Becker's Hospital Review

13 CEO / STRATEGY Healthcare funding 'has lost its predictability': Uncompahgre Medical Center CEO's plan for the future By Laura Dyrda N orwood, Colo.-based Uncompahgre Medical Center sits in a service area roughly the size of Delaware on Colorado's Western Slope — a region so sparsely populated that it qualifies as rural and frontier, with about seven people per square mile. As a federally qualified health center, UMC's mission is to provide comprehensive primary care for everyone, regardless of ability to pay. Under CEO Chuck Porth, that mission is being tested by a 13% Medicaid reimbursement cut this year, shrinking grant pools and rising operating costs, but it is not being abandoned. "The hardest thing we do in the next year is going to be adjusting to cash flow," said Mr. Porth. "We're going to have to be more flexible in what we do because all of our revenue streams are uncertain at this point in time. That's the biggest hurdle right now in healthcare, and at least in our part of the world, has lost its predictability as far as securing funding." Mr. Porth knows the landscape intimately. A fellow in the American College of Healthcare Executives with a career forged in large integrated health systems, he came to UMC with the tools and the disposition to build a durable organization, and has achieved results. UMC has a patient- centered medical home designation and participates in several value-based contracts, including the Medicare Shared Savings Program, where its clinical outcomes for diabetes and hypertension rank best in state year after year. But quality care is only part of what UMC has taken on. Mr. Porth has spent the past year expanding programs that address the social determinants of health, the upstream forces that drive so many of the conditions his clinical team treats downstream. "We started a free patient transportation service where we'll drive out to the patient's home, bring them to their appointment, and then return them home," he said. UMC has also begun delivering food to homebound patients who qualify, and in November, it launched a dental program — among the few in the area accepting Medicaid and uninsured patients — to address local needs. A high percentage of children in the region experience dental decay before kindergarten, and nearly 40% of adults have lost at least one tooth to decay. "Our next available appointment is several months out," Mr. Porth said, showing that demand has outpaced capacity almost immediately. The organization is actively pursuing grants to expand the program. On the operational side, Mr. Porth said the hardest part was finding the right expertise. Once he has providers in place, he steps back and lets them lead. That's what he did with the dental program. "I believe in a 'captain of the ship' approach," he said. "We wanted those two individuals [who championed the dental program] to be totally responsible for the quality of care provided in the dental suite." Looking ahead, the financial picture is sobering. Colorado is facing an estimated $800 million budget deficit, and more Medicaid cuts are expected. At the same time, grant funding — a critical revenue source for FQHCs — is contracting. "Healthcare, at least in our part of the world, has lost its predictability as far as secure funding sources," Mr. Porth said. "It's creating almost a month-by-month approach, taking a 'where are we at and what do we have to do' type of attitude." To stabilize the organization, Mr. Porth is pursuing diversification on two fronts: alternative payment models that move away from pure fee-for-service and new service lines that address unmet needs in the community. Aging in place services — home health, assisted living — represent a significant gap in the region. Emergency care improvements are also under consideration. He is looking for deeper strategic partnerships with hospital systems and community providers, including first responders. "I'm not really looking at doing more of what we're already doing, because we know what the revenue streams associated with that are or aren't," he said. "We're looking at different ways to provide care and service and expertise to the area." He is also rethinking the workforce model. As financial pressure mounts, Porth is reducing the number of W-2 employees and moving toward contract staffing, a shift that has opened unexpected opportunities. UMC has drawn skilled contributors from four different states, people who would not have been reachable under a traditional employment structure. "It's creating opportunities for us to create a different model of what working at UMC means, and we're all learning," Mr. Porth said. "But we're all committed to learning how to go forward in these different models." n

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