The Leader in To­tal Pa­tient Care

Alan B. Miller launched Univer­sal Health Ser­vices, Inc., in 1979, with six em­ploy­ees, one tele­phone and no rev­enue.

Modern Healthcare - - NEWS -

38 years of sus­tain­able growth

Over the next four decades, Miller, still the com­pany’s Chair­man and CEO, built UHS into a lead­ing health­care provider in the U.S. and the U.K. The com­pany now boasts $9.7 bil­lion in rev­enue, over 81,000 em­ploy­ees and over 350 acute care, be­hav­ioral health and am­bu­la­tory cen­ters in the U.S., the U.K., the U.S. Vir­gin Is­lands and Puerto Rico.

“I en­joyed the fact that we were build­ing hos­pi­tals in ar­eas that did not have any,” Miller said. “There was great sat­is­fac­tion in hear­ing peo­ple say, ‘Be­fore your hos­pi­tal, we had to travel very far to get good health­care. Your com­pany saved a lot of lives.’”

From the be­gin­ning, Miller was in­ter­ested in estab­lish­ing a di­ver­si­fied strat­egy. He re­al­ized that as the com­pany grew, both or­gan­i­cally and through strate­gic ac­qui­si­tions, it would find strength in fo­cus­ing ex­per­tise in mul­ti­ple fields. To­day, UHS is the largest fa­cil­ity-based be­hav­ioral health provider in the U.S. and has a sub­stan­tial pres­ence in the U.K.

“You have to be adapt­able,” Miller said. “Things change – I wanted to be in more than just acute care.”

In 2016, the com­pany’s Be­hav­ioral Health Di­vi­sion treated more than 620,000 pa­tients. But the fo­cus from Day One has been on qual­ity, not nec­es­sar­ily size, he said.

“We got to our size by an­nual growth – there was no tar­get, no de­sire to be the big­gest,” Miller said. “I’ve al­ways thought that if you have a very good brand, whether you’re sell­ing goods or ser­vices, peo­ple will rec­og­nize the qual­ity.”

The com­pany’s sig­nif­i­cant in­vest­ment in be­hav­ioral health is in­te­gral to its em­pha­sis on “to­tal pa­tient care,” a ref­er­ence to treat­ing both the body and the mind. This phi­los­o­phy took shape as UHS’ Be­hav­ioral Health Di­vi­sion was founded in 1983, shortly after its Acute Care Di­vi­sion, ac­cord­ing to Deb­bie Os­teen, Ex­ec­u­tive Vice Pres­i­dent of UHS and Pres­i­dent of its Be­hav­ioral Health Di­vi­sion.

“The pur­pose was to ad­dress both the phys­i­cal and men­tal health as­pects of our pa­tients,” Os­teen said. “By look­ing at health­care in a to­tal way, we are in a po­si­tion where we can fo­cus holis­ti­cally. It has made us stronger, not just as a com­pany, but in our clin­i­cians’ abil­i­ties to prop­erly as­sess and treat pa­tients, and ul­ti­mately to sup­port

the lo­cal com­mu­ni­ties in which our pa­tients live.”

UHS has fos­tered its po­si­tion as a be­hav­ioral health leader through this long-term fo­cus on to­tal pa­tient care, rather than sim­ply in­creas­ing size, Os­teen said. M&A prospects are closely scru­ti­nized.

“We have had many op­por­tu­ni­ties to grow, but we have been care­ful about that growth,” Os­teen said. “We have al­ways tried to fo­cus on be­ing the best in each com­mu­nity we serve.”

Growth isn’t just about adding fa­cil­i­ties or ser­vices. UHS is com­mit­ted to grow­ing as a provider by con­tin­u­ously im­prov­ing its ther­a­peu­tic en­vi­ron­ments, clin­i­cal pro­gram­ming and ed­u­ca­tion ser­vices, Os­teen said. Clin­i­cians are con­stantly bench­mark­ing them­selves and look­ing for new, bet­ter ways to im­prove qual­ity and safety.

