The only facility to make the list all seven years is Boston's Brigham and Women's Hospital. Blodgett has appeared on the list four times, most recently in 1997. The hospitals merged in September 1997 after a two-year challenge from the Federal Trade Commission ended and Spectrum officials promised the Grand Rapids community the hospitals would not increase prices for three years. They also vowed that price increases would not exceed the Consumer Price Index for another four years after that, Gonzalez says. Another 200 positions were targeted for reduction by attrition because of budget law-related revenue shortfalls.
Every department now has one director responsible for the same activities on two campuses.
Priority Health, an HMO that was started at Butterworth 11 years ago, invested in an aggressive care-management program at the time of the merger, which has paid off in shorter average length of stay, Gonzalez says. The HMO moved to a primary-care capitation model, also risky given widespread industry reports of failures. That has translated into attention to costs at both campuses. Placing risk with Spectrum's physicians makes care management essential, Gonzalez says. With 85 percent of the plan's premiums distributed to Spectrum's physician-hospital organization, the 600 doctors in the PHO are becoming attuned to how practice patterns affect the amount of money left after expenses.