An interview with Marna Borgstrom, YNHHS President and CEO

Editor's note: As the Yale New Haven Health System continues to grow in size and scope, the Bulletin will run a series of informative articles on the history, the vision and the growth of YNHHS.

What is Yale New Haven Health System?

Yale New Haven Health System (YNHHS) is made up of Yale-New Haven, Bridgeport and Greenwich delivery networks — which include the three hospitals and their affiliated outpatient services. YNHHS also includes a physician practice called Northeast Medical Group (NEMG), and the corporate offices that provide financial, strategic and administrative support to the members.

When was Yale New Haven Health System created?

The mid-1990s was really the beginning of our modern health system. In 1996, we signed an affiliation agreement with Bridgeport Hospital, and in 1998, with Greenwich Hospital.

Why was Yale New Haven Health System formed?

There were several important reasons. Healthcare costs were rising and we wanted to try to slow that growth. Insurance was another big reason. In the 1990s, health insurance companies were consolidating. Suddenly instead of working with many smaller, regional insurance companies, Connecticut hospitals were dealing with four or five huge insurers, and the government. The size of these new commercial payors put us at a real disadvantage when we tried to negotiate reasonable contracts.

How did affiliating with other hospitals make us stronger?

A larger provider system has helped us realize both economic and clinical advantages. We share certain business and administrative services — such as group purchasing, legal services, planning, marketing, patient financial and admitting services, and information technology. In addition, we have extended key service lines like Smilow Cancer Hospital, the Children's Hospital and heart and vascular services across the system, which has added value to both the hospitals and to patients.

How do patients benefit from being part of YNHHS?

In addition to the service lines which provide care closer to home, we are sharing best practices and developing a single standard of care at all three delivery networks. For example, we have established morning safety rounds at each hospital. We share quality metrics across the system for conditions such as heart attack, heart failure, stroke, pneumonia, surgical and perinatal care, primary care and geriatrics. By working together, we can elevate the quality and safety of care for our patients.

Are there other components to Yale New Haven Health System?

Yale New Haven Health System continues to grow. Last September, YNHHS grew by 30 percent with the addition of the Saint Raphael Campus which added 533 inpatient beds to YNHH, plus the Grimes Center for long-term and rehabilitative care. In addition to the three hospitals and their affiliated ambulatory organizations and physicians, Yale New Haven Health has relationships with other providers and several specialty networks.

Is Yale School of Medicine part of YNHHS?

Through the university, Yale School of Medicine signed an affiliation agreement with YNHHS in 1999 to collaborate on clinical program development, medical education and clinical trials. Yale School of Medicine is also one of our Epic partners. Epic is an excellent example of how the three delivery networks, plus the School of Medicine and NEMG are partnering to enhance care for providers and patients, and at the same time, beginning to meet the challenges of healthcare reform.

Has YNHHS been successful?

We have improved patient care, enhanced revenue, managed costs and increased patient volume for each of the delivery networks. We are more closely aligned with Yale School of Medicine than ever before in our history. The system has provided a lot of value to the delivery networks, but there is more we can do.

How has the system changed since it first formed?

In the early days, we felt it was important to emphasize the independence and identity of the local hospitals — but over the past five years or so, we have become more and more integrated and acted more like the regional healthcare system we are. The environment continues to challenge us because health care is not affordable the way it is currently organized. More and more hospitals have joined or formed systems. Stand-alone hospitals are very vulnerable today, as we saw with the Hospital of Saint Raphael, which is now part of YNHHS.

How has the system prepared us for changes in health care in this country?

As Connecticut's leading healthcare system, YNHHS has strengthened each of our individual hospitals and helped us succeed in this challenging healthcare environment. We are no longer three very distinct hospitals with some shared corporate services. We are more closely aligned and developing ways to manage a large population of people — not just when they are sick and need a hospital, but across the whole continuum of care. Being a system will help us make the transition from the old fee-for-service method of payment to performancebased payment — which will ultimately lead to more effective health care for our patients and the communities we serve.