For this month’s installment of Hospital Spotlight, HealthCare Business News spoke with Dr. Norman H. Chenven to get a history of Austin Regional Clinic and how he oversaw its growth from three to 360 physicians in an ever-changing environment.

HCB News: What inspired you to get involved in health care?
Dr. Norman H. Chenven: My father was a podiatrist. He encouraged both my brother and me to become doctors. I resisted that push initially, but lacking an alternative career interest after college, I applied to and was accepted into medical school. But it took until my third year and my first clinical rotations to realize that health care would be my future. It was clear that patient contact was something that engaged me like nothing else in my prior experience.

Medicine is an all-encompassing career and that is what I wanted. After my postgraduate medical training, I entered the Indian Health Service (IHS). I was assigned to the Tuba City Hospital in Arizona, located 50 miles from the Grand Canyon on the Western Navajo Reservation. The patients our team treated were predominantly Navajo and Hopi, as there are a number of small Hopi villages inside the Navajo Reservation.

This was a perfect place for me because, growing up as a Jewish boy from Brooklyn, I had always romanticized the dream of living in the west. This also happened to be my introduction to the concept of a multispecialty medical group practice, with 14 physicians of various specialties collaborating to care for 40,000 Native Americans. I loved that experience and the teamwork it required to successfully manage such a large population. The hospital had only 30 beds. It was a challenging experience, but the rewards were great. Many of the older Navajos didn’t speak English, and we relied on the nursing staff to translate for us.

HCB News: How did Austin Regional Clinic come about?
NC: My wife and I elected to move to Austin after my two-year service in the HIS was completed, so that she could attend graduate school at The University of Texas. After a three-year stint at the Brackenridge Hospital Emergency Department (now University Medical Center Brackenridge) in downtown Austin, I joined three other family practice physicians to start a private medical practice. It was a very good practice, but vaguely unsatisfying to me after having been in a multispecialty group practice environment on the reservation.

It was my good fortune to be presented with the opportunity and finance to build a larger practice with the arrival of PruCare in Austin, one of the first HMOs in Texas. With two other partners, I was able to begin to put together a more comprehensive medical practice that included multiple specialties — much like we had in Tuba City. From that modest beginning, Austin Regional Clinic (ARC) has grown to a 360-physician group with 21 locations in three counties in central Texas.

HCB News: What attracts employees to Austin Regional Clinic?
NC: We’ve evolved a healthy culture. For the 10th year in a row, we are a top-tier “best places to work” in Austin. We employ 1,868 physicians and staff, making us one of the largest Austin-area employers. A testament to our employee loyalty is that we have more than 100 employees who have been with us for 25 years or more. This is a supportive environment and there is great pride among the entire team with regard to high levels of patient satisfaction and our reputation for exceptionally high quality of care.

HCB News: What attracts patients?
NC: Staff is encouraged to go out of their way to meet patient needs and be personable. We have always focused attention on providing easy patient access to care, right from the beginning. We currently provide same-day care 365 days a year at our 21 locations, including six locations providing after-hours care as well.

HCB News: How has health care reform impacted operations?
NC: The concepts embodied in health care reform and population health are in our DNA. All the Affordable Care Act concepts such as encouraging prevention and immunizations, practicing evidence-based care and transitioning from volume- to value-based care were concepts that ARC embraced in delivering care to our HMO members. What has changed is that we’ve migrated from HMO contracts with payers to Patient-Centered Medical Home (PCMH) arrangements. We have developed a staff of 65 individuals using analytic tools to blend clinical information derived from our electronic medical record with claims data from the insurance companies in order to identify patients needing added services and interventions, to keep them healthy and avoid the need for expensive hospital care. This is truly a situation where an ounce of prevention avoids the need for a pound of cure.

HCB News: How would you characterize the leadership style practiced at ARC?
NC: We have a very collaborative leadership culture. We have a meeting once a week where we bring in leaders and managers from every department to problem-solve and maintain coordination. All issues and concerns are aired and we try to resolve issues rapidly while maintaining consensus.

HCB News: What is Austin Regional Clinic best-known for?
NC: We’re known for our adaptability in responding to the ever-changing health care environment. In the community, we’re known for the availability and access to care that we provide for our patients so they can be taken care of when they are in need.

HCB News: How will health care change over the next decade?
NC: Big box hospitals are likely to see many, if not most, health services migrate to the outpatient environment. The inpatient hospital setting will continue to shrink as technology for better, faster and less invasive care evolves. Health care has become a “team sport” and that favors the highly-coordinated and more efficient environment of a physician-directed multispecialty medical group like ARC. There will be flattening and streamlining, and the only thing holding back the speed of this change is the clumsiness and fragmentation of the fee-for-service payment model — and that is starting to change with ACOs and PCMHs. Physicians and administrators are working more closely together than they have historically. They’re working together to create a superior outcome for patients.