Peaks & Valleys

After weathering storm, Poudre Valley determines role in health mix

“The current health-care systems are broken, damaged. They aren’t working effectively.”
That’s the word from Poudre Valley Hospital’s new CEO, Michael Marini, who, in taking the helm, has inherited an organization recently battered by lawsuits, layoffs and labor disputes.
But that wave, at least, has crested. By the time Marini took over as CEO June 17, a lawsuit concerning the hospital’s privatization had been decided in PVH’s favor. (In the second part of the lawsuit, the board of directors of the Poudre Health Services District is appealing a ruling concerning whether the district is required to provide hands-on services, said hospital spokesman Armi Hall.)
Three years of staff reductions, from 1,461 to approximately 1,313, haven’t caused significant changes in operations, said Stephan Roths, the man who headed an effort to form a union. And the labor dispute itself is a thing of the past. Cause of death? Call it apathy.
Employee morale is up, boosted, Roths said, by an unprecedented annual bonus last year and the opportunity to receive one this year which “was good for morale but a bad thing for the union effort.”
The closest PVH came to entering into collective bargaining was the hospital’s maintenance workers’ vote in April to organize a union. Lacking majority support, it failed.
“A lot of people cheered us on but didn’t step up to the line to be counted,” Roths said. He said the impetus behind the effort was the same thing management is concerned about: industry trends that, as close to home as Greeley’s North Colorado Medical Center, translated to layoffs, and the national health-care chains, such as Columbia/HCA, patterns of acquisition.
So what Marini is saying is broken isn’t necessarily Poudre Valley Hospital. It’s the entire health-care system.
“In the last year, over 600 hospitals closed nationwide,” Marini said.
One of his top concerns is inequitable insurance payments. Fixes being put forth by many hospitals included managed care, capitated contracts, hospital-based insurance programs and regional alliances – programs Marini, in his 14-year tenure at NorthBay Hospital in Fairfield, Calif., put in place.A look ahead for Poudre ValleyIn the next five to 10 years, under Marini’s direction, expect PVH to:n Develop a 20- to 30-physician network. The concept, which was approved last month by the PVH board, “will give physicians an equal say on insurance contracts,” Marini said.
“It will be invisible to the patient. (PVH) will pick the hospital and physician panels. The doctors the patients will get will be specific to their insurance. This was set up in California seven years ago. Capitation and managed care hit California, Florida and Oregon 10 years ago.”n Develop a hospital-based health-insurance product.
“We would potentially develop this with other systems throughout Colorado. Form relationships with home care, professional nursing organizations and assisted-living groups to provide for a full spectrum of medical health needs throughout a person’s life.”
The purchase in April 1996 of Health Systems Management Inc. is part of that effort. Poudre Valley Health Care Inc. owns HSM along with HSI Health Plans Inc. of Fort Collins, which is marketing HealthLink, a health-maintenance organization focusing on Northern Colorado.n Remain a private hospital.
“My personal philosophy is in concert with the philosophy of a nonprofit organization. We can’t deny our responsibility to serve all the people of Fort Collins. There are about 20,000 people in Fort Collins without insurance. Local control and accountability are important. Community leaders want to have a strong say in health care in Fort Collins.”n Changing from a hospital to a health-care system:
“Although acute care is important, it’s not the only thing. The theme is ‘we are getting out of taking care of the sick into keeping people well for life.'”n New construction: Medical offices for outpatient services are proposed for a 95-acre property on Harmony Road owned by PVH. There will also be an office building for physicians. Sizes haven’t yet been determined, but Marini said the project should begin sometime in the next two years.n Formation of hospital alliances to influence insurance companies: “This is why you see the Catholic and Lutheran systems linking up to create larger influence over the insurance companies and how they deal with health-care dollars.
“We are in pre discussions (concerning alliances) with Lutheran Health Care, Centura and Health Care Colorado. We would hope to form a group of hospitals focusing on how to be effective in a capitated environment and to take on the risk of directly contracting for health insurance with employers.”
For example, 10 to 20 hospitals would develop their own insurance product and approach employers with it becoming “a competitor with the insurance company,” Marini said.
“This changes their attitude. We started something like this in Northern California (at NorthBay Hospital Group). It took three years to put in place. When I left, they were just starting to market it (the insurance product). It’s two months old there.”Who’s responsible for health messMarini blames Congress and strong lobbies such as the American Association of Retired Persons for much of what’s wrong with the health-care system.
“The programs that Congress puts into place aren’t fair to hospitals,” he said. ‘The strongest lobby is the AARP, and Congress doesn’t want to increase taxes or tell people that they have to pay more for health care.”They’ve taken the regulatory route,” he added. “We (hospitals) are the least likely to complain, but employers are subsidizing health care by paying to offset the loss. Insurance companies take 20 percent of the health-care dollar.”
Marini said the push to streamline operations at PVH will continue.”Our costs (PVH) are 20 percent below the Denver market,” he said. “Over time, due to changes in the industry, there will be pressure to reduce even more. One of our goals is to become more efficient.”
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