When John Haupert took over as CEO of Grady Health System, Atlanta, Georgia five years ago, the system was showing a $27 million dollar loss. But during that time, initiatives at Grady have reduced the system’s uninsured rate, maximized its electronic medical record system capabilities and improved senior care. As of the 2016 fiscal year, the hospital is now showing a $40 million profit. Haupert talked with H&HN about taking on the challenge and how the system has evolved in five years.

How has your Medicaid patient effort reduced the system's uninsured rate?

HAUPERT: There was a mindset that if someone had qualified for the charity care policy at Grady they remained under that policy. That policy looks at income levels for uninsured patients to determine if they receive free care or minimum cost care. They were never reassessed to determine if they became eligible for other types of funding.

We put a process in place that assesses a patient each time they come in to determine if anything in their financials has changed to qualify for other funding. We found there were thousands of existing Grady patients who would have qualified for the state Medicaid program if the patient had followed through on the actual application process.

That's easier said than done. For an unfunded patient or anyone who doesn't deal with the government, completing an application is a lot of paperwork and can be confusing. Instead of doing that ourselves, we brought in two competing Medicaid eligibility companies to compete to convert our qualified unfunded patients to Medicaid. We set performance parameters for those companies and worked closely with them to begin the conversion.

Part of what these companies do is handhold the patient and their family through that process to help them get their paperwork together, submit their documents, and remind them of deadlines. We were able to go from 42 percent of our patients being uninsured to 27 percent — meaning that difference came from Medicaid.  Now that program has matured, so we're finding fewer patients to convert, but we're still doing that analysis and helping new patients determine if they'll qualify for the traditional Medicaid program. Georgia is not a Medicaid expansion state, so we’re qualifying them for the traditional program.

Grady has efforts around senior care and complex geriatric care. What has that done?

HAUPERT: We were losing patients who may have been uninsured or on Medicaid when they became of Medicare age. There was already a senior health program in place, but it was more focused on wellness activity and case management. It wasn't robust enough and hadn't been well-funded. So we made a significant additional investment in our high acuity geriatric center.

There's not many around that staff board certified geriatricians. And we created an environment within that whole geriatric care process that provided the patient with lots of hands-on care management and patient navigators to help them through the system so they weren’t left to do it on their own. We also had more engagement from a marketing and interaction point of view with seniors. That’s helped us retain more of those patients.

Many people don't have an appreciation for difference between a geriatrician and an internist. There are some internist who are very good with geriatric populations and there are some who when patients are dealing with age-related illness or just age physiology are not as good at it. And it's amazing to see what a very well-educated experienced geriatrician can do particularly around medication management.

How did Grady change its financial trend?

HAUPERT: One of the most important things that happened was the decision to invest in an electronic medical record with Epic. EMR implementation does not improve your financials unless you fully take advantage of its tools. We weren’t using its functions to their maximum potential. At the same time, we had recruited a new CFO and new senior V.P. whom both had experience with Epic. We systematically, but rapidly moved from partial implementation of the EHR model to maximum investment. By having the people in place who understood what we were trying to do we fine tuned every component that goes into our financial  management — from coding and billing to receiving payment. In that one year period, we increased net revenue at Grady by $106 million.

Any advice for leadership who step into a similar situation that you did?

HAUPERT: When you enter a turnaround situation like this I think there are several approaches. You have to balance the urgency of the turnaround with the culture of the organization. I had to replace key people without creating an environment in which our 5,600 employees thought they would be laid off. At its heart, the organization has remained true to its mission, and the people providing care to the patients were doing a great job. We converted to a traditional corporate 501(c)(3) governance structure with community leaders who could influence others in the community to support Grady. Once that was done they could then bring in professional managers that Grady wouldn't have been able to recruit before. But some leaders make the false assumption that everything with the organization is wrong. Grady has survived for 125 years with some incredible people providing care to the patients.