C-Suite Conversations

What healthcare leaders need to know now

Laura Kaiser of SSM Health brings courage, conviction to questions around healthcare's future

By | June 8 th,  2017 | Affordable Care Act, chief executive officer, Furst Group, Harvard Business Review, Modern Healthcare, NuBrick Partners, president, SSM Health, Ascension, Blog, costs, Cuba, Intermountain Healthcare, New England Journal of Medicine, Top 25 Women in Healthcare | 4 Comments

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

U.S. healthcare has more questions than answers right now, but Laura Kaiser doesn’t shy away from them.

 

As the new president and CEO of SSM Health, Kaiser brings an impeccable resume back to her hometown of St. Louis, along with an inquisitive mind and a willingness to eschew the status quo.

 

“We need to think about how we make healthcare sustainable, affordable and accessible,” she says. “There’s always going to be a need for emergency care – acute, critical care, for injuries and illnesses that are unforeseen. But we need to invest in programs and services to minimize chronic conditions that are in fact preventable, because that will help us lower the overall cost of care.”

 

She’s outlined some of her thinking in major periodicals as co-author of articles in the Harvard Business Review and the New England Journal of Medicine. In HBR, she opined on “Turning Value-Based Care Into A Real Business Model.” And, in the medical journal, she and co-author Thomas Lee, MD, were blunt in encouraging big pharma to become full partners in the quest for value-based care: “As payers and providers work together to improve value, will pharmaceutical companies join that effort, or will they acts as vendors that merely maximize short-term profits for shareholders?”

 

“I think any approach to affordable care must have all stakeholders involved and engaged,” she says today. “I actually heard from one of the pharma companies after that was published, and they are interested in having further dialogue.”

 

Kaiser has no problem saying that healthcare is a right, not a privilege, for all humans, a stance her faith-based system supports completely.

 

“I’ve said this to many people without any intended partisan viewpoint,” Kaiser says. “No matter where you sit politically, healthcare isn’t political. For all of its flaws, the Affordable Care Act did three very important things. First, it heightened awareness about the need to provide excellent healthcare to all Americans. Second, it alleviated some financial hardship for people with pre-existing conditions. Last, it extended the availability of healthcare for people up to the age of 26 on their parents’ insurance coverage.”

 

A year and a half ago, Kaiser saw a different approach to healthcare during a fact-finding mission to Cuba, and she has been ruminating on it ever since.

 

“I wanted to see how it is that this small country – and one that has relatively limited resources compared to the U.S. – has better health outcomes than we do,” says Kaiser. “How are they doing that?”

 

Kaiser discovered that physicians, nurses and statisticians are embedded in each community at a rate of about one for every 1,000 to 1,500 residents.

 

“I visited a few of those clinicians,” Kaiser says. “Their medical records are spiral-bound notebooks with pencils. They provide primary care to patients and, if they need a higher level of care, patients are sent to a specialty practice, similar to a federally qualified health center in the U.S. If they end up needing hospitalization, they are simply referred to one of the hospitals across the country. It is a single system.”

 

And medicine is free, including insulin for people with diabetes.

 

“A lot of people in the U.S. have to make the terrible choice between buying medicines or food,” she says. “If we changed our approach, we could create incentives for people to stay healthy, and the overall cost of healthcare in this country would decrease. So, that’s my dream.”

 

At the time of the trip, Kaiser was chief operating officer of Intermountain Healthcare, a Utah-based health system known far and wide for its quality. Earlier in her career, she spent 15 years with St. Louis-based Ascension, another health system with a stellar reputation. Now, in taking the helm as only the third CEO in SSM Health’s history, she has a similarly pristine heritage to draw from – SSM Health was the first health system to be awarded the prestigious Malcolm Baldrige National Quality Award in 2002.

 

“The organization is deeply rooted in continuous quality improvement,” she says. “They have been on the cutting edge since the time of the Baldrige award, so there really is a great foundation on which to build the health system of the future.”

 

The answers that Kaiser and her team come up with should offer some interesting architecture for the future of SSM Health – and American healthcare.

 

 

SIDEBAR: The end of life brings questions, and courage, too

 

Much of the country’s healthcare spending occurs during the final weeks and months of patients’ lives. SSM Health President and CEO Laura Kaiser says that needs to be discussed openly and extensively.

 

“Discussing death and dying is becoming more acceptable thanks to people like Dr. Atul Gawande, who wrote the wonderful book Being Mortal, and Sheryl Sandberg, the author of Option B, a powerfully written book about recovering after suffering the loss of her husband,” says Kaiser, whose parents eventually chose hospice care after battling cancer. “Death and dying can be difficult to discuss, but it is something we need to grapple with as a country and as a society.”

 

She saw great courage in her parents as they made difficult decisions at the end of their lives.

 

“What my dad chose and experienced in hospice was beautiful care. It is what everyone should have if that’s where you find yourself,” Kaiser says. “Many years later, my mom made the same choice and had a similarly extraordinary experience.”

