Denver Health, a safety-net health system led by Donna Lynne, DrPH, is poised to receive a financial boost after Denver voters approved Ballot Issue 2Q. The measure increases the city's sales tax rate by 0.34%, generating up to $70 million annually to support Denver Health's mission.
Becker's spoke with Dr. Lynne, who previously served as Colorado's lieutenant governor and has been at the helm of Denver Health since 2022, about how the new funding will be used, the system's strategy for addressing financial challenges, workforce retention, and expanding outpatient services.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What do you expect to be the biggest financial challenge facing health systems in the coming year, and how are you preparing to address it?
Dr. Donna Lynne: The biggest issue is going to be public programs. For us, it's much more Medicaid than it is Medicare. Just about 50% of our patients are Medicaid, and about 20% are Medicare. So, that's 70% of our revenue. And, as a safety-net system, we don't have a lot of commercial business. What's going on in the employer market and traditional large insurer market is less relevant. Both what happens at the state level in Colorado and what happens nationally with respect to those two payers is probably the link we're focused on.
Q: Given the current economic climate, how are you prioritizing capital investments for the upcoming year? In what specific areas do you see the highest ROI?
DL: I'll break capital into a couple of buckets, including investment in technology, which is becoming really critical. This year, for example, we acquired a Da Vinci robot to assist in surgery but also to be a great training tool for our clinicians. Then, artificial intelligence — you can't go a day without hearing about AI. We've invested in ambient listening, which accomplishes a couple of things. Instead of a physician having to sit and type at his or her computer during a session or engage in transcription afterward, the ambient pilot we have going on — and will extend to the entire clinical team — allows the physician to return to having eye-to-eye contact with patients.
We've gotten great results where we see it's not only reducing burnout among physicians because they spend less time on the computer, but it also has improved the patient experience. In the cases where we've implemented it, we're seeing those two things, which are really important — reduced physician burnout and, hopefully, better retention, along with patients feeling more satisfied with their encounter.
The other bucket is really rebuilding facilities. As a safety net, we've been cautious because we're not throwing off a margin that allows us to build new buildings. We always have to go to the bond market. A lot of what we built in the 1970s is reaching its useful life. So we will move forward, hopefully with a decent rating now that we're more financially stable, and be able to invest significantly in full-scale replacement of some of our buildings.
Q: What strategic moves is your organization making to expand outpatient and ambulatory services, and how do you plan to balance this with maintaining inpatient care?
DL: We had a ballot measure here in Denver two weeks ago, in which voters agreed to an increase in their sales tax to help support Denver Health. It's because of our long history — we've been around for 164 years. We've served this community and been committed to supporting the underlying economic and social fabric. For example, we're in 19 high schools, and we don't get money from the city or schools. As you can imagine, in the public school system, we're seeing a lot of people who are on free or reduced lunch or qualify through other ways. They often don't have insurance or maybe have Medicaid.
But I view it as important for us to provide outpatient care. Schools are one setting, but we have a lot of clinics as well, and the demand is strong. People wait for appointments to see us. As part of that Ballot Issue 2Q money, we will add to primary care, pediatric care and dental care. That may mean expanding existing clinics, or it may mean adding a couple of clinics over the next two years.
Q: What specific strategies will your health system deploy in the coming year to improve employee retention, particularly in critical front-line roles?
DL: We're not dissimilar to a lot of other health systems. We all lived through COVID. And I say that we — as healthcare workers in general — were the most impacted workforce in the country.
I know a lot of other people, whether they were grocery workers or others, had their challenges. But we, of course, were treating people who had COVID, exposing ourselves without a lot of knowledge, particularly in the early phases.
What was interesting was there wasn't a lot of workforce turnover in the first year. I think everybody rallied to the challenge and knew this was a moment in history they wanted to be a part of. It resonated with why they went into healthcare.
What we and others saw maybe a year and a half out from March 2020 was people kind of saying, "I ran through the wall for this, but now I'm exhausted." Maybe they wanted to pursue a career outside of a hospital, particularly when hospitals were so hard hit. So we saw some turnover.
We also saw more conversations around burnout. In our strategic plan, which I worked on when I came to Denver Health, one of the key metrics was workforce retention, reducing burnout, and reducing acts of violence against our workforce — including verbal and physical violence.
Building that workforce was really important. We also didn't have a diversity, equity, inclusion, and belonging officer when I came to Denver Health. We thoughtfully built an understanding of what that role should be, so it wasn't just a name. We hired a DEIB officer about a year ago. That was important because our patient population is very diverse, and not having someone dealing with recruitment, retention and stressors was a missing component.
We're very focused on the workforce. We also invest in training for career advancement opportunities because that's important to me. Not everyone wants to stay in the same job. We provide tuition reimbursement, internal training programs, and pathways for employees to move into higher roles — like starting at the front desk in a clinic, then becoming a licensed practical nurse, and eventually a registered nurse. Building an internal pipeline is as important as making Denver Health a good place to work.
Q: How are strategic partnerships with community organizations and other healthcare institutions shaping your efforts to address key challenges within your health system and drive long-term success?
DL: I used to work at Oakland, Calif.-based Kaiser Permanente, and I learned a lot from their strategies around community engagement. They had more money to invest in the community and did things like providing affordable housing and supporting food markets.
It's clear you need to be perceived in the community as a good citizen. I don't mean as an individual, but as an organization. It's important for me and my leadership team to serve on nonprofit boards and support nonprofit organizations. Recently, I was at an event for a domestic violence shelter. We also have a clinic inside that provides healthcare to victims of domestic violence who come in.
We're a large employer with about 8,500 employees, so we're one of Denver's largest employers. Our employees are ambassadors for what we do. We like to get feedback from the community to ensure we're current with their needs.
With 8,500 employees and a very diverse patient population, we must be mindful of who we hire, where they come from, and their cultural competence.
It's common for us to support nonprofit organizations financially, participate in community engagement, and work with our diverse population. We have several team members dedicated to community engagement, which helps us reputationally. It also helped us pass the ballot measure. We did a lot of stakeholder work a year before the election to understand what communities need from a healthcare provider.
Everyone needs healthcare at some point, whether it's preventive care like a mammogram or an unfortunate event that requires hospitalization.