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What healthcare leaders need to know now

Maureen Bisognano looks beyond the healthcare silo for improvement

By | October 16 th,  2015 | Healthcare, Triple Aim, hospitals, IHI, Maureen Bisognano, Modern Healthcare, Blog, CEO, Institute for Healthcare Improvement, leadership, MOOC, safety, upstream, 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.


For the last 20 years, it’s been common for healthcare executives to look to the aviation industry for both inspiration and best practices in improving quality and safety. But Maureen Bisognano, CEO of the Institute for Healthcare Improvement, thinks perhaps we should look beyond the horizon for the next step.


“Twice this year, IHI has led a study tour down to NASA,” says Bisognano, who is retiring at the end of the year. “When you walk into NASA, there is a wall that tracks the journey of a space shuttle from when it comes onto the launch pad until it returns safely back home.”


That board also tracks every near-miss, equipment failure, employee injury and fatality that has happened across the shuttle program. And when teams see that wall, that gets them thinking about the depth of the details in such transparency.


“Nobody in healthcare understands safety that way,” she says. “If we make an analogy to healthcare, the left side of the map might answer questions like: Have we safely admitted patients into the hospital? Do we understand everything about that patient’s care and life outside the hospital, and have we brought that knowledge to the people who will be caring for that patient in the hospital?”


The other side of the board, Bisognano says, could provide responses to the question, “Have we safely guided this patient back into the community with access to medications, food and care?”
Looking at healthcare issues from a different angle is standard operating procedure at the IHI, which can usually be found on the cutting edge of health innovation. And, while it is true that the healthcare industry is adjusting to some of the biggest changes in its history under the Affordable Care Act, it’s Bisognano’s belief that the current disruptions are small compared to what’s coming down the pike.


“I think leadership is in the midst of a transition,” she says. “Leaders are going to be out in the community in ways they never were before. They’re going to begin to understand what it’s like to live in a particular neighborhood –how can their hospital or physician practice or ACO create health in that environment? They’re going to be looking way outside the walls of the organization. I think they’re going to be challenged by managing multi-professional teams, because there is no way that healthcare can be provided by a specific discipline anymore.”


Those are bold words, but Bisognano says that scenario is the end result of what it means to move “upstream” into a community to deliver care, a concept that has been around for years but is gaining new urgency as hospitals and health systems seek to prevent readmissions. And data is the key to that, Bisognano notes.



“The notion of ‘upstreamism’ means that people are going to be engaging with data and technology in ways that they never did before,” she says. “We need roles like ‘upstreamists’ and ‘extensivists.’ Upstreamists are people who say, ‘I will look at all of the population health data, and I will help us to think about what kinds of interventions will have the greatest impact on health by looking way upstream.’ ”


In a new project called One Hundred Million Healthier Lives, Bisognano and the IHI are having the chance to put a grand notion like that into practice by partnering with community organizations as well as a number of healthcare providers across the country.


“As an example, I’m seeing in some communities that the upstream data is telling the healthcare system that the biggest impact it could have is to work on getting homeless veterans into permanent housing,” she says. “In another community, we’re looking at the healthcare system partnering with others to work on the health of children under 5, because the children of that community are not healthy right now.


“By ignoring that population, these children are going to experience a future 70 years of bad health and lots of unnecessary cost and burden on the healthcare system. But if we put our focus and attention on those kids, we’re hopefully buying them and the healthcare system 70 years of good health.”


IHI’s sphere of interest extends far beyond North America. Bisognano and the IHI have long studied other nations’ healthcare systems, and she is quick to note that U.S. healthcare providers can get quite an education from other nations.


“I have the great fortune to be in a position to work in different countries all over the world. I see opportunities for us to learn from other countries – some low- and middle-income countries – and certainly from countries like Sweden and Denmark,” she says. “With the speed of change needed here, leaders who can look up and look out will be able to incorporate new models, new ways of thinking in a way that gets to the Triple Aim much more quickly.”


The Triple Aim, of course, is one of the IHI’s signature initiatives – improving the patient experience, improving population health, and lowering healthcare costs. It has been adopted by numerous hospitals and health systems. Through its conferences, research and open school (265,000 students in 73 countries), the IHI has multiplied its influence over the past two decades. Now, it is partnering this fall with the Harvard TH Chan School of Public Health to offer a free massive open online course (MOOC) that Bisognano hopes will attract more than 30,000 physicians and nurses in the next year.


