How Do You Make an Impact in Healthcare You Get a Damn Good Chief Impact Officer

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Healthcare Rethink - Episode 101

As healthcare challenges become more complex, the role of a chief impact officer in healthcare systems is gaining unprecedented importance. Healthcare Rethink Host Brian Urban explores the growing significance of this role with Lorena Zimmer, the Chief Impact Officer at Denver Health.

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Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and I have one question for our audience out there, how do you make an impact in healthcare today? Well, you get yourself a good chief impact officer, and to help us explain exactly what that is and what she does at Denver Health is the chief impact officer herself, Lorena Zimmer. Lorena, thanks for joining our little show.

Lorena Zimmer:

Thanks for having me, Brian. I'm really excited about the conversation today.

Brian Urban:

This is going to be a lot of fun. We've gotten to know each other here and there, and our calendars have finally landed on our actual recording. So, I'm very excited about this. And your work in particular inside Denver Health and outside, you are a lecturer of Young Minds at Colorado University as well, so I got to ask you a couple questions there. But let's start with Lorena Zimmer herself. So, you didn't wake up and become Chief Impact officer of a very large important safety net healthcare provider. You had a journey. Let's hear about that. What took you to your path in becoming an executive at Denver Health today?

Lorena Zimmer:

This job, chief impact officer, this title just didn't exist when I started my career. But I actually did start my career at Denver Health over 25 years ago as a little bitty baby tobacco program specialist back when the tobacco dollars were rolling out across the country. But then, I did have a bit of a circuitous route. I did stay in public health for a little bit and I went to the state health department, worked on tobacco, but quickly, started to work on health equity issues, health disparities, identifying health disparities, as well as the social determinants of health right when it was coming along, I remember somebody saying, "Hey, Lorena, can you figure out what social determinants of health means to us as a state agency?" And, we did one of the first in the country models on what social determinants of health was and how it relates to healthcare and health equity. It ended up being in almost every single strategic plan for the other state agencies too, because it relates to so much of the work, like education, Department of Housing, all of that.

And, since then, I've been taking that perspective in what is next, at least for me as a career. What was next was that I believe that education is an incredible component of maintaining health, but also, keeping you on a trajectory to improving economic mobility. But I've always worked with the people that need it the most. So, I started the Denver Opportunity Youth Initiative probably about 10 years ago now, working with youth 16 to 24 that were not in school or not engaged with work, trying to get them back on track. So that was a coalition of folks, collaborative, if you will, trying to figure out what was the next programmatic need, what was the cultural shift that needed to happen, as well as what are the policy issues that needed some mending, if you will, to help these youth get back on track.

From there, I ended up at the Denver Metro Chamber of Commerce, something probably not many public health folks think about. But, because of the leadership there, it was a great time to think about economic mobility in that perspective of the economy of Denver, which was growing rapidly at the time. So, I was there for about six or seven years. During that time, I continued to work on Denver Opportunity Youth Initiative, but then I also started an initiative called Prosper Colorado, which was our inclusive economic growth initiative, where we were bringing along the business community, but also, public nonprofits foundations to think altogether about how we could move more women and people of color across the economic continuum. So, we focused on workforce there again, supplier diversity or small business development, as well as the one issue that we heard from the community that we surveyed was housing affordability.

All of those issues continue to be priorities in our community, but that's what got me to Denver Health. Long circuitous route, there was some consulting in there as well. But, as an institution that has been around in Denver for over 160 years, we employ 8,300 people in our community. We see about... Sorry. Yeah, 1.3 million visits per year. So, we have a pulse on the community, and even though we are a safety net, that we are constantly trying to figure out the next financial step to stay afloat. We're also, because of our breadth of work, really involved in those issues if you think of us as a business, employing people, buying things from the community, and for housing, for example, how it affects our patients in our community. So, I also oversee a lot of the policy issues now too because of the background that I have around food insecurity, housing insecurity, we have youth violence issues, so firearm safety as well, among other things here at Denver Health.

Brian Urban:

Wow. It's amazing to hear your story, Lorena, because you are at the bedrock of what a lot of public health is based on is community health services and really working with those that are mid and lower in a socioeconomic status perspective and helping them gain better access, better literacy, and just a better quality of life. And then, you roll that into a policy world, yet again, another big connection to the public health world. And then, now you've grown into this overarching strategic role that is helping employ many, many lives and contribute from an economic, I'd say, improvement perspective as an anchor system in the greater Denver area. And, to your point, been around since 1860. There's been so many changes that happened over a course of 5, 10 years when you think about our modern society, but let alone 160 years, unbelievable. And you're talking about some of the measurable impacts you've had. Let's dig a little bit deeper into that.

