Hartford Healthcare CEO Elliot Joseph knows Connecticut has a fragmented health care delivery system. But he may have learned that fact best as a patient rather than as a chief executive.
Although he hasn’t made it very public, Joseph was diagnosed with acute promyelocytic leukemia in February 2009, forcing him to take a short medical leave of absence. And while he said excellent care and breakthroughs in science and technology helped eliminate his cancer, he had to navigate a system of care that wasn’t well coordinated, forcing him to go back and forth between doctors’ offices, hospitals and test labs.
“I was that person swimming in the ocean between these islands of care. It was a tremendous challenge,” Joseph recalls. “It’s not really a navigable system. It’s a system that doesn’t connect without great effort.”
That personal experience, Joseph said, is helping him shape a strategy to create a more integrated health care delivery system for Central Connecticut and beyond.
In an interview with the Hartford Business Journal, Joseph outlined future plans for Hartford Healthcare, which will include hundreds of millions of dollars in investments in the coming years for new technology, infrastructure, and doctors.
It’s a signal that the health care giant, which has nearly 15,000 employees, will be a major economic driver in the years to come.
The end goal, Joseph said, is to create a system that links providers across the spectrum of care so that patients, particularly the chronically ill, experience a more coordinated system. It will not only improve quality, but save on costs, cutting down on wasteful duplicative procedures, and also reducing emergency room visits, Joseph said.
But the shift, which is already underway, will require an expensive down payment. In fact, Hartford Healthcare is in the process of getting a credit rating as it intends, for the first time in its history, to issue bonds. That’s a signal for major future investment plans.
The organization’s board of directors just approved a $50 million investment in a new parking garage and the expansion of its emergency department, which will add 20 new patient beds.
And a strategy to add more primary care doctors and satellite offices — especially in the Farmington Valley — is also in the works.
“There is so much change, needs are greater, facilities are in need of upgrades,” Joseph said. “To move from fragmented, independent autonomous sites of care to an integrated delivery system requires great investment.”
Hartford Healthcare has grown into a behemoth organization with five hospitals and about 15,000 employees. Its revenues reached $1.4 billion in 2010 and saw 2.5 million outpatient visits. Joseph said the size of Hartford Healthcare has less to do with the organization’s ambition, than it does with lowering costs. By partnering with other providers like The Hospital of Central Connecticut, Hartford Healthcare is trying to leverage purchasing power to gain greater access to information technology and negotiate better prices with vendors.
It’s a particularly important move for a not-for-profit organization like Hartford Healthcare, which operates on slim margins and continually faces pressure from government and commercial payers. In fact, while it plans future multimillion dollar investments, Hartford Healthcare is also implementing cost cutting initiatives, including finding $15 million in savings by 2012.
Joseph said, in the national picture, health systems that get to over $3 billion in net revenue are distancing themselves from the competition, in terms of financial performance and quality.
“If you don’t get to a certain level of scale, you can’t invest in technology or electronic medical records to be successful and competitive,” Joseph said. But getting there means more than doubling Hartford Healthcare’s operation.
Recent affiliations and acquisitions by Hartford Healthcare are part of putting together that integrated system that Joseph sees as the future of the industry. By getting primary care docs and specialists under the same umbrella as the hospital, it creates a more coordinated system, Joseph said.
The most recent example is Hartford Healthcare’s acquisition of the Constitution Eye Surgery Center and affiliation with the parent company of The Hospital of Central Connecticut.
Joseph said Hartford Healthcare intends to be a major player in the eye surgery arena, with the goal of creating a center of excellence for the entire state. The acquisition will give Hartford Healthcare access to a patient base that supports 11,000 eye-related surgeries a year compared the 800 surgeries performed annually at Hartford Hospital.
In the case of The Hospital of Central Connecticut, the partnership brings together two of the largest and financially stable health care systems in Central Connecticut, both of which can now tap into each other’s resources and expertise and offer a broader range of services. That partnership is expected to save $230 million over the next five years.
Joseph said they are interested in more potential deals, but the organization’s main focus is to integrate The Hospital of Central Connecticut into its network. Federal Trade Commission officials took 10 months to approve the affiliation and wouldn’t allow either side to do strategic planning until they blessed the relationship, Joseph said.
“We are very interested in talking to high quality organizations that have common vision about how to create a more coordinated system for how to treat patients,” Joseph said.
The next challenge, Joseph said, is creating a unified electronic medical records system that will enable doctors’ offices and hospitals throughout Hartford Healthcare to communicate directly with one another, leading to quicker diagnoses, improved accuracy and an end to duplicate testing.
The effort includes a major initiative to put electronic health records in 200 physician’s offices that are affiliated with the organization by the end of 2011.
Joseph said Hartford and MidState hospitals are already wired, as is The Hospital of Central Connecticut, although its platform needs to be integrated into the network.
That investment is part of a larger primary care strategy, in which Hartford Healthcare is looking to integrate the medical home model of care and introduce 25 new doctors into the Central Connecticut community by the end of 2011. Joseph said the region has a shortage of about 100 physicians so he’s looking to attract doctors from out of state or recent med school graduates. It’s an important step because the “ultimate goal is to get people out of the emergency department, and into primary care and medical homes,” Joseph said.
Hartford Healthcare already has over 1,000 physicians either directly employed by the organization or affiliated with it in some way. It’s a number that is likely to increase with the changing landscape of small practitioners.
“The day and age of young people coming out of medical school who want to put a shingle out and set up their own practice doesn’t happen anymore,” Joseph said. “They want to come into an organized group.”
Of course, all these changes cost money, and Hartford Healthcare is preparing to invest hundreds of millions of dollars over the next decade.
Just last year, Hartford Hospital and MidState Medical Center completed $75 million worth of expansion projects, including expanded emergency departments.
Simply relying on investment income from the organization’s endowment is no longer economically viable.
Demand for new capital will require Hartford Healthcare to tap the bond market for this first time to take on new debt.
Joseph said organizations with larger scale have greater access to bonding, which gives him hope that markets will be receptive with a favorable bond rating.
Immediate plans include a $50 million investment in a new parking garage and further expansion of Hartford Hospital’s emergency department, including 20 new beds.
Hartford Hospital and the Connecticut Children’s Medical Center also intend to eventually move forward on a proposal to construct a new 11-story, $35 million medical office on Washington Street, near downtown Hartford.
But there is no timetable on the project yet, Joseph said.
“There are way more needs than our ability to fund them all,” Joseph said.
System at a glance
Hartford Healthcare
system consists of:
Hartford Hospital, 867-bed acute care hospital in Hartford.
MidState Medical Center, 144-bed acute care hospital in Meriden.
Windham Hospital, 130-bed acute care hospital in Willimantic.
The Hospital of Central Connecticut, 370-bed acute care hospital in New Britain.
Natchaug Hospital, 70-bed mental illness and substance abuse care provider in Mansfield.
Rushford, substance abuse and mental health provider in Meriden.
Hartford Medical Group, physician services group in Hartford.
Clinical Laboratory Partners, behavioral, psychiatric and addiction disorders provider of patient care, research and education in Newington.
Eastern Rehabilitation Network, rehabilitation center in Newington.
VNA Healthcare, home care, hospice and community-based health and wellness provider in Hartford.
Alliance Occupational Health
Central Connecticut Senior Health Services
Central Connecticut Physical Medicine
Central Connecticut VNA