 

Her parents’ bravery flows through Kaiser and gives her confidence while she confronts complex issues as one of the nation’s leading healthcare executives. Kaiser’s dad, a chemical engineer, was her first mentor about leadership. She has fond memories of him from her childhood, listening to classical music in the car while driving to the library together. They shared a love for the “Peanuts” cartoons – especially Lucy, seated in her counseling booth, offering a listening ear for five cents.

 

“I trusted my dad’s counsel and would knock on his home-office door, saying, ‘I have my nickel.’ He would say, ‘Come on in for the consult,’ ” says Kaiser with a chuckle. “I had many 'consults' with him and am the better for it today.”

 

 

2016 Top 25 Minority Executives in Healthcare--Patricia Maryland: Taking risks helps leaders grow

By | December 12 th,  2016 | Affordable Care Act, Patricia Maryland, St. John Providence Health system, Top 25 Minority Executives in Healthcare, C-suite, Modern Healthcare, risks, Ascension, Ascension Health, Blog, CEO, chief operating officer, diversity, leadership, Sinai-Grace | Add A Comment

 

Classic content: One in a series of interviews with Modern Healthcare's Top 25 Minority Executives in Healthcare for 2016.

 

Patricia Maryland is talking about her role as chief operating officer for the Ascension Health system, but her message seemingly echoes the philosophy of her entire career: to grow, you must take risks.

 

“A major part of my role is leading through change,” she says. “The healthcare industry is going through tremendous transformation which requires leaders to challenge the way we deliver care.”

 

While Maryland has been honored with a number of awards during the four years she has served as COO and president of healthcare operations, she says the arduous role that preceded her promotion stretched her in ways that made her current success possible.

 

In 2007, Ascension asked her to leave St. Vincent Health in Indiana and move to Detroit to become the CEO of St. John Providence Health System and Ministry Market Leader for Michigan. The recession was just getting started; General Motors and Chrysler were restructuring their debt through bankruptcy. The economic pain that Detroit became famous for was just taking shape. As a result, St. John was hurting too.

 

“That was the most difficult time,” she says. “A number of our patients who were formerly employed ended up losing their insurance. We had to close hospitals. We had to consolidate programs and centralize services, and that was very risky. I had to lead through the change of reconfiguring the health system to create long-term sustainability given the external factors impacting the region.”

 

It was a difficult professional time. But on the personal side, Maryland says she was taking a risk there as well. “My daughter was going into senior year of high school; my son was going into eighth grade. My husband was transitioning his career as well. I knew I had to make sure my family was settled and comfortable back in Michigan after having been away for 4-1/2 years.”

 

Looking back, Maryland says the sizable risk proved to be more than worth it.

 

“When I took on the role in Michigan, it was larger and more complex than my previous role, and I was further challenged because it was during the worse of economic times. But I felt like I grew so much from a professional perspective. That role really provided me with the experience I needed to prepare for my current role as chief operating officer. If I didn’t have that kind of experience in leading through change, I don’t think I would be as effective in my role today.”

 

With success comes confidence, and Maryland is utilizing her voice as one of the most powerful healthcare executives in the country to take aim at healthcare disparities. Through a series of op-eds she’s written, she is candidly and forcefully encouraging healthcare organizations and patients to build on the momentum created by the Affordable Care Act and work toward equity of care.

 

“Part of what spurred this outreach is that the African-American community has really embraced the ACA,” she says. “I think we’ve made some great progress to expand healthcare access for many minority populations, but we know that coverage alone is not enough to eliminate healthcare disparities.”
To truly be effective, Maryland says, healthcare organizations need to help patients navigate health systems that can be difficult to utilize.

 

“We must mobilize the newly insured to connect them to preventive care,” she says. “It’s really important that we get them into the appropriate setting right from the beginning. If you can get into a system early enough, see a primary care physician on a routine basis, and comply with your medication requirements, you can have a better outcome.”

 

Maryland is seeing this prescription for good health lived out in her own family. As the oldest of eight children, she was the primary caregiver for her mother, who passed away from diabetes complications at an early age. Three of her siblings are genetically predisposed to diabetes as well, and they and Maryland are determined that their outcomes will be different.

 

“They’re working hard to stave off diabetes,” she says. “They’re exercising, following and complying with their medication regimen, and keeping their weight under control. They’re taking personal responsibility to do what they need to do to stay healthy.”

 

Not every family, of course, has an executive like Maryland to be its advocate. That’s one reason why Maryland also has long been a champion of diversity in the C-suite.

 

“We definitely need to address the pipeline issues of finding more individuals who represent the type of patient we are treating within our organization,” she says. “But it’s also making sure that those who are in leadership roles have the cultural competency to be able to manage populations to which they are providing care.”

 

Such leaders, though, need to have the attributes of servant leadership, Maryland adds.

