CEO roundtable: Cost drives discussion in health-care industry

FORT COLLINS — Health-care costs are the overriding issue on the minds of executives from Northern Colorado health-care institutions, and almost all other issues flow from or touch that issue.

Executives met with BizWest at the Northern Colorado Health Care CEO Roundtable Tuesday in Fort Collins.

From Medicaid reimbursements to the ability to pay increased wages for health-care workers to consumers dropping out of individual insurance plans — all were top of mind.

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“We’re seeing people dropping out of insurance on individual plans,” said Evan Hyatt, executive director of operations for Kaiser Permanente NoCo. While the Affordable Care Act is still in place, uncertainty has entered the equation as a result of the Trump administration’s efforts to eliminate the health-care law. Uncertainty, Hyatt said, results in premium increases.

Carol Plock, executive director of the Health District of Northern Larimer County, said, “It’s not wholesale dropping out; it’s reducing. People suffering worst are those at lower-middle income. If people don’t qualify for Medicaid, then deductibles and copays can be so high that they delay care. A lot of systems are suffering because people can’t pay the copays when they do seek treatment.”

“If we lose the individual-insurance market, somebody has to pay for that care,” she said.

Jim Sampson of HUB International, which operates in the employee benefits and health-insurance markets, said group plans are still being offered to employees of many companies because the employment market is so tight due to historically low unemployment rates. Companies need to offer insurance as an incentive to get and keep workers.

Dr. Jim Sprowell, CEO of Associates in Family Medicine, a large Fort Collins-based clinic, said the changes in health-insurance plans have resulted in many patients unable to pay the high deductibles. “We’ve dumped more of the cost on the consumer, and we’re feeling that at the primary-care level,” he said.

Driving down costs

Health-care providers are developing numerous strategies to reduce the costs that drive decisions to seek care and affect profitability of hospitals and clinics.

Margo Karsten, CEO of Banner Health in Northern Colorado, said Banner has 22 clinical consensus groups that examine a diagnosis and figure out ways to streamline care. When a procedure is reimbursed through Medicaid, they ask what they can do to make sure that the reimbursement covers the cost.

Kevin Unger, president and CEO of UCHealth in Northern Colorado, said UCHealth is experimenting with new technology such as “wearables” — devices that patients can wear to monitor vitals 24/7. The wearables help avoid night-time interruptions as well as enable reduced levels of staffing.

UCHealth is also using the virtual clinic model in which a patient can use Skype from home to connect with a physician.

Sprowell said Associates in Family Medicine is seeing 800 to 1,000 new patients a month because of the high rates of growth in the area. Not only does that stress existing clinic facilities, but the clinic is having to rapidly recruit doctors to accommodate the patient growth and the impact of retiring physicians.

He said the organization is trying to expand access so that the growing number of patients can be seen before their conditions force them into emergency rooms, where costs are higher.

He also said that new electronic health record systems are having a positive impact on care and simplify things for patients moving from one treatment facility to another.

“We can get access to any system that is running Epic (medical records software system), which really helps drive down costs,” he said.

Dr. John Bender of Miramont Family Medicine said primary-care facilities are squeezed by low reimbursements from Medicaid and the inability of patients to pay. He said primary-care doctors and facilities receive about six cents of every dollar spent on medicine.

Bender said Miramont is looking for ways to reduce costs, including adding a direct primary-care model for about 1,000 patients. Direct primary care is an alternative to fee-for-service insurance programs in which patients pay a monthly, quarterly or annual fee for most health-care services.

Miramont has also closed a clinic in Loveland and plans to close the clinic’s facility in Wellington.

Long-term care facilities such as Good Samaritan, which has a range of senior-living facilities from independent-living to skilled-nursing care, have partnered with home-care services and others in an effort to keep patients in their homes longer. Offering meal programs helps independent-living patients maintain their physical well being longer, said Lisa Melby, executive director of Good Samaritan —  Loveland Village.

Yvonne Myers, chief operating officer of Columbine Health Systems, agreed. Columbine has added patio homes to its portfolio so that seniors have a continuum of care. It has partnered with traditional health-care providers and added an in-house physician group — two doctors and 15 nurse practitioners — so that patients can be seen whenever they have an issue without having to leave the facility to seek treatment elsewhere. “Having physicians who understand geriatrics is important,” she said.

Plock said the health-care system is not adequately planning for the large numbers of senior citizens who will need care in the years ahead. She said the senior population is expected to triple between 2010 and 2040. “People coming into that category don’t have the same level of retirement plan that previous generations had. The only safety net is Medicaid and a lot of people won’t be able to afford long-term care,” she said.

Unger said UCHealth is expanding orthopedic units in an effort to get ready for older patients.

Karsten said Banner is trying to tune primary care services in order to help older patients stay out of the hospital.

And Kaiser’s focus is on preventive care for seniors for the same reason — to reduce costs down the road, said Hyatt.

Jim LaBorde, administrator for Centers for Gastroenterology, said his organization is adding providers and expanding facilities to deal with anticipated population growth and increases in older patients.

Labor issue

Almost all health-care providers are having difficulty finding qualified staff members to meet patient needs.

Marilyn Schock, president of UCHealth Greeley Hospital, which is still under construction, is working to find a large number of staff members for all departments. She said that costs of living, especially housing costs, in Northern Colorado are a major factor in this recruitment effort. “It’s probably one of our number one conversations that we’ve had when hiring,” she said. She said educational resources in the area help, especially in recruiting nurses.

Myers said educational facilities are listening to health-care providers and working to train the people needed. She said Columbine is also embarking on an apprenticeship program to groom high school students for careers in health care.

Schock said all areas are impacted. Housekeeping staff positions, for example, are impacted by the growing number of hotels in the region, which also recruit from the same pool of people.

The shortage of qualified workers is driving up salaries, the health-care executives said.

Salaries for primary-care doctors, for example, have increased from about $173,000 to $217,000, Bender said.

LaBorde said benefit packages are also important. Employees like a range of benefits, from educational reimbursements to retirement plans and multiple types of insurance.

Some entities are also paying signing bonuses. Dr. Andrew Mills, president of Advanced Medical Imaging, said signing bonuses are used extensively in recruiting radiologists.

Hyatt said some doctors, especially those coming out of residency, like having extra time off.

Mental health care

Mental health care was described as “the great tragedy” by Plock. She said Larimer County doesn’t have a drug and alcohol withdrawal facility in the county. She said people with drug and alcohol issues need to be engaged in treatment and not just with detoxification.

She said the region is missing intermediate mental health care outside of hospital admission. She said mental-health professionals are working to create a continuum of care and “make it a seamless system. We could save a lot of money if we could intervene earlier,” she said.

Sprowell said Associates in Family Medicine has mental-health professionals in the office, which greatly helps the primary-care doctors who don’t have that expertise. There’s a shortage of psychiatrists nationwide, Sprowell said, and the same is true locally. He said mental-health experts in his practice are booked out for the next three months.

Bender said the regional health-care system is also impacted because it’s a regional center of excellence. Miramont, for example, has patients driving in from Rapid City, S.D., because services aren’t available there.

The BizWest CEO Roundtables in Northern Colorado are sponsored by Elevations Credit Union, EKS&H accounting firm and HUB International insurance brokerage.