HEALTH CARE PROFESSIONAL/ADMINISTRATOR
How Connecticut Orthopaedic Specialists’ Glenn Elia has recast his practiceÂ’s care-delivery model
On his first day as administrator for the New Haven Orthopedic Group, Glenn Elia remembers its founder, John Aversa, telling him, Â“If youÂ’re not growing, youÂ’re dying.Â”
The phrase became Â“sort of my mantra,Â” says Elia, CEO of the practice, now known as Connecticut Orthopaedic Specialists. He has made his mark by establishing new models for delivery of orthopaedic health care in venues such as company-run outpatient surgery centers and urgent care walk-in centers.
Connecticut Orthopaedic Specialists operates eight offices in greater New Haven, with MRIs at two locations and physical therapy centers at seven. It also cares for athletic teams from Yale University, Quinnipiac University and 16 high schools. The practice has 16 board-certified orthopaedic physicians, three podiatrists and a rehabilitation physician.
Â“My job here, besides running the business, is to sort of be a bit of a visionary about what are the needs of the community and how do we meet these needs,Â” Elia says.
Elia, now 56, began his career as a physical therapist, with BS degrees in biology and anatomy from Springfield (Mass.) College (1978) and a certificate in physical therapy from the University of Pennsylvania (1979).
In 1985, he transitioned to the administrative side of the business, as director of operations and director of physical therapy at a couple of walk-in centers.
While earning an MBA at Sacred Heart University (1992), he began physician practice management at Neurosurgery Associates in Waterbury.
Aversa, an orthopaedic surgeon who started the New Haven Orthopedic Group in 1963, hired Elia in 1993.
Â“We were growing and doing well but we needed someone to help give us more direction,Â” he says.
Â“At the time we recognized that orthopaedics was " > increasingly subspecialized,Â” Elia says. Â“People wanted not just a general orthopaedist. We changed the [business] name to Connecticut Orthopaedic Specialists to reflect what we believed to be a better representation of our work.
Â“We also saw the need to provide ancillary services such as developing a big rehab program.Â”
Seeking other opportunities, Elia traveled to Texas to research how several orthopaedic groups were managing their own outpatient surgery centers.
Â“That was really an important turning point,Â” he says. Â“We began to investigate the [Connecticut Department of Public HealthÂ’s] Certificate of Need process. It probably took a good year. We ultimately were successful. We got the first Certificate of Need for an outpatient orthopaedic surgical center [in the state]. We broke new ground, and opened up a one-room, single-specialty orthopaedic surgical center in Hamden in 2000.Â”
The strategy worked.
Â“We now started to compete with hospitals to deliver high-quality services,Â” Elia says. Â“More and more patients heard about it, and loved it.Â”
The practice added doctors and in 2011 opened a new, bigger outpatient surgery center in Branford, with three operating rooms and a pain-management suite.
Â“This is one example of leading the way,Â” Elia says. Â“Other [orthopaedic] practices have benefited, and now also have surgical centers.
Â“The other thing that caused our practice to grow was my knowledge of knowing how to deal with Hartford,Â” Elia adds. Â“We were able to acquire two MRIs.
Â“The walk-in center business is the latest wrinkle. We were finding a lot of patients were getting hurt and had to go to the [hospital] ER, which was not well equippedÂ” to handle orthopaedic patients.
About 18 months ago COS launched OrthoNow, an emergency walk-in care service currently open seven days at week, for limited hours, at its Branford and Hamden offices.
Â“We have got digital X-ray,Â” Elia says. Â“[Patients] pay for an office visit. It takes 20 minutes. Then they have a follow-up appointment.Â”
Elia also has pioneered new paradigms with health insurance companies.
Â“Probably the hardest thing to sell the first time was the surgical center, because it was so new,Â” he says. Â“We worked with the carriers to develop contracting and pricing. They began to realize this was a savings to them, rather than going through a hospital. As I developed a reputation, they began to trust that what I said was true. When we say weÂ’re going to do something, weÂ’ve been able to deliver the goods.Â”
David R. Fusco, president of Anthem Blue Cross and Blue Shield of Connecticut, was an early convert.
