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State of Medical Care: Preparing for Obamacare

From the sprawling Sutter North campus on Plumas Boulevard to the crowded waiting rooms of Ampla Health's clinics the challenge is clear.

For Yuba-Sutter medical service providers, it's a game of growth against driving down — or at least, stabilizing — costs and providing care to more people while becoming more efficient.

With the Affordable Care Act, known as Obamacare, going into effect in less than a year, health care leaders like Ampla Health President and CEO Benjamin Flores are readying more primary care physicians and larger treatment areas.

"The assumption is that a lot individuals that are currently underinsured or with no coverage of any kind will be eligible for Medi-Cal or some type of insurance," Flores said, noting that Medi-Cal is a provider whose mission includes serving those in lower-income brackets.

With three facilities in Yuba City, Flores said Ampla is also renovating its Olivehurst facility to increase capacity and optimize flow.

Rideout Health CEO Terri Hamilton said in addition to Obamacare's impact, Rideout officials are preparing for another patient increase with more baby boomers reaching an age where they require specialized services and care.

While the rising Rideout Memorial Hospital tower in Marysville is the most visible change, its completion will also open up space for outpatient care at the older Fremont Medical Center in Yuba City.

With the new configuration, Rideout expects to add eight physicians, seeing from 3,000-5,000 patients a year, Hamilton said.

Similarly, Sutter North Medical Group officials like Sandra Adams and Dean Ward expect a drastic increase in volume for urgent care and outpatient services.

Ward, ambulatory surgery center administrator, said outpatient care is becoming more popular and is more cost effective. Adams, Sutter Health's ancillary service and quality management director, said people who haven't had insurance before will likely turn toward clinics like Peach Tree Health Care, Harmony Health and Sutter Urgent Care.

With about 50,000 people coming through urgent care annually, Sutter North has added an additional four exam rooms.

"Urgent care is going to be the first stop for many of these patients," said Adams.

Strong services available

Sandra Adams has been with Sutter Health in a number of capacities for more than 25 years.

One key thing hasn't changed in that time frame.

"There's always a struggle with access for the patients," said Adams, Sutter Health's ancillary service and quality management director."

In her eyes, however, Yuba-Sutter has developed an array of strong medical services available to residents.

So, too, however, have providers in places like Sacramento and Davis, meaning that offering the best care at affordable prices is paramount to keeping patients local.

"Before, where it was just kind of directed to the patient, the patient is more involved in the medical care," Adams said, highlighting the fact that patients also have a higher expectation and more knowledge before they visit a doctor.

Rideout Health CEO Terri Hamilton said being the region's leading community health care provider is both a privilege and a challenge.

With a goal of offering services to anyone in need, Hamilton said, Rideout provided more than $50 million in uncompensated care last year. Factors like that, she said, mean waste and inefficiencies must be removed to keep costs in check.

After all, people will only pay so much for services and reimbursements aren't likely to be any larger in the future, Hamilton said.

Any net income Rideout brings in goes back into the system, Hamilton added, helping with infrastructure, recruitment and programs to keep people local instead of looking for services elsewhere.

"When you're not terribly sick, you can go anywhere you want," she said.

Offering ‘cutting edge of technology’

Beyond the more-visible bricks and mortar, millions in medical services dollars go toward technological upgrades.

Fall behind, officials say, and you not only lose patients but miss out on research and clinical outcomes.

With its first procedures on Wednesday, Sutter North Ambulatory Surgery Center administrator Dean Ward said the facility's new endoscopic ultrasound capabilities are an example of how upgrades can keep services closer to home.

"We've seen patients having to go all the way to San Francisco," he said.

The procedure allows a physician to use ultrasound technology to examine the esophagus, stomach linings and gastrointestinal tract for lumps and abnormalities. It also is used for biopsies.

With a high concentration of the disease in Yuba-Sutter, Ward said procedures can also monitor the spread of cancer to the respiratory and digestive systems.

Treating cancer is a specialty at Rideout Health, its recently expanded cancer center in partnership with UC Davis offering highly specialized care, Rideout Health CEO Terri Hamilton said.

Included in the technology at the facility is a linear accelerator which can treat within 1 mm of a tumor without damaging other cells.

"We have to keep on the cutting edge of technology," Hamilton said, whether it be medical advancements or with how patients can access records and lab results from home.

‘A ways to go’ in Y-S

In a lower-income area like Yuba-Sutter, health factors like obesity, and drug and alcohol abuse are prevalent, Yuba County Health Officer Joe Cassady said.

"It's probably apparent to the providers, and just folks in general, that we have a ways to go, probably, healthwise," he said.

With that in mind, officials are more conscious than ever to offer educational resources and focus on preventative care — to help people from ending up in urgent care or the emergency room.

The role of public health agencies has evolved quite a bit in the last several decades, Cassady said, with providers now handling most direct patient services. Offering flu shots, communicable disease tracking and nutrition and tobacco cessation advice are what Yuba County Public Health focuses on now.

Sutter Health Sacramento Region Community Benefits manager Holly Harper said preventative care is more important than ever, with agencies and providers focusing on mammograms, screenings and other services so that patients aren't dealing with AIDS, diabetes and cancer.

"All the efforts that help identify peoples' problem areas early on so they don't become emergent," she said, identifying a new six-week program for kids called beStrong in which exercise and healthy eating are highlighted.

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