Executive Perspectives in Healthcare – Garren Colvin and Gary Blank

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.

Check out our previous conversations with UC Health president and CEO Dr. Richard Lofgren and Mike Keating, president and CEO of The Christ Hospital. 

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.

LC: How is St. Elizabeth using technology to better serve the patients?

GB: With the heart and vascular construction, we’ve opened up a hybrid operating room, which is all state-of-the-art and has already performed numerous new procedures in that area. We’ve added a specific high-tech cardiac MRI for the heart and vascular institute as well. We just recently replaced our 320 CT scanner with a state-of-the-art dual source CT scanner which produces better cardiac and other imaging. We probably have the lowest radiation dose platform in the market at this point in time, from a Cat Scan imaging perspective. When we purchased it, we were the 10th hospital in the country to purchase it and only the 2nd non-university facility to have it. So it’s a new emerging technology.

GC: We have implemented the MyChart system for outpatient visits. This gives our patients access to the same medical records their doctors use – it gives all of our patients the ability to go online and manage their healthcare. They can go online, using their personal login and protected password, and get results from testing within 24 hours. We put precautions in for adverse test results, of course. If there is a negative test result, that isn’t available for the patient to view immediately without communication from the physician’s office. But for normal outcomes, the result just drops right in, and the patient gets to see the results within 24 hours.

The other thing we are trying to do is meet the changing needs of our patients and our community. Our physician organization, St. Elizabeth Physicians, performs online visits, e-visits, so that our patients who would not have the ability to make it into their doctor’s offices on a given day can get access to immediate care. Of course, they have to have the technology, but through MyChart typically a patient can email his or her physician anything overnight and by the next day, the patient will have a response back. Patients can also set online appointments and schedule their own appointments. St. Elizabeth Physicians is piloting video visits as well right now.

LC: What are some of the challenges with running such a large organization?

GC: I think that the biggest challenge is the pressure that comes from outside the organization. Any time you have regulatory changes which affect reimbursement, the challenge is to maintain your operations given what is happening in terms of reduced reimbursement. That puts pressure on cost – so then, the struggle is how to cut costs out of your system without negatively affecting the quality of care or the people within your organization. We have great physicians and great employees, and maintaining their morale is of the utmost importance.

GB: I would agree, I think it’s balancing that and it’s also a challenge to continually look at how we provide care to make sure that we’re able to do things as effectively and efficiently as possible without compromising employee engagement and quality outcomes. That’s just a tough balancing act, because at the end of the day, we’re here to provide excellent, high quality patient care and trying to reengineer and redefine that can be challenging.

LC: What advice would you give to an individual in healthcare?

GC: From my perspective, if you take care of you patients, your employees and your physicians, the rest will take care of itself. Our associates love what they’re doing and they are in this business because they truly care about our patients.

GB: Typically it’s to step back and gather all of the information before jumping to a conclusion, but it’s usually process, it’s not people that cause problems or poor outcomes. So you always want to look at the processes first and try to really look at the root of an issue and fix it. Too, it’s really the one piece that I’ve always held on to during my career – it’s kind of the golden rule with a twist. It’s not ‘treat people the way I want to be treated’, it’s ‘treat people the way they would want to be treated’ and really assessing them and looking at everyone. Everyone has a value system, so you can’t take your value system and portray it on others – you have to really reach down deep enough to understand others’ values and what’s important to them before you can really be effective as a caregiver and a leader.

For more information about St. Elizabeth Healthcare visit www.stelizabeth.com.