Increases to employer-sponsored health insurance co-pays and deductibles; reduction of employee health insurance benefits; and unemployment influence the number of people looking for lower-cost health care.

With that in mind, Brainerd Lakes Health - a regional partnership of St. Joseph's Medical Center, Brainerd Medical Campus, Convenient Care, and satellite SJMC clinics - is focusing even more on helping patients maintain good health in a cost-effective way.

One of the things that Brainerd Lakes Health has done is create a Convenient Care Clinic at Cub Foods, in Baxter, to provide a lower-cost alternative to same-day access.

Convenient Care is open four days a week: Monday and Friday 8 a.m. to 8 p.m.; Saturday and Sunday, 9 a.m. to 3 p.m. and staffed by a nurse practitioner.

Patients who need to be seen on those days have walk-in access to Convenient Care.

And, the Convenient Care has seen a 25 percent increase in traffic over the past year.

"By keeping the scope of services very narrow and focusing on low acuity problems, they can move patients through more quickly and at a lower cost," said Jani Wiebolt, SJMC president.

Convenient Care is one of the ways that Brainerd Lakes Health has tried to decrease patients' dependence on emergency room visits.

Adding more providers to the Urgent Care Clinic was another.

Physicians, nurse practitioners and physician's assistants staff the Urgent Care Clinic -located in the Brainerd Medical Campus.

"Oftentimes we were having to turn patients away and they'd end up in the Emergency Room because there wasn't enough capacity in the Urgent Care schedule for the day," Wiebolt said. "So by adding more providers to the Urgent Care clinic, we were able to see more patients there, and again, that's a lower cost alternative than going to the emergency department."

And, Urgent Care has seen an 8 percent increase over last year.

"People truly are looking for less expensive alternatives; I think that's a good indicator," Wiebolt said.

Another thing Brainerd Lakes Health did was add a physician's assistant within its SJMC clinics in Pequot Lakes, Pierz, Pine River, Crosslake, Pillager and Hackensack allowing more patients to be seen.

BMC also offers a nurse triage service: registered nurses can respond to telephone inquiries from patients - who, perhaps just have a question and may not need a clinic visit.

On the preventative side, there are other things that BLH is doing to help patients.

SJMC has programs that help patients manage chronic diseases like congestive heart failure (CHF).

CHF patients are likely to have multiple hospital stays because their illness gets exacerbated and they are admitted to the hospital to get their symptoms back under control, Wiebolt said.

A medical director, a cardiologist, and a nurse practitioner that specializes in congestive heart failure care manage SJMC's CHF management program.

A nurse works with groups of patients with CHF on an outpatient basis. The nurse communicates with patients daily about their health measurements and symptoms - things that might indicate a change in their health. A physician or nurse can then make modifications in their medications to possibly prevent a hospital visit.

Diabetic care is another area that BLH is focused on.

Helping patients manage their health on an outpatient basis reduces hospital stays and may delay or prevent long-term health complications resulting from diabetes.

"By managing those patients effectively you're decreasing overall costs in the system," Wiebolt. "There really is little, if any, reimbursement currently for these chronic disease management programs. A lot of that is simply an expense for a health system. We do it because it's the right thing for the patient."

And, insurers don't compensate for most patient education.

With increased patient use of Convenient Care and Urgent Care, additional staff at the clinics and a focus on preventative care St. Joseph Medical Center has seen a 3.5 percent decrease in emergency room visits this year compared to last.

In general the economy can affect the number of patients treated in the ER. Typically St. Joseph's ER volume increases dramatically in the summertime with tourism, Wiebolt said.

The drop in volume over last year may be a result of fewer travelers to the area.

People who have health insurance may be looking for lower cost alternatives; but the poorest of the poor may not have another alternative and end up being seen in the ER.

Gov. Tim Pawlenty used unallotment to reduce General Assistance Medical Care, a state-run program.

Low-income adults, ages 21-64, who have no dependent children under age 18 and who do not qualify for federal health care programs may qualify for assistance, according to the Minnesota Department of Health.

BLH has its own assistance program: Community Care - funded directly by the hospital and clinic operations.

In fiscal year 2009 (ending in June) Community Care provided $3.2 million in charity care.

"Because we have a community care program that serves both hospitalized patients and clinic-care patients we don't turn away patients at the clinic because of inability to pay," Wiebolt said.

They work out payment options with a patient. If they qualify for Community Care, they receive care for free or at a reduced cost depending on their income level.

"Nationally there has been a dramatic increase in the level of uncompensated care: either bad debt or an inability to pay. That's where access to some of these programs like General Assistance Medical Care becomes so important."