Pathways Program Expansion Delayed by Fear

UNM Hospitals is unique in many ways.  For one, it has had the benefit of generous local property tax support for decades – a taxpayer subsidy that is not common across the country, even among public hospitals. This support helped buoy the hospital through extremely tough times prior to ObamaCare, when emergency rooms across the country were closing under the pressure of too many uninsured patients.

UNM Hospitals and Health Sciences Center is also unique in its approach to community health – through the Pathways to a Healthier Bernalillo County Program. Nowhere else in the nation does a public, academic hospital partner with so many trusted, community-based organizations to address the social needs of the county’s most vulnerable residents before they end up in the ER.

Now that the GOP's plan to repeal and replace ObamaCare raises the spectre of 14 million Americans losing their insurance coverage next year, UNM Hospitals is reticent to commit to continue supporting the Pathways partnership.

However, reacting with such alarmism is like cutting off your nose to spite your face. Prevention is needed now more than ever.

UNMH had the foresight in 2009, under the leadership of then Bernalillo County Commissioner Deanna Archuleta, to dedicate 1% of the property tax it receives to this community health work through an innovative program called Pathways to a Healthy Bernalillo County. 

The Pathways program has been lauded nationally, in large part because it is designed to pay for outcomes – not just for efforts, to get people connected to care and social services. An economist determined the return on investment in Pathways to be 3-to-1.

The Pathways program has been so successful, its leadership has proposed scaling it up to serve more people, thereby preventing even more unnecessary hospitalizations and further stabilizing Bernalillo County’s most vulnerable residents amid the current chaos. 

Expansion talks were underway when voters approved the property tax for UNM Hospitals last November. Increasing support for prevention makes sense given the ROI and given the fact that UNM Hospitals’ uncompensated care costs have been cut nearly in half since 2014, according to an audit commissioned by NM State Auditor Tim Keller. 

UNM Hospitals CEO Steve McKernan, a fiscal conservative who has led the hospitals for more than two decades, has publicly expressed his support of Pathways.  However, the hospital has delayed signing a memorandum of understanding with Bernalillo County that would allocate funding to Pathways.

At a recent Bernalillo County Commission meeting, at which Mr. McKernan provides a quarterly report on how the hospital spends the mill levy, he expressed concerns that Medicaid may be defunded. He was reticent to support the county's request to continue Pathways, much less expand it to $2 million per year. The MOU for Pathways has been on his desk awaiting signature for months.

Further delaying the MOU would leave many patients and clients without a safety net. The 13 Pathways organizations would likely have to lay off 16 community health workers. When you decimate organizations like that, many of them will never recover. 

You erode the trust these organizations and community health workers have built over years with the community – at a time when families are most vulnerable. This is the time for a strong safety net to use its full capacity to keep families healthy and safe in their neighborhoods, with trusted allies, not a time to pull the bottom out from underneath their feet. Without community organizations to turn to, the county’s most vulnerable will most certainly be forced to seek help at the ER – the solution of last resort. 

A more balanced approach would be to continue the Pathways program and work more closely together to keep people healthy and to reserve the ER and hospitalization only for those who really need it.

The tax support for UNM Hospitals and Pathways is a form of payment for services – just like insurance companies pay for services. The Bernalillo County Commission, as our elected representatives, should be able to negotiate what services we want to purchase with our large public investment.

Eight years ago, we decided as a community that we wanted 1% of our purchasing power to pay for community-level interventions through Pathways. Now we want to invest 2% in community health interventions. The alternative is to dump all $96 million per year of our property taxes into UNM Hospital’s coffers and hope for the best. That doesn’t add up to a wise investment.



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published this page in Blog 2017-03-16 17:31:33 -0600
Building a healthy community in the South Valley of ABQ