CEO Ruth Brinkley discusses upgrading and integrating three systems to serve all commonwealth markets
By Ed Lane
Ruth Brinkley is president/CEO of KentuckyOne Health, an organization formed earlier this year from the merger of Jewish Hospital & St. Mary’s HealthCare and the Saint Joseph Health System. Brinkley brings more than 35 years of healthcare experience working in private and public healthcare organizations, most recently serving as president and CEO of Carondelet Health Network. Prior to joining Carondelet, Brinkley was an executive with Catholic Health Initiatives and served as president and CEO of Memorial Health Care System in Chattanooga, Tenn. A registered nurse who holds bachelor and masters degrees in nursing, Brinkley has also served as chief nurse executive and associate dean of clinical practice at the University of Alabama Hospitals in Birmingham. Brinkley was recently appointed to the Kentucky Health Benefit Exchange Advisory Board, and is a member of the National Association of Health Services Executives and the American College of Health Care Executives.
‘Forging Sustainable, Affordable and Adaptable Healthcare is Exciting’
Ed Lane: KentuckyOne Health was formed Jan. 6, 2012, when Jewish Hospital & St. Mary’s Healthcare announced it was merging with St. Joseph’s Health System of Lexington without UofL’s University Hospital, which had negotiated inclusion and was part of an original announcement. Subsequent exclusion of University Hospital in the merger was based on a legal opinion by Kentucky Attorney General Jack Conway and objections by Gov. Steve Beshear.
On Nov. 14, 2012, UofL and University Hospital announced a joint operating agreement (JOA) with KentuckyOne, which Gov. Beshear approved and executed. How will this new JOA benefit Kentuckians?
Ruth Brinkley: That’s a great question and the question I was hoping you would ask me first. If you look at the (federal) Affordable Care Act and where healthcare is going in this country, we clearly have to do something different. The difference is creating sustainability around our health systems; we want to not only be successful but to also be financially sustainable. There are three components of a sustainable health system – affordability, adaptability and acceptability. This new partnership allows KentuckyOne Health to move forward and incorporate these important principles as we continue to evolve as a system. We are extremely excited about the benefits KYOne can deliver across the commonwealth to residents who need healthcare and have not had access.
Our JOA with UofL and UofL Medical School helps bring missing components to our partnering in terms of educating and training health professionals, and enhances our research efforts across the state. What drives us is providing healthcare to more and more people – in the more rural and remote areas of the state and in some of our urban areas where we have underserved residents.
EL: How many locations, employees and physicians will KYOne manage in Kentucky and Southern Indiana under the terms of the JOA?
RB: If you’re talking total locations, meaning physician offices and hospitals and everything, then it’s more than 200 facilities. Roughly 18,000 employees and 3,000 physicians comprise our workforce. Hospitals alone will be 16.
EL: Catholic Health Initiatives initially announced it was investing $320 million to launch KYOne. How is this investment being utilized?
RB: In the short-term, we’ve made some much-needed capital infrastructure improvements. Longer-term, we are investing in information technology so that KYOne will be operationally and cost effective in the future world of healthcare as we go forward with the Affordable Care Act (implementation). KYOne’s computer systems will help keep better track of patients’ care and help patients keep informed so they can be active partners in their care. KYOne is also making significant investments in programmatic development. It’s not just a bricks-and-mortar strategy; we are investing in several of our key service areas. Heart and vascular service is important to us because KYOne provides more heart care than anyone in the commonwealth, and heart disease is one of the many healthcare issues in Kentucky. KYOne is also making investments in women’s services, orthopedics and cancer care. So that’s what KYOne has been doing to date. We expect that the partnership with the UofL and UofL Medical School will enhance those efforts in a positive way.
EL: Under the terms of the recently announced JOA with UofL and University Hospital, KYOne will invest $543 million during the initial five years. How will these funds be invested?