Â“I think Glenn shows great vision and great leadership in sort of stepping outside how we currently deliver care, and really pushing that agenda,Â” Fusco says, Â“to do it more effectively and to meet evolving needs of our community.Â”
Elia offers reciprocal praise of Fusco. Â“Dave has always been a like-minded visionary carrier,Â” he says. Â“Right now IÂ’m working with Anthem to develop new payment methodology.Â”
COS has what Elia describes as Â“an unusual relationshipÂ” with Yale in caring for its athletic teams: a Â“capitated contractÂ” health-care plan under which the university pays a per-member/per-month fee for patient care and surgical care.
Â“ThereÂ’s no one else around doing it,Â” he says. Â“It started in California in the 1990s, then died. But this agreement with Yale has been a very successful working relationship. We provide coverage at their health center and do surgery at their surgical center. If they use our surgical center they pay a fee.
Â“WeÂ’re proud of the fact that weÂ’ve kept the cost of orthopaedic care for Yale flat for ten years.Â”
In addition to caring for high school and college athletes, COS provides educational clinics for coaches on injury prevention and rehabilitation.
A corporate sponsor of the Southern Connecticut Conference (SCC), which represents 22 high schools and 27 sports in greater New Haven, the practice in 2010 established Â“Comeback Player of the Year ScholarshipsÂ” awarded annually to a severely injured male and female high school athletes overcoming great odds to become a role model. Each winner receives a $1,000 scholarship.
Â“That was GlennÂ’s idea, to recognize kids for the hard work they do,Â” says SCC Commissioner Al Carbone, Â“HeÂ’s a wonderful man, a father who cares about his kids, who played high school sports. HeÂ’s a very enthusiastic gentleman with a great mind for business. He is on the top level and ahead of the curve. But to me what is most impressive is he is not just somebody whoÂ’s doing business. He wanted to get involved in the community.Â”
Elia attributes much of COSÂ’ success to the support of the practiceÂ’s doctors.
Â“It took some vision and some insights, but I couldnÂ’t have done this if I didnÂ’t have physicians who were willing to take risk and invest in the practice,Â” he says. Â“A lot of physicians want to see patients and go home, like Groundhog Day [the 1993 film starring a weatherman repeatedly living the same day]. But this group has been willing to embrace change. ItÂ’s risk and return, which is why every group in Connecticut doesnÂ’t have what we have.
Â“ThatÂ’s whatÂ’s made us different. WeÂ’ve perceived need in the community and aggressively gone after ways to meet those needs. Now what we perceive is a need to deliver the services in a more efficient manner.Â”
Elia sees the need growing with the implementation of the Patient Protection and Affordable Care Act.
Â“There are a lot of changes coming with Obamacare,Â” he says. Â“We know that the way we get reimbursed will most likely change. Expect cost compressions. There are going to be more people in the system. Expect the remuneration is not going to go up.Â”
Aversa believes Elia is well equipped to meet the challenges.
Â“He has lived up to all our expectations,Â” Aversa says. Â“Every year we have added some new facet to our practice. With GlennÂ’s help, we are one of the most, if not the most, successful "site click here in the state in orthopaedics.
Â“You trudge and trudge and trudge, and when you think youÂ’re on top, thatÂ’s a dangerous time,Â” Aversa adds. Â“We donÂ’t want to be complacent. We always want to do the right things to enhance our practice.Â”
COS began offering cervical and lumbar surgeries at its surgical center last year, after merging with a neurological group. More partnerships are likely with other specialties and partners.
Â“WeÂ’re looking forward to working with Yale to bring orthopaedic care to another level,Â” Elia says. Â“I think Yale has aspirations of building an orthopaedic facility, and we certainly look to collaborate with them. WeÂ’re having those conversations right now.Â”
In addition, Elia is Â“actively communicating with providers all within the bandwidth of musculoskeletal.
Â“We have 350 employees, full and part-time,Â” he says. Â“We expect that number to grow.Â”
Aversa sees opportunities in home care.
Â“I would like to have a facility that we control that constitutes the continuum of care Â— nursing, rehab, diet, cleanliness Â— seamlessly,Â” he says. Â“I want you to come in the front door [and] be treated, be managed, be followed. Â“We should change our name "http:// /blog//#here">here Orthopaedic Complete Care. ThereÂ’s a trend to operate on people and send them to a rehab facility. But they do significantly better treated at home with support. ThatÂ’s a better way of doing it, and itÂ’s cheaper.Â”
Chances are, Elia will figure out a way to get that ball rolling.
Â—Â Karen Singer
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