🔒Fairfield County becomes major competing ground for Hartford HealthCare, Yale New Haven Health

Perhaps it’s a family that just moved up from Manhattan. Or a young couple settling into married life in Stamford. Or a single person who just moved to Shelton for a new job.

How or why they got there, tens of thousands of people have moved to Fairfield County in recent years — and the state’s hospital systems have noticed.

“I can’t imagine a much more competitive landscape anywhere in the country,” said William M. Jennings, president of the Fairfield region for Hartford HealthCare. Jennings was named to the role in May, having served as executive vice president for Yale New Haven Health and CEO of Bridgeport Hospital earlier in his career.

Jennings was drawn to the job at Hartford HealthCare in part because of the system’s dynamic growth in Fairfield, which includes the opening of 42 care sites and hiring of more than 200 medical staff in the past decade.

In the last year alone, patient volumes at HHC’s Fairfield County urgent care centers have grown 400%, Jennings said.

“That’s cause to celebrate because the community is responding to our level of service, our level of quality, our convenience and our accessibility,” Jennings said. “It’s proving that we’re fulfilling the mission and vision.”

HHC’s aggressive Fairfield expansion helped prompt Fitch Ratings to recently affirm its A-plus rating on the system’s approximately $1.3 billion in revenue bonds in September. Analysts also noted that HHC has increased its market share in the county to 32.7% from 9.5% in 2008, and now ranks second statewide only to Yale New Haven Health, according to Fitch.

HHC plans to make approximately $175 million in total investments in the Fairfield County region, including improvements to Bridgeport’s St. Vincent’s Medical Center (SVMC), which it acquired in 2019.

“[St. Vincent’s] market share has grown by 1.1% since being acquired by HHC, further bolstering HHC’s statewide presence,” Fitch noted in its analysis.

Kevin Holloran, a senior director at Fitch and head of its nonprofit hospitals and health systems analysts group, said he sees growth in Fairfield as logical.

“One reason for expansion is you’re chasing the payer mix or you are chasing the population,” Holloran said.

According to the most recent census, Fairfield County topped the state in adding 40,590 people in the last decade, making up for declines elsewhere. That trend is likely to continue as people continue to work remotely and move out of New York City, and companies continue to set up shop in Stamford on the Gold Coast.

Ambulatory care accelerates

Yale New Haven Health has long considered Fairfield County “an important part of our geography,” said Cynthia Sparer, senior vice president for ambulatory services. The state’s largest medical provider has an ongoing commitment to making its services more convenient to Fairfield residents, she added.

At YNHH’s southern Fairfield base, Greenwich Hospital, services have expanded in recent years to include a Yale Medicine Heart and Vascular Center, Yale New Haven Children’s Hospital Pediatric Specialty Center and expanded Smilow Cancer Hospital care. (Efforts to establish a formal Smilow Center in Greenwich were thwarted by neighborhood opposition in August.)

Across its geographic range, ambulatory care — or medical services performed on an outpatient basis outside of admission to a hospital — is playing a growing role at Yale New Haven Health.

“The pandemic just brought it into relief: People need access to health care and people want that access to be as simple and straightforward and uncomplicated and with as little risk as possible,” Sparer said. “People enjoy going to ambulatory facilities that are organized for them.”

YNHH’s newer sites include urgent care centers in Fairfield and Shelton. Affiliated PhysicianOne Urgent Care centers operate in Norwalk, Ridgefield, Stratford and Brookfield.

Fairfield-adjacent Milford Hospital also merged with YNHH in 2019, adding ambulatory capacity that is easily accessible from the I-95 corridor. The health system has since invested $17 million in the facility, now known as “The Milford Campus of Bridgeport Hospital.”

Health systems across the nation are pouring resources into ambulatory facilities like urgent care and surgical centers, Holloran said. They are cheaper to build and operate than hospitals and tend to score higher in quality rankings, in part due to the patient population they attract.

“It’s a better way to reach your customer,” Holloran said. “It’s higher quality, when you look at the whole picture.”

At Yale New Health, technological innovations have allowed for a shift to outpatient facilities.

“We’re pushing a lot more of what used to be in hospital ORs into ambulatory procedural spaces,” Sparer said.

Advances like robotic surgery, smaller implants and better training allow for everything from hernia repair to hysterectomies to be performed on an outpatient basis.

“The surgical procedures that lent themselves to ambulatory used to be a much shorter list. That list is growing and growing and growing,” Sparer said.

At Hartford HealthCare, inpatient care represents only 49% of the system’s revenue today, compared to 70% in 2004. Providing outpatient or inpatient services within 15 miles of every Connecticut resident has become the system’s rallying cry, resulting in its expansion to 430 care sites across the state.

When it comes to competing in Fairfield County, Hartford HealthCare may have the edge due to its recent investments in technology like telehealth and coordinated care infrastructure, said Jeff Hogan, president of Upside Health Advisors, a Farmington-based industry consultancy.

“The supply side of health care has to be better and more convenient and more patient-centric,” Hogan said. “Hartford has always been tactical in the way that it has deployed its resources.”

HHC may also benefit from its lower cost of care relative to YNHH, Hogan said. Insurers, employers and employees now have access to more data than ever on cost and quality and are demanding more from their medical providers. Employers have also become tougher customers post-pandemic as they seek to attract and retain highly-skilled workers, he added.

“There’s a demand for services that are more predictably priced and have higher quality,” Hogan said. “This variation and cost and quality become more important issues post-COVID for employers. The cost of care is part of the overall compensation package, as is the value of that coverage.”

Fairfield County, with its ready supply of concierge doctors and other high-end services catering to wealthy patients, presents a competitive challenge to both systems, Hogan added. Even so, those at all income levels are seeking more from doctors post-pandemic.

“People will pay for better and more convenient care,” he said.

Push to innovate

Due to the financial stakes and competitive market, Fairfield may push the state as a whole toward adoption of innovations like procedure price packages, warranties and stricter quality control, Hogan said. “You see the supply chain trying to move to the demand.”

The COVID-19 pandemic has also sped up the pace of change and innovation, according to Holloran of Fitch Ratings.

“When the proverbial dust settles, we are going to look back at the pandemic and say this was one of the great accelerator events in the history of health care,” Holloran said.

Providers may be forced to change their mindset, he added, prompted to say, “Let’s design things around people’s lives and how they want to interact with us.”