Backed by $3.1 billion health care giant OrNda HealthCorp, hospital executive Steve Hall has returned to San Diego to develop an integrated health care delivery system that will compete with existing systems such as Kaiser, Scripps, UCSD and Sharp/Columbia. "I believe competition, as long as we do not have duplication, will allow us to have a very high quality, cost-effective system for the people of San Diego," asserts Hall, 52, the new CEO of OrNda-owned Harbor View Medical Center in Downtown. "This is OrNda's place to start in San Diego."

    OrNda, the third largest investor-owned hospital management company in the United States, is looking to acquire a set of hospitals in San Diego; and Hall is working with OrNda's regional office to merge independent physician practices into OrNda's physician services division.

    For now, Harbor View is the only San Diego hospital of OrNda's 51 facilities in 15 states. However, OrNda, based in Nashville, Tenn., and Tenet healthcare Corp., based in Santa Barbara, have signed a definitive merger agreement under which Tenet will acquire OrNda, resulting in an $8.5 billion company operating 125 acute care hospitals in 22 states. The transaction, expected to close March 1997, will create a sister-hospital relationship between Harbor View and Tenet-owned Alvarado Hospital in San Diego.

    Hall returned to San Diego in August — recruited from a year-long stint with Columbia/HCA Healthcare Corp.'s Palm Drive and Healdsburg General hospitals in Sonoma County — to replace Roger Kielman, who served for three years as Harbor View's CEO before retiring. Joining Harbor View and overseeing its 408 employees is an opportunity to "marry OrNda's management expertise, the systems that they have for managed care and the ability to access capital," says Hall.

    No stranger to health care in San Diego, Hall worked here for eight years with EPIC Health Care, including six years as the executive director of Mission Bay and Clairemont hospitals. His expertise in managed health care led him to a consulting job with Coopers and Lybrand in Chicago. After about seven months, he returned to hospital administration, heading to Sonoma County before finding his way back to San Diego. He and his wife, Ann, who have two grown children, were happy to return to their home in Bird Rock.

    Although for-profit, $65 million Harbor View is a small facility compared to many of its San Diego peers, "its range of services are appropriate for a community hospital. We are the Downtown hospital; there's no one else around," says Hall, noting that the closest hospitals, Mercy and UCSD, are two miles of surface roads away.

    Hall credits Harbor View with a patient-friendly atmosphere, citing valet parking and a streamlined check-in for surgical procedures. Harbor View also is a disproportionate-share hospital, receiving federal money because it serves a large number of financially disadvantaged patients. Hall reports tentative plans to add a birthing center and to convert some of Harbor View's beds to a skilled nursing facility.

    The hospital works with local businesses, including many Downtown restaurants, through its Industrial Medicine Clinic that sees about 600 injured employees each month. Other programs include the Physical Therapy and Sports Medicine Center for the treatment of occupational injuries and job-related illness, drug and alcohol screening, and employers' education roundtables.

    It was Hall's "physician-friendly" attitude and his 26 years of experience in managed health care that led to his being hired, says Dr. William T. Mosley, Harbor View's chief of staff.

    "He expresses an attitude of friendly cooperation between the medical staff and the corporate hospital structure," notes Mosley. "He has told me that if he can work with the physicians on the staff to expand their practice and become more successful, the hospital too will grow and benefit. It’s really a win-win situation."

    Corporation-driven managed health care systems have been met with some skepticism in California — and in San Diego, dubbed a "model city" for managed health care, in particular. Hall spent much of his time as a consultant educating hospital administrators across the country about the changes and challenges involved with corporate health care systems. Ultimately, he says, "the key is going to be rewarding the health care system for keeping people well, not to reward it for denying appropriate treatment," a concern of critics.

    Hall suggests that health care networks operate efficiently and effectively when they have enrollments of about 600,000. Because San Diego’s population is expected to exceed 3 million in the next five years, he calculates there is room for five systems, each providing a full range of services.

    "It’s going to be really important to have several competing systems," insists Hall. "If you’re down to just one or two it starts to be like the old phone company. Competition does make people better. Otherwise they just start not paying attention to the details, not thinking about the patients, not competing for quality and cost."

    If it sounds like a theory based in economics, it is. Hall, who can be found playing golf or tennis, biking or gardening in his spare time, graduated with a bachelor's degree in history and political science. He was in law school when he joined the Army medical service corps during the Vietnam War and found out about a master's program that focused on business/hospital administration. He earned his master's at Trinity University.

    "I believe in managed health care as an alternative between socialized health care and a totally free, fee-for-service medicine, which we just started getting out of when managed health care came in," says Hall. "If you took the best of managed health care, meaning the various HMOs or health care providers, they would compete not only on cost, which has been what happened in the past more than anything else, but also on quality."