How Big, How Soon?

That translates to extremely high volume in the ED unless changes are made, she says. Those changes begin with the ability to exchange health information among providers that currently don't use the same systems. Moving to compatible systems enhances the goal of influencing patients proactively in a much more unified and holistic way. That can't be done without extensive investment in IT infrastructure, Eberst says. 

"Investment in IT absolutely has to exceed bricks and mortar," she says. "We also have to spread the footprint of the hospital in the community. The best way to do that is through physician clinics that are affiliated with your hospital or health system."

Those independent physician clinics won't want to affiliate if their lives can't be improved through that interaction, she says. One way that can be done is through IT investment that physicians know they have to make, but that they can't necessarily afford.

"It's important to build the infrastructure that allows the patients to be assigned to primary care physicians in your community so that he or she becomes the gatekeeper who manages those health needs," she explains.

That's tough to do when you don't employ your physicians, which is difficult in California because of state law that in theory prevents Eberst and the two hospitals she leads, 265-licensed-bed St. John's Regional Medical Center in Oxnard and 181-licensed-bed  St. John's Pleasant Valley Hospital in Camarillo, from hiring doctors. But St. John's has a foundation model, a way of circumventing the state's ban.

"We're expanding that foundation, with the goal of having at least 40 physicians  in there in the next four years," she says. In addition, they are working on a clinical integration model for physicians who are not interested in employment, "but who also understand the future is in working closely with the hospital," she says.