The challenges and strategies for sustaining healthcare in rural Nevada County was the topic of the monthly Community Forum hosted by the Sierra College Foundation on Friday morning.
Three guest speakers were invited to the Forum held at the Grass Valley campus of Sierra College with approximately 50 attendees.
Questions were answered about why healthcare costs continue to increase, how rural hospitals and clinics can compete with urban institutions, and what impact recent federal legislation will have on the healthcare community.
Jennifer Malone, CEO of Western Sierra Medical Clinic; Dr. Scott Neeley, CEO of Sierra Nevada Memorial Hospital; and Lisa Davies, CEO of Chapa-De Indian Health offered their perspectives on these issues with Carol Scofield acting as this month’s moderator of the Forum.
Changes for the healthcare community
Each speaker agreed that the world of healthcare has changed over the past few decades, and that providing access to healthcare in rural Nevada County is a priority for many.
Lisa Davies, CEO of Chapa-De Indian Health noted that one good thing for the healthcare community was the Affordable Care Act (ACA), also known as Obamacare from 2010, that expanded health insurance coverage through a mix of reforms and subsidies.
ACA expanded medical care to community members who weren’t able to access it before.
“They did without coverage,” Davies said. “It’s been a remarkable change.”
Medical facilities have been able to expand services and staffing.
“Over the last 15 years, we’ve added 200 jobs, over 80 jobs in Nevada County, and those are people shopping in our stores, going to our restaurants, bringing their families here to enjoy our region,” Davies said.
Other growing health and social needs in the community have impacted the umbrella services of healthcare as well.
“Nevada County has a higher incidence of drug overdose than the state average,” Davies said. “We’ve been able to add prenatal services, pharmacy services, care coordination services, to help patients with social needs that contribute to health.”
That increase in demand and need, the pace of the work, the amount of documentation and paperwork, the emotional toll, all of that has increased, making the healthcare workforce at risk of “burnout” over the years, according to Davies.
Taking care of employees and improvements in the quality of care over the decades have kept rural hospitals like SNMH competitive, according to Dr. Neeley.
“Over the last 40 years or so, there has been a real strong shift towards safety and quality in the way we deliver care,” Neeley said. “We have really grown into the fact that almost all medical error and harm is avoidable, and that by practicing evidence-based medicine, we can really achieve tremendous improvements in the quality of the care that we deliver.”
Neeley also stated that the world of medical care has “just gotten harder.”
“As it has become more technologically demanding; it’s also become a lot more expensive,” Neeley said.
People are demanding more technologically advanced approaches to care, whether that’s medical, medication, or procedural. SNMH is making the entry into robotically-delivered surgery within the next year — a multi-million dollar investment, according to Neeley.
People have come to expect technological treatment “not necessarily knowing whether that’s going to give them a better result or not,” Neeley said.
If there is one way to lower the costs of healthcare, it is to keep people healthy with education and preventative care.
A fairly well-known statistic is that 5 percent of the population is absorbing 80 percent of the care, according to Davies.
Healthcare has changed most significantly since the days when “a small town doc that you went to did everything,” Malone, CEO of Western Sierra Medical Clinic said.
The clinic movement, the community health, Indian health movement, hospital, clinics, foundations, have all realized that access to care is vitally important.
Western Sierra is able to serve clients within 4,000 square miles by adding smaller sites, making use of online treatment known as telehealth, and urgent care services.
“I will say that puts another layer on quality, because the worst quality is no access at all,” Malone said.
Legislative impacts coming in 2027
Another major challenge in sustaining rural healthcare has been with the recent HR 1, also known as the “One Big Beautiful Bill Act” that aims to reduce federal spending by approximately $1 trillion.
Starting in 2027, individuals aged 19 to 64 who are eligible for Medicaid via Affordable Care Act expansion will have to document that they work, attend school or volunteer at least 80 hours a month to obtain coverage.
Individuals, such as parents of children under 14 years, caregivers, individuals with a substance use disorder in treatment, and others are exempt from the HR 1 eligibility requirement.
Malone agreed with Davies that revenue streams are at risk.
“With HR 1, what we’re going to be seeing is our Medi-Cal population being very, very challenged with work requirements and having to re-enroll in Medi-Cal every six months,” Malone said.
More staffing will be needed to assist individuals with the ongoing paperwork to prevent them from falling off of the benefit, and money spent on additional staff could be used for other needs.
“It’s not only important for their health, but it’s also important for our community’s financial sustainability, and it will be very devastating for us to see that go away,” Malone said.
As people start facing these new requirements, there are several ways individuals can take steps to maintain their coverage, according to Davies.
People can turn to the network of non-profit organizations, schools, the county, and other trusted institutions for help filling our forms. Gaining access to the internet to update personal contact information with the county, and checking electronic mail will also help people.
People can take “some time to be informed,” Davies said. “Make sure your contact information is up to date with your health plan, with the county, make sure you know your renewal date. Make sure you are paying attention to the mail…If you have questions, go to Western Sierra or Chapa-De, or the county, and get those questions answered. It’s going to be a lot easier to maintain coverage than it is to recapture coverage after it’s lapsed.”
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