The population in Central Texas is growing at a rate (28 percent) that is nearly four times faster than the national average. Apart from more snarled traffic on MoPac, how does this growth challenge the local medical community to deliver healthcare during a significant population boom and its accompanying demographic shift?

Central Texas is expected to increase by 1 million people by 2020, with growth most notably in Williamson and Hays counties. Shortfalls in healthcare delivery for this growing community are already evident. A 2012 report by Seton Healthcare Family showed that the region will face a shortage of approximately 770 physicians by 2016.

The region overall has a young, surging population — in Austin itself the largest segment is aged 20-34, according to analysis of the 2010 census figures by City of Austin demographer Ryan Robinson. By 2020, an estimated 70 percent of the population will consist of racially or ethnically diverse residents, compared with 44 percent currently, according to Central Health’s 2011 report, Health and Health Care Trends and Innovations in Central Texas.

The low-income population is growing at an even faster rate than the general population. In 2009, 35 percent of all people in Travis County were living at or below the Federal poverty level, according to the Community Action Network’s 2011 report. People with low incomes are less likely to have health insurance, says the report, and Hispanics are more likely than other groups to live in poverty.

Dell Children’s Increasing Options for Rapidly Growing Youth Population

The 2010 census shows Texas adding nearly one million kids over the past ten years, and Dell Children's Medical Center of Central Texas , a member of the Seton Healthcare Family, is the regional facility dedicated to delivering effective healthcare to this rising tide of the most vulnerable sector of society.

Dell Children’s 72,000 square foot new bed tower is set to open in May 2013, explains Bob Bonar, President and CEO of the Seton Family of Hospitals, and CEO of Dell Children's Medical Center. “The region includes some of the fastest growing ZIP codes in the nation, and the rapidly growing number of children and adolescents, plus the rapidly growing number of families that are in their child-bearing years, has required us to accelerate the expansion of our services. In addition to the new bed tower, we’ve had to significantly expand our emergency department, and add three operating rooms.”

The primary demographic focus for Dell Children’s is adjusting their delivery of healthcare services to match the geographic population shifts and increases. (Over the next 10 years, the populations in Hays and Williamson Counties are projected to increase by 41 percent and 51 percent respectively.)

“We’ve opened an in-patient pediatric unit at Seton Medical Center Williamson, so kids with less complicated conditions do not have to come downtown to be treated,” says Bonar. The full-time facility is staffed by pediatric hospitalists, who practice hospital-based medicine and are on the team at Dell Children’s. The new model of localized pediatric care is working well, says Bonar.

The latest Kids Count survey, conducted annually by the Austin-based Center for Public Policy Priorities and funded by Methodist Healthcare Ministries and the Annie E. Casey Foundation, reported that 1.2 million Texas children have no form of health insurance. To alleviate this in Central Texas, Bonar explains that Dell Children’s social workers use a software program called Medicaider to help patients and their families determine if they might qualify for either Medicaid or the Children’s Health Insurance Plan (CHIP).

Bonar regards the national trend toward a value-based model of paying for healthcare as a positive step, particularly in the context of the region’s rising demand. “The plan is to develop clinical outcomes measures so that as we hold down the cost of healthcare, we also produce superior outcomes.” This approach is being adopted through studies to establish best practices within an out-patient setting to reduce expensive hospital stays, says Bonar. One of these studies is already in place.

“At the complex care clinic for children, a Seton initiative at Dell Children’s, we are studying whether or not active aggressive out-patient management of patients with chronic multiple illnesses can improve the health of patients, and lead to fewer hospitalizations.” Seton is testing similar models for adults, including a congestive heart failure study, says Bonar.

“We also are partnering with others to be certain that children’s health needs are addressed early, not when they become acute, and that there is adequate follow-up when children leave our care, so that they don’t return to the hospital. That’s better for kids and for families.”

People’s Community Clinic Provides Holistic Primary Care Solutions

One in five of the Central Texas population is uninsured. (24 percent as of 2009, the latest year figures are available.) Yet, that is only part of the medically underserved population says Regina Rogoff, Chief Executive Officer of People’s Community Clinic.

Access to healthcare is increasingly difficult for those on both Medicaid and Medicare. In July 2012 the Texas Medical Association released the results of its latest biennial survey showing that in Travis County only 31 percent of private physicians accept new Medicaid patients, an all-time low. (Only 58 percent accept new Medicare patients.) “There are a lot of people who are not even in queue to receive healthcare, and those that are in queue still have difficulty finding a provider,” comments Rogoff.

As a clinic focused on the delivery of affordable primary care to the region’s youth, women and families, the People’s Community Clinic is seeing first-hand the large growth in the Hispanic community, particularly the under fives, evidenced in the demographers’ charts, says Rogoff.

And the impact of this trend on the healthcare needs of the medically underserved? “In the absence of preventive maintenance healthcare you will see people with more complex and multiple conditions that require more invasive treatments,” says Rogoff.

A population increasingly young and Hispanic—a historically underserved ethnic group—puts the healthcare delivery focus squarely on women’s reproductive health issues, pre-natal and family planning, she says. The region’s rise in people in their reproductive years is reflected in Texas’ birth rate, the second-highest in the nation, according to the annual Kids Count survey.

“Access is a necessary but not sufficient component. There are other things that are necessary, including things like behavioral health and nutrition counseling.” As part of People’s Community Clinic's holistic approach, they offer an integrated behavioral health program, and promote healthy eating to pregnant women, even writing prescriptions for fruits and vegetables, explains Rogoff.

Curing the healthcare provider shortage should focus on growing family practice and pediatric resources, given the great growth in population is among the very young and the reproductive-age population. “We need to make sure we have providers that can serve them, by changing some of the reimbursement models. Being a family practitioner should be more highly valued,” says Rogoff.