As the only academic medical center in the Bronx, Montefiore Medical Center is poised to become the provider of choice for the borough's 1.2 million residents.
To do that, it's investing heavily in primary care and managed care.
"It is our hope that we will be able to put into place a reliable, efficient, competitively priced system that HMOs will be attracted to," said Spencer Foreman, M.D., Montefiore's president.
The seeds of Montefiore's Bronx and Westchester County ambulatory-care network were planted some 20 years ago, with the opening of two large and one small community health center, Foreman said. Five years ago, medical center officials decided to expand the network. It now includes eight primary-care sites with five more under construction and several more planned.
As a founder of the 9-year-old Bronx Health Plan, Montefiore entered the managed-care business earlier than most of its peers. The prepaid health services plan, which serves mostly Medicaid recipients, covers 40,000 members. Montefiore also is an owner in HealthFirst, the Medicaid HMO.
The medical center intends to control patients by controlling physicians. It hopes to add capitated contracts through the 140 community-based primary-care physicians of Montefiore Medical Group.
"To these spokes, we're building hubs," Foreman explained. One hub is a 150,000-square-foot office complex on the campus of its Jack D. Weiler Hospital division. The other is an eight-story medical-arts pavilion at its Henry and Lucy Moses Division. These projects are part of a $180 million modernization and building program financed this year. HUD is providing $157 million in mortgage insurance.
Like his colleagues, Foreman also is talking to a number of institutions about putting together a delivery network.
If Montefiore's hub-and-spoke strategy succeeds, it will have another problem on its hands: too many beds. "We think that managed care will reduce the demand for hospital services in the Bronx and Westchester County by 50% in the next five years," Foreman said.
The medical center is planning for "orderly downsizing" of its capacity, he said. This year, it took a $20 million cut in payroll.
And, with more than half its discharges coming from Medicare and Medicaid, Montefiore's financial health could be harmed by Washington's budget ax. Foreman said it's impossible at this point to estimate the potential impact. "We're obviously looking to the political process to help us," he said.
At a recent hearing on Capitol Hill, he urged members of the House Ways and Means health subcommittee to protect teaching hospitals' Medicare graduate medical education payments and disproportionate-share payments.
Financial stability is essential for success, but it's not the determining factor, Foreman said. "Money won't get you an appropriate strategy."