Will historic investments be enough to improve health in west Louisville?

As steel beams swung above the construction of Norton Healthcare’s West Louisville Hospital, two of the nonprofit’s top officials expressed clear expectations for the new facility.

Its goal won’t be to make the organization money, they said. Instead, its return on investment will be measured in improved health outcomes — a critical need in an area plagued by high rates of poverty and chronic illness.

“This isn’t about Norton Healthcare; it’s about the community,” said Corenza Townsend, chief administrative officer for the hospital.

That’s a sentiment Louisville’s racially segregated West End hasn’t always encountered.

For years, health experts and community members had raised alarms about poor health care access in the area, which they said contributed to a 12-year life expectancy gap between West and East End residents. And for years, the city’s largest health providers were slow to respond to calls for more resources.

In 2020, however, protests over the police killing of Breonna Taylor finally led several providers to turn their attention to disparities facing Black people in west Louisville. Today, Norton’s new hospital leads a list of health investments that are bringing more emergency and preventative care options to the community.

Now, as those investments come to fruition, people who live and work in the West End say they’re thankful. But they also say more still needs to be done to change lifestyle habits and reduce barriers to improving health, such as lack of transportation and places to buy healthy food.

Some also question if the new services will present competition for small nonprofit health centers that are already serving the area.

“On one hand, we welcome them because the population will get more specialty services and have that resource here in the West End,” said Dr. Bart Irwin, chief executive officer for Family Health Centers, which operates three clinics in west Louisville. “But being paranoid, like most healthcare providers are, we don’t know what the unintended consequences will be.”

New Norton hospital seeks to build trust

Russell F. Cox, president and CEO of Norton Healthcare, said the 2020 protests were a wake-up call for his organization.

“It was a time that seemed that we needed to put a very specific stake in the ground as to who we were and what we were going to be going forward,” he said.

In June that year, Norton established an Institute for Health Equity (now based in Russell) and created five “imperatives” to make healthcare more equitable. Those guidelines became a driving force behind the hospital, which will be the first built in west Louisville in more than 150 years.

The Norton West Louisville Hospital is slated to open in late 2024 in the Parkland neighborhood, at the corner of 28th Street and Garland Avenue. Norton is investing at least $70 million in the project.

The hospital will predominantly serve nine surrounding neighborhoods whose populations are between 30% and 97% Black, with poverty rates up to 47%.

Cox said the goal of the 20-bed facility is to focus on improving primary care so fewer people need in-patient care.

“Our goal is to keep you out of those beds,” he said.

Cox sees the hospital as approaching health care from a new philosophy that puts communities first. He said Norton will implement that philosophy by building trust with patients and creating an environment in which no one is afraid to access care.

The hospital is designed to have one entrance for all patients, making it easy to navigate the facility. It will have women’s health services, orthopedic care, cardiology, radiology, a 24-hour emergency department and extended hours for primary care services.

The hospital will be part of Goodwill’s Opportunity Campus, which will also offer childcare, legal services, a technology center, a barber school, banking services, trade training and a community cafeteria.

The combined resources will hopefully go a long way to improving health outcomes in the area, Cox said. But he doesn’t expect them to single-handedly improve life expectancy in the West End.

“This is going to be an ongoing, evolving effort that is not just about Norton Healthcare,” he said. “This is going to take a whole community continuing to do the right thing from a healthcare perspective.”

Community health centers worry about competition

At several West End community health centers, employees have already been practicing the philosophy Cox spoke of for years.

Family Health Centers operates three clinics in west Louisville that charge for services on a sliding fee scale with help from federal funding — allowing them to provide care for patients whether they have insurance or not.

CEO Irwin said people who use the clinics are dedicated to them, with some second-generation patients specifically seeking care from the nonprofit.

But he worries about what could happen once Norton’s hospital opens.

If Family Health Centers’ patients are lured to other providers, the shift could have a detrimental impact on the agency, which relies on Medicaid and sales at its two pharmacies to cover most of its costs, Irwin said.

