After creating a new model in academic health care, three partners look back at how far they’ve come—and look forward to future growth
Anywhere else, Gavin Nieters’s chances would have been slim to none. Born June 9, 2005, with a major malfunction in his tiny heart, Gavin needed highly specialized surgery. And the only place in the world it could be done was the University of Minnesota Children’s Hospital, Fairview. When Gavin was four days old, pediatric cardiothoracic surgeon John Foker, M.D., Ph.D., cut into his small chest and, in a 12-hour operation, corrected the deadly defect.
Gavin’s lifesaving surgery might not have been possible if it hadn’t been for an innovative partnership forged 10 years ago between the University of Minnesota, Fairview Health Services, and University of Minnesota Physicians. By combining a community health system with an academic health center and its faculty physicians, the partnership created an entity specialized enough to function at—and advance—the leading edge of medicine, yet sturdy enough to survive in a highly competitive health-care environment.
“Our patients are truly the beneficiaries of the University-Fairview partnership,” says Gordon Alexander Jr., M.D., president of University of Minnesota Medical Center, Fairview, and University of Minnesota Children’s Hospital, Fairview. “Over the past 10 years, our partnership has evolved. We had to get to know each other—to learn how best to work together and harness our strengths to achieve our unified vision of world-class patient care, research, and education.”
Setting the stage
For the University, the motivation behind the merger was largely economic. In the mid-1990s, the University of Minnesota Hospital and Clinics, like many of its peers, was struggling financially as it tried to provide highly specialized health-care services in an increasingly competitive managed-care environment. Its faculty physicians—then represented by 18 separate practice groups—were in the process of creating a single practice plan, University of Minnesota Physicians, which would help them thrive in the tough health-care market. But that was not going to solve the problem entirely. With the University’s hospital $140 million in debt, administrators eyed a number of options, including closing, downsizing, and partnering with an existing community health-care network.
Visionaries at Fairview Health Services saw a chance to support academic medicine while adding high-end services, such as transplants and leading-edge cancer care, to Fairview’s repertoire and providing new opportunities for its Riverside medical center, located just across the Mississippi from the University. In January 1997, University Hospital and Fairview merged, bringing together the strengths of each to create what they hoped would be a new and powerful paradigm for providing exceptional teaching, research, and clinical care.
At first the road was rocky. The merger brought together very different cultures—each used to doing things in a certain way. Employees worried about jobs. Physicians on both campuses tried to figure out how they fit into the new reality.
“After high-fives and champagne corks, within six or eight months each side was saying, ‘Who are these guys? These guys are crazy—we can’t get along with them,’” recalls David R. Page, Fairview president and chief executive officer.
Gradually, however, participants began to acknowledge and appreciate their differences. What were once seen as obstacles were reframed as opportunities. Today, the medical center is financially healthy, providing innovative care to patients from the Upper Midwest and beyond—and looking forward to future growth.
“We are standing on the verge of even more opportunities than we have had in the last five years, certainly more than in the last ten,” says Roby Thompson Jr., M.D., chief executive officer for University of Minnesota Physicians.
A sturdy financial foundation
What benefits did the merger bring? Top on the list for the University: “We’re still here,” says Frank Cerra, M.D., the University’s senior vice president for health sciences.
“When we embarked on this, the future of University Hospital was in great jeopardy, both financially and competitively,” Cerra says. “We were at risk of losing our primary teaching hospital—the hospital at which we performed most of our clinical research, and the place known for high-end, technologically oriented care you can’t get in most places.”
Before the merger, the University’s hospital was projected to lose $50-$55 million per year by 2000. Today, says James Fox, Fairview senior vice president and chief financial officer, it’s on a trajectory to produce $30 million in net income for the year.
Premier patient care
That solid fiscal foundation is not just good business. It also
allows the medical enter to provide premier care to patients. Since the
merger, Fairview has invested some $250 million in facilities and
equipment, from creating a kid-friendly imaging and sedation center in
the children’s hospital to adding a sophisticated da Vinci® robotic
surgical system for performing minimally invasive surgeries.
Steven Johnson, a retired Minnesota National Guard recruiter from Olivia, Minnesota, has been driving to the University five days a week to receive radiation treatment for prostate cancer. His oncologist, Chinsoo Cho, M.D., says the hospital’s TomoTherapy HI-ART System—the first in Minnesota—provides a distinct advantage over conventional therapies for treating Johnson’s condition. The $2.6 million device combines CT scanning and radiation therapy to improve the accuracy and efficiency of treatment.
