Todd Salnas was appointed president of St. Joseph Health, Sonoma County in July 2012, overseeing operations for Santa Rosa Memorial and Petaluma Valley hospitals, as well as a variety of non-acute care services throughout the county.
Mr. Salnas, 39, joined St. Joseph Health in 2009 and previously served as executive vice president and chief operating officer for Sonoma County.
Q: Now that health reform is here to stay, what is the feeling among hospitals and large providers?
Mr. Salnas: At St. Joseph Health, we began shifting to a more integrated, wellness–focused model well before health care reform became law. In 2006, we embraced a model that called us to place equal emphasis on top-quality, hospital-based acute care and promoting wellness. This requires our continued focus on fostering broad networks of care — not only hospitals for treating the ill or injured, but a more coordinated continuum of community-based care that relies increasingly on ambulatory and post-acute services.
This transformation demands that we balance maintaining our capacity to treat the sickest and most critically ill patients of the North Coast — a niche we fill through Santa Rosa Memorial Hospital and our Regional Level II Trauma Center — and keeping people healthier so they don’t need to be hospitalized. This evolution is rooted in the mission our founding Sisters have upheld for a century: improving health and quality of life in the communities we serve.
Because the Affordable Care Act incentivizes us to work more seamlessly with non-acute care partners to keep people healthier so they don’t need hospitalization, positive momentum continues to build across our region about ways we can broaden and more fully integrate networks of care. For consumers, that’s a welcome trend.
Q: Lately, the North Bay has seen significant movement toward coordinated care among providers, particularly in the form of accountable care organizations (ACOs) or ACO-type structures in the private sector. Will this movement continue and, if so, what will it look like for providers?
Mr. Salnas: At St. Joseph Health, our ministries throughout Northern California, Southern California and Texas have established more cohesive regional networks that leverage the expertise of physician and community health partners with groups of sister hospitals, non-St. Joseph district hospitals, physician networks, insurers and other key service providers.
We have proven locally we can rank among the top providers in the nation in reducing the need for re-admissions, for example, as demonstrated by Santa Rosa Memorial’s No. 3 U.S. ranking in treating heart attack patients. This cannot be accomplished without reliance on physicians and other experts along a continuum of care, and putting the supports in place to help patients achieve the best outcomes.
This same multipartner, multidisciplinary approach is a model we are replicating across all conditions, not just heart attacks. And we’re doing so collaboratively across the region to keep our communities healthy. The foundation we’re cultivating together enables us and our partners to successfully take on greater risk for keeping defined populations well. It positions us to be more accountable for promoting health and preventing unnecessary admissions.
Q: From your perspective, what is the biggest challenge facing hospitals post health care reform? Reduced payments from CMS? Maintaining a healthy patient census?
Mr. Salnas: In America, health care consumes too much of our national GDP. Policymakers and health care providers across the U.S. will continue to be faced with finding solutions to sustain Medicare in light of the need to control the federal deficit.
Analysts assert there is a high likelihood that reliance on inpatient hospitals will decline precipitously over the next five to 10 years. Revenue generation will no longer drive hospitals’ survival; rather, we must today and in the future ensure we continue providing the highest quality of care, while significantly lowering costs, so that we can expand access and support optimal health outcomes for people in our communities.
Q: There is a palpable shift toward prevention and keeping patients out of the hospital as much as possible. How will hospitals balance that while maintaining a healthy patient census? Will the old notion of “heads in beds” eventually become antiquated? Will that mean smaller hospitals?
Mr. Salnas: Our goal is to be Northern California’s health partner of choice, caring for the health and wellness of the people in our communities by providing the best value and highest quality outcomes through a coordinated, electronically integrated network. We are also optimizing our regional resources, and initiating new collaborative ventures with physicians, employees and a variety of community partners.
These enable us to pursue value-based contracts and purchasing, reduce inappropriate utilization of medical tests and procedures, and minimize variation from best clinical practices, thereby saving consumers and employers money and improving the quality of our community members’ care.
As health care leaders are our goals include:
- Bringing clinicians together to achieve better clinical outcomes, make care more efficient and improve the overall patient experience.
- Maintaining quality-focused, coordinated programs that will address care for the poor and underserved and fill gaps that have widened under present-day economic realities.
- Expanding care beyond the acute hospital setting, including wellness, prevention programs, long-term care, and palliation of suffering.
- Advancing opportunities for partnerships with other health care providers, both traditional and non-traditional.
Q: To what extent will technology play a role in the aim of reducing health care costs and producing better patient outcomes? Can you give an example of something that your company has done? Obviously we are familiar with electronic health records, but what are some other areas in health IT and technology overall that are worth noting?
Mr. Salnas: Through the Redwood MedNet Health Information Exchange project, we are increasing technological connectivity between providers to increase the quality and coordination of patient care. Entities collaborating in this project include:
- Community health centers
- Physician networks
- District hospitals
- And other independent providers.
Our telemedicine strategy will link St. Joseph Health, Northern California with specialists locally and in Southern California to expand North Coast patients’ access to super-specialized care typically available in academic settings.
For more than a year, our Heart & Vascular Institute’s electrophysiology team at Santa Rosa Memorial Hospital has led the way regionally in providing new therapies to treat common heart arrhythmias, including through the use of cryoablation.
Q: And, what are the associated challenges of developing and implementing such technology?
Mr. Salnas: Care provided through some of these programs is not always reimbursed by third-party payers. So finding long-term funding sources for them can be challenging.
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