 

“The nature of our work requires humility,” she says. “The fact that we are taking care of people at their most vulnerable state, when they are entrusting their lives to us, requires a different kind of leader.”

 

Maryland says her mentors Tony Tersigni (President and CEO of Ascension) and Bob Henkel (President and CEO of Ascension Health) have been her role models for servant leadership. In fact, it was Tersigni who identified her as a potential CEO leader within Ascension after observing her leadership style at DMC Sinai-Grace Hospital. Sinai-Grace also was where she’d unknowingly caught the attention of authors James Kouzes and Barry Posner, who ultimately featured her in their book “The Leadership Challenge” because of the work she did in transforming Sinai-Grace by challenging the process of how care is delivered. During this time, she was able to effectively garner the support from the Jewish community to assist in the transformation.

 

“You never know who’s paying attention to you,” Maryland says. “So always do your best – and do it with grace.”

 

 

Patricia Maryland: Taking risks helps leaders grow

By | July 8 th,  2016 | Affordable Care Act, Patricia Maryland, St. John Providence Health system, Top 25 Minority Executives in Healthcare, C-suite, Modern Healthcare, risks, Ascension, Ascension Health, Blog, CEO, chief operating officer, diversity, leadership, Sinai-Grace | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Minority Executives in Healthcare for 2016.

 

Patricia Maryland is talking about her role as chief operating officer for the Ascension Health system, but her message seemingly echoes the philosophy of her entire career: to grow, you must take risks.

 

“A major part of my role is leading through change,” she says. “The healthcare industry is going through tremendous transformation which requires leaders to challenge the way we deliver care.”

 

While Maryland has been honored with a number of awards during the four years she has served as COO and president of healthcare operations, she says the arduous role that preceded her promotion stretched her in ways that made her current success possible.

 

In 2007, Ascension asked her to leave St. Vincent Health in Indiana and move to Detroit to become the CEO of St. John Providence Health System and Ministry Market Leader for Michigan. The recession was just getting started; General Motors and Chrysler were restructuring their debt through bankruptcy. The economic pain that Detroit became famous for was just taking shape. As a result, St. John was hurting too.

 

“That was the most difficult time,” she says. “A number of our patients who were formerly employed ended up losing their insurance. We had to close hospitals. We had to consolidate programs and centralize services, and that was very risky. I had to lead through the change of reconfiguring the health system to create long-term sustainability given the external factors impacting the region.”

 

It was a difficult professional time. But on the personal side, Maryland says she was taking a risk there as well. “My daughter was going into senior year of high school; my son was going into eighth grade. My husband was transitioning his career as well. I knew I had to make sure my family was settled and comfortable back in Michigan after having been away for 4-1/2 years.”

 

Looking back, Maryland says the sizable risk proved to be more than worth it.

 

“When I took on the role in Michigan, it was larger and more complex than my previous role, and I was further challenged because it was during the worse of economic times. But I felt like I grew so much from a professional perspective. That role really provided me with the experience I needed to prepare for my current role as chief operating officer. If I didn’t have that kind of experience in leading through change, I don’t think I would be as effective in my role today.”

 

With success comes confidence, and Maryland is utilizing her voice as one of the most powerful healthcare executives in the country to take aim at healthcare disparities. Through a series of op-eds she’s written, she is candidly and forcefully encouraging healthcare organizations and patients to build on the momentum created by the Affordable Care Act and work toward equity of care.

 

“Part of what spurred this outreach is that the African-American community has really embraced the ACA,” she says. “I think we’ve made some great progress to expand healthcare access for many minority populations, but we know that coverage alone is not enough to eliminate healthcare disparities.”
To truly be effective, Maryland says, healthcare organizations need to help patients navigate health systems that can be difficult to utilize.

 

“We must mobilize the newly insured to connect them to preventive care,” she says. “It’s really important that we get them into the appropriate setting right from the beginning. If you can get into a system early enough, see a primary care physician on a routine basis, and comply with your medication requirements, you can have a better outcome.”

 

Maryland is seeing this prescription for good health lived out in her own family. As the oldest of eight children, she was the primary caregiver for her mother, who passed away from diabetes complications at an early age. Three of her siblings are genetically predisposed to diabetes as well, and they and Maryland are determined that their outcomes will be different.

 

“They’re working hard to stave off diabetes,” she says. “They’re exercising, following and complying with their medication regimen, and keeping their weight under control. They’re taking personal responsibility to do what they need to do to stay healthy.”

 

Not every family, of course, has an executive like Maryland to be its advocate. That’s one reason why Maryland also has long been a champion of diversity in the C-suite.

 

“We definitely need to address the pipeline issues of finding more individuals who represent the type of patient we are treating within our organization,” she says. “But it’s also making sure that those who are in leadership roles have the cultural competency to be able to manage populations to which they are providing care.”

 

Such leaders, though, need to have the attributes of servant leadership, Maryland adds.

