For Robin Wittenstein, Ed.D., it’s all one river flowing into the sea. The sea is “changing the world” and the staging ground is Denver Health.
For the CEO of Denver Health, it’s all an organic whole. The ER. The safety-net. Public health. Obesity. Smoking. Undocumented patients. The least expensive way — also the medically superior way — to do dialysis.
What’s the place, the role, of Denver Health? “To change the world,” Wittenstein says instinctively. “In the broadest sense.”
“We provide medical care, whether they’re ill or injured. But as part and parcel of the fabric of the community, we figure out how to change the world so that people can have a better life.
“Sometimes that’s one patient. A person may come into ER and be using substances.
“Sometimes it’s groups of undocumented people.”
Sometimes it’s outreach on mental health, sugar drinks or sexually transmitted diseases. Sometimes it’s students in Denver Health’s 17 clinics in Denver Public Schools. Wittenstein says “the world” and she means it.
For her, the broad sweep and the “devil in the details” meld together.
She can’t talk about one without the other. Like that flowing river, her words naturally flow from the concept to the detail and back.
So, yes, medical care for the undocumented is a big part of “changing the world,” but before you know it Wittenstein is poring into the details.
“Until recently, the only way they could get service was to come to Denver Health’s ER and then leave. They were typically uninsured and weren’t eligible for Medicaid except in an emergency. We recognize that the ER was not a good method for them.
“But state Medicaid rules just changed. Now these undocumented patients can get kidney dialysis at an outpatient center. Clinically, it is a much better way to deliver care.
“We were constantly having conversations with legislators. One physician did research on the complications from getting dialysis only in an emergency. Some of the research was done on her own time and some as part of her work at Denver Health.
“We were educating the people who had the ability to change the rules, the legislators. HCPF — that is what Medicaid is called in Colorado, Health Care Policy and Finance — changed because there was evidence. The rule change will save the state a lot of money because outpatient dialysis is less expensive. Plus, when you get regular dialysis treatments, you’re less likely to get complications.
“So here is one way we are changing the world.”
Denver Health sees itself as changing the community in other ways, too. For example, in reducing consumption of sugar beverages. Denver Health reaches into the community as an educator. It targets parents of young children to help them understand the negative impact and the lifetime health implications — obesity.
“Our public health department — it’s a Denver Health thing. It’s not at all hospitals. Until 1997, we were city owned and operated, so the public health functions of Denver were part of what we did. Since 1997, all medical aspects of public health services come out of Denver Health — it’s part of our operating agreement with the city.
“It’s an advantage to the City of Denver for us to do this because public health expertise is integrated into the health care system. For example, disease surveillance, smoking, obesity, sexually transmitted diseases, are all looked at through the eyes of both public health and the medical profession.
“Denver has seen a decrease in smoking, which leads to fewer strokes and heart attacks.
“How do we identify and help people deal with depression? We completed a study on mental health among adolescents — the level of depression and anxiety and stress is frightening.
“We work on ways to partner with community organizations, to help deliver services to people in need.
“We partner with DPS: We have school based-health centers in 17 high schools, nurse practitioners who work in the schools, do physicals, help students struggling with substance abuse or mental illness — their own or in their family. The schools give us the space, but we pay for all the rest.”
Who pays for all this? Denver Health’s total budget is $1.1 billion.
The largest portion of Diver Health’s revenue comes from the federal government via Medicare and Medicaid. “Because we are a safety net hospital, the largest majority of patients are uninsured or underinsured; therefore we get federal assistance.”
Some funding comes from the state of Colorado for the care of uninsured patients.
“The City of Denver covers some of the costs of uncompensated care. If you have a medical need, you don’t need to wait until it’s an emergency,” says Wittenstein. “You can go to one of our health care clinics — nine across the county. All have different names. They will take care of anybody who needs care whether you have insurance or not.”
Then there are grants.
And fundraising, via the Denver Health Foundation. “We are not as actively involved as we could be. We’re looking at how we can connect with the philanthropic community better. We focus on equality of care — there is a mission behind this that is related to social justice.”
Wittenstein says she spends a lot of time in the financial policy offices — “how we interact with the state Medicaid office, the more strategic aspects. I spend as much time looking at quality of care indicators as I do at financials. At the core of what we do, our people lay their hands on patients. That’s the most important aspect of my job.”
What prepared Wittenstein for this job?
She studied health planning at Penn State and earned an MBA from the University of Miami and an Ed.D at George Washington U — then went to work in the field for close to 40 years.
Her most valuable education, she says, has been mentorship from people in health care management.
“I was really lucky. At a small Catholic hospital in Miami I ended up connecting with the woman who was the CFO at the time. A female CFO was very unusual in the 1980s. She took me under her wing. She gave me a lot of advice about pathways for my career and the opportunity to do things that do not necessarily appear on a resume — such as, to fail and keep going.
“That changed my whole trajectory.
“People who just stopped and provided guidance and assistance, and feedback, helped me be better — incredibly intelligent and caring people.”
I ask Wittenstein, “Are you a mentor?”
“I try to be. I have been involved in formal mentoring programs. I get matched up with someone early in their career. Also, more informal mentoring. I try to give to others in the way that was given to me.”
Wittenstein say she puts in 11 to 12 hours a day at work. “These are the hours I’ve kept a very long time.” She and her husband, who is retired, have two grown children.
Wittenstein is bullish on Denver Health.
“The people who work here believe in their heart of hearts in taking care of people, no matter what. The level of care and compassion amazes me.
“A lot of hospitals and doctors provide good medical care. When you come to Denver Health, first and foremost you are a person. Not someone with or without an insurance card. For a lot of people when they walk in, that is the first time all day they’ve been treated as a person.
“We treat people with respect and dignity — something we all want.
“You see people from every walk of life. You see see complicated medical conditions and the complicated human lives that people live. You see the ways their lives impact their health and vice versa, in a way you may not see somewhere else.
“Even if a doctor at Denver Health goes off to be a plastic surgeon in Manhattan, he or she got to see this range, which makes them a better physician.
“Every practitioner should have an opportunity to work in an institution like Denver Health. We deliver on the mission of social justice.”
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