2009 Dynamic Dozen, No. 8: CoxHealth

CoxHealth has started 2009 at a fast clip with two big announcements: The Clinic at Walmart and a bump in its ranking on the annual list of the nation's Top 100 Integrated Health Systems.

The nonprofit health system reported 2008 revenues of $1.9 billion, up from just more than $1.7 billion in 2007 and almost $1.55 billion in 2006.

In addition to a steady increase in revenues last year, CoxHealth finalized a settlement with the federal government, ending a three-year investigation into potential errors involving complicated Medicare billing practices and CoxHealth's business relationship with the physicians group - not owned by CoxHealth - at Ferrell-Duncan Clinic. As outlined in a July 2008 press release issued by CoxHealth, the hospital agreed to pay $60 million plus interest. Patient care and safety were never under investigation.

Moving forward, CoxHealth is in an expansion mode. On the agenda are a new emergency department and parking garage at Cox South and the conversion of Cox Walnut Lawn into an orthopedic specialty hospital.

With The Clinic at Walmart, which opened March 2 at the Walmart supercenter on South Campabell Avenue, CoxHealth is venturing into another arena of patient care.

"We are committed to providing quality care in an accessible setting for our patients, and I can't think of a more accessible place than Walmart," said Laurie Cunningham, vice president of corporate communications. "We've been talking to them for almost a year."

With an average per-visit cost of $50, the clinic will be open 10 a.m.-7 p.m. Monday-Saturday and 11 a.m.-4 p.m. Sunday. Basic walk-in services will include treatment for sinus and upper respiratory infections, earaches, bladder infections, insect bites and stings as well as some screenings, flu and tetanus shots, suture removal and sports physicals, Cunningham said.

CoxHealth's physician clinics' standing as accredited by the Joint Commission on Accreditation of Healthcare Organizations also applies to the Walmart site, a first for a Walmart clinic.

"It's a rigorous process you have to go through," Cunningham said of accreditation. "We get surveyed every three years."

The Clinic at Walmart provides another avenue of care that can reduce emergency-room usage for routine health concerns, especially after hours and on weekends when physician offices are typically closed.

"It's so important that people in our community have access to primary care," Cunningham said.

"We always hope people establish themselves with a physician, but this can be a wonderful option. ... This is more affordable for patient care (than an emergency-room visit) and better for the health system, too."

For its continued work on integrating its system, CoxHealth rose nine spots to No. 49 on the annual list of the Top 100 Integrated Health Systems, a list CoxHealth has been on since 2006.

An integrated health system puts "all sorts of medical services ... under the umbrella of one organization," Cunningham said.

CoxHealth's efforts began in the mid-1990s with the emergence of managed care.

"Our board of directors and senior leadership felt that CoxHealth could compete more effectively in the marketplace through a closer alignment of medical services ranging from the traditional hospital-based inpatient and outpatient services to physician clinics, behavioral health and home health care," said CoxHealth CEO Robert Bezanson in an e-mail response to questions.

Integrated systems improve the quality of care and keep costs down because all sides know what the others are doing, Cunningham said.

CoxHealth recently partnered with six Missouri-based and Kansas-based health systems to form Mid-America Service Solutions, a limited-liability purchasing partnership.

"That will help us reduce our costs, because we'll be able to purchase in greater volume ... which will then be passed to the patients we serve," Cunningham said.