Reflections After a Decade: Duke LifePoint Healthcare's Shared Vision for Quality Care

David Dill, president and CEO of LifePoint Health, and William Fulkerson Jr., MD, executive vice president for Duke University Health System, detailed how the joint venture continues to improve the quality of care provided, along with the strategies they hope to implement in the future.

2021 marks the 10-year anniversary of Duke LifePoint Healthcare, a joint venture between Duke University Health System, an academic health system in North Carolina, and LifePoint Health, a national health system with 89 hospitals across 29 states.

The joint venture currently operates across 14 hospitals across four states: North Carolina, Virginia, Pennsylvania, and Michigan. Duke LifePoint partners with community hospitals through acquisitions, shared ownership, and joint ventures to help the organizations reach success around quality care and safety, physician recruitment and retention, and the ability to expand services.

Prior to the joint venture’s founding in 2011, Duke and LifePoint partnered to increase the quality metrics of Maria Parham Health, a hospital that LifePoint had acquired in North Carolina, due to a pre-existing referral partnership, according to William Fulkerson Jr., MD, executive vice president for Duke University Health System. He also noted that Maria Parham, the first hospital to join Duke LifePoint, saw its quality became best in class and garnered the attention of other hospitals in the area.

Fulkerson and David Dill, president and CEO of LifePoint Health, recently spoke with HealthLeaders to reflect on a decade-long partnership, how the joint venture continues to improve the quality of care provided, and what strategies they hope to implement in the future.

Starting small

"Smaller community hospitals began reaching out to us … and wanted to know if Duke would acquire them," Fulkerson said. "We run great hospitals, but we don't run smaller community hospitals. It occurred to us that this was an opportunity, perhaps, to introduce LifePoint to these organizations, and to think about what a joint venture would look like between Duke and LifePoint."

Even back then, LifePoint had a strong tradition of running successful hospitals in non-urban communities, Fulkerson said. Duke felt that by leveraging LifePoint's operational and financial strength with its strength in program development, safety, and quality, the two organizations could make this joint venture work.

"It's in our vision statement that we are a quality-driven health system, and realizing that being able to deliver safe, high-quality care in a smaller community is absolutely necessary to the success of the enterprise," Fulkerson said.

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"This partnership wasn't founded initially to just go out and buy hospitals or contribute hospitals into it," Dill said. "It was what Dr. Fulkerson said: the relationship started to help improve care at the bedside. I think because of that, it had a great chance of success from the beginning."

One of the avenues to success includes a joint venture board, in addition to the standard hospital governing boards. Both Fulkerson and Dill participate on the board, which reviews results, strategies, and identifies new ways to deploy capital into the future.

The two systems also operate a Quality Oversight Committee as part of their program, which is made up of a group of clinicians from LifePoint, to review the quality results of each of the Duke LifePoint hospitals.

"At least once a year, every one of our CEOs is accountable for communicating their results, follow-up items from the previous meeting, and also taking feedback to continue to push their organizations forward," Dill said.

Fulkerson added that the joint venture also employs patient safety officers, a set of staff primarily comprised of registered nurses from Duke that work at LifePoint hospitals.

Creating success over the last decade

Dill said that of the joint venture achievements, he's most proud of is a 39% reduction in preventable harms between 2011 and 2020. Some additional highlights include:

• A 62% reduction in hospital-acquired pneumonia
• An 85% reduction in hospital-acquired urinary tract infections
• A 62% reduction in venous thromboembolisms

Duke LifePoint has also seen "significant improvement because of this framework within our national quality program," Dill said.

"That's just proof positive of what we're about," Fulkerson said.

The joint venture also became a member of the Hospital Engagement Network (HEN) through the Centers for Medical and Medicaid Services, Fulkerson said. Organizations involved in the network help identify solutions that have reduced hospital-acquired conditions and share those learnings with other healthcare organizations.

"We had the largest reduction in preventable harms of anybody participating in the HEN then. In fact, we were recognized with The Joint Commission’s John M. Eisenberg Patient Safety and Quality Award in 2018," Fulkerson added. "It's a prestigious national award for achievement and patient safety and quality, and we're proud of that."

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Duke and LifePoint have also invested over $1 billion of capital into the joint venture.

"Those are investments in the communities where we operate, but what we're building and what we're investing in is growing and expanding service lines in each of these companies," Dill said. "Revenue started at zero, and now we're up to around a little over $1.5 billion per year in annual revenue is rolling through the partnership."

Duke LifePoint also brought clinical affiliations to the communities, through the Duke network, Dill said. Depending on the needs of the community, Duke can provide clinical teams for cancer, telestroke, heart programs, and more to the hospitals.

"There are reasons some of these types of partnerships are successful and some aren't," Dill said. "We haven't agreed on everything, but we work through it together."

He added, "When I think about the real reason the partnership has been successful, there's a lot of trust and respect for both organizations. But that shared vision from the very beginning is a great reminder that if you start with that, then everything else just gets a little bit easier."

Future strategies

Both leaders are bullish on the prospects for the joint venture, with plans to continue to bring quality care and patient safety to hospitals in the region.

"Continuing quality is a journey; you're never done," Dill said. "We're looking for ways to continue to grow the footprint of hospitals or other ancillary services that support changes in the delivery of care. There are a lot of lessons learned through COVID, and one of them is people may want to receive care a different way, and we need to be ready for that."

He added that there may be investments in technology due to the changes in patterns of how patients receive care.

"We'll continue to look for acquisition opportunities going forward, where we think we can bring a unique product to the table for organizations with a tremendous track record of success," Fulkerson said. "I've been impressed with Duke LifePoint's and LifePoint's ability to build on the communities we serve today with more vertical integration and expansion of physician services in those organizations that just serve to bring more and more services to the communities there."

He echoed that Duke LifePoint made about 10 years' worth of progress in virtual healthcare and telehealth in six months during the COVID pandemic, and the systems plan on continuing to assess their strategy there.

Dill added that those who are interested in building partnerships need to account for how much work it takes and that if leaders go in with a shared vision, success is achievable.

"I don't think there will ever be another partnership like this one," Dill said. "The amount of time that we spent together, the work that we've spent, what we have built together, it is the barometer of all partnerships."

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