“Will our patients stick with us?” he asked. “I don’t know.”

Dr. Swannie Jett, CEO of Park DuValle Community Health Center, said community providers have been the “bedrock” of the West End for decades.

Park DuValle got its start in west Louisville 55 years ago during the civil rights movement, providing care to African Americans who were denied access because of their race, Jett said.

It now has two locations in the West End, near Central High School and Algonquin Park.

“If we were not present and providing services, the health of Louisville would be a lot worse today,” Jett said.

Patients who use community health centers will likely always have a need for them, Jett said. But like Irwin, he does worry new services could draw away both patients and staff.

Irwin and Jett said nationwide shortages of health care professionals already make recruiting challenging. And community health centers can’t offer the same benefits that larger providers can.

“People that come work for us, it’s really about the mission and why Park DuValle was created,” Jett said.

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Irwin said he met with Cox from Norton shortly after the hospital was announced, and he hopes the service providers can “have a reciprocal relationship where we could feed patients into their system, and they could get care and then we get them back again.”

In an interview, Cox said Norton does not want to take patients away from other providers, a sentiment Townsend agreed with.

“It’s not about us coming down here and dominating the area,” Townsend said. “Those are our partners, too.”  “I think it’s fair to say that anytime anybody brings forth a new idea, there’s a lot of questions, and I think they were justified,” Cox added. “We did our best and continue to do our best to work with, communicate and involve in the process.”

New locations alone won't improve life expectancy

While every West End provider says their goal is to improve health outcomes for their patients, they know opening new service locations alone won’t get them there.

The community continues to lack options for fresh food, safe housing and other resources needed to maintain health. And many patients face access barriers, even when providers are located in their neighborhoods.

Irwin said many people who use Family Health Centers struggle with getting transportation for medical appointments. And some don’t have phones or stable addresses, making it difficult for clinic employees to communicate with them.

“Because you have resources doesn’t mean that one, that people are going to use it; two, that they have transportation; three, that they are going to communicate better with their health care providers,” he said.

Jett said for health outcomes to permanently change, better investments also need to be made in education, employment, affordable housing and grocery stores.

“Health is the end state, but your wealth in this country determines your health, and that shouldn’t be the case,” he said.

Jett said Park DuValle Community Health Centers is attempting to help patients holistically, where it can.

Humana gave Park DuValle $500,000 to assist patients with their bills and provide health literacy programs, including cooking classes, he said.

The nonprofit provides space for Kroger’s mobile market at its main location (on Chestnut Street?) at least once a week, so people don’t have to travel as far to get groceries. And Jett said he is working to bring a farmer’s market to the West End to give residents even more access to fresh produce.

Other providers moving into the area are following suit.

Dr. Jamaal Richie, a primary care provider at University of Louisville Health’s Urgent Care Plus location in Parkland, said being in a residential area allows many of his patients to walk to the office. And Richie participates in Central High School's medical program, getting youth interested in the field from a young age.

Richie, who grew up in Parkland and graduated from Central, said patients are excited to see a doctor who looks like them. He said some have told him they've never seen a Black doctor before.

"It eases their ability to share their deepest secrets with me and the things that concern them most about their health, and that's important because that allows me to provide them the best care," he said.

Humana’s CenterWell Senior Primary Care clinic, which recently opened within the Norton Healthcare Sports and Learning Center in Russell, provides free transportation for patients who need it. And it employs health educators to help patients learn how to manage chronic conditions.

At the Norton hospital, patients will be able to attend classes on financial literacy and nursing as a new mother. The organization has also ensured people who received construction job training at the Louisville Urban League were involved in building the facility.

Education, mentorship and ease of access are all important parts of improving health outcomes for good, Richie said.

"When it comes to healthcare, it is multifaceted in terms of how we want to reach folks," he said.

Reach reporter Kate Marijolovic at kmarijolovic@gannett.com or on Twitter @kmarijolovic.

This article originally appeared on Louisville Courier Journal: How new investments are changing health care access in west Louisville