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2016 Top 25 Minority Executives in Healthcare--Trent Haywood: Clinical leaders essential in move to value-based care

By | December 6 th,  2016 | Blue Cross Blue Shield Association, chief medical officer, Community Health Management, population health, Top 25 Minority Executives in Healthcare, Trent Haywood, Modern Healthcare, Blog, Centers for Medicare and Medicaid Services, health disparities, healthcare costs, leadership, physician executive, Lawton, VHA | Add A Comment

 

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

 

Trent Haywood has multiple titles after his name – an MD as well as a JD. But to find respect and cohesion among his leadership-team peers as he moved into a role as a physician executive, he says his biggest lesson was to check his degrees at the door.

 

“Someone gave me advice early on that, if you’re going to transition away from the bedside, you have to become comfortable no longer being called ‘Dr. Haywood’ but just ‘Trent,’ ” says the chief medical officer of the Blue Cross Blue Shield Association. “Being viewed as ‘the doctor’ has great social capital, but it prevents other executives from really getting to know you and sharing with you as a peer.”

 

But make no mistake – Haywood says he believes that more clinician executives are needed precisely because of their unique qualifications to bring the value to value-based care and to balance patients’ needs and concerns with healthcare finances.

 

“The business is evolving,” he says. “The model used to be ‘the suits and the scrubs.’ The suits did their thing, and the rest of us in scrubs did our thing. It was very siloed, and as long as you stayed on your side of the fence, it worked well.

 

“The model is changing. You have a new generation of clinicians who are going back and getting additional degrees. I think it’s going to continue to be the norm where you’re going to have many more clinicians in leadership roles.”

 

 

Haywood says his experience was easier than a lot of physician executives because he was able to wear both hats on a weekly basis for a seven-year period while he worked at the Centers for Medicare and Medicaid Services.

 

“On the weekends, all I was doing was focusing on individual patients as they came through the door of the ER. Then, during the week, I would be back at CMS flying all around the country trying to make a difference on a national level. My situation was unique; I was fortunate.”

 

Haywood’s own influences in leadership included his parents. His father Stanley, who recently passed away, had the longest tenure on the Lawton, Okla., city council in history. His mother Charlotte led the young people’s program for many years at the church the family attended.

 

“I learned early on from my mother that if you want maximum output, you have to take the time to invest in people,” he says. “You also have to delineate which people you are going to invest your time in.”

 

Haywood’s father coached him in athletics and impressed upon him the importance of teamwork over individual accolades. “If everyone showed up for practice, they were going to get into the ballgame, regardless of ability,” he remembers. “He put the onus on the team to think beyond ourselves and how we were going to approach the game in a team-based manner.”

 

In the same way, Haywood notes, payers and providers are going to need to work together as a team to help renovate the U.S. healthcare system. As someone who has worked as the deputy chief medical officer for the government (CMS), and chief medical officer for a major provider association (VHA) before coming to BCBSA, he thinks the convergence can’t happen soon enough.

 

“You’re going to see more and more collaboration across the board within a population-based framework,” Haywood says. “If I want to manage a population, then I need to understand more acutely where that population is going in terms of specialists and which ones are performing better for my population.”

 

But the talk between payers and providers needs to evolve beyond healthcare delivery, he says. Affordability is critical when many families live paycheck to paycheck with little savings, and that is reflected in BCBSA’s push for transparency in healthcare costs, Haywood adds.

 

“We don’t want families paying for waste in the system, and so that’s led to the issue of transparency. And the purpose is affordability – how can we make healthcare affordable for a family?”
Haywood has been using BCBSA’s new Community Health Management hub tool to take a deep dive into the data that affects healthcare consumers at the ZIP code level. For example, he recently dug into the statistics to show how something that many people take for granted – access to a car – affects population health, with many people in struggling neighborhoods unable to maintain nutritional health because they lack transportation.

 

“We need to get into the communities and do a better job of population health at the community level,” he says. “We need to find answers to questions like: What are the characteristics of a population? What are the environments in which we find those populations? And what are the behavior patterns of those communities?”

