Connie Clerici remembers the moment she figured out what it was going to take to get her health-care business past the public system’s gatekeepers. It was 1992, and Clerici, at the age of 30, had just launched her company, a home-care provider called Closing the Gap Healthcare Group.
Looking for a referral, she met with the head of discharge at Toronto’s Hospital for Sick Children. Clerici—her firm’s president and CEO—was aware of the hospital’s exacting standards and reputation, and was ready to offer whatever assurances she could that day. She was not ready, however, for the woman’s blunt ultimatum: “She looked at me in the eyes and said, OK, kiddo. I’m going to give you one chance and one chance only. You mess this up and you will never get another referral from us.'”
“That child,” says Clerici, “received not the Cadillac of service but the Jaguar of service, because I was so terrified.”
Today, Clerici—this year’s winner of the PROFIT Award for Excellence in Entrepreneurship at the Canadian Woman Entrepreneur Awards—looks back and laughs at that early lesson. She can recall countless such encounters since then, each one serving to underscore the importance in public health care of playing by the rules.
Over the past two decades, every province—faced with an unsustainable rise in health-care costs—has had to rely more on third-party providers. In Ontario, the turning point came in 1996, when the province instituted a “managed competition” policy. Since then, a throng of private businesses have entered the field to bid on contracts worth millions.
The opportunities are broad—everything from medical supplies to nursing and therapy within the home to support at long-term care facilities. But competing for public health-care dollars is nothing like competing in the free market, and business owners must be prepared to meet stringent government criteria.
Without a determined focus on those criteria, Clerici says Closing the Gap would never have survived, let alone grown to its current stature. The company, based in Mississauga, Ont., now generates $25 million in annual revenue and employs more than 500 health-care professionals—nurses, physical and occupational therapists, speech pathologists, dieticians and social workers—who care for thousands of patients in homes across Ontario.
Although business opportunities exist within the public health-care system, Clerici says, the barriers to entry are high. Before a company can even bid on a home-care contract in Ontario, for instance, it must meet numerous “prequalification criteria.” There’s a criminal check, a labour-relations review and a demand for service experience and financial capacity. If, after all that, the company manages to win a contract, it must develop an information infrastructure to track hundreds of data points measuring patient outcomes.
To satisfy these demands, Closing the Gap has made large investments in its quality-management system. It involves, among other things, a quality charter that describes the level of service clients can expect; a quality manager to generate ideas based on the charter’s principles and deliver instruction to staff; a privacy officer to protect patient information; ethics training for all staff; a client-safety officer who investigates any safety complaints and ensures that staff adhere to best practices; and even quarterly reports released to the public that touch on aspects of accountability, budget management and key performance indicators.
It’s a level of transparency that many entrepreneurs would find alarming. For example, any one of Clerici’s competitors can simply go online and look up the details on any of Closing the Gap’s contracts. A contract’s value, the hours of work to be provided, the length of the contract and the region covered—it’s all made available to the public.
Clerici, for her part, doesn’t resent all the red tape and reporting requirements. The practice of tracking and measuring patient outcomes, she says, has made her company better and more efficient, which to some extent proves that the system is working. “Ontarians should be really proud of the fact that organizations are made accountable,” she says. “We know we’re using a lot of public dollars, so we believe in that high level of transparency.”
And then, of course, there are the political obstacles of running a for-profit health-care business. Public labour unions have been vociferous in their opposition to third-party providers. In 2008, the Ontario government placed a moratorium on new bidding, which has left Closing the Gap in “contract-extension mode” for the past few years. It’s a frustrating development for Clerici, but one that she realizes could easily change with the shifting of political tides—yet another consideration for private health-care providers. “Every time there’s a change in political power,” she says, “you have different priorities made.”
Regardless of the party in power, though, the need for private contractors in health care is inescapable. Protecting the status quo is not an option, says Clerici. Nor is bankrupting the taxpayer to pay for inefficient delivery of care.
And if unions view her company as a threat, Clerici doesn’t mind. “I actually take it as a compliment,” she says. “To be a threat means you’re doing a good job because you’ve raised the standards for everyone.” Clerici is proud of Closing the Gap’s achievements and hopes to take what she’s learned to expand the company nationally one day. If anyone thinks she’s a threat now, just wait.