It’s ‘schiz­o­phrenic’ bal­anc­ing cur­rent growth with healthcare re­form

Modern Healthcare - - Q & A -

Will Cook takes over on Sept. 8 as pres­i­dent and CEO of Univer­sity of Colorado Hos­pi­tal in Aurora, suc­ceed­ing John Harney. The hos­pi­tal, which has 6,012 em­ploy­ees, is part of the four-hos­pi­tal Univer­sity of Colorado Health sys­tem, which is af­fil­i­ated with the Univer­sity of Colorado School of Medicine. The sys­tem re­ported rev­enue of $784.6 mil­lion in the fourth quar­ter of fis­cal 2015, up 17% from the same pe­riod a year ear­lier, with an op­er­at­ing mar­gin of 13.5%. Cook pre­vi­ously served as se­nior vice pres­i­dent of the health ser­vice di­vi­sion at Univer­sity of Pittsburgh Med­i­cal Cen­ter, chief op­er­at­ing of­fi­cer of UPMC’s physi­cian ser­vices, and pres­i­dent of UPMC Mercy. Mod­ern Healthcare re­porter Adam Ruben­fire re­cently spoke with Cook about the chal­lenges fac­ing aca­demic med­i­cal cen­ters, his am­bu­la­tory-care strat­egy, and the task of strad­dling the old fee-for-ser­vice and new pop­u­la­tion health man­age­ment en­vi­ron­ments. This is an edited tran­script.

Mod­ern Healthcare: What are the dif­fer­ences be­tween the Univer­sity of Pittsburgh Med­i­cal Cen­ter and the Univer­sity of Colorado?

Will Cook: What drew me to Univer­sity of Colorado Hos­pi­tal is its aca­demic hub with the Univer­sity of Colorado School of Medicine. It’s ex­tremely im­por­tant to me that I stay a part of aca­demic medicine where there’s in­no­va­tive re­search and teach­ing. Another thing that drew me that was sim­i­lar is that UCH is part of a larger sys­tem that has very good com­mu­nity hos­pi­tals in Fort Collins and Colorado Springs.

There are many dif­fer­ences. When you’ve seen one aca­demic med­i­cal cen­ter, you’ve prob­a­bly seen only one aca­demic med­i­cal cen­ter. One of the big­gest dif­fer­ences is the lo­cal mar­ket dy­nam­ics. What’s very at­trac­tive about Univer­sity of Colorado is that it is the only aca­demic med­i­cal cen­ter within a 600-mile ra­dius of Den­ver. That brings with it a very spe­cial op­por­tu­nity as well as re­spon­si­bil­ity to en­sure that we make avail­able to the res­i­dents of the Rocky Moun­tain re­gion ac­cess to the high­est lev­els of care, work­ing hand in glove with the Univer­sity of Colorado School of Medicine to make sure that we have lo­cal spe­cial­ists and sub­spe­cial­ists. That’s the big dif­fer­ence be­tween the Colorado and the western Penn­syl­va­nia mar­kets.

In the Den­ver area, you have sev­eral other play­ers— HCA, Kaiser Per­ma­nente and As­cen­sion. Univer­sity of Colorado’s mar­ket share is around 20%. So how can we en­hance our pres­ence in the Den­ver mar­ket as a re­gional aca­demic med­i­cal cen­ter?

MH: What are the chal­lenges that aca­demic cen­ters are fac­ing?

Cook: You al­ways worry about the bud­get for the Na­tional In­sti­tutes of Health. One of the ways the U.S. is go­ing to solve its prob­lem of spend­ing about twice as much on healthcare as other de­vel­oped na­tions is that we’ve got to come up with new mod­els of care. We’ve got to fig­ure out new ways to do things that are not only im­prove­ments in terms of qual­ity of life, but also in terms of re­duc­ing costs. While aca­demic cen­ters are well known for the highly sub­spe­cial­ized care you can’t get at a com­mu­nity hos­pi­tal, we’re very well poised to fig­ure out how we lever­age knowl­edge about ge­net­ics and de­velop per­son­al­ized medicine to more ef­fec­tively treat cer­tain dis­eases, or even bet­ter, pre­dict them be­fore they hap­pen and al­low peo­ple to take nec­es­sary steps to avoid dis­ease pro­gres­sion. Be­ing a part of an in­sti­tu­tion that is con­stantly on the fore­front of look­ing for new ways to treat dis­eases and de­velop new mod­els of care is where the fu­ture is.