A strik­ing ex­am­ple of the com­pany’s ded­i­ca­tion to growth un­der the to­tal pa­tient care phi­los­o­phy is found in its ef­forts to in­spire per­sonal growth and suc­cess through spe­cialty pro­grams and ser­vices. Niche pro­gram­ming is con­stantly iden­ti­fied and ex­panded to re­spond to the needs of di­verse pop­u­la­tions. For ex­am­ple, spe­cialty mil­i­tary pro­grams ded­i­cated to ac­tive duty ser­vice mem­bers, vet­er­ans and their fam­i­lies help man­age the ef­fects of com­bat stress, post­trau­matic stress, de­pres­sion, post-de­ploy­ment ad­just­ment, as well as trauma res­o­lu­tion and sta­bi­liza­tion pro­grams.

Other pro­grams are of­fered to treat eat­ing disor­ders, autism spectrum disor­ders and neu­robe­hav­ioral con­di­tions that are the re­sult of com­plex med­i­cal con­di­tions and trau­matic brain in­juries. For th­ese spe­cialty ser­vices and all of the com­pany’s be­hav­ioral health pro­grams, a full con­tin­uum of treat­ment is avail­able, in­clud­ing

“There was great sat­is­fac­tion in hear­ing peo­ple say, ‘Be­fore your hos­pi­tal, we had to travel very far to get good health­care. Your com­pany saved a lot of lives.’” Alan B. Miller Chair­man & CEO UHS

in­pa­tient, out­pa­tient, day treat­ment and par­tial hos­pi­tal­iza­tion. By of­fer­ing a va­ri­ety of set­tings, pa­tients have treat­ment op­tions that will sup­port them wher­ever they are on their re­cov­ery jour­ney.

Ed­u­ca­tion is a key com­po­nent of treat­ment in chil­dren and ado­les­cent pro­gram­ming. Be­tween 2015 and 2016, there was a 25% in­crease in the num­ber of ado­les­cent pa­tients who ob­tained their high school diploma or GED while re­ceiv­ing men­tal health treat­ment in the Be­hav­ioral Health Di­vi­sion fa­cil­i­ties. Thanks in part to a ma­jor em­pha­sis on the im­por­tance of ed­u­ca­tion in treat­ment nearly 300 young pa­tients achieved this feat in 2016.

“I’m very proud of this ac­com­plish­ment. No other com­pany can say they have made this sig­nif­i­cant a con­tri­bu­tion in this area,” Os­teen said.

An­other facet of the fo­cus on ed­u­ca­tion is men­tal health aware­ness. Like other be­hav­ioral health providers, UHS is work­ing hard to erase the stigma around men­tal ill­ness, mainly through com­mu­nity out­reach and ed­u­ca­tion. It’s a stigma that re­mains a ma­jor ob­sta­cle in con­vinc­ing cer­tain in­di­vid­u­als to get the treat­ment they need, Os­teen said.

“Shame drives the stigma,” Os­teen said. “There is a mis­un­der­stand­ing of what men­tal health is­sues are about and what causes them. Peo­ple do not un­der­stand that as­pect of care.”

In 2013, UHS be­came an af­fil­i­ate of the Na­tional Ac­tion Al­liance for Sui­cide Pre­ven­tion, in an ef­fort to pro­mote a con­ver­sa­tion around sui­cide pre­ven­tion that elim­i­nates stigma and ed­u­cates com­mu­ni­ties and care­givers about how they can iden­tify warn­ing signs. Be­ing proac­tive and en­cour­ag­ing pa­tients to get the care they need is im­por­tant, said Karen John­son, Se­nior Vice Pres­i­dent for Clin­i­cal Ser­vices and Com­pli­ance Of­fi­cer for the Be­hav­ioral Health Di­vi­sion.

“We do sig­nif­i­cant com­mu­nity out­reach with emer­gency de­part­ments, pri­mary care physi­cians, schools and clin­i­cians who deal with var­i­ous age groups. Our goal is to ed­u­cate them to iden­tify the signs and symp­toms of an in­di­vid­ual who is ex­pe­ri­enc­ing sui­ci­dal thoughts,” John­son said.

