Executive Perspectives in Healthcare – Garren Colvin and Gary Blank
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Lead Cincinnati sat down with some of the most powerful hospital executives in the region for wide-ranging discussions about the present and future of healthcare.
Below is our conversation with St. Elizabeth Healthcare's Garren Colvin, executive vice president and chief operating officer, and Gary Blank, senior vice president, chief of patient services and chief nursing officer.
St. Elizabeth has been the heart and soul of healthcare in Northern Kentucky for more than 150 years. What started as a single small hospital in 1861, St. Elizabeth Healthcare now operates six facilities. Over the years the mission has remained the same, “to provide comprehensive and compassionate care that improves the health of the people we serve.”
Garren Colvin, executive vice president and chief operating officer and Gary Blank, senior vice president, chief patient services and chief nursing officer, answered LEAD Magazine’s questions regarding St. Elizabeth Healthcare’s plans for the future.
LEAD Cincinnati: How does the St. Elizabeth healthcare model differ from other systems in town?
Garren Colvin: Our model has been based on having a strong and vibrant partnership with our physicians, primarily with the doctors employed by St. Elizabeth physicians, which has 400 providers, about half of which are primary care, and also with the independent physicians on our medical staff. We believe that fostering collaborative relationships with our physicians allows us to better serve the residents of Northern Kentucky. We think this collaboration defines us as an organization – it is the heart of our care model and one that we believe works very well for us.
In addition to those relationships we have with our physicians, we are in the early stages of a Physician Hospital Organization which will combine the expertise of our employed physicians at St. Elizabeth Physicians and our independent physicians, so that we can bring together the best medical minds in the area to address the needs of our community.
Gary Blank: One thing we’ve tried to do through the heart and vascular institute – and in some of our specialty-type clinics and areas – is have a more collaborative relationship with specialties. So, in our valve center, for instance, where it’s been a little different in the past, you would have an appointment with a cardiologist, and maybe you’d have an appointment with a surgeon, and each of them kind of maybe touches base and makes a recommendation for care, or we try to have the surgeon and the cardiologist meet with the patient and their family at the same time, so the family won’t have to go to different areas, and then [the doctors] develop a plan for care for that patient that they discuss and report on. Historically, if you saw a cardiologist, they treated you as a cardiologist would. If you saw a surgeon they’d treat you the way a surgeon would treat you. In this case, we’re developing a collaborative approach for what they feel is best customized to meet the patient’s need.
LC: What are some of the challenges you are experiencing in healthcare with the ever-changing systems?
GB: I think it’s an ongoing, just regulatory kind of pressures. It’s really preparing for a shift in focus from volume to value, and hinging on truly quality outcomes. So it’s not what you do, it’s how you do it and the service you provide and the outcome that’s achieved. At the end of the day it’s just doing the right thing and focusing on the right thing for the patients and the community.
GC: The biggest challenge is going to be to target when that shift from volume to value takes place. If a healthcare system shifts too early, it is going to be detrimental and if a system waits too late, it is going to be detrimental. So the best thing to do is to prepare, so that you are ready to change your model when the moment is right, and we think we have done a great job at getting prepared with a lot of our initiatives such as the CPCI (Certified Primary Care Initiative). This mindset of constant preparation is what is going to help us address changes in the future.
LC: Tell me about the vision for St. Elizabeth as it continues to grow and, with that, information on the new heart and vascular institute?
GC: Overall, our growth strategy, our focus going forward, is to pursue what has been called the “triple aim.” As the delivery model for healthcare shifts toward population health management, we need to improve the health of the whole population, improve the patient experience, and reduce the per capita cost of healthcare. For us, the reason for our existence has always been the patient, and we will continue to focus on that going forward. The Heart and Vascular Institute is a great example of a program where we can save costs by preventing heart-related incidents down the road. Not only is it financially smart, but much more importantly, it is better for our patients.
GB: On the heart and vascular institute, it really is developing a model that is going to be patient-focused. It’s not as much about the bricks and mortars perspective – that’s a small piece of the heart and vascular institute. It’s really aligning our care delivery around the future as well as what’s most efficient and effective for our patients. Plus, ensuring that the services that really are state-of-the-art and cutting-edge are here and available in our community and local neighborhoods. So that was really a key piece – ensuring we have a program that’s able to be very comprehensive, high quality and available to our communities.
LC: Now has that center opened?
GB: It is, to a large extent. We do have a comprehensive goal of, if we look at our community health plan and some of the weaknesses we have in our market like obesity, diabetes and hypertension and a variety of other pieces. So what we’re really also focusing on is we have a group of diseased patients that we need to manage and provide high level care to, but we’re really also focusing on the prevention and wellness side of things, so we set a goal of trying to reduce cardiac-related deaths by 25 percent over the next 10 years. We’re into that year one, and a lot of what we’re seeing – we just started a program in Kenton County Schools called My Heart Rocks, and it’s really focused on prevention and wellness, and educating the youth on healthy lifestyle and healthy choices. So that piece has started and we’re really moving forward in a lot of areas with community education through events related to wellness and prevention. So, our long-term goal is to work with the current population and prevent things from happening in 10 to 20 years, dealing with the issues that are already at hand, but really trying to shift that whole culture and mode and really help the statistics in our community.
LC: How has the Affordable Care Act affected St. Elizabeth, and how do you see it doing so in the future?
GC: Prior to the Affordable Care Act, a significant amount of our population was indigent, self-pay patients who did not have insurance and had enormous difficulties paying their medical bills. Under the Affordable Care Act, Kentucky expanded Medicaid eligibility to an increased number of previously ineligible individuals. Kentucky also implemented the Health Benefits Exchange. This combination of the expansion of Medicaid eligibility and the availability of Health Benefits Exchanges has meant that approximately 300,000 more Kentuckians now have access to affordable insurance. At St. Elizabeth Healthcare, we have always taken care of those patients as part of our mission, but now we are getting paid to treat more of those individuals that we are seeing. We are also seeing a significant reduction in our proportion of self-pay patients as a result. Now, the problem will be that this is going to put an undue burden on Kentucky from a budgetary perspective, because I would guarantee Kentucky didn’t project 300,000 growth. In addition to that, in two years, the federal government’s reimbursement back to the states will be decreased, so that will put an even bigger burden on the state. So we’re concerned with how Kentucky will deal with that burden moving forward, but for the time being, it has been very beneficial.