System Integration in 2011: Q&A With Gary Campbell, President and CEO of Centura Health

Gary Campbell, president and CEO of Colorado-based Centura Health, discusses the task of leading an integrated health system in a changing industry.

Q: As pay-for-performance replaces fee-for-service, how does Centura plan to organize physicians to receive maximum payments for quality outcomes? How do physicians work together across specialties/hospitals to decrease cost without compromising quali

Gary Campbell:
Centura Health defines value as the confluence of cost, safety [and] quality, service and convenience. Optimal health care value requires integrated systems of care across the full continuum of health needs. Truly integrated systems of care in turn require physicians, hospitals, home care agencies, and other providers to be clinically, financially, and philosophically aligned. We believe the key to clinical alignment is an integrated electronic health record that serves pre-hospital, hospital, and post-hospital providers.

Financial alignment is arguably easiest through employment of physicians and "ownership" of the continuum of care, but employing physicians is not always practical — nor is there a guarantee that employed physicians will be motivated to find ways to reduce cost. We are very intent on fostering the development of patient-centered medical homes and other forms of accountable care organizations or integrated delivery networks as ways to organize ourselves to create integrated systems of care, but the organization structure is not nearly as important as the care processes themselves. We have a variety of efforts underway to work with physicians to identify, acquire and deploy those care processes that are critical to improve health care value. One of our efforts is to use our multidisciplinary clinical effectiveness groups to identify and deploy standardized care processes that are proven to increase value to the patient.

Q: Centura Health operates 13 hospitals. How do those hospitals work together? What are the challenges in creating bridges between different hospitals, and how do you accomplish it?

Centura Health was formed in 1995 to join the health care ministries of Catholic Health Initiatives and the Adventist Health System in Colorado. Over time, [our 13 hospitals and numerous operating entities] have started working collectively to apply a new and innovative way of thinking across the system.

One of the biggest changes has been moving from the mindset of owning and operating hospitals, long-term care facilities, and home care agencies to owning and operating systems of care that address the full continuum of health needs. Internally, we've implemented policies to encourage a shift from a singular focus on individual operating units to a much more integrated, holistic and patient-centered focus. Referred to as "disciplined entrepreneurship," our policies call leaders throughout the organization to work together collaboratively. We align and coordinate our efforts through a process known as "Centurization," which involves self-managed multi-disciplinary teams, including representatives from all involved entities, who work together to create common standards and benchmarks, and ensure we are addressing the health needs of people across the state.

Q: You mentioned the use of EMR to achieve integration. What role does EMR play in achieving hospital integration, in your experience?

GC: Centura Health made the strategic decision to implement a standardized, integrated electronic health record in 2005. We began the journey with one goal in mind: to improve the overall delivery of care.  

Early on in the implementation process, we started to see the first signs of integration with teams who had previously worked independently coming together to design our EHR. This inclusive process helped build a foundation of trust that was woven into the fabric of our culture, and as our hospitals went live on the EHR and patient data began to flow across the network, those same teams began talking to each other to leverage best practices to enhance the way we deliver care to our patients. Today, our physicians and clinicians compare clinical effectiveness between facilities and continue to collaborate to improve quality of care across our entire statewide network.  

Q: What about rural hospitals? How do you integrate facilities with fewer resources and potentially fewer providers into your network?

GC: Outreach to rural areas is a key component of Centura Health 2020, [which is] our strategic plan that charts the course for the future of health care for all Coloradans. Through a clinical integration model, we connect rural partners with our systems of care to bring much-needed resources to their local communities. We operate specialty clinics in partnership with rural facilities, and in partnership with UnitedHealthcare, we recently launched a [telehealth pilot project] called Connected Care, aimed at delivering specialty care locally through state-of-the-art video technology.

We also work with rural hospitals to determine how strategic affiliations and service agreements between our organizations can expand the scope of health care services offered in the region and enhance the health status of Coloradans. Our affiliations are designed to extend our systems of care into rural communities in a manner that ensures the right care is delivered at the right time and in the right place.

Q: What do you see as the most pressing challenges for system integration and alignment over the coming year? How do you plan to meet those?

GC: The first challenge is to understand the current environment and have a compelling vision for change. In early 2009, we convened 300 people in a four-month process that culminated in the creation of our plan for the future, called Centura Health 2020. Through this effort, we identified what we believe are the keys to reinvent health care delivery and optimize health care value across Colorado. Centura Health 2020 is our guide for system integration and alignment. We have planned our work, and now we are working our plan.

Our success in this regard is dependent upon health care providers and organizations, both within and outside of Centura Health, coming together to make Centura Health 2020 a reality. The keys are to build trust, think creatively, communicate effectively and keep our focus on the ultimate goal of greater health care value.  

GC: What have been your biggest successes so far in terms of integration, and how did you accomplish those?

Q: Centura Health 2020 has become a critical part of our culture and a rallying cry for our own health care reform. The process of writing the new standards for how health care can and should look has inspired individual associates and physicians to reach higher, to be better and to do more. They feel empowered to help create the future. It's not just about me, my department or my entity. It's about how we are all connected across the state and across disciplines. We are encouraged, empowered, and challenged to look at health care from the consumer's perspective. It's not just about listening — it's about anticipating. Best practices are shared across our network, from best ways to communicate to transference of clinical excellence, which raises the bar for all of us. It's about providing the right care, at the right time, in the right place.

Learn more about Centura Health.

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