Peo­ple are more apt to see a doc­tor for a heart con­di­tion than de­pres­sion, Os­teen noted. But data from the Na­tional Al­liance on Men­tal Ill­ness shows that 1 in 5 U.S. adults ex­pe­ri­ences men­tal ill­ness in a given year – so providers like UHS play an im­por­tant role in ed­u­cat­ing the public that it’s okay to seek help.

Grow­ing to­gether

Con­sol­i­da­tion is the name of the game in to­day’s health­care in­dus­try.

Provider merg­ers and ac­qui­si­tions have the po­ten­tial to greatly im­prove pa­tient ac­cess and qual­ity, but that’s not a guar­an­tee. So, as UHS con­tem­plates myr­iad op­por­tu­ni­ties for growth and ex­pan­sion, the com­pany must care­fully eval­u­ate the chal­lenges and ben­e­fits of those ac­qui­si­tions and part­ner­ships with an eye to­wards pa­tient care, Os­teen said.

“We are look­ing for fa­cil­i­ties and com­pa­nies that com­ple­ment our ser­vices,” Os­teen said. “We’re

also look­ing for fa­cil­i­ties and com­pa­nies where we feel we can make the care we de­liver bet­ter. If it fits strate­gi­cally into our mis­sion in that com­mu­nity, state or coun­try, we have been able to pur­sue op­por­tu­ni­ties pretty vig­or­ously.”

Thanks to strong fi­nances, UHS lead­ers haven’t been lim­ited in their ef­forts to mind­fully en­gage with other com­pa­nies that fit the com­pany’s mis­sion of pro­vid­ing su­pe­rior health­care ser­vices. “We don’t need to grow just to grow,” Os­teen said. “Our mis­sion and goal is to be the best.”

“As we con­tinue to de­velop part­ner­ships with larger sys­tems across the coun­try to in­te­grate be­hav­ioral health ser­vices, our mas­sive foot­print in 37 states, Puerto Rico, the U.S. Vir­gin Is­lands and the United King­dom has be­come very at­trac­tive to po­ten­tial part­ners and col­lab­o­ra­tors,” Os­teen said.

“Peo­ple say, ‘They have scale and we’re look­ing for a larger provider that can meet the needs not just in one com­mu­nity, but in sev­eral com­mu­ni­ties,’” Os­teen said. “Sys­tems in larger mar­kets have sought us to be in part­ner­ship with them. That has al­lowed us to share our best prac­tices as well.”

Sin­gle-hos­pi­tal sys­tems are of­ten grate­ful to en­gage and part­ner be­cause they do not have the same re­sources or sup­port on their own, par­tic­u­larly around be­hav­ioral health.

“Our pro­grams help them with busi­ness struc­tures and clin­i­cal pro­to­cols,” Os­teen said. “Part of my role is to en­sure our part­ners are op­er­at­ing at the best pos­si­ble level when it comes to men­tal health.”

In 2016, the Be­hav­ioral Health Di­vi­sion added 458 psy­chi­atric beds in new or ex­ist­ing fa­cil­i­ties, and ex­panded its foot­print in the U.K. by ac­quir­ing the adult ser­vices di­vi­sion of Cam­bian Group, a be­hav­ioral health provider. UHS now op­er­ates 103 fa­cil­i­ties through its sub­sidiaries in the U.K.

The Cam­bian ac­qui­si­tion played an im­por­tant role in ex­pand­ing the com­pany’s con­tin­uum of care in the U.K., Os­teen said. While Cygnet – a U.K. provider ac­quired by UHS in 2014 – mainly con­sists of in­pa­tient psy­chi­atric fa­cil­i­ties, Cam­bian pro­vides ser­vices that help pa­tients sta­bi­lize their men­tal ill­ness and read­just to daily life after acute care.

As de­mand has in­creased for be­hav­ioral health ser­vices, UHS has iden­ti­fied nu­mer­ous op­por­tu­ni­ties for growth, Os­teen said. More in­di­vid­u­als are seek­ing psy­chi­atric care than in past years, some­thing Os­teen at­tributes to a re­duc­tion in stigma and im­proved ac­cess thanks to U.S. health­care re­form and men­tal health par­ity.