 

Like his father, the city councilman, Haywood hopes to make a difference on the local level – by guiding BCBSA policy on a national scale.

 

“Most healthcare decisions happen outside the four walls of a clinical setting,” Haywood says. “I’m excited that we’re going to transition to more of a preventive healthcare model instead of a disease-based model.”

 

 

BCBSA's Trent Haywood: Clinical executives essential in move to value-based care

By | June 24 th,  2016 | Blue Cross Blue Shield Association, chief medical officer, Community Health Management, population health, Top 25 Minority Executives in Healthcare, Trent Haywood, Modern Healthcare, Blog, Centers for Medicare and Medicaid Services, health disparities, healthcare costs, leadership, physician executive, Lawton, VHA | Add A Comment

 

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

 

Trent Haywood has multiple titles after his name – an MD as well as a JD. But to find respect and cohesion among his leadership-team peers as he moved into a role as a physician executive, he says his biggest lesson was to check his degrees at the door.

 

“Someone gave me advice early on that, if you’re going to transition away from the bedside, you have to become comfortable no longer being called ‘Dr. Haywood’ but just ‘Trent,’ ” says the chief medical officer of the Blue Cross Blue Shield Association. “Being viewed as ‘the doctor’ has great social capital, but it prevents other executives from really getting to know you and sharing with you as a peer.”

 

But make no mistake – Haywood says he believes that more clinician executives are needed precisely because of their unique qualifications to bring the value to value-based care and to balance patients’ needs and concerns with healthcare finances.

 

“The business is evolving,” he says. “The model used to be ‘the suits and the scrubs.’ The suits did their thing, and the rest of us in scrubs did our thing. It was very siloed, and as long as you stayed on your side of the fence, it worked well.

 

“The model is changing. You have a new generation of clinicians who are going back and getting additional degrees. I think it’s going to continue to be the norm where you’re going to have many more clinicians in leadership roles.”

 

 

Haywood says his experience was easier than a lot of physician executives because he was able to wear both hats on a weekly basis for a seven-year period while he worked at the Centers for Medicare and Medicaid Services.

 

“On the weekends, all I was doing was focusing on individual patients as they came through the door of the ER. Then, during the week, I would be back at CMS flying all around the country trying to make a difference on a national level. My situation was unique; I was fortunate.”

 

Haywood’s own influences in leadership included his parents. His father Stanley, who recently passed away, had the longest tenure on the Lawton, Okla., city council in history. His mother Charlotte led the young people’s program for many years at the church the family attended.

 

“I learned early on from my mother that if you want maximum output, you have to take the time to invest in people,” he says. “You also have to delineate which people you are going to invest your time in.”

 

Haywood’s father coached him in athletics and impressed upon him the importance of teamwork over individual accolades. “If everyone showed up for practice, they were going to get into the ballgame, regardless of ability,” he remembers. “He put the onus on the team to think beyond ourselves and how we were going to approach the game in a team-based manner.”

 

In the same way, Haywood notes, payers and providers are going to need to work together as a team to help renovate the U.S. healthcare system. As someone who has worked as the deputy chief medical officer for the government (CMS), and chief medical officer for a major provider association (VHA) before coming to BCBSA, he thinks the convergence can’t happen soon enough.

 

“You’re going to see more and more collaboration across the board within a population-based framework,” Haywood says. “If I want to manage a population, then I need to understand more acutely where that population is going in terms of specialists and which ones are performing better for my population.”

 

But the talk between payers and providers needs to evolve beyond healthcare delivery, he says. Affordability is critical when many families live paycheck to paycheck with little savings, and that is reflected in BCBSA’s push for transparency in healthcare costs, Haywood adds.

 

“We don’t want families paying for waste in the system, and so that’s led to the issue of transparency. And the purpose is affordability – how can we make healthcare affordable for a family?”
Haywood has been using BCBSA’s new Community Health Management hub tool to take a deep dive into the data that affects healthcare consumers at the ZIP code level. For example, he recently dug into the statistics to show how something that many people take for granted – access to a car – affects population health, with many people in struggling neighborhoods unable to maintain nutritional health because they lack transportation.

