Correction: This story has been edited to accurately reflect St. Luke's spending on its Fruitland expansion.
Betsy Hunsicker walked onto the maternity floor a year ago, during her first week as CEO of West Valley Medical Center in Caldwell, and saw a mother leaving.
"The baby was being transported," Hunsicker says.
The infant wasn't a severely premature birth, in dire need of neonatal intensive care for survival. But it was struggling to keep up its oxygen levels. Mother and baby were being separated - and going to another city for their care.
Canyon County is growing, and so is West Valley's need to accommodate its local patients, Hunsicker says. West Valley's owner, HCA - short for Hospital Corporation of America - has "its eye on" the Caldwell hospital and has invested millions of dollars in upgrades in recent years, she says.
After seeing that mother and baby leave, Hunsicker learned that more than half of Canyon County's new mothers are delivering their babies in Ada County.
Hunsicker has a goal: "Keep more of those babies here."
Karl Keeler, CEO of Saint Alphonsus Medical Center-Nampa, is amazed at how starved Canyon County seems to be for basic health care services.
"We do free heart and stroke screenings probably every quarter. We see probably 200 or 300 people at each of those screenings," he says.
The screenings are especially important for people who are obese, because they are at higher risk of health problems such as heart disease and stroke. Canyon County's obesity rate is high compared with its neighbor to the east.
Saint Alphonsus in Nampa also has two vans to shuttle people to and from appointments. They take patients not just between Saint Alphonsus centers but to the dentist, the chiropractor or another local hospital. Though the vans are advertised only through word-of-mouth, they're so popular that volunteers staff them full-time.
Thirteen years ago, St. Luke's Health System planted its feet in Fruitland, opening a cancer clinic in the agricultural town of 4,700 people.
Last year, the Boise-based system greatly expanded that footprint. St. Luke's is investing $55 million in a Fruitland expansion, including a $30 million 80,000-square-foot medical plaza and all-hours emergency room.
That wasn't the only major investment by a nonprofit hospital system in Fruitland. The building is across the street from a $10 million, 30,000-square-foot health plaza Saint Alphonsus Health System opened in 2012.
The St. Luke's Fruitland grand opening last July was a to-do. Hundreds of people, from elderly men in hats and suspenders to teen girls in bright fashions, came to see their community's shiny new medical center.
"Fruitland has exceeded our original plans for number of patient visits per day," says Kathy Moore, CEO of St. Luke's West Region.
Why are three health-care organizations so focused on the western Treasure Valley?
"I'm a Caldwell High School graduate, so my heart's often in Canyon County," Moore says.
St. Luke's spent tens of millions of dollars to buy Nampa's Saltzer Medical Group - an acquisition an appeals court said must be unwound, after a federal judge decided it violated antitrust laws. St. Luke's also built a Nampa emergency department and plans a full-scale Nampa hospital.
The health system has invested about $70 million in Nampa over the past seven years, St. Luke's executives say.
"We had a choice to make," Moore says. "We could either build in Meridian or closer to home" for Nampa patients.
Before St. Luke's built its Nampa emergency department, about 25 percent of St. Luke's Meridian Medical Center's emergency-room visits came from Canyon County.
CLOSE TO HOME
The hospitals are expanding in strategic ways across the region. It's part of a general push to offer outpatient care in a variety of places instead of just admitting a patient to a hospital.
Executives for West Valley, Saint Alphonsus and St. Luke's all say patients don't want to drive a half hour to get to their doctor, the emergency room or their child's pediatrician. So the organizations are peppering neighborhoods with primary-care offices and opening urgent-care facilities in places like Fruitland.
There's another dynamic at work, too. The population is exploding. It is aging. And its health needs are complex.
About 50 doctors saw patients at West Valley Medical Center when Dr. Richard Augustus, chief medical officer, arrived 18 years ago. Now there are about 250 doctors.
"We're seeing sicker and sicker patients. It's just, I think, part of the nature of health care in the Valley," Augustus says. The aging population is "a significant part of it."
Canyon County's population grew more than 125 percent from 1980 through 2013, according to a Saint Alphonsus community health needs assessment. That was about twice Idaho's population growth and four times the U.S. population growth.
And that population is more likely to be overweight, uninsured, in poor health both physically and mentally and lacking basic medical care.
ALL ALONG THE INTERSTATE
As you drive along Interstate 84 through Nampa, a new sight decorates the southern skyline: Saint Alphonsus sank tens of millions of dollars into a new maternity and heart center just off the freeway's Garrity Boulevard exit.
That, plus a much-expanded Nampa Health Plaza, make up the bulk of a new Saint Alphonsus campus.
Less than a year after the Birkeland Maternity Center and Heart Center opened, with a neonatal intensive care unit and some specialized cardiology care for people with serious heart problems, Keeler is delighted with the results.
"People that otherwise had left Canyon County to go to Ada County for services are staying in Canyon County," says Keeler, who oversees Saint Alphonsus operations in Nampa and Ontario. "We are actually seeing Ada County ambulances."
Next month, the hospital expects to break ground on a new clinic at Karcher and Middleton roads - part of its plan to have a Saint Alphonsus primary care site, or at least a Saint Alphonsus affiliate, "within a 15-minute drive of anywhere in the Treasure Valley," Keeler says.
THE WESTERN MARGINS
Hospitals are increasing their reach into rural communities, too.
St. Luke's and Saint Alphonsus have their new Fruitland centers.
West Valley has doubled the size of its clinic in Wilder, added primary-care providers in Middleton and New Plymouth, has a clinic in Nampa and is expanding its services in Caldwell.
Keeler says Saint Alphonsus is building another outpatient center in Ontario now It is spending $4.5 million to put urgent care, therapy, podiatry and specialists into a building it is renovating across from the Ontario hospital, he says.
If demand now is any indication, there will be plenty of patients to go around for the hospitals in the western part of the Valley, officials say.
Keeler says the maternity, heart and emergency centers, in their first and second years, are already as busy as Saint Alphonsus projected they'd be in years four and five.
"We'll continue to evaluate the market and see where it goes," Keeler says.