UHS has re­sponded by adding beds at ex­ist­ing fa­cil­i­ties and build­ing new fa­cil­i­ties in re­gions where there is a shortage of psy­chi­atric beds, Os­teen said. For ex­am­ple, the new Co­ral Springs Be­hav­ioral Health in Stu­art, Fla., is sched­uled to open this summer. The new, 80-bed acute psy­chi­atric fa­cil­ity is be­ing opened to help meet the area’s men­tal health needs. “We are ex­cited about the po­ten­tial there,” Os­teen said.

“Shame drives the stigma. There is a mis­un­der­stand­ing of what men­tal health is­sues are about and what causes them. Peo­ple do not un­der­stand that as­pect of care.” Deb­bie Os­teen Ex­ec­u­tive Vice Pres­i­dent, UHS, and Pres­i­dent of Be­hav­ioral Health Di­vi­sion

UHS lead­ers have de­ter­mined that the com­pany’s big­gest op­por­tu­nity on the hori­zon in be­hav­ioral health is in­te­gra­tion and part­ner­ship with acute care hos­pi­tals who are seek­ing the com­pany’s ex­per­tise in ad­dress­ing the men­tal health needs of their pa­tients, Os­teen said. Strate­gic growth is tai­lored to the needs of each sys­tem, in­clud­ing leas­ing beds, con­struct­ing fa­cil­i­ties and en­ter­ing into joint ven­tures, she said.

As an ex­pe­ri­enced provider of in­pa­tient psy­chi­atric care in the U.S., UHS can of­fer its ex­per­tise in the op­er­a­tions and de­liv­ery of be­hav­ioral health ser­vices, said Isa Diaz, Vice Pres­i­dent of Strate­gic Plan­ning and Public Af­fairs for the com­pany’s Be­hav­ioral Health Di­vi­sion. Med­i­cal providers, par­tic­u­larly con­cerned about a grow­ing num­ber of pa­tients with men­tal ill­ness in their emer­gency de­part­ments, are seek­ing out UHS for help in pro­vid­ing high­erqual­ity men­tal health and sub­stance use dis­or­der treat­ment in their com­mu­ni­ties in a more ef­fi­cient man­ner.

Not-for-profit sys­tems ap­pre­ci­ate UHS’ abil­ity to align with their sys­tem priorities and mis­sion, as well as the for-profit com­pany’s cap­i­tal that can be used for im­prove­ment of fa­cil­i­ties or ser­vices. UHS can be an at­trac­tive busi­ness part­ner for hos­pi­tals con­sid­er­ing ex­pand­ing their psy­chi­atric ser­vice line. Some hos­pi­tals en­ter joint ven­tures with UHS to con­tinue the ser­vice in-house, oth­ers col­lab­o­rate to make bet­ter use of ex­ist­ing ca­pac­ity, and main­tain an on-go­ing part­ner­ship with UHS in or­der to con­tinue to serve all the needs of their pa­tients.

In an ef­fort to re­duce emer­gency depart­ment board­ing and treat un­der­served in­di­vid­u­als in the Seat­tle, Wash., area, Fairfax Be­hav­ioral Health ren­o­vated a med­i­cal-sur­gi­cal floor in­side the Pa­cific Cam­pus at Prov­i­dence Re­gional Med­i­cal Cen­ter Everett, trans­form­ing it into a 30bed adult psy­chi­atric unit. In this “hos­pi­tal within a hos­pi­tal” model, UHS con­trib­uted cap­i­tal for lease­hold up­grades and op­er­ates the unit on a leased floor in the acute care hos­pi­tal owned by Prov­i­dence Health & Ser­vices, Diaz said.

UHS and Prov­i­dence are now pur­su­ing fur­ther op­por­tu­ni­ties for joint ven­ture part­ner­ships in which UHS may of­fer its core com­pe­tency of be­hav­ioral health ser­vices to Prov­i­dence in mar­kets where the health sys­tem al­ready op­er­ates be­hav­ioral beds or in un­der­served mar­kets shared by both or­ga­ni­za­tions.