 

“The nature of our work requires humility,” she says. “The fact that we are taking care of people at their most vulnerable state, when they are entrusting their lives to us, requires a different kind of leader.”

 

Maryland says her mentors Tony Tersigni (President and CEO of Ascension) and Bob Henkel (President and CEO of Ascension Health) have been her role models for servant leadership. In fact, it was Tersigni who identified her as a potential CEO leader within Ascension after observing her leadership style at DMC Sinai-Grace Hospital. Sinai-Grace also was where she’d unknowingly caught the attention of authors James Kouzes and Barry Posner, who ultimately featured her in their book “The Leadership Challenge” because of the work she did in transforming Sinai-Grace by challenging the process of how care is delivered. During this time, she was able to effectively garner the support from the Jewish community to assist in the transformation.

 

“You never know who’s paying attention to you,” Maryland says. “So always do your best – and do it with grace.”

 

 

Karen Ignagni: The post-ACA landscape offers a blank slate for visionary leaders

By | September 2 nd,  2015 | Affordable Care Act, AHIP, care coordination, consolidation, Healthcare, payers, population health, pricing, Modern Healthcare, pharmaceutical, providers, Blog, CEO, costs, disease management, EmblemHealth, insurers, Karen Ignagni, leadership, transparency, Top 25 Women in Healthcare | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

The healthcare industry is in a time of historic change. Hospitals and health systems are merging and acquiring each other; health insurers are doing the same. The provider and payer worlds themselves are converging as health systems create their own health plans and insurers are affiliating with providers.

 

But no one should read into what is happening now as a guarantee of what the industry will look like when the tectonic plates stop shifting, says Karen Ignagni, the new CEO of EmblemHealth who recently completed an incredibly influential run as CEO of America’s Health Insurance Plans (AHIP). Ignagni spoke with Furst Group during her final days at AHIP and before taking over at EmblemHealth.

 

“The way to think about convergence is that it’s the beginning of numerous possibilities,” she says, “and how it evolves will be dependent upon individual market dynamics and individual stakeholder leadership.”

 

Despite the uncertainty, it should be an exciting time for innovators, Ignagni notes.

 

“It’s crucial to be open-minded and not think the past is prologue,” she says. “Some folks love that idea; others who are looking to continue a strategy charted some years ago are terrified by it. There’s no handbook for where we are today. As a leader, you need to understand that and be willing to take out a blank piece of paper and create your vision.”

 

Ignagni leaves no uncertainty as to where she stands on that issue.

 

“If you can think about this as the best of times, then you’ll have an opportunity to make an enduring contribution.”

 

She says it was her desire to make a new kind of contribution that led to her decision to leave AHIP, the organization she had forged, and take the reins at EmblemHealth.

 

“First of all, leading AHIP is one of the best jobs in the country with the best team in the country,” Ignagni says, “But I’m excited about this new chapter. I’m thankful to the Emblem board for the opportunity to move from representing what our companies are doing to actually doing the work and taking an operations role in a health plan serving working families, seniors and the medically underserved.

 

“For me, it is coming full circle,” she adds, noting that she worked for the AFL-CIO in the ‘80s, where one of her roles was fighting for health benefits for union members.

 

More recently, of course, Ignagni was a pivotal player in the reform debate. Her advocacy was a signature moment in a career that saw her as arguably the most powerful payer voice for more than two decades – she previously led the American Association of Health Plans and guided AAHP’s merger with the Health Insurance Association of America that formed AHIP.

 

Despite the changes that the Affordable Care Act has brought, Ignagni agrees that the entire health care industry still has a long way to go to begin to meet consumers’ expectations.

 

“The health arena has to become much more like Amazon,” she says. “When I go on Amazon, they know who I am, I don’t have to re-enter all of my information, and things come overnight. That’s the customer-service standard that we in the health care arena need to emulate—everything needs to happen in real time.”

 

The status quo, she warns, won’t fly with consumers any more.

 

“Health care stakeholders need to embrace transparency,” Ignagni says. “For example, how much does a drug really cost? Right now, it is a black box of pricing. With pharmaceutical companies, the rhetoric is all about innovation. But how much of the price consumers are being asked to pay is for innovations, marketing and sales, and profit-taking? In the health plan community, consumers know precisely the answers to these questions. Now regulators will use the reporting structure for health plans to ask pharmaceutical companies similar questions.”

 

Payers have outed providers by revealing hospital pricing during the unprecedented wave of health-system mergers, and also has taken the pharma industry to task for what it views as price-gouging, like $84,000 Hepatitis C treatments. Ignagni, as the payers’ chief lobbyist, has led that charge.

 

“Our motivation as health plans is to get the price of the premium as affordable as possible for consumers. That’s a very different objective than a large pharmaceutical company charging whatever it can, or a hospital consolidating so it can raise all of its pricing to the level of the highest priced hospital in the network.”

 

She acknowledges that, under the new paradigm of convergence, payers and providers will need to work together. But payers must be equal partners in the arrangement, she warns.

