Packaging HIV care.

Following the success of his cancer centers, entrepreneur Bernard Salick is now targeting HIV with a nationwide chain of for-profit medical centers

You have HIV, and in the middle of the night you feel a medical crisis coming on. So you rush to the nearby 24-hour HIV center where you receive your primary care and where the doctors have all your records. You receive treatment and are sent on your way.

Sound far-fetched? Not to Bernard Salick. He is launching a chain of for-profit HIV treatment centers that he says will set the standard of care in the nation. In doing so he is underscoring the dramatic shifts that have taken place in AIDS treatment and in the very nature of the disease.

"Outpatient is clearly the way to go," Salick says. "You can get so much more done in an outpatient setting. The patients have the security that they can go home at night."

In February Salick announced that his firm, Bentley Health Care, had formed an alliance with Montefiore Medical Center in New York City to establish the first of its HIV centers by this fall as well as three cancer care centers. Under the agreement, which comes with a $100-million investment from Bentley, Montefiore, which is nationally known for its HIV care, will retain control of all medical matters. In turn Bentley will be paid a consulting fee. Bentley also acquired the assets of the International AIDS Network, a New Jersey group of more than 40 physicians specializing in infectious disease.

"It's a sentinel event," says Spencer Foreman, president of Montefiore. "To the extent we're successful, other hospitals around the country will follow." The share of the profits generated by the care centers would be a boon to hospitals, many of which are short of cash.

Salick has been able to recruit some of the biggest names in HIV medicine to his cause. Among the researchers on his national advisory board are such heavy hitters as David Ho of the Aaron Diamond AIDS Research Center, Paul Volberding of the University of California AIDS Program, and John Bartlett of Johns Hopkins University. In addition, Salick had already lured Luc Montagnier--codiscoverer of the AIDS virus--from France to head up an HIV research center that Salick endowed at Queens College, his alma mater.

"I'm no rocket scientist," says Salick, whose specialty is kidney disease. "What I'm real good at doing is bringing people together." He even says he almost pulled off the unimaginable: a dinner with Ho, Montagnier, and Robert Gallo, the other discoverer of HIV and Montagnier's bitter rival. "The dinner was all set, but one guy blew it off," says Salick without revealing who demurred. "That doesn't mean I wouldn't try again. I couldn't care less about past history."

Salick says the HIV center, which will operate like a health maintenance organization, will provide a full spectrum of care beyond primary medical treatment. "Our center will have everybody: a psychiatrist, a social worker, a dietitian, all of whom will have expertise in the area of AIDS." Moreover, he promises that the center will be open to all individuals having an emergency even if they do not normally receive their treatment there. "We will serve everybody," Salick says.

Bentley Health Care is an attempt by Salick to create his second medical empire. The first, Salick Health Care Inc., was begun in 1983 after his 6-year-old daughter was diagnosed with a rare bone cancer from which she later recovered. After experiencing frustrations with conventional cancer care, Salick decided to open a chain of 24-hour cancer care centers. (He had already developed a chain of dialysis centers.) By 1996 he had opened a dozen centers. In a move that raised eyebrows over the potential for conflict of interest, Salick Health Care was acquired in 1997 by Zeneca Group PLC, a British pharmaceutical firm that makes cancer treatment drugs. Salick pocketed more than $100 million, but he was ousted from the firm he founded.

Salick says HIV has reached a point at which he can transfer the expertise he developed with cancer centers to treatment of this disease. "I'm struck at the rapidity with which ADDS has been brought under control in the past few years," he says. "Imagine being a hospital planner. Last year 70% of your patients were inpatients with AIDS, and now there are none. What do you do with the hospital? You go crazy." His outpatient centers, he maintains, will provide the solution.

Adds Foreman: "When I met with Salick early on he said it was his view that the AIDS epidemic will be converted entirely into one that parallels the cancer epidemic. We believe this will change the way care is delivered nationally."

The physicians that Salick has recruited clearly agree. "Quality of life is going to be a major issue now that people don't die nearly so frequently or so quickly," says Donald Louria, chairman of preventive medicine at New Jersey Medical School and a member of Bentley's advisory board. "These centers are designed to be patient-friendly."

"Salick's experience has been dealing with catastrophic illness and long-term, multidisciplinary care," says Brian Saltzman, head of Bentley's HIV program in New York City and former codirector of the Beth Israel Medical Center AIDS In-patient Unit. "That's the direction HIV is moving in. Dr. Salick has certainly given us the freedom to try to make everything extremely patient-driven."

