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Interview with Larry Schulz

Planting the Seeds of an Accountable Health Community

Many health care providers are reaching out to engage other community leaders in efforts to address the Triple Aim of improving the health of their citizens, the patient care experience, and the affordability of care. A key focus of such community engagement is to help curb rising health care costs in order to adequately fund social determinants of health such as jobs, housing, education and environment that contribute greatly to an individual’s health. ICSI is supporting the development of such “accountable health communities” (AHCOs) through workshops, publications, citizen and clinician dinners and, most recently, a ReThink Health online course on the leadership essentials required to drive change in the health care system.

ICSI interviewed Larry Schulz, CEO of Lake Region Healthcare in Fergus Falls, MN, to highlight its activities in this arena, and to learn how attending the ReThink Health course influenced Lake Region’s efforts.

Pictured, L to R: Jennifer Gard, Brandi Sillerud, Jason Bergstrand (garden project coordinator) and Wayne Myrvik (master gardener) plant one of 29 trees in the “Lake Region Takes Root” orchard.

Why is Lake Region working to establish an accountable health community?

Shulz: Foremost, our mission is to improve the health of the people in our region. We also believe that this is important for the viability and economic health of our community. In addition, we want to develop a rural health model that works and is sustainable.

When did you begin work in this area?

Schulz: We began changing our approach from just treating sick people to disease prevention and wellness four years ago. Our board recognized we had to go beyond our medical group and involve other community leaders to achieve better health in our region. The opportunity to do so arose two years ago with the “Forward Fergus Falls Initiative.” Through it, community leaders came together to define what we wanted our community to be in the future. A key goal identified was to focus on wellness so we would have a healthy Fergus Falls.

What key community groups did you bring together?

Schulz: Representatives of the school district, the community college, local businesses, community development officers, local politicians and others.

What are some of the activities you’ve instituted to date?

Schulz: We initially conducted a community survey to identify possible initiatives. Our Lake Region providers, in conjunction with public health, then completed a community health assessment. From there we helped facilitate a number of wellness initiatives with the support of multiple organizations. These included a Bike and Walk to Work Week as part of a Partners for Health project, turning donated land into a community garden so citizens had access to healthy foods, and Lake Region itself acquired a health club to promote fitness.

What challenges did you face to set these activities in motion?

Schulz: There are financial challenges, as our hospital is not reimbursed for these activities and we and other businesses have limited funding. So much of our investment has been in staff time. It’s also been challenging to engage certain groups, as they have their own ideas rather than going along with the community consensus.

You’ve made good progress to date. What advice can you give to other communities wanting to move toward establishing an accountable health community?

Schulz: Start by making sure there is commitment and alignment within your medical organization, and then establish a good relationship with public health. You must engage the business community as well, and have the right people at the table for discussions and action. It’s also critical to agree upon a vision that the community will endorse. Finally, make sure you have trust in the community. That reduces any competitive issues and hidden agendas.

Have you set or are you achieving Triple Aim goals?

Schulz: We have process measures, such as how many people participated in the Bike and Walk event, or are involved in the community garden. Now we want to work toward measuring improvements in health baselines, mortality rates and the total cost of care. That would be part of establishing our accountable health community.

Why did you participate in the ReThink Health course?

Schulz: Our main challenge is to secure broader community involvement and then keep groups engaged. We believed the course could provide insights on that area.

How did you approach the course?

Schulz: We involved a team of roughly a dozen people that included physicians, hospital patients, medical group management and some community leaders. This provided knowledge and better understanding across diverse stakeholders. We shared our perspectives and points of view after each course session to discuss how what we learned might be applied in Fergus Falls. 

Has the course helped you with your community engagement challenge?

Schulz: Yes. Two ideas in particular helped. Part of one session highlighted the power and importance of story to engage the community. Show a human story and benefits from our actions rather than facts and figures. Another was how to listen to other perspectives without becoming defensive in order to collaborate and find a workable solution.

Any other “Aha” moments?

Schulz: We were intrigued by one case study shared in the course where a group determined the total budget spent on health care in a region and then went to businesses and other community leaders and asked them to contribute 1% of that sum to wellness and other health community type of activities. So we’re exploring if that approach might work locally.

Could ReThink Health’s simulation model enhance your efforts?

Schulz: Simulation models could spur and guide discussions so it could be faster to address what projects to take on in our community, and in what priority they should be implemented. That could benefit not only a single community, but a broader region as well, mainly because such exercises enhance collaboration, which is needed in order to tackle large, complex issues.