 

“Health plans have an advantage in population health,” she says. “We’ve already written the book on it. It’s not a future state we’re evolving to -- we're there with our focus on disease management and care coordination. Now the question is, how do health plans bring these skills together with clinicians and hospitals to create new payment arrangements that result in more efficiency and effectiveness for patients?”

 

To get the industry to where it needs to go in these areas, Ignagni says, will take a new level of leadership. Leaders, she says, will need “resilience, agility, and the ability to handle a significant amount of unpredictability, because we are talking about writing a new chapter.”

 

Even with her new role, don’t be surprised if Ignagni is one of the primary co-authors of this next passage for the healthcare industry.

 

 

At HealthPartners, Mary Brainerd's leadership approaches solutions from a nuanced angle

By | August 5 th,  2015 | Affordable Care Act, delivery, merger, payers, Triple Aim, financing, Modern Healthcare, organizations, ParkNicollet, providers, Blog, cancer, CEO, Head + Heart Together, Institute for Healthcare Improvement, leadership, Mary Brainerd, Northwest Alliance, safety, HealthPartners, quality, Top 25 Women in Healthcare | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

While HealthPartners CEO Mary Brainerd is pleased that more people now have insurance through the Affordable Care Act, you’ll have to excuse her if she’s a little frustrated with how the law has had a rocky start in Minnesota, where innovations that already existed were scuttled by Obamacare.

 

For example, Minnesota residents who had pre-existing conditions already had insurance coverage through a special high-risk pool that included businesses as well as individuals. It had been functioning just fine for 30 years. The ACA shut the program down. Those individuals were forced to buy insurance products on the clunky exchange and now, in Year 2, are facing rate hikes of more than 50 percent because the risk pool is too small.

 

“That’s a federal issue, and we wish it would change,” Brainerd says. “But it appears no one has the political will at the federal level to ask, ‘What’s not working, and how can we help make it better?’ The more you segment the market when people have serious health conditions, the higher the costs are both for these individuals and for these smaller funding pools that are responsible for covering their costs.”

 

It’s an intriguing patient-centric perspective on Brainerd’s part, and comes from an angle that’s a little different than the typical healthcare-industry party line. But perhaps that’s to be expected from a respected executive with a degree in philosophy (as well as an MBA).

 

“I think there are actually a lot of areas in which both philosophy specifically and liberal arts in general add value, and that is that you spend time studying many different perspectives on the same topic,” she says. “So when you’re faced with challenges and decisions, you’re less likely to think there’s a formulaic right answer. Instead, you’re more likely to think there are many perspectives on this issue to explore and understand before moving to quick decisions.”

 

A 2013 merger with the ParkNicollet system was significant for HealthPartners because it doubled the organization’s patient base to more than 1 million and expanded the payer-and-provider capabilities that the company had been executing for 50 years. Other healthcare organizations are now jumping into the payer-provider mix, and Brainerd has some advice for them.

 

“I think the challenge for organizations that are just creating those capabilities is not to think of them as two separate businesses but instead to look at them as very integrated, synergistic businesses that have the same strategy. We have the same strategic plan for our delivery system as we do for our health plan, and it’s focused on people as our chief resource and asset.”

 

Yet the enormity of merging two large organizations was a challenge.

 

“There are 23,000 people making decisions across our organization every minute of every day, and so what we do and how we do it has to come from that shared sense of value and a common sense of purpose,” Brainerd says.

 

As the vehicle for that mission, HealthPartners’ culture is known as “Head + Heart, Together.” Internally, it has helped build cohesion. Externally, it has encouraged the organization get in front of the trend toward collaboration. For example, HealthPartners, Allina Health and a physicians’ group were all thinking about building an MRI center in one region of the Twin Cities metroplex. Instead, they worked together and built one center that they all utilize.

 

HealthPartners and Allina also joined forces in an initiative called the Northwest Alliance, with a view to achieving Triple Aim results in quality and health improvement, especially in urgent care and mental health services.

 

“Neither of us alone would have been able to bring that capability to the community,” she says.

 

The results, she says, have been so strong that HealthPartners and Allina are planning to extend the original 7-year agreement before it even expires.

 

Brainerd is equally committed to HealthPartners’ ties with the Institute for Healthcare Improvement, making, as in the case with the Northwest Alliance, the Triple Aim its overarching view of care. The Triple Aim’s focus on quality and safety is an area in which her personal experience has shaped her.

 

More than a decade ago, she was a patient in her own system as she dealt with breast cancer. Her care was excellent, but there were some less-than-stellar interactions with the system that made her re-evaluate what HealthPartners’ patients experience.

 

“I think anyone I know who has worked in healthcare and then has encountered the healthcare system as a patient, either themselves or a close family member, is changed by that experience,” she says. “Still, to this day, I almost viscerally recall that feeling of vulnerability that you have, and also the understanding that the physical challenges of treatments and surgeries is in many respects not even half the challenge of the emotional and psychological impact of a serious illness.

