Nashville group proposes new health care system for indigent


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NASHVILLE, Tenn. — Nashville health care providers, community leaders and government officials are proposing a new system for caring for indigent patients that they hope will be a model for the nation.

The proposal envisions a network of care by providers across the city with Nashville General Hospital serving as a hub. It comes from a stakeholder team that includes the city’s three major hospital systems as well the medical schools, the health department and the community clinics.

“This was the first time that all of those entities were sitting at the same table to talk about health care,” said Meharry Medical College President and CEO Dr. James Hildreth, speaking in a phone interview. “A lot of cities and places have tried to figure out how to care for the indigent. We can develop a system that can be a model for the nation.”

The Indigent Care Stakeholder Work Team was convened by Hildreth in 2017 in response to a proposal to close inpatient care at Nashville General. The city’s public hospital serves as the primary teaching hospital for Meharry and is the city’s main safety net provider, delivering more than $83 million in uncompensated care each year, according to Meharry.

Nashville’s major hospital systems — Ascension St. Thomas Health, HCA Healthcare and Vanderbilt University Medical Center — jointly provide another $150 million in charity care.

Dr. Dexter Samuels is a member of the stakeholder team and executive director at the Center for Health Policy at Meharry. He said the proposal will prevent duplication of services and also make sure the limited money for indigent care is used efficiently.

A program of coordination called BetterHealth Nashville will track patients’ medical care, regardless of where they are treated. The Meharry-managed program also will track nonmedical factors that affect patients’ health, such as nutrition, housing and transportation.

“So if you don’t have a ride to a doctor’s appointment, or you can’t fill a prescription, or you need some social services, care coordinators will help provide or facilitate that,” Samuels said.

The stakeholders group will present its report to Nashville Mayor David Briley. It is recommending the formation of an implementation team to put its ideas into action.

According to Meharry, Nashville has about 100,000 people who are either uninsured or underinsured.

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