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.”

 

 

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.

 

 

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