 

“We need to get into the communities and do a better job of population health at the community level,” he says. “We need to find answers to questions like: What are the characteristics of a population? What are the environments in which we find those populations? And what are the behavior patterns of those communities?”

 

Like his father, the city councilman, Haywood hopes to make a difference on the local level – by guiding BCBSA policy on a national scale.

 

“Most healthcare decisions happen outside the four walls of a clinical setting,” Haywood says. “I’m excited that we’re going to transition to more of a preventive healthcare model instead of a disease-based model.”

 

 

Bernard Tyson: Workers will share in healthcare costs, but cost shifting is not sustainable

By | September 18 th,  2014 | chairman, Furst Group, Healthcare, Top 25 Minority Executives in Healthcare, executive, Modern Healthcare, Bernard J. Tyson, Blog, CEO, diversity, Gen KP, healthcare costs, Kaiser Permanente, leadership, millennials, Vision 2025 | Add A Comment

 

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

 

At a recent New York Times conference on healthcare, Kaiser Permanente Chairman and CEO Bernard J. Tyson drew applause when he said that healthcare costs can’t continue to be shifted onto the backs of American workers, who have seen few wage increases in the last 20 years.

 

It’s one thing when a consumer activist or patient advocate makes a bold statement like that; it’s quite another when the words come from one of the most powerful healthcare executives in the country. In a conversation the following week, he elaborated on that point.

 

“You have the American people seeing the cost of living going up every year and seeing the cost of healthcare going up three or four times the cost of inflation,” Tyson said. “They see no real wage increases and then they get stuck with the added cost that’s been shifting to them from employers and insurers.

 

“That is not a long-term solution.”

 

What does seem to be working is the Kaiser Permanente business model, in which the organization serves as both health plan and healthcare provider, with capitation helping to fund the delivery of care and hospitals viewed as expense centers rather than revenue generators.

 

“One of the moral obligations that I believe I have as a leader in the healthcare industry is to bring a lot of transparency as to why I believe our model is the best way to go,” Tyson says. “It’s a system that doesn’t pay for volume, that isn’t motivating people to produce more of something in order to get paid. What we have been able to do for almost 70 years is align the incentives of the financing mechanism with the hearts and minds of physicians and other caregivers who continually sign up to do the right thing.”

 


The healthcare industry has recently gone through a period where many hospitals were building new patient towers that executives needed to fill with inpatients to pay for. Readmission penalties have changed the rules. Now, consciously or unconsciously, a growing number of U.S. healthcare organizations seem to be emulating Kaiser Permanente as they acquire or create their own health plans in the reform era.

 

“In our system of care,” Tyson says, “you have the caregiver team all working together with aligned incentives where the physician is not making any more or less if he decides that the patient needs to be in a hospital or the patient needs to be at home with a nurse.”

 

Healthcare removed from the high-volume, fee-for-service environment has always been the goal at Kaiser Permanente, Tyson says.

 

“It’s in the DNA – it’s how the organization was built,” he says. “In his early years, Henry J. Kaiser’s mother died. He believed that she died prematurely because they were poor and couldn’t afford the right healthcare. Of all the businesses he created and all he did in his life, it’s pretty interesting that this organization is the standing legacy that continues to carry his name forward into the future.”

 

The future at Kaiser Permanente can be held in the palm of your hand, if that palm is holding a smartphone. The organization has invested heavily in information technology with the autonomy its capitation model has allowed.
“We are,” Tyson says simply, “the alternative to the mainstream delivery system that you see out there. We get a lot of people who come in to look at how we run our hospital systems.”

 

When a Kaiser Permanente member has to enter the hospital, whether through the emergency department or a planned admission, his or her electronic medical records are available 24/7 online throughout the system. That’s not a goal; it’s a present-day reality.

