It's 'schizophrenic' balancing current growth with healthcare reform, says new University of Colorado Hospital CEO

Will Cook takes over on Sept. 8 as president and CEO of University of Colorado Hospital in Aurora, succeeding John Harney. The hospital, which has 6,012 employees, is part of the four-hospital University of Colorado Health system, which is affiliated with the University of Colorado School of Medicine. The system reported revenue of $784.6 million in the fourth quarter of fiscal 2015, up 17% from the same period a year earlier, with an operating margin of 13.5%. Cook previously served as senior vice president of the health service division at University of Pittsburgh Medical Center, chief operating officer of UPMC's physician services, and president of UPMC Mercy. Modern Healthcare reporter Adam Rubenfire recently spoke with Cook about the challenges facing academic medical centers, his ambulatory-care strategy, and the task of straddling the old fee-for-service and new population health management environments. This is an edited transcript.

Modern Healthcare: What are the differences between the University of Pittsburgh Medical Center and the University of Colorado?

Will Cook: What drew me to University of Colorado Hospital is its academic hub with the University of Colorado School of Medicine. It's extremely important to me that I stay a part of academic medicine where there's innovative research and teaching. Another thing that drew me that was similar is that UCH is part of a larger system that has very good community hospitals in Fort Collins and Colorado Springs.

There are many differences. When you've seen one academic medical center, you've probably seen only one academic medical center. One of the biggest differences is the local market dynamics. What's very attractive about University of Colorado is that it is the only academic medical center within a 600-mile radius of Denver. That brings with it a very special opportunity as well as responsibility to ensure that we make available to the residents of the Rocky Mountain region access to the highest levels of care, working hand in glove with the University of Colorado School of Medicine to make sure that we have local specialists and subspecialists. That's the big difference between the Colorado and the western Pennsylvania markets.

In the Denver area, you have several other players—HCA, Kaiser Permanente and Ascension. University of Colorado's market share is around 20%. So how can we enhance our presence in the Denver market as a regional academic medical center?

MH: What are the challenges that academic centers are facing?

Cook: You always worry about the budget for the National Institutes of Health. One of the ways the U.S. is going to solve its problem of spending about twice as much on healthcare as other developed nations is that we've got to come up with new models of care. We've got to figure out new ways to do things that are not only improvements in terms of quality of life, but also in terms of reducing costs. While academic centers are well known for the highly subspecialized care you can't get at a community hospital, we're very well poised to figure out how we leverage knowledge about genetics and develop personalized medicine to more effectively treat certain diseases, or even better, predict them before they happen and allow people to take necessary steps to avoid disease progression. Being a part of an institution that is constantly on the forefront of looking for new ways to treat diseases and develop new models of care is where the future is.

MH: What is your strategy to develop University of Colorado's outpatient-care system?

Cook: The University of Colorado Hospital has been very successful, especially over the recent years, in growing the Anschutz campus into what in my opinion is one of the finest medical centers in the U.S. And the consistent growth in financial performance of UCH has been almost unbelievable.

But when I ask what's next, I think that if academic medical centers are to survive, they've got to get out into the community and have very strong relationships with community hospitals and community physicians, and even employ their own physicians. How do you become more of a referral center by providing access to those sub-specialists in different parts of the community?

That means looking at ways that we can partner with other hospitals, private physicians, and employ some of our own physicians. How we implement a more robust community strategy and make those services available is going to be vital. I come back to what's really attractive is that UCH is now a part of UCHealth, the broader system that has these wonderful hospitals in the North and the South.

MH: What worries keep you up at night as a hospital CEO?

Cook: How can we as an academic medical center continue to ensure that we are able to fund the research and innovative approaches to medicine despite decreasing NIH funding, particularly when seeing payer-mix degradation from commercial to government-type insurance that doesn't necessarily reimburse you at the same rate? How do we simultaneously come up with new models of care while also continuing to be as busy as we are?

As an example, just this last year they built out a new tower, increasing beds from 533 to 620, and it's already almost full again. So on one hand, you've got things that are going gangbusters in the existing paradigm. But if you peer out into the future and you say to yourself, “How is America going to solve its healthcare problem,” it's got to be in part by reducing utilization. How do we have a growth strategy that also takes into consideration that we've got to provide care in a different way?

It's almost a schizophrenic thing. We're growing; it's almost like Field of Dreams, “You build it and they come.” We're blessed to have access to these resources and these magnificent doctors that are bringing patients in. But peering out five, 10, 15 years from now, what will healthcare look like? I think it will be less about sick care and more about healthcare.

So how does that fit in the world of an academic medical center? No matter what happens with healthcare reform, it won't cure heart disease or cancer. Academic medical centers will always be needed. But I'd like to have us take a view as to being something that's not just an academic medical center. How can we also be in the community? How can we develop a primary-care strategy that is also about new models of care that keep people out of hospitals?

MH: What's the legacy of John Harney, the man you're succeeding?

Cook: I never knew John personally. But everything I've heard about John is that he was very visible and always out speaking with front-line staff, had a wonderful relationship with the medical staff, and cared very much about patients. He was a big supporter of his chief nursing officer, which helped them receive accolades for nursing care. It speaks to his belief about the importance of front-line staff and making sure that we constantly support patient care.

I hope to carry on John's legacy of being a big proponent of employee engagement, patient satisfaction and quality, because I think a lot of the accolades that UCH receives comes from the fact that there is a good group of nurses and other staff. John really did a good job of fostering that sort of environment, and I hope to carry on that tradition.