When E. Mitchell Roob Jr. applied to become head of Indiana's largest county-owned healthcare organization in early 1994, his resume lacked healthcare experience.
So the board of Health and Hospital Corporation of Marion County took a very hard look at the man hoping to become the organization's next president and executive director, leading the Marion County Health Department and 328-bed William N. Wishard Memorial Hospital in Indianapolis. In the end, despite candidates with strong healthcare backgrounds from across the country, the board chose from its own back yard.
"Mitch knew Marion County, its economy and its politics," said John Whelan, chairman of the board of HHCMC.
Roob, 34, had spent the previous two years working for Indianapolis Mayor Steve Goldsmith as the city's director of transportation and public works. "When I left public works, I thought I met all of the challenges there were. But that is not true at Health and Hospital Corporation," Roob said.
Roob's knowledge of the local political and legislative landscape was put to use almost immediately.
When Methodist Hospital of Indiana and Indiana University Medical Center, both in Indianapolis, began merger talks in 1994, Wishard's long-standing relationship with IU and its medical school was threatened. Wishard's emergency room has been run by the university's medical school for 20 years and trained IU medical students.
"It obviously put our future up in the air, and we weren't privy to the merger discussions," said Whelan, a four-year veteran of HHCMC's board and president and chief executive officer of Golden Rule Insurance Co. in Indianapolis.
The $1 billion IU-Methodist merger was unprecedented, combining the state's only academic medical center with the state's largest not-for-profit hospital.
But the deal drew the attention of Indiana Gov. Evan Bayh, who appointed a blue-ribbon task force to examine the merger because of the negative impact it could have on Wishard's traditional role of caring for the indigent. Led by the Indiana attorney general, the investigation lasted a year, and Roob attended every one of the task force's meetings.
"Mitch did a wonderful job of making sure that Wishard and its care of the indigent wasn't damaged because of the merger," Whelan said.
At Wishard, the indigent account for 37% of patients, while Medicare and Medicaid combine for another 43%. To ensure a stable future, Wishard agreed this year to form a primary-care system with the IU medical school and its faculty. IU and Wishard committed
$20 million each over the next four years toward the venture, known as Indiana Health Care, which will employ 65 full-time employees and medical faculty and train 225 primary-care medical students annually.
"Our ability to get patients, particularly paying patients, would have been compromised had we not created that venture," Roob said of Indiana Health Care.
"In a very short period of time, Mitch has really come up the curve in dealing with a multitude of tasks," Whelan said.
Roob, who was born and raised in the Chicago suburbs, earned his bachelor's degree from DePauw University in Greencastle, Ind., and his master's in business administration from Notre Dame University in South Bend, Ind.
Bucking a national trend of struggling metropolitan public hospitals, Wishard has a recent history of profitability, although in the late 1980s observers wondered if the facility would close.
Federal disproportionate-share payments in the late 1980s and a new Medicaid disproportionate-share program in Indiana in 1991 helped Wishard bounce back.
To ensure a strong financial future for the hospital, Roob led the formation of the Central Indiana Managed Care Organization, a partnership of Wishard, IU Medical Center and Methodist. The entity earned a Medicaid contract through Indiana's risk-based Medicaid managed-care program and now has more than 20,000 enrollees.
Wishard's financial improvements have helped it land on HCIA's list of the Top 100 hospitals for the past three years.
In 1995, Wishard reported net income of $5.4 million on net revenues of $186.6 million, according to HCIA, a Baltimore-based healthcare information company. The hospital has assets of $237 million.
Roob studies the healthcare system up close and personal. Every Friday he performs a different job at the hospital or health department-inspecting water in the county sewage system, washing dishes in the hospital cafeteria or assisting in the emergency room.
Roob relishes the changing healthcare environment because, he said, "there is so much more to do and learn."