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Making Women's Health Work

Elyas Bakhtiari, for HealthLeaders Magazine, March 8, 2010
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Women's health is becoming more expansive and multidisciplinary, but there's no one-size-fits-all approach to success.

When the number of deliveries began dropping at Carolinas Medical Center a few years ago, hospital administrators knew why. A competitor had opened a new luxurious birthing center just down the road, with spacious suites, some of which featured air-jet Jacuzzi tubs, wireless Internet access, and other hotellike amenities.

That left Carolinas facing a challenge that many women's health service lines have to deal with these days. The market was sending signals for the 874-bed hospital in Charlotte, NC, to respond with a fancy birthing center of its own. Women deciding where to deliver their child tend to be more discerning healthcare consumers than most, and the details and aesthetics of the hospital matter.

But on paper, a capital investment of that size isn't always easy to justify. Even with a high volume of births, obstetrics isn't a very profitable service line and has to compete with other high-margin services for resources.

Many hospitals forge ahead into investments with the oft-cited statistic in mind that women make 80% of a family's healthcare decisions. A happy mother can fuel growth in other service lines by sticking around for pediatric care or referring her parents for cardiovascular care or returning later in life for bone and joint services.

Some hospitals are capitalizing on women's influence on these other services by broadening their service line to include much more than obstetrics. Women's health is becoming a cross-departmental, birth-to-death service line that distinguishes clinical gender differences in heart care, orthopedics, oncology, and other areas. That approach is the future of the service line.

"For some, there still is the perception that [comprehensive] women's health is purely a marketing tool," says Paula Johnson, MD, director of the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital, a 777-bed teaching affiliate of Harvard Medical School in Boston. "More important is that the programming itself is based on fundamental biological differences in how disease is expressed in women, and based on that need, you then develop the program."

But not everyone is there yet. Many hospitals still bet most of their chips on obstetrics and gynecology. Strategic threats and opportunities still remain in the traditional women's health model, so the transition has been slower. The right approach depends in part on the strategic goals and needs of the community.

With a competitor already distinguishing itself in the market based on birthing amenities, Carolinas decided to brand its obstetrics services around quality instead of immediately rushing a new women's hospital.

"We were looking at how to re-attract volume. Our competition had attracted mothers to their beautiful women's center, and we were dealing with an aging building," says Tina Ralyea, assistant vice president of women's services for Carolinas Health System, a 29-hospital nonprofit system in North and South Carolina. "But we decided to focus our efforts on patient satisfaction and providing that wow factor for care and quality service."

Even with a different strategy in place, Carolinas couldn't resist the pressure and market forces forever. Its certificate of need was approved to add rooms with amenities similar to its competitor's, and it plans on building by the middle of 2011.

Success Key No. 1: Invest in high-risk OB
A key step in Carolinas' efforts to differentiate its women's health services by quality was seeking disease-specific accreditation in maternal child care and high-risk obstetrics from The Joint Commission, which it received in December 2009.

The certification process not only improved quality and enabled the hospital to tell patients that it offered gold-standard care, but it also provided a strategic advantage and opened up a new market niche. The high-risk obstetrics specialization combined with a new children's hospital capable of handling high-risk patients established Carolinas as a go-to destination for complicated deliveries, says Ralyea.

"We have reached out and gotten many referrals from out of county because we know that this is the place to come and deliver for high-risk mothers and babies," she says. Physicians have also been helpful in publicizing the facility's accreditation out of county and generating new referrals.

These high-risk obstetrical services not only help with market differentiation, but they can also generate more revenue than most birthing services. For hospitals that have them, neonatal intensive care units often act as the "cash cow" of the women's health service line, says Sue Korth, vice president and chief operating officer for Methodist Women's Hospital, a 116-bed (with 28 NICU beds) facility slated to open in June in Omaha.

"Patients want to come to your facility if you have a Level III NICU and can take care of those babies," she says. "The length of stay is pretty high and the reimbursement is good."

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