Through all of these channels, Bisognano hopes the IHI will play no small role in preparing next-generation leaders. “I’m so encouraged with the students who are learning improvement. They see improvement as just a way of life, so they don’t feel the frustration. They also don’t tend to get as burned out because, when they see a problem, they have the tools to improve it.”



ACHE report on diversity: The more that things change...

By | October 9 th,  2015 | disparities, Healthcare, American College of Healthcare Executives, Blog, diversity, leadership, inclusion | Add A Comment




Every five or six years, the American College of Healthcare Executives conducts a new survey on diversity and inclusion in healthcare as it relates to leadership of our industry.


Its new report, by Leslie Athey, starts with a pretty candid preamble, essentially saying, "We've been talking about the lack of diversity at the top in healthcare for years. Why another survey?" Then it answers its own question: Because things haven't changed.


According to the survey, racial and ethnic disparities are very much alive in the healthcare industry today. African-American respondents indicate their salaries are lower than those of their white counterparts. "Further," says ACHE, "minority respondents were less likely to report that race relations in their organizations were good and more likely to report their careers had been negatively impacted by discrimination."


The article can be found in the September/October issue of Healthcare Executive magazine. For the full special report, click here.


ACHE notes that strides have been made, but there is still a long way to go. That's also the reason we continue to sponsor the Top 25 Minority Executives in Healthcare and the Top 25 Women in Healthcare awards for Modern Healthcare. We haven't arrived yet as an industry. The message still needs to be repeated. Leaders of healthcare organizations should reflect the communities and members they serve; statistics show that companies with diverse leadership perform better than those that don't. It's as simple as that.


Read our Guide on increasing workplace diversity and inclusion to learn more.

At Ascension, Patricia Maryland’s patient-centered focus aligns with a passion for analytics

By | September 25 th,  2015 | Healthcare, Patricia Maryland, executive, Modern Healthcare, patient-centered care, president, analytics, Ascension, Blog, leadership, Top 25 Women in Healthcare | 1 Comments


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


As the oldest daughter in a large family, Patricia Maryland, Dr.PH, was often left in charge when her mother was hospitalized during a years-long struggle with Type 2 diabetes. Her mother eventually died of complications from the condition, and Maryland recalls her frustration with the fragmented healthcare system in which they found themselves.


“We didn’t understand at that time she needed more than general primary care,” she says. “Someone should have been helping us navigate her care to the appropriate subspecialist and other support systems as her condition continued to worsen.”


Unfortunately, similar stories have played out within hospitals and health systems across the United States.


As president of healthcare operations and chief operating officer of Ascension Health, a subsidiary of Ascension, Maryland is committed to leading change – knowing from experience the great need for personalized, coordinated care in this ever-changing healthcare environment.


“I think we can do a better job in healthcare,” says Maryland. “The time has come for us to turn the process upside down – or should I say right-side up – organizing the providers around the needs of the patients, not expecting the patients to figure where to go in our complicated health systems to get the care they need at the convenience of the providers.”


As the world’s largest Catholic health system, Ascension’s mission is steeped in delivering spiritually-centered, holistic care to all with special attention to those who are poor and vulnerable. Maryland makes a point of saying that all healthcare leadership should approach the business of healthcare from a similar perspective.


“Without passion for why we are here and what we are trying to do, we will not be able to be the transformational leaders that healthcare needs today.”


That passion has not dampened her business objectivity, however. Quite the contrary. Maryland’s passion is paralleled only by her dedication to analytics, cultivated through her master’s degree in biostatistics and doctorate in public health.



Maryland explained that biostatisticians tend to work in pharmaceutical industries or medical research areas, with a focus is on efficacy, research, precision and statistical analysis. However, she believes that in today’s health industry, metrics are essential for all healthcare leaders.


“Data analysis is the lifeline of any business, particularly a healthcare organization,” she says. “It is vital that we maintain clear and measurable data so that we can address opportunities for improvement that would not be realized otherwise. By tracking trends, Ascension analyzes where we need to go and what decisions we need to make on any given initiative.”


Maryland says statistics are especially crucial as the roles of payers and providers overlap and converge.


“As we think about population health management and the direction that the health industry is moving, analytics and the ability to predict outcomes using data is so important,” she says. “Predictive analytics have helped us manage risk.”


Her background has come in handy as Ascension has moved boldly into this new era of providers taking on risk. She was one of the architects of Together Health Network (THN), formed by partnering with Trinity Health, another Catholic system, to create a physician-led, clinically integrated network in the state of Michigan. THN worked with Blue Cross Blue Shield of Michigan to create Connected Care, a Medicare Advantage product that rolled out in January 2015 and already has surpassed enrollment projections.


