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How Collin County’s Healthcare Providers Are Managing Record Population Growth

Four Collin County leaders talk about how their organizations have met the challenge of keeping people healthy in the midst of a population explosion.
| |Illustration by Pete Hoey
Collin County Hospital growth
Pete Hoey

Collin County saw its population surpass 1 million in 2018, and it is now the fourth-fastest growing county in the country. That growth presents all sorts of challenges to professionals working in education, transportation, and every other area of public life. Add a pandemic to the mix, and leaders in healthcare have found themselves racing to keep up. In early March, Will Maddox, editor of our sister site D CEO Healthcare, emceed a panel of four such leaders who talked about their own unique sets of issues. Onstage at the Plano Event Center were: Dr. Michelle Forbes, chief medical officer at Catalyst Health Network; Jared Shelton, president of Texas Health Presbyterian Hospital Allen; Collin County Commissioner Cheryl Williams; and Dr. Philip Wilson, assistant chief of staff and a pediatric orthopedic surgeon at Scottish Rite for Children Frisco. Here are some highlights from their talk.

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


Cheryl Williams: “One word that is synonymous with Collin County is ‘growth.’ We have 20 years of phenomenal growth, 36 percent in the last 10 years. That equates to about 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 percent. High school graduation or higher is 93.8 percent; bachelor’s degrees or higher is 52.3 percent. We have a foreign-born population of about 21 percent. We have about 50.9 percent White, 17.6 percent Asian, 15.8 percent Hispanic, and 10.9 percent African American. So we’ve got a very diverse population.”

How did that growth affect Texas Health Presbyterian Hospital Allen?

Jared Shelton

Jared Shelton: “The hospital opened in December of 2000. It was originally designed not as an acute-care hospital. It was originally designed as an ambulatory center. It was going to be a two-story facility with outpatient services to serve the community. At the time, Allen was 43,000 residents. So it was still very much a bedroom community. They’d already broken ground on the site, and a group of OB-GYNs approached Texas Health and said, ‘We’re looking for a place to deliver because the area started to grow a lot faster.’ So they actually midstream changed the facility. They added a third floor onto the hospital. Fast forward to today, and Allen is about 108,000 people. We recently completed a $68 million expansion that added 25 beds immediately. We’ve got another 50 beds we will grow into over time.” 

Collin County’s growth has brought more kids playing sports, which means more kids getting hurt. How has Scottish Rite met that challenge?

Dr. Philip Wilson

Dr. Philip Wilson: “I think the Frisco campus is the next step, the extension of Scottish Rite. We just had our centennial. The hospital was founded by W.B. Carrell. At that time, he was caring for the children of Dallas and the most prevalent disease, which was polio. The Masons came to him and said let us help you with this, and they formed the hospital in 1921. Then, when the vaccine for polio came about in the ’50s, we transferred the focus to general needs like hip dysplasia and spine problems. In the ’90s and early part of this century, we expanded and started a partnership with Children’s to cover the trauma in Dallas. And so then, as the population growth shifted north, we had this explosion in sports, which is fantastic. Collin County is an incredible place for our kids to be involved in these things, but the other side of the fence is the injuries that kids can get. So that was the next need that we saw. The hospital responded to that, and it’s kind of an anchor for us to get a second hospital 25 miles from our primary hospital.” 

How has Catalyst Health Network provided a safety net for underserved Collin County residents?

Dr. Michelle Forbes

Dr. Michelle Forbes: “Thinking about the realities of poverty here, we’re challenged to make our mission real for all communities, not just those who have access or wealth but to those communities that lack access. Facing that challenge and focusing on the reality means doing the kind of work we’ve done in Dallas, which is establishing healthcare access points. I’m talking primary care. When primary care is done well, we keep our patients from using acute-care facilities. If we manage chronic conditions, we decrease the overall health spend for all of us. The money that we save can be used for roads. That’s the challenge here, when we face the reality of poverty. It’s healthy care for all.” 

With the diversity of the Collin County population, how do you approach culturally competent care?

Shelton: “There’s a lot of business value to having a diverse workforce. The White population in 2010 was about 72 percent of the city. Now it’s 59 percent. Our Asian population went from 13 percent to 24 percent in that time. The African American population went from 8 to 10. So we’re getting more diverse, and we want to have an environment where people feel comfortable coming to get care from people who understand their background.”

Mental health is an enormous problem. Thirty to 40 percent of our jail population has some sort of mental health issue.

How does Collin County approach the intersection of mental health and criminal justice?

Williams: “Mental health is an enormous problem. At any given time, 30 to 40 percent of our jail population has some type of mental health issue. Jails across the state and throughout the country have been kind of the de facto mental health facilities that were closed down in the ’70s and ’80s. My personal opinion is that’s a complete moral failure on our part. There’s a lot of people in jail who shouldn’t be in jail. They should be in treatment. They get picked up for minor infractions, and it escalates. Oftentimes because they’re in crisis, they don’t respond well to being arrested, and so they assault an officer. So it’s a huge problem, intractable almost, in my view, and we have struggled with it. With state grants and county dollars, we have set up a mobile crisis team so law enforcement can use them when a person may not need to go to jail or maybe the problem can be resolved if they just had some crisis intervention. All these services, of course, really don’t touch the demand. I mean, the demand has just absolutely outstripped all our efforts. We’re now in the process of designing a $134 million expansion to the jail infirmary so that we can better treat those patients. We really need more mental health professionals in the jail. In our most recent budget, we added full-time, 24/7 mental health support to the jail so that we can better identify people who may be in crisis, to help deescalate people who are in crisis so that we can avoid the kinds of tragedies that can happen in a jail environment.” 

How have you met the double-whammy challenge of a worker shortage plus a pandemic?

Shelton: “Contract nurses or traveling nurses have really been a godsend to us. But you have contractors who right now are making multiples of a typical nurse salary. I’ll give you an example. Say the Pacific Northwest was not in a COVID surge. They could reallocate excess staffing to Texas to help us get over our surge. That works out. But what we’ve seen is a very interesting dynamic where we’ve had travel nurses that have come from within Collin County. They leave one facility and go 5 miles down the road, traveling to another hospital, just sort of robbing Peter to pay Paul. That’s not sustainable. Hopefully part of the solution will be that the pandemic is entering a new phase, and we won’t have these severe surges, and things will take care of themselves. In Collin County, we’re very fortunate in that Collin College was the first community college in the state to have a four-year bachelor’s of nursing program. And so we’ve got these great local resources that we can tap in to.” 


Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…