Entrepreneurship for Public Health Within an Integrated Health Care System Patricia A. Gabow, M.D. Chief Executive Officer Denver Health November 2008
Entrepreneurship in Public Health System
When you think public health care system, what is the first word that comes to mind? Entrepreneurship??
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Entrepreneurship in Public Health System
Entrepreneurship: The practice of starting a new business or revitalizing mature organizations. • • • • • •
A difficult undertaking Sees opportunities Develops new markets Mobilizes capital resources Innovates Creates employment 3
Entrepreneurship in Public Health System Entrepreneurship
Bumpy Road
Public Hospital
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Entrepreneurship in Public Health System Overview of Denver Health Foundations for Entrepreneurship Examples of Entrepreneurship Conclusion
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Denver Health Rocky Mtn Center for Medical Response to Terrorism
911
Denver Health Medical Center
Rky Mtn Regional Trauma Ctr Public Health
Regional Poison Center & Nurseline
Schoolbased Health Centers
Family Health Centers
Correctional Care
Denver Cares
Denver Health Medical Plan 6
Entrepreneurship in Public Health System
Denver Health’s care role • • • • • • •
Major provider for the uninsured Major Medicaid provider Major provider of care for children/CHP Increasing role in Medicare Major trauma center in the state Major correctional care provider Major state partner in disaster preparedness 7
Entrepreneurship in Public Health System DH Unsponsored Care and City Payment
$300,000,000 $250,000,000 $200,000,000 City Payment
$150,000,000
Total Unsponsored Care
$100,000,000 $50,000,000 $1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Entrepreneurship in Public Health System
How can the capture of the uninsured market serve as a foundation for entrepreneurship?
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Entrepreneurship in Public Health System
Foundations for Entrepreneurship • • • • • • • •
Integrated system Efficiency Quality Independent entity Employed high quality physicians Sophisticated information technology Innovation Facilities 10
Denver Health Rocky Mtn Center for Medical Response to Terrorism
911
Denver Health Medical Center
Rky Mtn Regional Trauma Ctr Public Health
Regional Poison Center & Nurseline
Schoolbased Health Centers
Family Health Centers
Correctional Care
Denver Cares
Denver Health Medical Plan 11
Entrepreneurship in Public Health System Denver Health Special Populations The uninsured
Denver Health provided over $3,100,000,000 in unsponsored care since 1991 45% of DH charges are to uninsured people DH has remained in the black every year since 1991
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Entrepreneurship in Public Health System
Trauma Survival (2001-2006 average) • Blunt Trauma • Penetrating Trauma • Overall Survival Rate
95% 87% 93%
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Entrepreneurship in Public Health System Medical Mortality
Entrepreneurship in Public Health System Denver Community Health Pediatric Patients Percent UTD @12 mos (3:2:2:2) & 24 mos (4:3:1:3:3) 100% Dr. Hambidge's WCV / Immunization Intervention Study implemented on all new borns at DH (n=2843), 7/98-7/99
90% 80%
Percent UTD
70%
12 mo UTD DTaP Shortage: Recommendation to suspend 4th & 5th DTaP doses, 4/21/01
60% 24 mo UTD
Reminder / Recall System implemented system-w ide, 4/98
50% 40%
Immunization Registry started in New born Nursery, 12/19/96, and implemented across DCH system gradually over 8 w eeks; Consistently recording data as of 4/1/97
30% Immunization Registry initiated in Immunization Clinic, 4/95
20% 10%
Open Access initiated, 10/02-12/03
DTaP Shortage llifted, 10/23/02
Also occurring system-wide during this time: * Quarterly AFIX Assessments to improve immunization rates in each clinic * Flag of WIC program patients not UTD on immunizations
0%
Sep-06
May-06
Jan-06
Sep-05
May-05
Jan-05
Sep-04
May-04
Jan-04
Sep-03
May-03
Jan-03
Sep-02
May-02
Jan-02
Sep-01
May-01
Jan-01
Sep-00
May-00
Jan-00
Sep-99
May-99
Jan-99
Sep-98
May-98
Jan-98
Sep-97
May-97
Jan-97
Sep-96
May-96
Jan-96
Sep-95
May-95
Jan-95
Quarter/Year
Entrepreneurship in Public Health System
Blood pressure under control on at least 2 of 3 visits* • • • •
Hispanic African American White National Average is
51% 51% 52% 30%
*Regular Users 17
Entrepreneurship in Public Health System
Foundation for Entrepreneurship • • • • • • • •
Integrated system Efficiency Quality Independent entity Employed high quality physicians Sophisticated information technology Innovation Facilities 18
Entrepreneurship in Public Health System
Employed high quality physicians • • • • •
240 full-time physicians All faculty at UCSOM Educators Researchers National/international reputation
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Core Applications Diagram (2007) Care Providers, Support Personnel & Management COMMON USER PRESENTATION
Gaurdian RX
Finance/Lawson HR/Lawson Scheduling.com Materials Mgmt Dietary Case Mgmt. Marketing ERV HealthDoc VaxTrack
PACS
Clinical Reference Services
RIS EKG ER Lab
CTI Engine
Pathlab Bloodbank
Interface Engine
CPOE
INVISION & Signature
Payroll
Voice Trans
Enterprise Access Directory MPI Admissions / Registration Appointment Scheduling ORDERS Lifetime Clinical Record
Patient Accounting
Imaging Medical Records
