Creating a Continuum of Care in Watertown

Prairie Lakes Healthcare System and Brown Clinic

By Alex Strauss

Prairie Lakes Chief of Staff Casey Johnston, MD, CEO John Allen, and family doctor Stacie Lenssen, MD

For a city of fewer than 25,000 people in one of the nation's most rural states, Watertown, South Dakota has long enjoyed an exceptionally high level of healthcare. For more than 80 years, Brown Clinic has been a big part of that. The physician-owned primary care clinic has been a cornerstone of the community, providing pediatrics, internal medicine, Ob/Gyn, and family medicine with a deep sense of local connection. Today, more than 70,000 patients visit one of Brown Clinic's two locations each year.

Now, as the healthcare landscape in Watertown undergoes a significant transformation, the providers of Brown Clinic find themselves at the center of one of the most significant developments in recent years. On January 1, the clinic officially becomes a part of Prairie Lakes Healthcare System, the system which operates Watertown's 81-bed hospital and provides an increasingly diverse range of specialty services.

The resulting larger organization will, for the first time, allow Prairie Lakes to offer what CEO John Allen calls a seamless continuum of care for residents of Watertown and the 10 counties they serve.

"The immediate short term benefit is the ability for us to keep care local and ensure that we have our ear to the ground as to the changing needs and demographics of the community," says Allen. "Keeping it local creates a level of agility that frankly you don't find in a larger health system today."

"Longer term, it's going to allow us to develop a level of seamlessness in care that we have not had before in this community. We now have the ability to care for people from birth all the way through old age and palliative or end-of-life care."

Uniting for a Seamless Healthcare Future

Prairie Lakes Healthcare System, which has been in its current configuration for 35 years, has its own rich history of service to the region. In addition to the hospital and emergency department, Prairie Lakes offers Cardiology, Dermatology, Ear, Nose & Throat, General Surgery, Hospice, Home Care, Nephrology, Orthopedics, Pulmonology, Urology, and Wound Care.

The health system also operates Prairie Lakes Cancer Center, Prairie Lakes Mallard Pointe Surgical Center, rehabilitation services, and dialysis units in Sisseton, Watertown, and Ortonville, Minnesota. Until now, primary care was the missing piece.

"We have had a great relationship with Prairie Lakes for years, but about two years ago, we started looking more seriously at ways we could make things better for the community together," says Brown Clinic family medicine doctor Stacie Lenssen, MD. A native of Brown Valley, Minnesota, Lenssen says she took the position at Brown Clinic 20 years ago so she could be within driving distance of family.

"I came to Brown Clinic for the location, but also because it was an independent clinic in a small area where you could get to know your patients really well, but you also aren't completely alone," she says. "I really love the practice here."

For the past three years, Lenssen has served as the General Partner, or business head, at the physician-owned clinic. She says the new alliance feels natural, given Brown Clinic's long history of collaborative projects with Prairie Lakes, such as the establishment of the region's first hospitalist program.

"In that case, our doctors started the program and the hospital took it over," says Lenssen. "So when we were looking at different scenarios for working together, we started to realize that this really all needed to be under one umbrella. That turned into a decision for us to combine together into a single entity."

Expanding Services, Closing Gaps

This is not the first time Prairie Lakes has expanded its services through this kind of strategic alliance. In 2022, Glacial Lakes Orthopedics, an independent physician-owned orthopedic clinic with 11 employees, became Prairie Lakes Orthopedics. As one of the three orthopedic surgeons formerly with Glacial Lakes (now Prairie Lakes Orthopedics), Casey Johnston, MD, has a unique perspective on the new alliance.

"From my personal experience, the model of trying to sustain a private, independent medical practice has become a lot more challenging in recent years," says Johnston, the current chief of staff at Prairie Lakes. "The costs of doing business have outpaced the ability to make that up with reimbursements. At some point, it becomes an unsustainable process."

Johnston says, when you add to that the regulatory issues and communication issues that arise from using a different electronic medical record system than the hospital, the writing was on the wall.

"Eventually you have to ask 'Are we doing the patients of Watertown a service by doing it this way or would it be better to combine forces?'" says Johnston. "We made that decision and never looked back."

Now that he is on the other side, Dr. Johnston has himself faced the frustrations of working with the different EMR and radiography systems at Brown Clinic, Prairie Lakes' largest referral source.

"Right now, there are a lot of mechanics involved for me to gain access to their patient notes, which involves things like faxing," says Johnston. "We actually have to transfer X-rays using manpower because we aren't on the same system. And, of course, it's cumbersome for patients to access their own records."

Some communication will be easier right away, but it will likely take a couple of years for Prairie Lakes to fully implement new EMR and PACs systems across its entire footprint. But Johnson says better access will not only be easier for him and for the referring physicians, but will also mean better, more cohesive and navigable care for patients.

Navigating Integration

The two organizations signed a letter of intent in May and have spent the last seven months ironing out the processes, systems and protocols needed to bring two large entities together.

But CEO John Allen says full integration is going to take longer and involve more than just changing the signs and the records systems.

"The merging of two cultures and making sure we are aligned with each other will be an ongoing process," he says. "The cultures of these two organizations are already quite similar. But it's like a UN conference; you may be saying the same things but you're saying it in different words."

The size and scale of the operation alone makes it clear why a slow and steady approach is needed. Whereas, the Glacial Lakes Orthopedics acquisition added a few dozen people to Prairie Lakes' employee roster, Brown Clinic brings about 130 people (including 17 physicians and five advanced practice providers) and will increase the size of Prairie Lakes' workforce by 20 percent.

But the larger size will make some things easier. At a time when it is tougher than ever to attract new doctors to small communities, Dr. Lenssen says being part of a bigger system and being able to offer employed status will help with recruitment.

"As we have been interviewing physicians, we are finding that many don't want to worry about running their own business anymore like we did," she says. "These young physicians are training in health systems, so this makes it a more comfortable move for them. It makes a huge difference when they are making those decisions."

She says having access to a large and dynamic health system that offers a full continuum of care can also make a difference to young families deciding where to live.

"Our town is growing. We have lots of new manufacturing and other things coming in and we have new families coming in," says says. "They want to make sure that they are getting what they are used to in the big cities, as well."

"Exceptionalism really needs to be through the eyes of the consumer, the patient," agrees Allen. "The opportunity is for an exceptional healthcare experience for the communities that we serve. That is the driving motivation behind the agreement."

"It's one thing to talk about the continuum of care," he continues. "But it's another to ask ourselves 'Where are the gaps in types or levels of care and how can we fill them?' That process, as we continually look for ways to improve health in our community, is really the fun part."