterology, pulmonology, podiatry, nephrology, palliative care, wound care, hepatology and infectious disease.
- Added X-rays, pulmonology tests, ultrasound and pre-operation clearance services.
- Will add providers in cardiology, psychiatry and eventually neurology.
Creating a space for innovation
Lee says, even though, Central Health is a government entity, “it feels like a startup.”
It is testing out many new services and pilot programs under the health equity plan. “There’s so much innovation happening in this city,” Lee said. “We don’t need to do things the way it’s always done.”
Some of that innovation will be finding other funding sources outside of property tax. Central Health expects to spend down a significant portion of its reserves by 2030 to fund its health equity plan. Grants, fees for care and philanthropy could all be part of adding funding as well as tax rate increases.
Central Health’s innovation also should focus on improving health and preventing future health problems, Lee said. Lee talked about the possibility of using existing technology such as continuous glucose monitors, new technology in generative AI, as well as personal connections through community health workers to create a proactive care at home program for people with diabetes, for example.
When it comes to finding health care in Travis County, he said, there should be “no wrong door.”
“If you come in through the hospital, a clinic, or the jail, you should be navigated to continuous care.”
“Central Health has a central role to play,” he said in creating this “blanket of care” while creating “one size fits one” and “whole person care.”
How to get care through Central Health
To sign up for MAP, MAP Basic or Sendero health plan, contact Central Health at centralhealth.net or 512-978-8000.