MH: What is your strat­egy to de­velop Univer­sity of Colorado’s out­pa­tient-care sys­tem?

Cook: The Univer­sity of Colorado Hos­pi­tal has been very suc­cess­ful, es­pe­cially over the re­cent years, in grow­ing the An­schutz cam­pus into what in my opin­ion is one of the finest med­i­cal cen­ters in the U.S. And the con­sis­tent growth in fi­nan­cial per­for­mance of UCH has been al­most un­be­liev­able.

But when I ask what’s next, I think that if aca­demic med­i­cal cen­ters are to sur­vive, they’ve got to get out into the com­mu­nity and have very strong re­la­tion­ships with com­mu­nity hos­pi­tals and com­mu­nity physi­cians, and even em­ploy their own physi­cians. How do you be­come more of a re­fer­ral cen­ter by pro­vid­ing ac­cess to those sub-spe­cial­ists in dif­fer­ent parts of the com­mu­nity?

That means look­ing at ways that we can part­ner

“We’re grow­ing; it’s al­most like Field of Dreams, ‘You build it and they come.’ ”

with other hos­pi­tals, pri­vate physi­cians, and em­ploy some of our own physi­cians. How we im­ple­ment a more ro­bust com­mu­nity strat­egy and make those ser­vices avail­able is go­ing to be vi­tal. I come back to what’s re­ally at­trac­tive is that UCH is now a part of UCHealth, the broader sys­tem that has these won­der­ful hos­pi­tals in the North and the South.

MH: What wor­ries keep you up at night as a hos­pi­tal CEO?

Cook: How can we as an aca­demic med­i­cal cen­ter con­tinue to en­sure that we are able to fund the re­search and in­no­va­tive ap­proaches to medicine de­spite de­creas­ing NIH fund­ing, par­tic­u­larly when see­ing payer-mix degra­da­tion from com­mer­cial to gov­ern­ment-type in­sur­ance that doesn’t nec­es­sar­ily re­im­burse you at the same rate? How do we si­mul­ta­ne­ously come up with new mod­els of care while also con­tin­u­ing to be as busy as we are?

As an ex­am­ple, just this last year they built out a new tower, in­creas­ing beds from 533 to 620, and it’s al­ready al­most full again. So on one hand, you’ve got things that are go­ing gang­busters in the ex­ist­ing par­a­digm. But if you peer out into the fu­ture and you say to your­self, “How is Amer­ica go­ing to solve its healthcare prob­lem,” it’s got to be in part by re­duc­ing uti­liza­tion. How do we have a growth strat­egy that also takes into con­sid­er­a­tion that we’ve got to pro­vide care in a dif­fer­ent way?

It’s al­most a schiz­o­phrenic thing. We’re grow­ing; it’s al­most like Field of Dreams, “You build it and they come.” We’re blessed to have ac­cess to these re­sources and these mag­nif­i­cent doc­tors that are bring­ing pa­tients in. But peer­ing out five, 10, 15 years from now, what will healthcare look like? I think it will be less about sick care and more about healthcare. So how does that fit in the world of an aca­demic med­i­cal cen­ter? No mat­ter what hap­pens with healthcare re­form, it won’t cure heart dis­ease or can­cer. Aca­demic med­i­cal cen­ters will al­ways be needed. But I’d like to have us take a view as to be­ing some­thing that’s not just an aca­demic med­i­cal cen­ter. How can we also be in the com­mu­nity? How can we de­velop a pri­mary-care strat­egy that is also about new mod­els of care that keep peo­ple out of hos­pi­tals?

MH: What’s the legacy of John Harney, the man you’re suc­ceed­ing?

Cook: I never knew John per­son­ally. But ev­ery­thing I’ve heard about John is that he was very vis­i­ble and al­ways out speak­ing with front-line staff, had a won­der­ful re­la­tion­ship with the med­i­cal staff, and cared very much about pa­tients. He was a big sup­porter of his chief nurs­ing of­fi­cer, which helped them re­ceive ac­co­lades for nurs­ing care. It speaks to his belief about the im­por­tance of front-line staff and mak­ing sure that we con­stantly sup­port pa­tient care.

I hope to carry on John’s legacy of be­ing a big pro­po­nent of em­ployee en­gage­ment, pa­tient sat­is­fac­tion and qual­ity, be­cause I think a lot of the ac­co­lades that UCH re­ceives comes from the fact that there is a good group of nurses and other staff. John re­ally did a good job of fos­ter­ing that sort of en­vi­ron­ment, and I hope to carry on that tra­di­tion.

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