The United States will celebrate 250 years of independence in 2026, but another such celebration is being held much closer to home this year, and its leaders are just as proud.
The nonprofit Boulder Community Health, one of only two independent health-care systems in Colorado, may be part of a vanishing breed across the nation, but it’s celebrating its 100th anniversary with a fierce defense of its independent status.
“It means decisions made in Boulder for Boulder,” said Janet Martin, who served 10 years on the system’s board of directors and now is vice chair for its foundation. Not being affiliated with large hospital chains such as UCHealth or Centura, she said, “gave us the ability to be nimble and make business decisions in a fairly quick fashion, and really tap into the creativity of our staff and Boulder.
“That really showed up in COVID,” she said, “when much of the rest of the country was struggling, BCH was able to come in and figure it out. The community and the hospital pulled together in a scary time.”
Martin said BCH set up an entire floor at its Della Cava Center for delivering vaccine during the height of the pandemic. “They orchestrated the whole experience, starting with availability in the parking garage, guiding people up the stairs into the center, people stationed to make sure you knew where you were going, signage to make sure all the precautions and social distancing were being followed, and a lot of people available to administer the shots,” she said. Martin was impressed with how much detailed thought had gone into people’s experience, including the light jazz music that was played while they waited 10 minutes for their results.
“To me, it was just such a contrast with what was happening in big cities, with no plan at all and people sitting in their cars for hours and hours in order to get the vaccine.”
To keep that connection with the community vibrant, said John Greff, who joined the BCH board in 2018 and currently chairs it, “one of the things we do is a biannual community-needs assessment. It’s a fairly involved process of identifying what needs the community might have that we’re not currently meeting, and what we might need back from the community as well.
“BCH listens,” he said, “and acts fairly quickly to provide new innovations and service lines for the community. Many of these specific lines might not be available if BCH was not an independent. The reason that probably is, is that they’re not profitable lines of business — and if you’re part of a larger system, they might just shut those lines of business down, whereas as a nonprofit community hospital we can provide those things.
“Obviously they have to be within reason,” he added. “We can’t jeopardize the overall financial health of the hospital to provide all lines that are required.”
Dr. Robert Vissers became BCH’s president and CEO eight years ago. “I remember that when I took the job, they said the average tenure of a hospital CEO is three and a half years, so good luck.” But he added that making the best use of the system’s independence has kept him in the job.
“It comes down to making sure we leverage the advantages of being an independent, use our nimbleness, our creativity and willingness to engage in innovative solutions, and having enough humility to recognize that there’s some things that maybe we don’t do as well as others can, and really taking that to focus on our core business,” he said. “But I think the most important thing is using that independence around financial autonomy and decisions about what we do to invest in the community’s health.”
Part of that focus, Vissers said, involves “bringing more investment and care around mental health because that’s what the community needs, not because the system office in another state decides that it isn’t financially viable and we need to spend more money on revenue-generating services.”
Greff said such a dedicated mental-health unit required a major financial investment from BCH, “but with that, we got significant support from members of our community through their generous donations to support and build this service line. We had a smaller unit previously, but we’ve made a major investment in the Della Cava Center now, where the behavioral health center is located.”
Part of BCH’s last fundraising campaign focused on that behavioral-health component, Greff said, “and significant dollars were raised from the community to support that program. Our original goal was $2 million, and it was part of a larger expansion that we were doing in the Della Cava Center. That campaign was originally $8 million. We raised more than that.”
Being free of a chain’s constraints, Vissers said, “doesn’t mean anything unless I use that independence to make the right decisions for the community and listen and understand what the community wants and what they need.”
As much as BCH officials hail the system’s unaffiliated status, however, Vissers has repeatedly stressed that “independence in and of itself is not our mission nor our vision. Our vision,” he said, “simply is to create and care for the healthiest community in the nation.”
The years leading up to BCH’s centennial have been eventful. The flagship Boulder Community Hospital moved in 2019 from its longtime location on North Broadway to the sprawling Foothills Hospital campus in east Boulder. It opened satellite medical centers in Lafayette and Erie. Its struggling telehealth venture got a jolt of adrenaline thanks to the remote-connection needs prompted by the COVID-19 pandemic, as well as a $636,842 grant from the Federal Communications Commission for video-visit workstations, remote monitoring equipment and more.
Then, last month, came a $5 million donation, the largest single-donor gift that BCH’s foundation has ever received, from the Hoover family. David Hoover served as CEO of Ball Corp. until he retired in 2011, and retired from the BCH board of directors in 2018. Suzanne Hoover serves on the BCH Foundation’s board of trustees.
“The donation by the Hoovers for physicians and staff is so important,” Martin said. “It starts to address all those long-term issues.”
Many of the challenges of staying independent are obvious, especially given the fact that hospitals affiliated with large chains can achieve cost savings by buying supplies in volume.
