Tri-Cities Community Health: Al Cordova, Chief Executive Officer

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Tri-Cities Community Health is a mid-sized Federally Qualified Health Center (FQHC) comprised of four facilities serving the communities that span the three cities of Pasco, Kennewick, and Richland in Washington. Within this population there are a fair number of migrant workers and citizens from outlying towns.

Recently, the Affordable Care Act made it possible for Tri-Cities to be granted $7.4 million for the construction of a new state-of-the-art, 40,000 sq.-ft. health center. When Al Cordova, chief executive officer, came onboard in December of 2011, the center had already been opened and was proving itself to be a valuable asset to the organization.

Tri-Cities is also at the tail-end of implementing an electronic medical record (EMR) system, and it is renovating and expanding medical facilities. Furthermore, the Department of Health Resources and Service Administration has awarded Tri-Cities $650,000 to establish a new community health center in Richland, an area that does not yet have one. Tri-Cities also submitted a federal grant application for $500,000 to establish two school-based health centers that will be located on school campuses.

“We see ourselves moving into sort of a growth mode,” Cordova said. “We have 17 medical providers—physicians and nurse practitioners–and we’re planning to add more.”

Four more physicians joined in September, Cordova added, and the budget calls for the recruitment of six more.

A patient population in need

Cordova stressed that Tri-Cities has a significant patient population who desperately need Tri-Cities’ services. Close to 75 percent of the patient population the organization serves is under the 100 percent poverty guideline.

“You can imagine there’s just a lot of people out there who can’t afford to have healthcare or have insurance coverage,” Cordova explained.  “So we serve a population that truly does need a safety net and that’ s why we have been able to qualify for these projects, for these grants that we have received and plan to receive over the next few months.”

Cordova’s background is varied and prestigious. He started off his career with Kaiser Permanente, where he served as an assistant hospital administrator and later as assistant medical group administrator. This led him to positions with Harvard and John Peter Smith Network in Texas, the latter of which made him responsible for 21 community health centers, 18 school-based clinics and 22 specialty clinics, all of which generated 700,000 visits each year.

After retiring early and quickly becoming bored with retirement, he looked around for a role in which he could be influential. He settled on Tri-Cities, mainly because it is an FQHC.

Cordova likes to tell people about his background, not to earn bragging rights, but to show them that FQHC CEOs tend to have a great deal of experience.

“I came here because of the mission,” he stated. “I’ve already worked for some of the best healthcare organizations in the country. My goal in the time that I’m going to be here is to make this the premier FQHC in the state of Washington.”

A lofty goal with loftier challenges

The road to being the best is paved with many stop-gaps along the way. One of these is the sheer volume of individuals who qualify for services, not to mention the revenue problems that come with 30 percent of Tri-Cities’ patient population being uninsured and not qualifying for Medicaid or other state-funded programs.

When 33 percent of your patient population can’t reimburse you, Cordova said an emphasis on maintaining financial viability becomes essential.

“These kinds of organizations are challenged because in order to become financially viable you’ve got to not only operate efficiently, but you’ve got to find ways to bring in some additional revenue.”

Part of Cordova’s lofty goal is to make Tri-Cities appealing enough so that they can draw insured patients to their services and with them, the revenue that will offset the cost of treating those with no insurance.

“When I talk about making this a premier organization, the landscape is changing for healthcare,” Cordova explained. “We’re moving away from this fee-for-service environment where we’re going to get paid for quality outcomes and patient satisfaction.”

He is pushing Tri-Cities to adopt the patient-centered medical home model with the goal of being certified as such by the end of 2013. In 2014, when healthcare reform has been fully rolled out, Tri-Cities will also benefit financially since most of the now-uninsured will then have some level of insurance from which the organization can be reimbursed.

“I think a lot of the focus does need to be placed on moving to this patient-centered medical home model where you’re not only coordinating but facilitating the provision of care across the spectrum of care, where you have people assigned a personal physician, where you have a physician-direct medical practice,” Cordova said. “We have to move toward the whole patient orientation. So I think we’re going through an evolution that is consistent with what is deemed expected.”

So far, he added, healthcare reform cannot be paid for on a per-unit basis. It’ll have to be paid for by keeping people healthy and providing preventive care and case-management support.

“It’s interesting how it’s coming back around. When I worked for Kaiser Permanente 25 years ago, the organization was already functioning as a patient-centered medical home. As an HMO, Kaiser did operate with the notion of rationing care, but to actually provide more of a holistic orientation,” Cordova said. “FQHCs are better-prepared for the future when we talk about coordinating care and providing this holistic care and looking to meet the different needs of patients.”

Not only does Tri-Cities provide primary medical care, but it also has a robust behavioral-medicine program, a detox facility, the WIC program, home-care services, and a chemical-dependency unit.

“When we’re talking about moving toward the patient-centered medical-home model, we’re in a much better position to do that than let’s say a medical group or a private practice, because they generally don’t have these other pieces and we do,” Cordova said. “We have the dental, the mental health, the outreach, the case management under one organization, and our communication and coordination is good and can treat patients for a variety of medical problems.”

-by Pete Fernbaugh

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