 

“It expedites getting to a diagnosis, and then determining what the treatment is,” Tyson says. “In the outside world, you can end up in the emergency department 12 to 24 hours before they figure out what’s going on. In our world, within 45 minutes or an hour, you can be in a hospital bed and we’re starting treatment. The whole point is to manage the quality of care and the logistics of care.”

 

With EMRs already in place at Kaiser Permanente, Tyson has the freedom to look down the road to make sure the organization is still a health care leader 10 years from now. To that end, he’s taken a particular interest in the younger employees who are part of his workforce, which numbers about 200,000.

 

“I have a particular interest in the millennials right now,” he says. “I feel that part of my responsibility is to make sure that the future generation of leaders is in the pipeline, contributing in very different ways than what I went through 30 years ago when I was growing up in KP.”

 

Gen KP, as the millennial group is called, has direct access to Tyson – no hierarchy. And Vision 2025, Kaiser Permanente’s future planning project, includes contributions from the organization’s future leaders. “I will tell you that having the millennials as part of that thought process is making us think very differently about the future. It’s refreshing.”

 

Looking more broadly, Tyson, who took the helm of Kaiser Permanente in 2013, hopes to make a wider impact in making healthcare more affordable and eliminating disparities in the U.S.

 

“I strongly believe that healthcare is unaffordable in large part because it’s siloed, and it’s running off the wrong chassis,” he says. “I would love to continue to contribute to the affordability agenda in this country.”

 

Like his comments about shifting healthcare costs, Tyson’s perspective on the topic leans toward an empathy for American workers.

 

“I think everyone breathing in this country should have the same equal rights and a level playing field for the ability to pursue life, liberty and happiness,” he says. “And the question I ask myself is, what is the role that healthcare can play in allowing people a good chance of doing that? We continue to have health disparities in this country; it isn’t a level playing field.”

 

Tyson said the changes brought by the Affordable Care Act can make a real difference in grading the surface of that field. “I think the elements are in place to put the pressure back on the industry in its transformation to produce higher quality care at a lower cost. And I know that’s possible.”

 

It’s a point Henry Kaiser would probably second.

 

Helen Darling: A strong voice for employers in the healthcare debate

By | June 10 th,  2013 | Furst Group, glass ceiling, Healthcare, mentoring, National Business Group on Health, payers, executive, health insurance, Lean In, Modern Healthcare, patient safety, president, providers, Sheryl Sandberg, 100 Most Powerful People in Healthcare, Blog, board of directors, CEO, employees, employers, Fortune 500, healthcare costs, healthcare reform, Helen Darling, leadership, marketplaces, national debt, quality, Top 25 Women in Healthcare | Add A Comment

 

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

 

The healthcare industry is undergoing major changes, but Helen Darling says the providers and payers who comprise much of the industry aren’t doing enough to control costs and improve quality. Her words carry a lot of weight – she’s the president and CEO of the National Business Group on Health, which represents many of the large employers in the U.S.
Darling says her membership would like to see big improvements in safety, quality and costs, but have doubts about whether that could actually happen in an industry with limited competition.

 

“With our healthcare system, there are no countervailing forces that will essentially force organizations to reduce costs and improve quality and safety,” she says. “We saw very little attention paid to patient safety until the federal government took this tiny amount of money and said, ‘We’re going to hold this back if you don’t meet certain Partnership for Patients goals.’ And that did get people’s attention, but that’s what it took.”

 

Darling’s non-profit organization represents many Fortune 500 and other large companies, serving as a united voice on healthcare policy and offering solutions to healthcare issues in the marketplace. She says her membership is concerned about where healthcare is headed.

 


“All you have to do is look at every report written concerning the national debt or the annual deficit and see that healthcare is the driver,” she says. “It’s not Social Security. It’s not education. It’s not feeding children. It’s all about healthcare.”