“We are somewhat disadvantaged at our size,” Vissers noted. “In fact, the No. 1 reason for independent hospitals to merge to a larger one is to use that scale to leverage higher rates from the payers. And sometimes, appropriately so, in order to cover the incredible expense of providing health care — and now to pay the increasing costs around supplies and workforce.”
A key to overcoming it, he said, “is to be thoughtful and creative, and try and find ways to achieve that at scale without losing the core value of being independent, having autonomy around your finances and your investment decision-making.”
He identified three ways that BCH has met some of the challenges.
“We’ve all seen supply costs go up, and certainly in health care they’ve gone up over 20% in the past two years,” Vissers said. “But we belong to a purchasing coalition that has hundreds of hospitals in it — Vizient — and so we actually enjoy similar pricing to big systems like Mayo that we participate with in this purchasing group.”
Vissers also hailed partnerships with other health-care providers in the community. “A specific example I can bring forward is our need to provide in-patient rehab for our community,” he said. “We had a very high-quality but very small rehab unit at the old hospital, and we didn’t have space because of the significant equipment needs, to move that group over to the new facility at Foothills. So we were seeking a bigger solution, but to do it on our own was cost-prohibitive. We approached UCHealth about utilizing the top floor of what was, at the time, their new Broomfield facility. They were agreeable to doing a joint venture because they also had rehab needs. We were able to bring forward staff, expertise and support, and with that, we were actually able to build a rehab unit that was twice the size of the one we had before and serve a broader region, but take advantage of some of the things UCHealth brought to the table. Between the two of us, we were able to create an outstanding in-patient rehab for the patients of the region.”
Perhaps the major solution, however, and one that changed the face of life within BCH, was a partnership with Eden Prairie, Minn.-based Optum, an information and technology health-services business that’s part of insurance giant UnitedHealth Group.
“So far, I don’t think there’s been any downsides of working with Optum,” Greff said. “We began working with them in 2020 as the pandemic began. We’ve outsourced services to Optum in ways we believe is going to be a beneficial thing for the hospital.” Part of that was “rebadging” about 280 BCH employees to become Optum employees.
Even with Optum taking over some systems and employees, Greff said, “I don’t feel like we’ve lost control. In fact, I think we’ve tightened up the process for collecting receivables. The other thing that they’ve helped us with is billing.” He said that means BCH gets paid sooner with fewer disputes.
“It’s very challenging to have the level of analytics and data to make high-level strategic decisions. In fact, it’s a challenge even for much bigger systems,” Vissers said. “In our partnership with Optum, they bring to bear the data and analytics and support of a Fortune 500 company that is expert in this space but at a place that’s much more affordable and accessible for a smaller system.
“They also have taken over our revenue cycle,” he said. “The way we get paid and work with the insurance companies is incredibly complex, and half of their business is insurance, and it’s an area of expertise for them that now they are able to manage more effectively for us,. both in terms of cost-effectiveness but also in making sure that it’s a smooth experience for the patients and that we get paid accurately for what we do.”
Optum also provides another answer to that volume-buying dilemma.
“While Vizient helps us with common purchasing, like gloves, there are many other contracts that we have, so using the size of Optum to help renegotiate another of our other contracts, they were able to demonstrate significant savings over the next several years,” Vissers said. “Instead of paying them for the service, we pay them a percentage of the savings. So it really was a win-win to both of us, and we were both motivated for us to save as much expense as we can.
“We do pay them a flat fee, and it allows us access to the wide array of expertise and consulting, but at a much better rate, and, for example, instead of having to hire an actuarial scientist, which we never could — they go for a pretty darned high rate, more than I make as a hospital CEO — we can bring in that very specific expertise into the analysis of an initiative, or something we’re looking at doing around population health or with an insurance company.”
Greff noted that while the relationship is still early in the process, “it looks very promising for being very cost beneficial to us.”
Tonushree “T.J.” Tyagi serves as a liaison between Optum and BCH as vice president and “Optum Partnership Executive,” watching over the partnership that includes managed services spanning revenue cycle, inpatient and ambulatory-care management, analytics and project management. She serves in a dual role on BCH’s Management Council as well as on the OptumInsight Provider market executive team. But she’s also part of the Boulder community.
“I got to know BCH because I had a son that was born there, and unfortunately came six weeks early, and he was in their special-care nursery, which is a very scary time for a parent,” Tyagi said. “But we had exceptional care at BCH. So many of our leaders and staff are so closely connected to this community and to the value of having a locally governed, independent health care system in our community.”
Optum, she said, is “able to provide many services at a discount compared with what BCH has been able to provide those services historically because Optum has already made a ton of investment in, for example, revenue-cycle technology and expertise that allows us to provide those services in a more efficient way and in a higher performance way for BCH.”