Pharmacy Cardiology Electronic Claims
Electronic Eligibility Checking
Enrollment Systems
Core Siemens Applications Departmental non-Siemens Applications Minor non-Siemens Applications
E-Mail Internet Intranet
Reporting Ad-hoc Statistics Express Query Decision Support Data Warehouse
General Accounting
Nurse Sched. OR Scheduling
DIAMOND Managed Care
Payors and Other External Organizations
Entrepreneurship in Public Health System IT
Right People
Right Process
Right Communication and Culture
Right Environment
Right Reward
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Entrepreneurship in Public Health System Lean Savings
Entrepreneurship in Public Health System
Entrepreneurship in Public Health System
Examples of Entrepreneurship • Vail Valley Medical Center Partnership • Rocky Mountain Center for the Medical Response to Terrorism, Mass Casualties and Epidemics • Rocky Mountain Poison and Drug Center • Correctional Care • Unique Clinical Services • Denver Health/University of Denver Affiliation • Public – Private Facilities Partnership 24
Entrepreneurship in Public Health System
Vail Valley Medical Center Partnership • Shared trauma call with three other entities • Vail CEO requested exclusive Denver Health contract • DH trauma surgeon hired (3 year contract) for Vail • Began VVMC ICU nurses spending time at DH • Added three surgeons/began general surgery coverage • Added ICU coverage (75%) • Added hospitalists • Added infection control • Added pediatric hospitalist
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Entrepreneurship in Public Health System Trauma Outreach Admissions 70
50 40
Percentage ISS > 15 Trauma Outreach Admissions
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Percentage Outreach Trauma Admissions
20 10
year
2008*
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1998
number of admits
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Entrepreneurship in Public Health System Rocky Mtn Regional Level I Trauma Center
911
Department of Emergency Medicine
Denver Center for Public Health Preparedness
Public Health
Denver Health Telemedicine
Denver Health Community Health Centers
Rocky Mountain Poison and Drug Center
Rita Bass Trauma and EMS Education Institute
Metropolitan Medical Response System 27
Entrepreneurship in Public Health System
Rocky Mountain Center for Medical Response has brought in $16.4 million in grant funding Rocky Mountain Center for Medical Response established Denver Health as a leader in disaster preparedness
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Entrepreneurship in Public Health System Rocky Mountain Research & Consulting
Rocky Mountain Poison Center Rocky Mountain Drug Center
DH Appointment Center (DHAC)
DH NurseLine DH SpanishLine
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Entrepreneurship in Public Health System
Rocky Mountain Poison and Drug Center Pharmaceutical Relationship • Call centers for adverse events – Pfizer, Amigen, etc. – Radars
• Endowed chair • Sofware development
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Entrepreneurship in Public Health System RMPDC Revenue Analysis 1998-2007 $25,000,000 $23,072,795
$20,000,000 $18,954,045
Revenue
$15,000,000 Gross Rev $10,184,301
$10,418,853
$10,000,000 $9,234,095 $8,110,761
$8,047,324
$5,000,000 $4,464,836 $3,345,479 $2,393,081
$1998
1999
2000
2001
2002
2003 Year
2004
2005
2006
2007
Entrepreneurship in Public Health System
Correctional Care • Prison population is growing • Prison population is aging and increasingly women • Prison population has constitutional right to health care • Limited competition • It’s our mission
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Entrepreneurship in Public Health System
Correctional Care • Create division • Built locked, state of art facility • Clients – City/County – State – Federal Government
• Educational area of excellence 33
Entrepreneurship in Public Health System
Clinical Services • Based on physician expertise • Unique areas – minimal/no competition – – – –
Microvascular/Limb reimplantation center Severe eating disorders Laproscopic urologic surgery Atrial ablation
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Entrepreneurship in Public Health System
Denver Health – University of Denver • Education – Medical LEAN Institute
• Engineering
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Entrepreneurship in Public Health System
Public/Private Capital Projects • Denver Health facilities need with limited capital – Denver Health land – Private entity builds building – Lease components to health related business—downsteam revenue
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Entrepreneurship in Public Health System Denver Health’s Growth 1997
2006
Gross Revenue
$339.9
$803.1
Net Patient Revenue
$154.7 M
$318.8M
Net Operating Revenue
$251.4 M
$518 M
Grants
$26.2M
$41M
Physician Billing
0
$16M
Cash on Hand
$33M
$125M
Entrepreneurship in Public Health System Denver Health’s Growth 1997
2006
Ambulance Trips
53,733
78,103
Babies delivered
2,763
3,575
Total admissions
18,535
20,585
Total outpatient visits
255,600
321,313
RMPDC/Nurseline calls
159,300
396,631
Square Footage DHMC
1,088,951
1,481,630
Hospital beds
349
500
New buildings
8 since 1997
Entrepreneurship in Public Health System
Conclusion • Public Health Systems can be entrepreneurial • Public Health System must be entrepreneurial • Public Health System entrepreneurship must build on core strengths 39