 

“It was a life-changing experience for me, and I hope it made me a better leader for our organization.”

 

While Brainerd says she believes the healthcare industry had made significant progress in safety, she also wonders what other blind spots exist.

 

“If, 10 years ago, we didn’t see those issues in patient safety, what are the things we’re not seeing today that future leaders will reference and say, ‘Why weren’t they focused on that?,’ ” she says. “For example, in our aim to minimize pain, we’re actually creating an environment where there are many worse health consequences as the result of the abuse, misuse and overuse of narcotics. More than 80 percent of the world’s narcotics are prescribed in the United States. And then I wonder what tomorrow’s example will be. I want to look for it.”

 

 

Sister Carol Keehan: Gender diversity is a must-have for healthcare leadership -- and so is solidarity with the poor

By | July 17 th,  2015 | Affordable Care Act, Catholic Health Association, Modern Healthcare, poor, Sister Carol Keehan, Blog, CEO, gender diversity, leadership, Top 25 Women in Healthcare | Add A Comment

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

As the president and CEO of the Catholic Health Association since 2005, Sister Carol Keehan is arguably one of the most powerful healthcare executives in the country and played a significant role in getting the Affordable Care Act passed. Yet there was a time in her life as a hospital executive with a nursing background that she felt stymied in her efforts to help the poor obtain medical care, so she went back to school to get a master’s degree in finance.

 

“I thought I had a lot of really wonderful ideas, particularly for how we could take care of people who couldn’t afford care. And I would always get just literally nailed by the finance person,” she remembers. “They would say, ‘That would be a nice idea, but you couldn’t do it for these reasons.’ And most of the time, those reasons were, ‘It’s easier for me not to get involved.’ But that’s just not right.”

 

Armed with that degree and an understanding of the intricacies of Medicaid, cost-based reimbursement and the art of negotiating contracts with insurance companies, Keehan became an even more formidable force to be reckoned with. She’s been honored by many, including a Trustee award from the American Hospital Association and another from Pope Benedict XVI. And in 2010, Time magazine named her one of the 100 Most Influential People in the World.

 

Keehan says she sees more women following a similar path in healthcare these days. “More and more, you’re going to see women reclaiming leadership positions,” she says. “More women are going into business schools, and more women are getting a degree in finance in addition to a degree in nursing.”

 

Gender diversity in leadership is important, she says, and should simply be common sense. She notes that it was primarily sisters from religious orders who built some of the largest healthcare systems in the U.S.

 

“Whether it’s the Catholic Church or whether it’s healthcare, if you only use 50 percent of the talent you’ve got, that’s a problem,” she says. “If you only use men, you’ve got a problem. If you only use women, you’ve got a problem.”

 

She has faced her share of opposition over the years. She had a well-publicized battle over her support of the ACA with a number of U.S. bishops, who erroneously believed the law provided federal funding for abortion.

 

“You don’t hear the bishops saying, ‘Repeal the Affordable Care Act,’ ” Keehan says. “The bishops always wanted healthcare for everyone. They got some advice that I didn’t think was correct. I had spent as much time as anybody working with the people writing the bill at the House, in the Senate and in the White House. So I knew exactly what was in the bill. Two federal judges already ruled early on that there was no federal funding for abortion in the bill.”

 

Keehan sees her positions on the issues based on morality and theology more than politics. She has spoken frequently about “solidarity as the moral foundation for health reform.” And for her, that solidarity begins with economically disadvantaged people.

 

“Part of it is your worldview,” she explains. “Do you see yourself as someone who is out to get everything they can for themselves in the time they have? Is the impact of what I do measured by what it gets for me?”

 

That’s opposed to Keehan’s worldview, which she describes in this way: “We are a part of something much more wonderful. We’re a part of creation, we’re created by a loving God and the fullness and our greatest happiness will come when we imitate that loving God and appreciate the relationship we have with other people whether we know them or not.”

 

As a veteran world traveler—she’s on the board of Catholic Relief Services--she has seen the poorest of the poor in countries like Rwanda and Guatemala and has strong opinions on issues ranging from immigration and climate change to how world powers sometimes take advantage of developing countries.

 

“We have a responsibility to take care of ourselves and to take care of our families, and there is a priority you put to that,” Keehan says. “But when that priority gets so out of balance that you don’t care what happens to other people, you really diminish yourself.”

 

Those experiences in the bleakest parts of the world, she says, make her more determined to make a difference as a leader, and more committed to prayer.

 

“I think you pray better when you’ve seen that kind of suffering. You also think about the impact of things when you live in a consumer society,” she says. “You can always find a reason why you can’t do something, but it does push you to find reasons why you can do something.”

 

Keehan’s concerns for the poor in the U.S. are no less strong, and she says one of the traits needed for leadership is championing people whose voices are often drowned out in the nation’s capital by the cacophony of lobbyists and special-interest groups.