So, of those really cool interventions, programs that mean so much to the lives you serve, food, transportation, youth, mental health, what's been some of the highlights that have really impacted your work, and what do you think is going to be maybe some of the future investments Denver Health is going to take relative to the successes you've seen or the needs maybe you've seen come out of the programs you've deployed?

Lorena Zimmer:

Yeah, that's great. I came to Denver Health also because of the breadth of work that we did. So, like you mentioned, we're all across the community. We're not just this hospital here where I sit, but we're also 19 school-based health centers, 10 community clinics. You mentioned mental health. For example, we are one of the largest providers of behavioral health services in the state of Colorado that people often don't acknowledge, and that is also one of the priority issues here. We've had over 80,000 visits last year for mental health and substance use disorder. So we could treat people in our community better. But, what is exciting and what I see is that our hospital being a safety net, people come to work here for the mission, the mission of being able to provide the highest quality equitable care for everyone in our community, regardless of ability to pay. But that's not something that's easy to budget for, if you will. But also, because of the passion of our employees, we are able to do so much.

I think with my role, what I brought to the table was this visibility that there is other opportunity. So, a lot of things happen way out in one of the clinics or in this other silo over here, but the ability to accelerate, like you said, with interventions in policy, and broader work, and bringing it all together under one place has, I think, really made a lot of our staff that we're passionate about firearm safety. And all of a sudden, it goes out in the CEO communications that it is a priority for Denver Health, because we've been able to bring together internal collaboration, and that's really exciting. But then also, because of my external facing role, because of my experience in the community, being able to bring other partners to the table, great examples in Food, for example, Food Bank of the Rockies and Project Angel Heart, which does medically-tailored meals, has really been able to understand our role in the community and how we could collaborate on bigger projects. Ideally, we serve 1000 people through this collaboration that is then something that could really influence policy.

Brian Urban:

Yeah, wow. I mean, it's touching so many facets of the human condition, and so many different cultural definitions of health and what it is to live in a subculture of a very big, fast, at times very rural and urban state like Colorado. It's just so fascinating. And, obviously, partnerships are a big part of what, I think, helps some of these programs deploy from a safety net hospital like Denver Health. So, can you tell us a little bit about what partnerships have really made some success for the programs you've put out there today? Or if you can tease a little bit of what might be in the future for us, Lorena, of partnerships that might be coming? So, I'm curious.

Lorena Zimmer:

I'd say, we have partnerships with small nonprofits and large nonprofits. Just ones that are able to dedicate efforts to Denver Health patients makes a huge difference for us as well, to be able to provide that quality of care that people want and deserve. So, some of those partnerships, again, back to food, we have some partnerships where they come to our clinics to deliver food once a week or Food Bank of the Rockies, we did a pilot with them to do a food box delivery. So, a lot of us get food boxes, we pay for them, and we have these meals that are prepackaged and everything. It's not quite as fancy as that, but imagine being low-income, having diabetes or cardiovascular disease, having a hard time buying enough food for yourself, much less your family, and being able to be offered the opportunity to have food delivered to your house. It relieves some of that stress of having to provide for yourself and others that ideally will make your health condition better.

So, I mentioned that on the housing side, we have had some partnerships where we thought creatively. So Denver Health has a foundation. A lot of hospitals have foundations. Some foundations are able to give out money. Denver Health's Foundation receives money, but it takes also that prioritization from the community, because anything that makes our patients better saves Denver Health money. So, for example, on the housing side, we partnered with Denver Housing Authority to rehabilitate one of the buildings that we have to do low-income, older adult housing. But then, we leased back one of the floors to do transitional housing. So, a lot of our patients... Depends, but in the units that you would expect, we didn't survey mom baby for example, but we hover about 20% of our patients have housing insecurities.