“We are especially attractive to payers because our organizations – both Trinity and Ascension – have some of the best metrics in the state,” Maryland says. “We are able to offer the value combination of high quality and low cost to major payers, and to take on and manage their members with a level of consistency.”


With Ascension operating in 23 states as well as the District of Columbia, the THN experience has been a strong test run to for the organization in developing comprehensive, integrated systems of care. It’s also working to round out other parts of the care continuum – including senior care and home care – so it can better serve its communities.


Ascension also has taken the plunge into insurance. The system acquired U.S. Health and Life Insurance Co. last December and is using that platform as well as MissionPoint Health Partners, its population-health management company, to develop benefits and gain experience by managing the quality and cost of care for Ascension’s own associates and their dependents. In essence, it has become its own incubator for development of an insurance product for self-insured employers.


“We are going to pilot it first with our own employees,” Maryland says. “Once we have a proven track record with our associates, we’ll take it to market. How do we go anywhere else and offer the product unless we ourselves can say, ‘Look at our results.’ This is also why data is so important. We believe we have the best practices, and with this data we will be able to demonstrate it.”


From new partners to new products, healthcare’s future looks a lot different than it did just a few short years ago. Yet despite the changes in how her system and the industry operate, she says the fundamentals are the same. After all, as Maryland knows, healthcare is deeply personal.


“Considering Ascension’s scale and scope, we asked ourselves, ‘If not us, then who?’ We are committed to leading change in the healthcare arena,” she says. “Through standardizing and connecting once disparate systems, we remain true to our Mission of delivering compassionate, personalized care to those who need it the most.”



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.



ACHE’s Deborah Bowen: Healthcare leadership is still about people trying to make a difference

By | August 18 th,  2015 | disparities, Healthcare, ACHE, ACHE Congress, American College of Healthcare Executives, Deborah Bowen, Modern Healthcare, president, Blog, CEO, diversity, FACHE, healthcare policy, 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.



Deborah Bowen guides one of the most influential associations in healthcare, but her complex work with C-suite leaders is rooted in a simple desire: to change people’s lives for the better.


As the president and CEO of the American College of Healthcare Executives, Bowen heads an enterprise that assists administrators in developing their abilities to lead their organizations. Its Fellow certification (FACHE) is one of the most respected designations in the halls of a health system and its annual Congress is one of the industry’s biggest draws. But Bowen says she herself is drawn to the servant leaders she sees all around her.


“I think one of the great things about this profession and this field,” she says, “is that I’ve always found the people in it are very dedicated to giving back. I think we all come to it from a place of trying to make a difference in whatever way we can.”


Bowen began her career as a social worker dealing with some of the toughest issues out there – drug addiction and alcoholism.


“I started out working with heroin addicts,” she says. “That is a difficult line of business because people often don’t get better because they don’t have the right support networks. Some of them get detoxified, but then they’re going right back into the same environment that probably drove them to addiction in the beginning. That was the catalyst for me to say, ‘Maybe there is another way to do this work that might have more impact.’ ”


She moved on to Wisconsin’s Department of Health and Social Services, where she gave grant money to programs battling drug abuse and alcoholism.


“That’s where I started to learn a little but more about what it means to influence decision-makers,” Bowen says, “and if you influence decision-makers, you can potentially have a bigger imprint in changing policy.”



Her interest in policy work led her to the state medical society, where she held a variety of roles.
“I have a great deal of respect for physicians and the work that they do,” she says. “Wisconsin was very progressive in their thinking. We opened free clinics. We did a lot of good work there, which I’m sure continues today. So my first foray into association management was through the physician community.”


She eventually spent a number of years at ACHE, but found the path to advancement blocked, so she joined the Society of Actuaries in the No. 2 role before ACHE recruited her back to become the chief operating officer under longtime CEO Tom Dolan.


When Dolan announced his retirement, Bowen says she never thought she was a shoo-in to succeed him.


“Being an internal candidate is a blessing and a curse,” she says. “Everybody knows you well, and sometimes the allure of an outside candidate can be greater than the person you really know. Obviously, I’m honored to be in this role.”


As the first female CEO at ACHE, her promotion mirrors an industry trend – about half of ACHE’s members are now female.


“I grew up at a time when it was a male-dominated field,” Bowen says. “I remember the early days when they always turned to the woman to take minutes in a meeting – it didn’t matter what your title was. But I’ve been fortunate because I’ve had good people in my court and, frankly, almost all of them have been men.”


