The TOMAGWA Health Care Ministries had no choice after available resources were outpaced by the influx of patients needing help, putting the health center at its limit.

“In our 25 years, that’s never happened before,” said Judy Deyo, the ministries’ executive director.

In Montgomery County, a fast-growing area with rising home values and dropping unemployment rates, local officials are struggling with a changing health care landscape. More people have insurance due to the federal health care law while the county population, including the number of low-income residents, is on the rise.

But Montgomery County has a shortage of primary health care clinics, forcing many people to turn to hospitals for care. From 2007 to 2012, state data shows the cost of hospital emergencies in Montgomery County was $1.6 billion – nearly three times as much as in Fort Bend County, which has 100,000 more residents. Much of that cost is passed on to taxpayers, the insured and employers, said Mark Escott, medical director for the Montgomery County Health District.

“We could put that $1.6 billion to better use,” he said. “One of the biggest problems is that we have more people with health insurance and more low-income families, but they have no primary care. We need more than insurance cards to solve our problem.”State health officials said many of these ER visits could be avoided if residents were better informed and had access to local outpatient care facilities. Local and state departments are working to provide relief and educate low-income and uninsured families on how to stay healthy and avoid hospitalizations. Meanwhile, county and local clinics have created new programs to address the problem.

“Right now our health care system, particularly the hospitals, are geared to getting people in and people out,” Escott said. “We’re not spending enough time with patients to solve the real problem.”

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Prevention policy

The Texas Department of State Health Services tracks potentially preventable hospital admissions to gauge each county’s level and quality of care.

Admissions for conditions such as diabetes, dehydration, angina, hypertension and bacterial pneumonia are deemed preventable by health officials. The thinking is that if the patient had access to and sought appropriate outpatient health care, the hospitalization would likely not have occurred.

“This is our way of seeing where resources are needed the most,” said Mike Gilliam, assessment and benchmarking specialist with the state health department.

The state also tracks the average hospital charge per patient, now about $32,000.

Montgomery County’s average charges for preventable admissions ranks eighth in the state – slightly behind urban and more populous counties like Travis, El Paso and Bexar.

Among preventable admissions, congestive heart failure has been the costliest condition for the county, accounting for more than $300 million of total charges at an average cost of $54,000 per patient.

Montgomery County hospital patients stayed 5.4 days at a cost of $42,000 – the highest averages in the Houston region.

Escott said those charges are most damaging to families living paycheck to paycheck.

He said that if there were more primary care options like clinics and health centers in the community, many admissions could be avoided. For instance, patients often seek hospital care after their blood pressure elevates and they can’t afford their prescribed medication.

“But that one hospital visit would’ve paid for their hypertension medication for the rest of their lives in many circumstances,” Escott said, adding that other problems include patients running out of medication and not scheduling an appointment, or not being able to afford a refill.

Most of the residents admitted to Montgomery County hospitals live in Conroe and in the southeastern and northwestern corners of the county, according to state data.

A 2013 Texas Health Institute study revealed that one in five Montgomery County residents did not have a primary care provider. Another 15 percent reported foregoing care because of costs.

Dealing with growth

Many residents don’t seek care unless they’re sick, Escott said.

“We’re taught from a young age that we should go to the doctor when we’re sick,” he said. “But in reality we should go more often because even though you feel fine, you’re probably not.”

Montgomery County is on pace to have 1 million residents by 2040, twice its current population. Two hospitals have already broken ground in the county, and they’re expected to be operational later this year. Still, the county is struggling to serve an increasing population of low-income residents.

The Tomball nonprofit provides health care to uninsured, low-income families and individuals in Montgomery, Harris and Waller counties. Deyo said TOMAGWA provides post-hospitalization and follow-up care. She projects more than 14,500 uninsured patients will visit this year

However, Deyo said the number of people seeking medical care is outpacing resources, and officials last year were forced to turn away patients, a decision she hopes to avoid this year.

“It was a very tough decision,” she said. “It’s my belief that there aren’t enough resources in the county to meet our needs.”

She said she’s hoping to see more in-kind gifts, grants and donations this year.

Many communities in the Houston area are underserved, according to the U.S. Department of Health and Human Services. Such communities have a lower-than-standard ratio of primary medical care physicians per 1,000 residents. At least half of Montgomery County has more than 3,500 residents for every one physician.

With more patients headed to the ER, the Texas Department of Health Services has a program to curtail avoidable admissions, but for now less than half of Texas counties qualify. The state now provides aid to 13 counties, including Liberty and Walker counties, on a budget of about $2 million set aside by lawmakers. So far, that investment has resulted in a 14.8 percent decrease in hospitalizations and a subsequent drop in hospital bills, which fell by $10 million from 2012 to 2013.

“We have a long way to go,” Gilliam said. “But our hope is that the initiative will grow and help the state provide better health care for everyone.”

Solving problems

The initiative works by identifying the specific admissions each county struggles with and then educating health care officials on solving the problem. For instance, in Liberty County, county residents are admitted for bacterial pneumonia, congestive heart failure and chronic obstructive pulmonary disease.

The program has led to the county establishing nutritional and smoking-cessation services to lower admissions.

“It allows us to see how to better serve a community,” Gilliam said.

The Texas health department plans to ask lawmakers for $3.4 million to expand the program to support 27 additional counties, Gilliam said.

The state estimates that by funding 27 severely affected counties with low to moderate populations, it would result in 6,450 fewer hospitalizations and $230 million less in hospital charges. “Every county is different and has its own set of issues,” Gilliam said. “We hope this program will lead to better health care and lower cost across the state.”

Though Montgomery County doesn’t qualify for state assistance, Escott said the community is focused on solutions.

“We’ve had many success stories,” he said. “What people needed was not a hand out – they needed someone to help them be engaged. We’re creating plans that actually work, and that goes beyond simply writing a prescription.”