Then, those patients that are here begin to get better. And in many cases, if you weren't homeless, you'd be released to go home and get better there. If they don't have a place to go, they end up staying longer at Denver Health. So, that costs us money. And, like I mentioned, our team is amazing. They don't want to release anybody to the streets. So now, it's not many units, it's not enough units. It's 14 transitional housing units here. We're also partnering with Colorado Coalition for the homeless, where we lease respite care beds, and we're able to then move people there. But then, that partnership and their work leads people... Many of the people that end up at respite care become guided by their navigators into other housing opportunities as well. So, it's about having the right community partners and the ones that are willing to prioritize our patients, because they know the importance of food, or housing, or whatever, other health related social need, but also, yeah, how it affects the hospital as well.

Brian Urban:

Yeah, hitting the basic needs of what a human should be supported with is exactly what I think of a safety net hospital, an anchor system, a community healthcare provider, and I love that you're executing very well on that, and you find that that's a common thread across a lot of the different points of care, I would imagine, that you have out there. And, looking at Denver Health, just from an outside perspective, I'm in a different time zone, very familiar with the front range, and the different healthcare providers, and the network in the broader metro area of Denver. But, looking at you all, you provide so many different services. And just looking at it here, I noted down, you got primary care to women's mobile health units, which is very cool.

Lorena Zimmer:

The Mammo Van.

Brian Urban:

I was thinking, it's going to be a great preventative access service at school-based services, urgent care, and it goes on mental health, etc. So, the school-based services and the mobile units, really curious about that. Are you seeing from, I guess, your future innovation vision here and points of care that you're getting so diverse in what you offer, that people are becoming more engaged, and thus, they're maybe sharing insights back to you that could lead to more innovation? Are you finding that true in some of the newer things that you're doing, or the staples that you've had in terms of points of care? I'm curious, what have you seen and felt?

Lorena Zimmer:

I love the way you're framing that. So, we do have probably about 50 different points of care, if you will, not just the hospital, the school-based health centers, the mobile units. We are constantly getting input. And our team wants nothing more than to be the innovators and the leaders in this space, because they want to provide that quality care for our patients. Our clinics, for example, are in our lower income neighborhoods. And, they want to be able to be there. One of those partnership opportunities is, for example, where do we park our mobile van, and on which days, and how do we provide that? And, sometimes, it's the consistency. Bringing in a little bit about health equity here, for me, the way I see health equity through the social determinants of health lens is removing barriers to being healthier. So, that means, access to care, better food, better housing.

On the access to care part for example, we started having our mobile unit go to one of our neighborhood nonprofits to be able to provide care there, because that community we weren't seeing come into the clinics. So with the consistency of being there and having the right community partner advertising us in the right way, this is now a staple where we go to revision every week with our mobile units to provide that primary care. We've innovated, for example, again, on mobile units. We have the MOMAT unit now, so mobile methadone unit moving to be able to provide care in a part of town that doesn't have access to methadone.

So, that's really exciting for our team. Another mobile unit is going to be... Probably the next one will be dental. Our dental team sees the need all across the city, particularly in our low-income communities, to have better access to dental healthcare. So, that is something that we're constantly wanting to improve, is that access to care in our communities, and then what does that mean? Where's the next clinic? Where's the next mobile unit going? But also, just like any hospital, an emergency room is that eye to what is coming next, is the next wave of care that is needed. So, we're looking at that data to see how do we improve, or where do we need to grow our services?

Brian Urban:

I love that. And, very much it sounds like a community-led patient population-led healthcare strategy. You're getting a lot of insights from the services you're providing to the lives that you're helping, and weaving that back into strategic planning, and you're making it work. And I love that. I think, that's a model that a lot of really large healthcare systems of an integrated delivery in nature, or even of a standalone hospital, community hospital struggle with, in a lot of ways, is hearing honest feedback of how they can help improve their existing services, or innovate on top of that. And then, how do they communicate that back? So how is it a fluid conversation? I think this is a lovely model for those in our audience that stretch across healthcare to take back into their worlds and make a significant impact.

So as a sidestep, Lorena, I wanted to circle back to the education side of your brain, not just from your background, but what you helped deliver today to the young minds in Colorado. So, are you still in lecture mode? Are you guest lecture mode? What's your world with delivering education to the young minds that will be of the next generation perhaps in healthcare, or policy, or population health?

Lorena Zimmer:

Right. I'm not still a guest lecturer at School of Public Health. Sorry. I have done several engagements. I did teach social determinants of health at University of Colorado at Denver. But, I'm always gravitated towards the next generation and influencing them. I mean, at Denver Health, serving the community, right? We have a high school program where we bring in high school students for mentoring and learning about the healthcare field. We also have a program for college students that want to enter the healthcare field. Of course, we want to see a very diverse population come through and create access to these jobs that we see. We do a lot of apprenticeships, for example, here at Denver Health. They may not be federally registered apprenticeships, but we train a lot of people. So, as far as what-

Brian Urban:

You're still there, still there in a different way.