Salick's cancer centers received generally good reviews from patients, although at least a few doctors complained that the centers were overly cost-conscious. Salick says he will be able to run the new centers efficiently by collecting good data. "You collect the data in a consistent fashion, and you can find out what something costs, you can predict the future, and you can find out which type of drugs you should be developing for the disease," he says.

While Salick maintains that New York City lags behind the nation in managed care, his center will have some competition, although not from 24-hour centers. For example, the Center for Special Studies at the New York Hospital has opened an outpatient HIV clinic in the headquarters of Gay Men's Health Crisis. Ultimately, Salick expects to expand to Miami, Los Angeles, San Francisco, and Washington, D.C.

Some AIDS activists are taking a wait-and-see attitude toward the centers, but Daniel Zingale, executive director of AIDS Action, a Washington, D.C.-based advocacy group, has high praise for Salick. "He impresses me as a visionary with a genuine interest in addressing the current and future challenges of the epidemic," Zingale says. "I believe he is committed to providing quality care and doing that in a cost-effective way. We need both of those things very badly right now. I think he understands we're at a pivotal point in the epidemic, and the ground is shifting beneath all of us."

Salick knows it is possible that the epidemic will change yet again. "It's a very strange disease," he says. "It's had unbelievably dramatic changes in such a short period of time. Neither you nor I can predict what AIDS is going to look like a year from now, but it sure is working in the right direction." In the meantime, he says, he will just stick to his plans: "You do well, be profitable, and sustain your standard."

RELATED ARTICLE: Building for health

New York City's new Callen-Lorde Health Center takes high tech to the not-for-profit health care world

Six floors in a newly renovated building. The latest in technology and equipment. A medical library complete with Internet capacity. Comprehensive medical and social services. Completely computerized records. In short, everything that any patient could ask for in a health center. And it's all set up to cater to gay men and lesbians.

With little fanfare the Callen-Lorde Health Center opened its doors in March in New York City's heavily gay Chelsea neighborhood. "We believe it is the largest, most comprehensive lesbian and gay health center in the nation, " says Dean LaBate, executive director of the center, which is named for AIDS activist Michael Callen and poet Audre Lorde. When the not-for-profit center is finished, it will include a dental clinic, a mammography unit, and on-site radiology.

The project is housed in a former paper-box factory that was gutted and rebuilt. The price includes a novel $7.6-million bond from the state of New York that has to be paid back over 30 years as well as $3 million raised by the center itself.

"What you see before you is the result of some really good planning on the part of folks here, the convergence of some new finances that never existed before, and the goodwill of a community that rallied to support the notion of a health center," LaBate says.

The center was formerly known as the Community Health Project, itself the product of the merger between two gay clinics in 1983. Housed in a space at the Lesbian and Gay Community Services Center that staffers describe as cramped and funky, CHP managed to keep adding programs over the years, from Health Outreach to Teens to lesbian health services. The result was a sometimes-chaotic exercise in juggling by administrators trying to make everything fit.

"Any one floor here is bigger than the entire space we had," LaBate says. "The fact that we were able to have 18,000 patient visits there a year was pretty wonderful in itself, given the dimensions of the space and the schedule." LaBate says the new center is expected to have nearly twice as many patient visits in its first year; within five years the goal is 62,000 a year. The budget for the current fiscal year is $3.4 million and is expected to top $4 million in the next fiscal year, which begins in July.

Because CHP still had the air of a 1960s-style free clinic--with many patients uninsured and unable to pay for treatment--one of the challenges facing the Callen-Lorde Center will be to attract a broader range of patients. "The goal in the first year is to become the option for everyone," LaBate says. The center expects that its doctors will enroll with various managed-care plans and hopes to form alliances with various local hospitals.

The Callen-Lorde Center won't have the market to itself. Although the center draws on a long history of serving gay men and lesbians, bigger-name health care institutions have been trying to draw on the market. Some have done so directly, such as Beth Israel Medical Center, with a lesbian health program; others have done so indirectly through HIV-care programs.

LaBate maintains that he is unconcerned about competitors, especially since many of them are driven by a single disease: HIV infection. "The more services for the community, the better," he says. "Other institutions have discovered the gay and lesbian market. But our mission is different. Our mission is to serve the community."