Dick Clark, CEO of the Portland Clinic, on competing as a midsize provider in a market dominated by large health care systems.
Since taking the helm as CEO of the Portland Clinic in 2015, Dick Clark has introduced several changes at the midsize health care provider, including partnering with food business entrepreneur Chuck Eggert on a grocery store at the clinic’s Northeast Portland location.
His next big venture is moving the clinic into a new downtown Portland location that will offer integrated services, including a healthy food restaurant and possible nursing school.
In this interview, Clark discusses his strategy for competing in a market dominated by larger providers and how he fosters a workplace culture that attracts doctors.
This interview has been edited for length and clarity.
What is the biggest challenge you have faced since you have been at the helm?
We are a nearly 100-year-old business. We say we have no guarantees for our future. We have to make sure we continue to serve our customers, serve our patients and be pure to our mission. We compete where necessary and collaborate where possible.
We have been able to establish good collaboration with Providence, Kaiser, Legacy, OHSU and other private businesses that go beyond health care. That has been really fun, because I enjoy partnerships.
How do you try to position the clinic as a medium-sized health care business?
We try to position ourselves like Deschutes Brewing, Powell’s Books, Voodoo Doughnuts – we try to say we are the locally owned, independent provider of health care. There are a lot of other choices in health care, but we can offer something that is personal, local, nimble, specific to people.
I always say if health care offerings are A to Z, we do A to W. We don’t do X,Y and Z. Those are often more complicated things, such as oncology, neurosurgery, cardiac surgery. There are a lot of good providers in town that can provide that.
We provide basics that most people need 90% of the time: pediatric and baby wellness check-ups, urology procedures, primary care annual exams. What really attracted me about the clinic when I was making the change from Providence was the loyalty of our patients.
How difficult is it to compete in a health care market dominated by large providers?
Like any provider our size, we have to be careful in terms of capital investments. We have to be selective in what we do and what we don’t do. We also have to compete for providers.
Portland is a very attractive place for providers, doctors and especially new graduates to move to. We are competing with Providence, Kaiser and Legacy. We try to not necessarily match on a compensation level; we try to be a culture where doctors feel they can practice some of the art of medicine.
Medicine has a lot of standardization, which is very important from a safety and quality standpoint. But we also have opportunity to be tailor made for our patients. If a patient needs more time to be seen, we can allow more time.
I always say we punch above our weight class when it comes to attracting doctors.
You plan to move into a new building in downtown Portland. Why the move?
We have been in and around our downtown location for nearly 100 years. Our current building has been around since 1974. We really want to develop something that is more modern, where we can see patients efficiently. We will be replacing that building from 1974, probably in the next three years.
Our hopes and aspirations are not only to create a clinic like we have right now, but have it be an integrated wellness center that has a healthy restaurant, up to 30,000 square feet of clinic operations, and some type of independent school of education around nursing or medical care where we can work with the caregivers of the future.
Finally, we would like there to be housing. It could be more than 100 units, ideally for active people aged 55 or older, right upstairs from us. If they have medical needs and are patients of ours, they can easily see us. They will also benefit from the educational facility and have shared teaching facilities and interaction with the students.
What are the challenges of including housing in your expansion plan?
A large challenge is the city’s requirement for inclusionary housing, which makes the finances more challenging. We are trying to make it work if it includes housing. But we may choose to go without that component, which would mean a whole new set of finances.
This vertical integration of health care services is a departure from your business model. Why go this route?
We have pioneered that with our branch over on Northeast 50th and Sandy Boulevard, where Chuck Eggert has the Basics grocery store located. Chuck’s business is separate and co-located with our clinic. It has worked well for our patients and the surrounding neighborhood. With the success of that partnership, we wanted to take it to a larger scale downtown.
We think we can really differentiate ourselves by having something that is a flagship clinic for us in a downtown area, so that when you go past, you say, “Wow, that is the Portland Clinic. That is really different.”
Do you consider acquisitions as a way to grow?
We have affiliated with private, independent clinics over the years. We have had three in the past 10 years and we have grown through that. They have an existing branch and they take on the name of the Portland Clinic. That is one strategy.
We also have a separate organization – the Portland Coordinated Care Association. These are other like-minded, independently owned health care businesses in the Portland area. There are about 300 providers in this association.
We formed our own locally owned health system. We don’t have a hospital associated with us; we contract through our insurances with other hospitals, but this is another example of us expanding our reach and maintaining our independent medical practice in the Portland area, especially in this time when it is harder to do that.
What will be the biggest trend affecting health care in the next decade?
People have expectations for access to anything; health care is among those. We have a lot of technology that is developing where people won’t necessarily have to come to the doctor’s office.
There will be video visits, which we have now; more things resolved through email; we have a MyChart system, where patients can write messages and doctors can respond to them. Routine things can be handled over the phone or on video.
There is this on-demand health care. It won’t tip fully that way; a lot of the power of medicine is still touch. What that means is that people will still seek, and our providers will still want to provide, that human element that you can’t necessarily get though electronics. It will be a balance between those two.
Something we are big on is that health care is moving from the fee-for-service model to more of a value proposition, where ideally people work in partnership with their caregiver and make adjustments that can lead to a healthier lifestyle.
What financial challenges are there moving from fee-for-service to a value-based system as a midsize provider?
There is more risk in it. With this system, we have to negotiate with our payers and ask them to help us with the infrastructure required to achieve goals. This is a shift for everyone, not just for us as a medium-sized business.
Hospitals are a huge capital investment. As you have fewer people who will require an in-patient service, that is a risk for them as well.
With all that said, this is the right thing to do for our patients. In a lot of cases, it is more safe treatment. Wellness is really important – people will be able to enjoy life more.
We are blessed here in the Northwest with this in-migration of people. In a lot of cases, we will be able to benefit from people who will want to participate in programs like this. If we had a migration of people out and a shrinking population, we might have more of a challenge.
You spent almost three decades working in the nonprofit sector for Providence and the Portland Rose Festival. What is the most valuable lesson you have taken to the business world from working in that sector?
The sense of community that Portland has is deep here. We are a private business owned by 44 doctors. We also try to be a good citizen of the community.
We have a foundation we restarted about three years ago. Now we give micro grants of $1,000 to $5,000 to worthy nonprofits. We try to do our part to address the social determinants of health. It resonates with our 600 employees. This also goes back to how we compete.
I have this program specifically because I end up interviewing 40 to 50 applicants a year. I tell them about this work we are doing, and it resonates with new providers. When they are looking at their choices, they may say, “I have to balance salary with school debt, but I want to work at a place where I feel good.”
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