‘We want to move beyond the walls of the hospital’

Mary Boosalis continues to find new ways to grow Premier Health’s presence and influence in southwestern Ohio. She takes pride in the Dayton-based system’s approach to partnering with other community organizations to address everything from community health to the opioid crisis. Most recently, Premier joined forces with the University of Dayton to ink a deal for a long-term development project for the city’s former fairgrounds. The organizations bought the 38-acre property for $15 million. Boosalis, who was named one of Modern Healthcare’s Top 25 Women Leaders in 2019, has been with Premier since 1986; she became president and CEO in 2017. She recently spoke with Modern Healthcare Managing Editor Matthew Weinstock.

MH: Tell me a little about the fairgrounds project and how it fits into Premier’s overall strategy to diversify and grow?

Boosalis: I’ve been with Premier, starting with Miami Valley Hospital, about 34 years. I think a hallmark of Premier has been twofold, that leads to the fairgrounds project. One: We consider ourselves a community asset, not only a provider but—and this gets us to the second characteristic—that we will often partner in innovative ways. We’ve done so many things historically and the fairgrounds is kind of a capstone.

A long time ago, we decided to partner (with the University of Dayton) on things rather than compete. Be it to purchase properties or to work in neighborhoods. This is also a long-term example of that.

We looked across the country because this was an unusual opportunity, and we didn’t just want to presume or rush to do the first thing that sprang to mind that benefited only our organization or theirs.

Between the two of us, the vision that emerged is we’re not interested in an immediate return on the investment. We’ve developed a joint venture. We have gotten a lot of neighborhood input. And we came up with a name that we think reflects that input—onMain. It’s on Main Street and we wanted to convey a sense of inclusivity.

It will be mixed use.

It is going to offer an opportunity for some housing. And we’re sensitive that it’s not all high-end or housing that’s out of reach. We’ve had a lot of experience in developing neighborhoods. We did a project called the Genesis Project that offered loans to our own employees, many times people who would not always be in a position to purchase a home, and that way they were actually close to work and transportation. And we felt like it stabilized the neighborhood.

MH:

With shrinking reimbursements and the focus on affordability, how do you justify this kind of venture to your board and community?

Boosalis: That’s one of the reasons we partnered.

We have a very diverse board and it has been an expectation that we are part of the community. And that goes beyond the four walls.

If we’re supposed to be improving the health of the communities, the idea again is not just to be acute inpatient or outpatient care, but what are you doing on a day-to-day level to influence people’s well-being.

MH: Expand on that and let’s talk about your approach to population health.

Boosalis: I’ll give you another example of something we just started—a paramedicine program. What we’ve done is pair a paramedic, a clinician and a social worker within the neighborhoods where we’ve looked at emergency room data and seen high propensity or above normal use of the ER. When you look at what people are being treated for, they’re often chronic diseases: high blood pressure, diabetes. The emergency room is not the best setting.

By visiting people in the home and intervening early … we’re trying to prevent an unnecessary emergency room visit. And then also have a customized plan of care along the lines of population health for those individuals.

We’re starting small, but I think you’re going to see that grow. It’s another example of a partnership because the paramedics are not ours, they’re the city’s.

We want to move beyond the walls of the hospital and really look at the continuum

of care and meet people where they are. That is where the industry needs to go.

MH: Part of moving beyond your four walls is the growth in urgent care, right?

Boosalis: We have just finished our ninth urgentcare center. It’s very deliberate in the design. When you walk in there’s a lot of visual transparency. There’s the use of apps and kiosks. And an advanced practitioner runs them and it’s very deliberate in not offering all kinds of hightech equipment. Because the data, and I think this is correct nationally, shows that something like 30plus percent of people who utilize urgent-care centers do not have a relationship with a primary-care doctor.

A lot of the data shows that people are actually very good at figuring out that they need urgent care or an emergency room. And then the other piece of information that motivated us was, besides seeing an opportunity quite frankly in the market for unattached patients, was that there’s too much overutilization of emergency rooms.

MH: How do you imagine that Premier urgent-care centers will evolve?

Boosalis: You may see us do more retail type functions. You may see us do regular visits if it makes sense.

You have to look at each community and how they behave. They’re not all exactly the same. And we’ll kind of have to take our cues a lot from the consumers.

MH: You’ve done a lot of work building partnerships to attack the opioid problem, too. Can you talk about that?

Boosalis: I’ll never forget when a nurse told me that two of her grown children were addicts. And she had gone through all her personal savings. Hearing that stops you in your tracks.

We’ve looked at what works well in other parts of the country. We did education on not leaving prescriptions in your medicine cabinets. (We have disposal containers) and collected 1,200 pounds of drugs.

We did a public service campaign around not stereotyping addiction. We have a pilot on prescribing alternatives to narcotics. We’re finalizing a partnership with Verily (on an opioid rehab center).

Our foundation started the A Promise to Hope program the last couple years. It is all around the addicted mother and their infants. It started out with opioid addiction and we’ve had some success and we’re going to expand it. ●

“We have a very diverse board and it has been an expectation that we are part of the community. And that goes beyond the four walls.”