Lorena Zimmer:

... I'm still there. I'm still passionate about that. I still sit on the board of the Denver Opportunity Youth Initiative. But I think, yeah, being able to talk to people about true systems change and what that means is one of the things that I do every day, because it is that larger investment and bigger picture investment that's going to make a difference in health in the future. But it's tough. It's tough work.

Brian Urban:

Yeah. I still think now in a different peak of your career and life learning, you're having an impact toward workforce development, not just at Denver Health, but obviously, through the board position that you still hold. And then, everything you do probably in regular life. But, it sounds like it's an opportunity for another university or college institution to come knocking at your door. Not to be your recruiting representative here, but if anyone out there is looking for a brilliant mind to learn from, highly suggest Lorena Zimmer, chief impact officer at Denver Health.

Lorena Zimmer:

What an honor. Thanks.

Brian Urban:

So, it's the depth of experience that I think is just so intangible and valuable that you bring to the lives you serve. And, I'm just so excited to have had your voice on our show. But, I can't let you go without looking a little bit ahead into the future, Lorena. So, let's go out maybe five years, maybe a little bit more if you like. What does Denver Health grow into? And maybe, what does your role as chief impact officer ultimately make a contribution toward? What do you think you're going to feel and see five plus years from now from your work?

Lorena Zimmer:

Well, at Denver Health, we're really working on figuring out what is that financial model of sustainability for Denver Health. I sent you an email about that. But, we are really looking at how and what that means, because we have to be ready. We're always thinking ahead even more than five years to what is the next thing that's coming through our doors. But, right now, for example COVID, for example, we had a large influx of newcomers last year. How do we be ready for the next public health event, if you will? But, what we're seeing now is a desire to be more integrated. So, if we do receive more money and there's an emphasis on the school-based health centers, for example, through our philanthropic arm, we want to grow some of that mental health and behavioral healthcare in our schools. So more of that integration of what happens to make our community healthier.

So what I say is that Denver Health really is committed to making an impact with our patients obviously through the collaborations, in my lens, not making an impact in their health, is our clinical teams always there at the ready. But also, thinking more broadly about what changes need to happen and what collaborations need to happen through the right government relations or policy work. But also, to our people, so our staff is incredibly important to keep them engaged, and they're part of the community. So how do we make this a better community, as well as the impact we can make in the community itself, because of our anchor institution status that we play here, we have to be an example to others. Most hospitals have to do community benefit reporting and prioritize a few things. We get that input from the community. We're constantly listening to the community in many different ways. But also, just the depth and breadth of our work and the impact that we have in our community is what is always at the forefront.

That's what I see in the next five years. I'd like to see a few policy changes on how, for example, food and housing are being reimbursed to hospitals, how behavioral healthcare is being reimbursed, or who or what types of clinicians are being reimbursed, and what community work can be labeled as healthcare. Those are all possibilities in the near future that could really benefit our patients and our community. As far as the hospital, Medicaid reimbursement is always an issue as well.

Brian Urban:

Yeah, yeah, it definitely is. And hopefully, that starts to change as we're coming into another election year. But, great points, and thank you for walking us through your health equity, maybe, long range planning, that you have at Denver Health. And to your point, I am so hopeful for a lot of changes in how behavioral health can be more of an infrastructure inside the healthcare system in the U.S., rather than points of care sporadically during a time of need there. More prevention is needed for sure in the space. And, I just love what you are doing. You got a fan, I'd say, following you now a little bit more closely on LinkedIn and through other channels. Lorena Zimmer, the chief impact officer of Denver Health, thank you for joining our show here today.

Lorena Zimmer:

Thanks, Brian. And, thanks for allowing me to share a lot about how, as a hospital, we can do a lot in our community through being able to look at and get that input from the community on the health related social needs. So, thank you for that opportunity. We'll talk soon, I'm sure.

Brian Urban:

Oh, yes. I feel a follow-up coming on. And, definitely a lot of our viewers I think are going to gravitate towards Denver Health, the model you deliver, and a lot of the great work that you're sharing in your channels. And for more exciting excerpts and insights, please visit us at finthrive.com.

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