 

“I’ll often say to people in an audience that a $25 co-pay is not going to stop you or me from getting a mammogram. But it often is the difference for a single mother with two children. ‘Do I spent $25 for a mammogram, or for meals for the rest of the week till payday, or fill my child’s prescription?’ ”

 

Up until she took the role at CHA, Keehan not only worked in hospitals but actually lived in them all her adult life as a Daughter of Charity. Though hers is a special calling, she says she feels that everyone in healthcare has a calling.

 

“In healthcare, if you don’t feel you can make a real difference, you must have some spot in your soul that’s dead and you need to get it resurrected. You have an opportunity to make such a big difference in the lives of so many people.”

 

 

A roundup of analysis on King vs. Burwell and the future of the ACA

By | June 26 th,  2015 | Affordable Care Act, American Hospital Association, subsidies, ACA, decision, health insurance, King, King vs. Burwell, lawsuits, Obamacare, Blog, Burwell, John McDonough, America's Health Insurance Plans | Add A Comment

 

As we head into the weekend, here are some of the key analyses on the results of King vs. Burwell:

 

Vox’s Sarah Kliff explains the ruling…:
http://www.vox.com/2015/6/25/8804053/king-v-burwell-obamacare-scotus-in-favor

 

…And Harvard professor John McDonough, who helped develop the ACA, is interviewed:
http://www.hsph.harvard.edu/news/features/the-supreme-court-surprise-that-wasnt/

 

Although the subsidies can’t be easily revoked...: http://www.modernhealthcare.com/article/20150625/NEWS/150619978/roberts-opinion-means-obama-successor-cant-easily-revoke-subsidies

 

…The lawsuits are not over yet.:
http://ebn.benefitnews.com/blog/ebviews/the-aca-lawsuits-arent-over-yet-2746768-1.html

 

Plus, statements from:

 

America’s Health Insurance Plans:
http://www.ahip.org/News/Press-Room/2015/AHIP-Statement-on-Supreme-Court-Ruling.aspx
…and the American Hospital Association’s CEO:
http://blog.aha.org/

 

Finally, you can read the decision for yourself:
http://1.usa.gov/1QRFMoZ

 

 

Georges Benjamin advocates for a better health system

By | August 7 th,  2014 | Affordable Care Act, Furst Group, Georges Benjamin, Healthcare, politics, Top 25 Minority Executives in Healthcare, executive, health system, Modern Healthcare, Blog, diversity, leadership, public health, affirmative action, APHA | Add A Comment

 

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

 

Georges Benjamin had a wonderful experience as a military physician, eventually rising to become chief of emergency medicine for Walter Reed Army Medical Center in Washington, D.C. But the diverse environment he experienced in those days bore little resemblance to what he encountered when he returned to life as a civilian.

 

“I was a beneficiary of a time when we had active affirmative action programs and had a significant number of minority students in my medical school classes as well as my residency,” he says. “There were many leaders who were part of a minority when I served in the military. When I went out to the private sector I noticed that I was far too often the only minority leader in the room. Thankfully, that’s begun to change.”

 

Today, as the executive director of the American Public Health Association, Benjamin is a strong advocate not only for the public health workers his organization represents, but also for diversity at every level of a company.
“In a country like ours, which has such a variety of experiences, the value in having a diverse workplace is that people bring in different ways of thinking,” he says. “We bring our experiences to the problem-solving process, and I think it helps create different solutions.”

 

In today’s political climate, he says, “we’re all kind of living in a type of echo chamber where we will only tune in and listen to people who agree with us. If you talk to yourself and answer your own questions, you’re less likely to get the most inclusive and innovative answers.”

 

Benjamin and the APHA are a non-partisan organization. They have both extolled and chastised Republicans and Democrats on issues that affect public health. But Benjamin says he’s seen a change in how politics can affect public health.

 


“Increasingly, politics is playing a role in healthcare, for better or for worse,” he says. “Many of my colleagues just want to follow the science, and we should. But public health practice is both an art and a science that often uses the policy process to make broad system change. That makes it political. It’s increasingly difficult to appeal just to science when people are camped out in their ideology, so we also have to convince them on the merits of the evidence when it does not line up with what they believe. I tell students we should not be afraid to engage in the political process and to be an advocate. Recognize also, that sometimes you have to compromise and that negotiation is the most powerful tool in your toolkit.”

 

Benjamin is a leader well-versed in the nuances of the D.C. beltway, and a student of its history. During a recent sabbatical at Hunter College, where he stayed in the former home of President Franklin D. Roosevelt, he spent time collaborating on a coffee-table book that compiled political cartoons on healthcare during the past 100 years. “The Quest for Health Reform: A Satirical History,” was released in 2013.

 

“The thing that struck me was really how the rhetoric against health reform has not changed all that much,” he says. “Some of these arguments against it have been around for a long time and have mostly proven to be false.”