Prov­i­dence Sa­cred Heart Med­i­cal Cen­ter and Chil­dren’s Hos­pi­tal, in Spokane, Wash., was iden­ti­fied as an ideal lo­ca­tion for a joint hos­pi­tal to ad­dress the need for be­hav­ioral beds in that re­gion, Diaz said. UHS and Prov­i­dence worked to­gether to ob­tain ap­proval from the state to build a 100-bed free­stand­ing be­hav­ioral health fa­cil­ity sched­uled to open in 2018.

What­ever the so­lu­tion providers may choose, UHS works to be a valu­able, trusted part­ner for the long-term. “That’s what sets us apart,” Diaz said.

An un­wa­ver­ing ded­i­ca­tion to qual­ity care

Size mat­ters in the rapidly chang­ing health­care in­dus­try, but providers won’t suc­ceed if they can’t prove they of­fer high-qual­ity care.

UHS is the largest provider of in­pa­tient be­hav­ioral health ser­vices in the U.S. and a key player in the U.K., but its be­hav­ioral health fa­cil­i­ties also hap­pen to be among the best per­form­ing in the coun­try. Miller said the dis­tinc­tion of be­com­ing the largest be­hav­ioral health provider came as a mat­ter of cir­cum­stance, rather than cor­po­rate goals.

“My in­ter­est is in top qual­ity, not size,” re­it­er­ated Miller. “We are not in­ter­ested in hav­ing a large num­ber nec­es­sar­ily. Our idea is to serve the com­mu­nity at the high­est level, tak­ing care of peo­ple as if they were our own fam­ily.”

For four decades, UHS man­age­ment has op­er­ated un­der the cor­po­rate phi­los­o­phy that if the com­pany pro­vides qual­ity ser­vice, the fi­nan­cial re­turns will fol­low, said Os­teen. “That has been the case since the com­pany was founded and re­mains true to­day,” she said.

UHS has the num­bers to back up its claims of qual­ity. More than 91% of its be­hav­ioral health fa­cil­i­ties out­per­form the na­tional av­er­age for all seven clin­i­cal qual­ity mea­sures de­fined by CMS’ In­pa­tient Psy­chi­atric Fa­cil­ity Qual­ity Re­port­ing pro­gram. Pa­tients also re­port pos­i­tive ex­pe­ri­ences: in a 2016 sur­vey of more than 312,000 UHS pa­tients, the av­er­age pa­tient sat­is­fac­tion score was 4.46 out of 5.

“We are very proud of that,” John­son said. “That is the re­sult of the work of each in­di­vid­ual staff mem­ber at each hos­pi­tal. They take per­sonal re­spon­si­bil­ity for pro­vid­ing high qual­ity, com­pas­sion­ate care in a way that pa­tients per­ceive as ex­cep­tional.”

UHS takes a data-driven ap­proach to solv­ing is­sues that may arise across its fa­cil­i­ties, mon­i­tor­ing risk in­di­ca­tors such as read­mis­sion, falls and pa­tient sat­is­fac­tion, all of which are key in­di­ca­tors of a be­hav­ioral health ser­vice’s per­for­mance. At a cor­po­rate level, UHS uses th­ese met­rics to de­velop best prac­tices and in­ter­ven­tions that can be ap­plied in fa­cil­i­ties through­out the com­pany, and in­di­vid­ual fa­cil­i­ties are en­cour­aged to de­vise and share their own best prac­tices with their sis­ter en­ti­ties.

Ninety-two per­cent of pa­tients served in the be­hav­ioral health fa­cil­i­ties re­port that they felt bet­ter upon dis­charge, as com­pared to when they were first ad­mit­ted. For be­hav­ioral health pa­tients, that’s a telling met­ric, John­son said.

“No­body de­cides one morn­ing to say, ‘I re­ally want to go to a psy­chi­atric fa­cil­ity to­day,’” John­son said. “This is a sit­u­a­tion where peo­ple are des­per­ate and at one of the low­est points in their lives and they need as­sis­tance. If we can pro­vide safe, qual­ity care and safely dis­charge them into the com­mu­nity for con­tin­ued care, feel­ing bet­ter than when they came, it’s hard to ask for any­thing more than that.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.