RB: It’s too premature to specifically address that question since we want to collaborate very closely with the leaders of the University Medical Center and University of Louisville to decide how those funds will be invested. It will be a collaborative decision, and physicians will definitely be actively engaged in making those decisions. Our current KentuckyOne physicians and the physicians from the University Medical Center as well as executives will be involved.
Seventy million dollars will be invested in IT; that’s for sure. A lot of people may not know this, but KYOne and our predecessor entities have had partnerships with UofL for 60 years. So some of the KYOne financial support will be a continuation of what was already being provided.
EL: What are the major impacts of the finalized JOA as they relate to doctor-patient relationships, insurance coverage and services for the poor, at risk and uninsured?
RB: Let me take those apart. KYOne will maintain these services through the new operating agreement. We listened to the concerns of the governor and the attorney general and, as importantly, our communities. The JOA means that UofL will be operating part of the organization, and KentuckyOne will be operating another part of the organization. So that’s an inherent part of the JOA. In terms of charity here, our two organizations have provided almost $300 million in free or charity care: KentuckyOne provided $150 million and the University provided about $125 million. Collectively we have had a very strong commitment to free care or charity care, which is the nature of both organizations’ mission. We will continue to do that.
As the Affordable Care Act goes forward, some of those persons will have insurance and easier access to healthcare. Right now, the way our overall health system across the country is set up, people who don’t have insurance – private or commercial – Medicare, or Medicaid often have trouble accessing the system. We are very excited about those additional persons who will have insurance, so we can reach them. However, this does not decrease in any way KYOne’s commitment to the uninsured, underinsured and underserved because there will still be patients who don’t have insurance.
EL: KYOne will operate as a non-profit?
RB: KentuckyOne has always been a not-for-profit organization, as has University Medical Center; it is important for the public to realize that by the very nature of its (not-for-profit) charter it is community owned. Our assets are owned by the community, and so that is the definition of a not-for-profit. Obviously, the legal structures are a little different when you’re talking about a “public not-for-profit” as opposed to “private not-for-profit.”
EL: In your discussions with the governor, did he seem to be pleased at the way the operating agreement with the University of Louisville was restructured?
RB: All of our communications with the governor regarding this relationship came through the University of Louisville. During the (JOA announcement) press conference, UofL and the governor indicated that all the attorney general’s legal concerns were satisfactorily addressed. The governor and the attorney general were not a part of negotiations. The way the (UofL partnership request for proposals) bid process worked, KYOne (which was chosen) as well as other bidders were not involved in discussions with state officials for obvious reasons.
EL: How will KYOne modify its operations in order to comply with the Patient Protection and Affordable Care Act, commonly called ObamaCare or the Affordable Care Act?
RB: As will every healthcare system in the United States, KYOne will obviously need to bend the cost curve in order to decrease the cost of care. KYOne also will be modifying its operations to provide more outpatient services, in-home services and to bring the care vertically or physically to places that are closer to the patients and to the communities we serve. KYOne already has two virtual clinics running in rural and remote areas: one is in Clay County and the other is in Whitley County.
EL: What are your major concerns as CEO of KYOne regarding the upcoming implementation of Obamacare?
RB: There are going to be new rules and regulations. It’s clear that healthcare is moving forward with the Affordable Care Act, which I think is a good thing for our state and citizens. I’m not concerned, but I want to be diligent and aware of what’s going to be written into those rules and regulations. Through the Catholic Health Initiative’s national system and its advocacy in governmental relations functions, KYOne wants to understand and give comment on proposed regulations and how they will impact Kentucky and the care KYOne delivers. Ultimately, it’s about meeting the needs of those KYOne serves, so we want to make sure regulations support that. I’m confident government wants the same thing.
EL: With the completion of the merger and JOA, how does your organization compare to others in the state?
RB: KYOne was Kentucky’s largest medical entity when organized in January 2012. In licensed employees and operating revenue, Baptist Health after its recent merger temporarily was larger than KYOne. Now with this joint operation with UofL, KYOne is by far the largest. What’s important to me is not so much being the largest but being able to reach people, to collaborate with all entities providing healthcare, because none of us can do it alone. I believe those who evaluate KYOne will gauge our success on how well we are able to do those things in terms of building a sustainable system and taking really good care of our patients.
