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What healthcare leaders need to know now

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.

 

 

Pam Cipriano: In value-based care, nurses are ready to lead

By | July 14 th,  2015 | care coordination, finance, Pam Cipriano, chief nursing officer, nurses, Blog, nursing, value-based care, American Nurses Association, executive leadership, quality, Top 25 Women in Healthcare | 3 Comments

 

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

 

As the healthcare industry begins to shift to value-based care, Pam Cipriano is utterly convinced that nurses are prepared to lead that transformation in many ways.

 

“I believe nurses are continuing to be the key providers in this transition of care,” says Cipriano, president of the American Nurses Association, which represents the interests of 3.4 million registered nurses. “Nurses have been the owners of care coordination for decades – they have this skill as a core competency. They tend to be the most holistic members of the team regardless of settings.”

 

Care coordination, says Cipriano, is a linchpin for quality, and the industry is taking notice of the pivotal role nurses can bring to the entire equation.
“That may come under many different names: care coordinator, case manager, outcomes manager,” she notes. “The major insurance companies have already seen the enormous value of having nurses in these roles.”

 

In every quality-improvement initiative, it is nurses who play a crucial role in determining if that patient experience will succeed or fail, adds Cipriano, who has served on boards and committees for a variety of respected industry organizations, including the Joint Commission and the National Quality Forum.

 

“When providers say, ‘We’re going to prevent readmissions, we’re going to prevent hospital-acquired conditions, or we’re going to make sure that people with chronic conditions don’t come back to the emergency room for their care and that they’re taking their medications’ – it’s nurses who are driving all of these activities.”

 

Cipriano herself has been driving the agenda for the ANA since her election in 2014. Yet she took a non-traditional path to nursing, beginning in a med tech program at a state college in rural Pennsylvania. Dissatisfied, she began looking for a parallel course of study to which she could apply her chemistry and biology courses and ended up at the Hospital of the University of Pennsylvania School of Nursing. She became heavily involved in the National Student Nurses Association and her career took off. She eventually earned a Ph.D. and has served in a variety of leadership and teaching roles for the University of Virginia, including chief clinical officer and chief nursing officer.

 

Her first year leading the ANA was a whirlwind, including a very visible role as the nation dealt with a number of cases of Ebola.

 

“What was most important was not only protecting the nurses, but also making sure we played a role in reducing the fear and anxiety of the public,” she says. “There was so much bad information that was being propagated and people were unable to focus on the science in the height of emotion.”

 

The ANA worked with the AMA, AHA, CDC, HRSA and many nursing associations to provide information and a reasoned response to the situation. Cipriano even did a media tour with Rich Umbdenstock, retiring CEO of the AHA, guesting on numerous morning radio shows across the country to assuage the public’s concerns.

 

That’s the kind of leadership that many nurses demonstrate, Cipriano shrugs. But she is not sure they receive adequate credit for their executive acumen.

 

“First and foremost, I believe there is a myth that nurses don’t understand finance, and so I believe there is a bias against placing nurses in positions that would oversee an organization’s financial position and budgets,” she says. “Yet if you think about a typical hospital, over half of the personnel and usually more than half of the budget is under the leadership of the chief nursing officer.”

 

That’s a lot of responsibility. And so Cipriano admits one of her pet peeves is when chief nursing officers or executives don’t report to the chief executive officer of the organization.

 

“It is absolutely critical that the chief nursing officer not only report to the highest level executive but also has access to and regular interactions with the governing body of the organization,” she says. “We now have pretty solid data linking outcomes of care and patient satisfaction and engagement scores with direct relationships to not only the nurses but also other employees directly involved in care. So why would you relegate that CNO to a role that is viewed as less important?”

 

Cipriano says many nurses don’t seek out a CNO role not only because they prefer to manage at the point of care but also because of the politics that can derail a career at that level.

 

“If you talk to nurse executives across the country, there are many who have left their jobs or been removed from their jobs because they didn’t get along with the CEO or they didn’t go along with the CEO,” she says. “And so, being in a CNO job is really tough work advocating for person-centered care and those who provide that care.”

 

If you get the impression that Cipriano is a fierce advocate for nurses, you’re right. As she continues her term as ANA president through 2016, she’s also helping nurses adjust to possible shifts in the setting of patient care as it moves from primarily hospitals to all sorts of venues, including the home, along the continuum of care. She’s also testified at briefings on Capitol Hill championing the installation of lifting equipment because nurses and so many others are injured trying to lift patients.

 

“Nurses are fifth in line among occupations for the most musculoskeletal injuries, ahead of many manufacturing jobs. It’s scary,” she says. “The turnover cost for a nurse can be huge --- it can be over $100,000 for an organization.”

 

Ultimately, she says, she wants to see nurses recognized by consumers and policy makers as intelligent, highly skilled and resourceful healthcare leaders.
“I want nurses at every level to be recognized as individuals who bring a lot of underrepresented knowledge to the conversation.”

 

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