 

If consensus around broad health reform was hard to achieve over the past century, Benjamin bore witness to at least a temporary change in the aftermath of the 9/11 attacks for a more narrow reform of the public health system. At that time, Benjamin was the secretary of health for Maryland and was thrust into the national spotlight as his state and the nation grappled with deadly anthrax-laced letters.

 

Funding and support for public health reform was increased, and APHA, which Benjamin joined in 2002, was supportive of the Bush administration’s national public health preparedness program. But when the recession hit a few years later, budget cuts forced many of these public health programs to be curtailed, Benjamin says.

 

“The potential was there to build our public-health defense in a robust and organized manner, but then the recession came, and resources were withdrawn,” he says. “We have our first Middle Eastern Respiratory Syndrome (MERS) cases here in the U.S. right now. We’re always going to have new diseases that emerge; having an adequate health and public health system to address them is our challenge.”

 

Public health, Benjamin says, “is a leadership exercise.” As such, APHA works with the Department of Health and Human Services on the report for the nation’s Leading Health indicators, and partners with UnitedHealth Foundation on America’s Health Rankings. It’s also been in the forefront of warning of health risks associated with climate change, and the need for sophisticated health information technology. “We are also strong supporters of the Affordable Care Act,” he says.

 

While Benjamin believes the U.S. healthcare system has made progress in reducing readmissions and hospital-acquired infections, his military discipline shines through when he talks about what it will take for the industry to get where it needs to be.

 

“What we’d like to do,” he says, “is get a health system that is predictable and raises the bar over time.”

Foresight is the key to David Lopez's leadership

By | July 14 th,  2014 | Affordable Care Act, David Lopez, Furst Group, primary care, Top 25 Minority Executives in Healthcare, executive, Harris Health System, health system, hospital, Modern Healthcare, Blog, CEO, leadership | Add A Comment

 

One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)

 

Over the last several years, as many hospitals and health systems across the country were building patient towers for their acute-care needs, David Lopez, the outgoing CEO of Harris Health System in Houston, was quietly shifting his organization in anticipation of some of the changes that the Affordable Care Act has brought.

 

He didn’t expect more revenues from inpatient services; he worked to build a strong wellness program and to ramp up primary care heavily. There’s a reason for that.

 

“If you look at our statistics, 64 percent of our patients have no insurance,” he says. “For us, more volume on the acute-care side means we spend more money. For us, it’s not about generating more revenue. It’s about managing our costs.”

 

Harris provides 35,000 admissions every year, but Lopez notes that outpatient visits have reached 1.4 million annually, with an additional increase of 300,000 expected in the next 18 months.

 

“If the patient can be taken care of in a primary-care setting or another setting, the best way to lower your cost overall is to avoid the admission,” he says. “You’re better off doing that than looking at the patient as a potential revenue opportunity.”

 


Lopez has been in hospital work his entire adult life and served as CEO at Harris for 10 years. He notes that healthcare has become “a lot more political” than it was in the past. “When you mix politics and healthcare and money, it makes for an interesting relationship between all three of those components,” he says. “There’s a very direct relationship between what we are able to do based on the money that’s available.”

 

As the leader of one of the largest public health systems in the country, Lopez was used to having to deal with funding that wasn’t always available, as well as the transparency and scrutiny that comes with public governance. A couple years ago, Harris County took a penny from the hospital district’s tax rate to cover some of their expenses. The health system hasn’t gotten that penny back and, with the district’s population growing by 100,000 people a year (“the unincorporated areas have a population larger than the city of Philadelphia,” Lopez notes), it’s a struggle to have a break-even budget.

 

Despite the challenges, Lopez’s respected work earned him an award as one of Modern Healthcare’s Top 25 Minority Executives of the Year for 2014. John Guest, his predecessor at Harris, noted that Lopez “has the patience of Job,” a quality that was needed as Lopez and his staff worked to revamp the system so it would be less impacted by uninsured patients.

 

“Once you’ve established what you need to get accomplished, you’ve got to keep after it,” Lopez says. “You don’t let little things deter you. Maybe the outcome is not happening at the speed you wanted, but if your focus is right, you stay with it.”

 

In Lopez’s case, the focus was lessening the pressure on the emergency department by transforming the safety-net system into one more reliant on primary-care clinics.

 

“We want to be healthcare providers, not sick-care providers,” Lopez says. “We’ve designated all of our clinics as medical homes; they’ve all received certification. So now we’re trying to get our community members to understand that this is your doctor, and we need your help to address your health needs.”

 

Wellness is part of that strategy and something Lopez takes seriously. He’s been a runner for 40 years, and last year Harris ranked first among Houston’s largest employers for its wellness program. He says that, ultimately, Harris’ patients will need to do their part too.

 

“We’re trying to be inclusive with our patients,” he says. “It can’t just be something that we do for them. We need a partnership with them where they participate in the process and buy in to the concepts and approaches.”
Such an approach, of course, requires foresight and patience. Lopez has plenty of both.

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