Silva finds she can 'make a difference' at local HMO

February 4, 2010
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Pam Silva is familiar with the anxiety of having a child hospitalized and trying to cut through the tangled bureaucracy known as American health care.

Even for this COO of health maintenance organization Grand Valley Health Plan, health care can be a maze to navigate.

“I had the unfortunate situation where, three and half years ago, my son had a near drowning. I was right in the middle of the health care mess,” recalled, Silva, 46, of Grandville.

“Even being educated, even being in the industry, it is tough. It’s tough because you have all these different doctors, who are supposed to know everything, wanting to run this test, wanting to do this, or wanting to do that, and telling you, ‘You can’t do that.’ You have to be quite savvy and you have to be well-educated to make the best possible decision.”

Too often, Silva said, care is dictated by protocols that are driven by priorities other than patient care, contributing to waste in the health care system that’s been estimated to be as high as 30 percent.

“Obviously, a third of the time, it’s not going to change anything. It’s just a protocol because we’re afraid of malpractice or that somebody’s going to make money off the Internet,” she said.

That’s the first lesson about Pam Silva: Be careful what you ask because she will not hesitate to tell you what she thinks.

The plain-spoken Silva has worked at GVHP for 17 years, the past three as an executive vice president and COO. She’s done marketing, health care delivery management and a variety of other roles during the job that she finds challenging, rewarding and sometimes a little frustrating.

A native of Jenison, Silva has taken a career path that started in retail and hospitality and morphed it into the top administrative job at one of the most decorated HMOs in Michigan.

Unique in the state, Grand Valley Health Plan is a for-profit, privately held staff-model HMO. It has its own doctors’ offices, its own doctors and other medical staff, and claims a long history of utilizing the much-touted patient-centered medical home model.

GVHP is a sister company to two others, one for electronic medical records in physicians’ offices, and the other a surgical center co-owned by a doctor’s practice.

“I am responsible for Grand Valley Health Plan, and operationally, my title is vice president of operations, COO for Grand Valley Health Plan. However, I am also part of a management team that is also responsible for Grand Valley Technology Services, which is a technology company that resells NextGen (software) to practices. And I’m part of a management team that runs the Grand Valley Surgical Center. 

“I do spend my time, at a broad level, in multiple different companies. Some days are more challenging than others, but it all integrates well. It all has to do with health care.”

Silva holds an associate’s degree in hospitality management and a bachelor’s degree in business administration, both from Davenport University. She spent years supervising and marketing for McDonald’s, a favorite target of the anti-obesity crowd.

“I had worked for McDonald’s Corp. and then for a franchise. I was an area supervisor for many years and did all their local store marketing. Then my owner-operator sold. McDonald’s Corp. wanted me to come back.

“I just thought it was a good time to make a change, so I went to a local retail organization where I didn’t want to be the boss, and within a couple of weeks, I was managing one of their stores and doing all of their marketing, along with one of their owners.”

Silva recalled her time in those businesses as an era of education and growth. Then she had her first son — now a freshman nursing student at Northern Michigan University — who needed his mother’s attention due to health issues. Silva continued to work in marketing from her home. A friend suggested she do some work for GVHP as a way to get out of the house. For two years, she served as a marketing consultant, then joined the staff.

“It’s been an awesome opportunity,” Silva said. “Probably the thing that has kept me here is I totally believe in the mission.”

Grand Valley has 200 employees, and about one-tenth of them are medical care providers at one of five locations around Grand Rapids. The company, based at 829 Forest Hill Ave. SE, is owned by several investors — including President and CEO Ron Palmer, one of the co-founders in 1982 — and an Employee Stock Ownership Plan.

Layoffs, buy-outs and companies going out of business have combined to shrink the HMO market across the state. At Grand Valley, membership stood at 7,665 at the end of the third quarter on Sept. 30, less than half of the 15,000 it had at the start of 2006. To accommodate the change, Grand Valley closed its Kentwood office, moving those patients to the Wyoming location, and laid off six in 2009 thanks to a dispute with its partner in the surgical center on Leonard Street.

Yet layoffs could have been more drastic if it were not for the employees and the stake they carry in the company’s future.

“You can’t constrict to your death. You have to still be innovative and creative and move forward, and being small has allowed us to do that,” Silva said. “Our employees are invested in the organization. … You don’t have to work as hard to get their buy-in, and they’re part of the solution.”

Teams of employees came up with ways to trim expenses, she said. For example, Grand Valley was able to cut overtime by 80 percent to 90 percent by moving meetings off the lunch hour. Other employees cut their weekly hours from 40 to 32 but were able to keep their benefits.

“We had never done layoffs before. And we would have had to do more; however … we had teams come up with very creative, innovative things to do that reduced the expenses enough that we only needed to lay six people off,” Silva said.

“Not being brought up in health care, if you will, gives me a different perspective, because I think that health care has a lot of inefficiencies. It lacks patient focus. This is not a widget manufacturing company.”

Silva pointed to, for example, the enormous amounts of money spent on health care at the end of a person’s life. People need to be more proactive in deciding whether using extraordinary, even uncomfortable, measures to extend someone’s life for a month or two, racking up bills in the process, is the best approach, she said.

“I know very few people who would choose to live their last month or two in a hospital if they could be living at home with their family, hugging people and laughing and all of that,” said Silva in her characteristically straight-forward manner.

“And while they may have got two extra months of life, it wasn’t really a quality life. But we just fail to educate people that that’s what it’s going to be. We spend way too much money on end-of-life care. If somebody has a terminal disease and they are given a couple of months to live, why are we pulling out all these heroic measures that are decreasing their quality of life? This is my own opinion.”

In fact, people should be introduced to hospice care as early as stage III cancer, she said.

“I don’t like the thought any more than anybody else does of a committee who knows nothing saying, ‘Oh, no, no, no,’ but I do think that the population, the community we live in, the people — they need to be more educated on advanced directives and what does this really mean. They need to be given the information. They need to be given the options.”

Silva and her husband, Dennis Silva, who owns a Web site design concern, have four sons ages 11 to 18. They are busy attending swim meets, water polo matches and marching band performances. In the summer, the boys and their father take off to camp in state parks, and Silva joins them as her schedule allows.

“We love to camp, we love to do family stuff,” she said.

Silva said she sometimes must confront on-the-job stereotypes about women.

“There’s kind of this stereotype out there that you’re going to take care of everybody. And you’re just so ‘relational.’ Then when you come off and you’re just pretty much objective, then there is a different perception,” she said.

“I think that it’s fair to say people expect men to be more objective. … And I’m a very objective person, so sometimes I shock people. I’m also very direct, which can play with me or against me. I always tell people, ‘Don’t ask me what I think if you don’t want to know because I’m going to tell you. You may not like it.’

“I’m not one of those women’s libbers from years ago,” Silva added. “I just do what I enjoy and I work with great people. I’ve been fortunate to be in an organization where I can impact and I can learn and I can grow, and I can make difference.” HQ

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