And thanks to the merger, medical innovations like TomoTherapy are reaching more patients faster. With research an important part of its mission, the University has always been a valuable source of new knowledge in health care, and its hospital historically has transformed new knowledge into better patient care.
The world’s first successful open-heart surgery was performed here. So were the first successful pancreas transplant and the first successful bone marrow transplant—to name just a few of the University’s medical firsts.
By strengthening the Medical School, the merger has allowed this long tradition of innovation to continue. In 1997, the hospital became the first in the world to successfully transplant all intra-abdominal organs from both living and deceased donors. In 2003, the establishment of the Center for Minimally Invasive Surgery, the first in the region, put the medical center at the forefront of teaching, research, and clinical care in this important and fast-growing field. Medical research currently under way at the University is aimed at improving knowledge and patient care in such diverse areas as memory loss, rheumatoid arthritis, compulsive gambling, and lung disease.
Linking the University directly to Fairview’s network of seven hospitals and dozens of clinics means more patients have access to the region’s top adult and pediatric specialists. And it has given University of Minnesota Physicians’ more than 650 doctors—most of them Medical School faculty—a more prominent place in Minnesota’s health-care picture.
“Increasingly, health plans are choosing to include our medical system in their contracts because we offer patients options that no one else can offer,” Thompson says. “Whether it’s Blue Cross and Blue Shield or HealthPartners or Medica, they want us in their portfolios.”
In the first years following the merger, the Medical School went through some tough times as a number of faculty members left for other institutions. But today, recognizing and appreciating the strengths of the partnership, top scholars are joining the team, and the reputation of the hospital and the Medical School are on the rise. Last year the Department of Pediatrics alone welcomed 13 new faculty members, including specialists in diabetes, emergency medicine, infectious disease, and blood cancers.
Cerra notes that the U.S. News and World Report “Best Hospitals 2006” edition lists the University of Minnesota Medical Center, Fairview, among the top 50 U.S. medical centers in 11 areas: kidney disease; respiratory disorders; endocrinology; gynecology; orthopaedics; neurology and neuro-surgery; cancer; ear, nose, and throat; heart and heart surgery; urology; and digestive disorders.
“That’s a real sign of success,” he says.
Top faculty attract superior students, says Thompson. And since most Minnesota health-care professionals are trained at the University, that’s good for all of us. “Those students are Minnesota’s future clinicians and care providers.”
Pattern for partnership
Despite its bumpy beginnings, the University-Fairview merger is seen today as a model for other academic health centers. In a 2000 report, the Association of Academic Health Centers and University HealthSystem Consortium cited the University-Fairview merger as a national model for academic-community partnerships.
“It truly is regarded as one of the big successes in bringing academic and community-based capabilities together,” Fox says.
The merger also has provided a pattern for other partnerships within the system. In May 2005, Fairview broke ground for a new ambulatory care clinic in Maple Grove—a collaboration with University of Minnesota Physicians that will bring the expertise of University doctors to the community.
“[This] is a great example of how Fairview and University of Minnesota Physicians intend to work together in the marketplace,” Fox says.
Thompson anticipates more such agreements in the future. “Our academic mission acknowledges the growing need for us to have a larger presence in the community,” he says.
Eye to the future
Perhaps more than anything else, the partnership has set the stage for exciting advances in the years ahead.
When the merger occurred, hospital functions were split between the University and Riverside campuses. With the dust finally settling after a decade, partners are now standing back to take a big-picture look at configurations for the next 20 years. A Clinical Sciences Campus Plan developed in 2004 calls for creating a new specialty medical center, consolidating clinical laboratories, and offering a more inviting, user-friendly setting for patients and their families.
Plans are also under way to construct a state-of-the-art replacement facility for University of Minnesota Children’s Hospital, with groundbreaking scheduled to take place this year.
Thompson predicts that the link between discovery and its application will grow even stronger in the years to come. “I foresee major growth in the clinical presence on this campus as the Medical School becomes more focused on being a translational research engine that transfers basic science and education to the bedside at earlier stages,” he says.
“I’m very optimistic,” concurs Cerra. “We’re in exciting times.”
By Mary Hoff