 

Darling herself has led a storied career, directing studies at the Institute of Medicine before becoming the health legislative aide for U.S. Sen. Dave Durenberger (R-Minn.). She later worked as a senior executive for Mercer, Xerox and Watson Wyatt (now Towers Watson) before agreeing to lead NBGH. She is a member, and co-chair for ten years, of the Committee on Performance Measurement of the National Committee for Quality Assurance and is Vice Chair of the Board of the National Quality Forum.

 

Patient safety, she said, is a key concern for her and NBGH.

 

“There’s nothing like statistics having to do with patient safety to galvanize attention to the problem,” she says. “Just think about the amount of harm or death because somebody, for example, gets an infection. Even if they don’t die, they suffer. I’m sure everybody knows families of someone who got C-Diff or MRSA in the hospital. All you have to do is look at the data and see how much human suffering and wasted cost are behind healthcare associated harm.”
The lack of progress on that front, she says, is perplexing.

 

“What I don’t understand, to be honest, is why there isn’t more of an outcry,” she adds. “If somebody eats a hamburger that has some contamination, it’s all over the television. If a plane goes down, people are on it for days in the 24/7 news cycle. And yet every day, in hospitals across the United States, people are being harmed and in some instances are dying from conditions that are preventable and avoidable.”

 

Darling encourages the executives she represents to serve on the boards of hospitals (something she herself has done), and her group offers them a patient safety toolkit. She encourages trustees to press for frequent safety reports to be given to the CEO and the Board of Directors.

 

“Historically, hospitals have a risk-management report, and they might have a quality report if, say, the Joint Commission did its audit and found something. The risk-management report will say things like, ‘There was a patient fall this month and we have booked $3 million as part of the liability reserved to take care of it.’ That’s it. Historically, there has been no root cause analysis, no report on what changes they’re making to stop that from ever happening again. That is changing but it isn’t fast enough or universal.”

 

To be fair, a few of the major employers who make up NBGH’s membership have similarly been criticized for their reaction to healthcare reform, including some who have changed terms of employment that make fewer employees eligible for health insurance. But Darling says health insurance has never been an automatic benefit for the workforce.

 

“At any given time during the year, we have 60 million people without coverage, and most of them are working people. Health insurance has always been a perk,” she says. “It’s never been something that everybody has, and it is very much related to wages. The irony is, the people with the lowest wages get the least benefits. But I don’t think it’s going to get worse. If the insurance marketplaces work the way they’re supposed to work, we will be better off in terms of coverage (although not in terms of the costs of health benefits coverage on a net basis).”

 

But the penalties for lack of coverage will need to change before that happens, Darling adds.

 

“The penalty is not as much as it will cost people to get the coverage. They can’t tell people they have to have a package that will cost, on average, $7,000, and then tell them the penalty for not buying coverage is $1,000. They’re going to have to change the package because it makes the subsidies much richer. They will bankrupt the country on that one.”

 

Still, she says she’s confident that the gap will be bridged.

 

“All that needs to be sorted out, but I actually think we will have more people covered. Nobody will be happy about a lot of the details. In the end, I think more states will look a little more like Massachusetts.”

 

Darling has been selected numerous times by Modern Healthcare as one of the Top 100 Most Powerful People in Healthcare in addition to her new award as one of the Top 25 Women in Healthcare. The Modern Healthcare article announcing the Top 25 Women was headlined, “Beyond the Glass Ceiling,” and Darling said she thinks some of that ceiling is self-imposed among women.

 

“I belong more to the Sheryl Sandberg ‘Lean In’ school,” she says. “I’ve been hiring men and women and mentoring them for a long time. I still see significant differences in the way men and women assess themselves, in the way they think about their careers and their families.”

 

She laughs as she relates a humorous story she heard on the radio recently. “It said that if women miss a child’s school event, they are just wracked with guilt. But if a man merely drops the child off at the event, he feels like he made a major contribution. That’s pretty funny, and pretty accurate.

 

“And as long as that’s true, women won’t always be able to have the same kind of executive career that men do. They can have the combined benefits of living in both worlds but as long as executive careers require the kind of 24/7 commitment to work that most do, women and men will have to choose what balance or lack of balance they really want.”

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