Packaging HIV care - entrepreneur Bernard Salick plans for-profit HIV medical centers - includes also article on New York City's new, high-tech Callen-Lorde Health Center

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."