How Collin County Health Care Providers Are Managing Record Population Growth

Collin County saw its population surpass 1 million in 2018, and it is now the fourth fastest growing county in the nation. This growth presents all kinds of challenges for professionals working in education, transportation and all other areas of public life. Add a pandemic to the mix, and healthcare leaders found themselves racing to keep up. In early March, Will Maddox, editor of our sister site D CEO Healthcare, moderated a panel of four such leaders who spoke about their own issues. On stage at the Plano Event Center were: Dr. Michelle Forbes, Catalyst Health Network’s chief medical officer; Jared Shelton, president of Texas Health Presbyterian Hospital Allen; Collin County Commissioner Cheryl Williams; and Dr Philip Wilson, Deputy Chief of Staff and Pediatric Orthopedic Surgeon at Scottish Rite for Children Frisco. Here are some highlights of their speech.

What is the basic picture of Collin County’s demographic profile?


Cheryl Williams: “A word that is synonymous with Collin County is ‘growth’. We have 20 years of phenomenal growth, 36% in the last 10 years. This equates to around 81 residents on average moving here every day. Our median income is $97,000 per year. We have a poverty rate of about 6.2%. High school graduation or higher is 93.8%; bachelor’s degrees or higher is 52.3 percent. We have a foreign-born population of about 21%. We have approximately 50.9% White, 17.6% Asian, 15.8% Hispanic, and 10.9% African American. So we have a very diverse population.

How has this growth affected Texas Health Presbyterian Hospital Allen?

Jared Shelton

Jared Shelton: “The hospital opened its doors in December 2000. It was not originally designed as an acute care hospital. It was originally designed as an outpatient center. It was going to be a two-story facility with outpatient services to serve the community. At the time, Allen had a population of 43,000. So it was still a dormitory community. They had already paved the way to the site, and a group of OB-GYNs approached Texas Health and said, “We’re looking for a place to give birth because the area has started to grow much faster.” So they actually changed the setup along the way. They added a third floor to the hospital. Fast forward to today, and Allen has around 108,000. We recently completed a $68 million expansion that immediately added 25 beds. We still have 50 beds that we will grow into over time.

Collin County’s growth has brought more kids into sports, which means more kids are getting injured. How did Scottish Rite meet this challenge?

Dr. Philippe Wilson

Dr Philippe Wilson: “I think the Frisco campus is the next step, the extension of the Scottish Rite. We have just celebrated our centenary. The hospital was founded by WB Carrell. At that time, he was caring for the children of Dallas and the most common disease, poliomyelitis. The Freemasons came to him and told him to help you, and they formed the hospital in 1921. Then when the polio vaccine came out in the 1950s, we shifted the focus to the needs general like hip dysplasia and spinal problems. In the 1990s and the turn of this century, we expanded and began a partnership with Children’s to cover trauma in Dallas. And so, as population growth moved north, we had this explosion of sports, which is fantastic. Collin County is an amazing place for our kids to be involved in these things, but the other side of the fence is the injuries kids can get. So that was the next need we saw. The hospital responded to that, and it’s kind of an anchor for us to have a second hospital 25 miles from our main hospital.

How did Catalyst Health Network provide a safety net for underserved Collin County residents?

Dr. Michelle Forbes

Dr. Michelle Forbes: “Thinking about the realities of poverty here, we are challenged to realize our mission for all communities, not just those with access to wealth, but also those without. Meeting this challenge and focusing on reality means doing the kind of work we did in Dallas, which is establishing health care access points. I’m talking about primary care. When primary care is done well, we prevent our patients from using acute care facilities. If we manage chronic disease, we reduce overall healthcare costs for all of us. The money we save can be used for roads. This is the challenge here, faced with the reality of poverty. It’s healthy care for everyone.

With Collin County’s diverse population, how do you approach culturally competent care?

Shelton: “There’s a lot of business value in having a diverse workforce. The white population in 2010 was approximately 72% of the city. Now it’s 59%. Our Asian population grew from 13% to 24% during this time. The African American population has grown from 8 to 10. So we’re becoming more diverse and we want to have an environment where people feel comfortable coming for care from people who understand their background.

Mental health is a huge issue. 30-40% of our prison population has some sort of mental health issue.

How is Collin County addressing the intersection of mental health and criminal justice?

Williams: “Mental health is a huge issue. At any given time, 30-40% of our prison population suffers from a mental health issue. Prisons across the state and across the country were kind of the de facto mental health facilities that were shut down in the 70s and 80s. My personal opinion is that it’s a complete moral failure on our part . There are a lot of people in prison who shouldn’t be in prison. They should be in treatment. They get arrested for minor infractions, and it escalates. Often, because they’re in a crisis, they don’t react well to the arrest and so they assault an officer. So it’s a huge problem, almost unsolvable, in my opinion, and we’ve struggled with it. With state grants and county dollars, we set up a mobile crisis team so law enforcement can use them when a person doesn’t need to go to jail or can Maybe the problem can be solved if he just had a crisis intervention. All these services, of course, do not really affect demand. I mean, the demand just exceeded all of our efforts. We are designing a $134 million expansion to the prison infirmary to better treat these patients. We really need more mental health professionals in prison. In our last budget, we added a full-time, 24/7 mental health service to the prison to better identify people who may be in crisis, help defuse people in crisis in order to avoid the kinds of tragedies that can occur in prison.

How did you meet the twin challenges of a labor shortage and a pandemic?

Shelton: “The contract or traveling nurses have really been a godsend for us. But you have contractors currently earning multiples of a typical nurse’s salary. I’m going to give you an example. Assume the Pacific Northwest did not experience a COVID surge. They could reassign excess personnel to Texas to help us overcome our influx. It works. But what we saw was a very interesting dynamic where we had traveling nurses who came from Collin County. They leave a facility and drive 5 miles down the road, going to another hospital, sort of robbing Peter to pay Paul. It’s not sustainable. Hopefully part of the solution will be that the pandemic enters a new phase, and we don’t have these big surges, and things sort themselves out. In Collin County, we are very fortunate because Collin College was the first community college in the state to offer a four-year Bachelor of Science in Nursing program. And so we have these great local resources that we can tap into.


Will Maddox

Will is the editor of CEO magazine and editor of D CEO Healthcare. He wrote about health care…

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