EL: How will KYOne manage operations at its 200 locations in Kentucky and Southern Indiana?
RB: I don’t have the answer yet, but the principle would be that KYOne is an integrated health system. What KYOne will look like is still to be determined; however, in terms of being an integrated system we don’t want duplication of services. We want to follow the same strategic plan – having it adapted for each community that we serve. How the strategic plan plays out in Louisville will be different from how it plays out in Martin and London and other cities around the state. As KYOne partners and collaborates with the University of Louisville, our teaching programs will look different in Martin than in Louisville. KYOne is being very careful, very disciplined and deliberate about making sure it economizes where it can, because a part of a sustainable medical system is affordability. KYOne will economize and make the optimum use of the resources it has.
EL: Will KYOne’s IT system be a key component of its operations?
RB: Yes. There are many applications of IT. For instance, through our virtual clinics KYOne will be able to deploy a specialist to a remote site through virtual care – some call it telemedicine or telehealth – so we’ll be able to use that. Certainly electronic medical records will make care easier because we won’t have to duplicate testing and procedures.
Another application is robotics. We have robotics across KentuckyOne, both in Louisville and Lexington and other parts of the state. Robotics, virtual care, electronic medical records, the development of systems and processes that make workflow easier for our patients and families all will revolutionize healthcare in a very positive way. That’s a lot of work, but KYOne is committed to doing that.
EL: How long will it take to implement KYOne’s strategic plan?
RB: The agreement with UofL is for 20 years, with renewable options. KYOne is certainly not going to take 20 years to integrate. We just started the integration planning, and I envision it will take us two to three years to fully integrate. The complexity of this effort is magnified because at the same time the whole healthcare industry is making multidimensional changes. What is most important for KYOne is developing a culture of excellence and high performance in terms of providing value to all of those we serve.
EL: Are there some markets in Kentucky that are underserved by KYOne and that will require KYOne to develop new or expand existing facilities in order to provide adequate statewide coverage?
RB: That’s part of our strategic planning process. We are looking at where KYOne is and where services may be needed. No one system can do all this by itself. KYOne will constantly look for ways that not only advance our mission, but also serve more people better in a cost-effective way. KYOne wants to be both nimble and adaptable as we grow and develop.
EL: KYOne recently announced the purchase of a Dupont Circle office building in Louisville. How will KYOne use this facility?
RB: We had been looking at that property some time, so the timing of the announcement was coincidental. This facility could help support our existing operations at Medical Center East and physicians who practice in that area.
EL: Have you made a decision as to where KentuckyOne’s headquarters is going to be located?
RB: KYOne has been working through this process with the University of Louisville. We will be announcing something soon. We have something in mind. Probably before the end of the year.
EL: How would you describe your executive team?
RB: KYOne’s team incorporates people from the area, and we’ve brought in some people. KYOne has a wonderful team of executives and physician leaders. I’m excited to be working with a great group of healthcare professionals. It’s the people that really make a system. We are very blessed.
EL: As a native of Georgia who has worked in healthcare in Tennessee, Alabama, Missouri, Illinois and most recently in Arizona, how is your transition to Louisville and Kentucky progressing?
RB: I was born in a little town called Wadley, Ga. I’m a farm girl. Wadley is about 100 miles southeast of Atlanta off of I-20 east, toward Augusta. I grew up in a little town called Geord, Ga., and went to high school in Augusta and Waynesboro. I love Louisville; it’s a great city. I lived here before, when I first joined Catholic Health Initiatives back in 1998. CHI had a regional office then, and so I lived here and loved Louisville at the time – and I still do. So coming back has been good, because Louisville has become an even better city since I left in 2001-2002.
Ed Lane (firstname.lastname@example.org) is chief executive of Lane Consultants, Inc. and publisher of The Lane Report.
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