Optum manages the rebadged employees, she said, “but they’re still deployed to BCH.”
Another advantage to the partnership, she said, is that Optum can “create career pathways for those employees that would have been difficult for them to have had at BCH. So as they grow beyond the scope of their roles that they’re in today, they have opportunities for career advancement.
“Also because of our scale,” Tyagi added, “we have access to a deep bench of talent that can be brought in to support Boulder when there are fluctuations in the job market. It’s that ability to create stability in those functions that we manage, no matter what’s happening in the local market.
“Can we be part of the story by allowing BCH to continue to serve independently for the next 100 years? That’s our hope and aspiration,” she said.
Still, nothing comes easy in the current climate.
“Compensation for employees is very challenging these days,” Greff said. “We’ve done a lot in the last year to take care of our employees, but still we have many many openings, as do other hospital systems, not just locally but nationally as well. And as you can imagine with the pandemic that’s been with us for the last couple of years, burnout is a pretty significant issue.
“We’ve done a lot in the past year to upgrade wages and benefits,” he said. “We made a significant adjustment at the beginning of this year that was a significant cost to us to make sure we were competitive with others in the local market.”
Vissers said that as of January, the average hospital in the United States was spending about 40% of its nursing budget on contract labor, having to bring in outside employees to work. “That represents 20% to 30% of the workers,” he said. “We just looked at the same month period, which was probably the peak of our workforce challenge, and we were at 20% — which is a lot less than the national experience and is somewhat lower than the regional experience.”
He said BCH “works very hard to make sure that we’re at least at market for our pay. Every year we evaluate and try and make sure we’re market competitive. What it means is a commitment to our employees and our patients that that’s where our investment is made. It explains in part why our margins are very tight. When we have increased resources, our focus is on patient care, local care, and employee investment and wellness.
“The second reason why I think we’ve done well, and I hear this from the employees, is that we have a very positive culture. People love being a part of the team. When I talk to my nursing staff and other employees, what they emphasize overall is ‘I love my team, I love working here,’ and they feel that sense of purpose, which is at least as important as all the other factors that get them out of bed in the morning and have them come to work.
“You would think that would be uniform across health care, but it’s been such a difficult time that there has to be an effort made to reinforce that purpose, and make sure we continuously bring meaning to our employees’ engagement every day,. regardless of whether they’re at the bedside or not,” Vissers said. “I believe, and I hope, that every employee feels like every day they’ve made a difference, they’ve reduced suffering, they’ve prevented harm or illness, and that they’ve saved lives.”
Gov. Jared Polis recently paid tribute to BCH’s leadership and staff for its “passion and commitment to the health, wellness, safety and care of the Boulder County community. Your resilience through months and months of uncertainty is appreciated,” he said, mentioning the pandemic-related issues as well as a series of devastating wildfires. “Through it all,” Polis said, “you completed an innovative partnership with Optum that helps you remain independent, you put the care of the community first and you earned top marks for patient satisfaction.”
In a statement issued last week, the Colorado Hospital Association also hailed BCH, noting that it “has been a pillar of the Boulder community and an invaluable member of our state’s hospital community for the past 100 years.
“While many Colorado hospitals are now part of larger health systems, others including Boulder Community Health have chosen to remain independent. Ths comes with its opportunities and challenges,” the statement said, mentioning BCH’s “constant commitment to its community, offering services and programs specific to the needs of the Boulder area, offering stable and well-paying jobs, and being a strong steward for its patients, employees, friends and neighbors.”
Would BCH ever consider giving up its independent status and being absorbed into a chain? Vissers hopes not.
“What ends up happening in the community, and why we’re so resistant to losing that independence, is generally costs go up, quality does not improve and sometimes goes down, and patients leave the community. For the most part, when you are acquired, it’s very different from thoughtful partnerships and affiliations.”
It’s not that he hasn’t been approached about a merger or acquisition.
“When I first arrived, it was very common,” Vissers said. “But I think we’ve been so consistent in our answer that that has pretty much stopped.
“But I will say that when I’m asked that, my answer is always this: If you have a way that we can partner with you to improve the care and the health of our community, we are very happy to engage in those conversations. And now, that’s what the conversations have been. Can we do this together? How can we solve this regional problem around the specific service line etc. But I think right now they understand that not only are we not interested in acquisition but we are more than capable of maintaining independence if we choose.
“Independence always has to be something that makes sense, that gets us closer to our vision,” Vissers said. “So there may come a day where the board and the community feel that that’s not the best path toward our vision. But right now we have that belief and we are able to maintain that path. We’ll continue to look for innovative ways to partner and succeed and shore up areas that need scale in order for us to continue to have the choice.
“So I can tell you that under my tenure, and I hope it will be a long one, my goal will be to always make sure that we have the choice. And I hope that if it happens in the future that it was the right choice, not because we were forced into it.”