Bowen says attitude can be a bigger determinant of success than gender. “The way I have thought about it over the years is that we all have choices to make. You can choose to focus on those things that are going to detract from you, or you can choose to focus on the things that represent who you truly are: What is your purpose and how are you going to move the needle?”


Finding purpose has been a key attribute for Bowen since her formative years. Even before her work as a social worker, it was instilled in her by her mother, a piano teacher who would take Bowen with her as she gave lessons in an African-American church on the South Side of Chicago.


“It was an eye-opening opportunity for me as a child to understand that not everybody lived the way I did,” she says. “Understanding the challenges of other communities was very revealing for me. There were women who had to stay up all night because they were worried about rats getting to their babies. When you hear that, you realize there are disparities in life.


“I took that to heart and thought, ‘That’s not fair and that’s not right. And if I can do anything to even the scales, I’m going to try to do that.’ ”


Sometimes the piano students would come to Bowen’s home in middle-class suburbia for a lesson, and it was not unheard of for Bowen’s family to find newspaper burning on their lawn.


“In some respects, those were different times. But in some respects, they’re not different at all when you think about some of the things that have gone on lately with race relations. We have much work to do.”


It’s also why Bowen remains determined to chart a different path for her own leadership and for ACHE.


“My legacy, I hope, is going to be all about building the culture of ‘and.’ We need to make sure we are understanding each other’s point of view and leveraging each other’s skill sets, because we all have something to bring to the table to improve healthcare.”



Marna Borgstrom: A new era calls for a new kind of leadership

By | August 14 th,  2015 | Healthcare, Marna Borgstrom, Modern Healthcare, president, Blog, CEO, health disparities, healthcare reform, leadership, Yale-New Haven Health System, 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.


For healthcare leaders today, it is clear that the big challenge, and the big opportunity, is to invest in the evolution of what has been a cottage industry into a true system of care. One in which efficient, integrated healthcare services are aligned with the ways in which care is paid for; where both provider and patient accountability matter.


While Marna Borgstrom, CEO of Yale New Haven Health System, believes we are moving in this direction, she notes that few systems, if any, are “there” yet. Many providers are not organized to take risk for populations of patients. Many payers can’t accurately and effectively take and manage capitated payment or significant risk arrangements. And the state and federal governments aren’t aligned on what or how they pay for care.


As Yale New Haven Health System is on its journey to provide unparalleled value to those it serves, Borgstrom stresses that at the same time health systems must continue to provide life-saving care and invest in the research and technical advances that have turned many terminal diseases into manageable chronic conditions. Borgstrom says, “We don’t want to lose that which has made us great in our quest for a more sustainable, comprehensive system of care.”


This need to thrive in both worlds – improving the health of the population while also healing the sick – demands effective, committed and innovative leadership in healthcare that can navigate these changing dynamics. This is a topic Borgstrom has been returning to often lately as she works with her own leadership team and her board and begins to build a template for the type of leadership that Yale New Haven will need in the years to come.


To that end, she has begun collecting her thoughts to share with the organization on developing executives who can guide a large, complex enterprise like Yale-New Haven. Some qualities, she says, are must-have standards that make sense in any business climate:


General leadership abilities. “You have to be able to get people to follow your vision and prepare for the future before change is upon us, while weighing the risks. You also have to be able to hold people accountable – sometimes we tolerate cultures of optionality that haven’t delivered well.”


A mastery of complexity. “Be able to juggle a lot of things as you evaluate decisions. Have an understanding that it’s not going to be linear and ambiguity rules.”


Able to balance “what” vs. “how”. “You can’t just say, ‘We’re getting this done at all costs.’ You can’t leave bodies in your wake; you can’t sacrifice the culture of an organization to achieve a single goal. You have to play for the long term but perform well and consistently in the interim. It’s not easy.”


A knack for partnership. “It’s all about partnership today . . . partnerships within your organization and with other businesses. To be a good partner, a leader needs individual qualities like integrity; like being a thoughtful listener. And you’ve got to enjoy working with others.”


Solid professional skills. “You need good strategic positioning skills and, in our case, a passion for academically based healthcare. You also need a depth of knowledge of healthcare as a mission and a business, and the public policy that goes with it.”


But then there are other intrinsic, less-obvious traits that she says are becoming just as essential given the landscape of the healthcare industry.


Among them, Borgstrom says, are:


Building cohesion. “You have to be able to bring out the best in other people because this is increasingly a team sport. It’s not just bringing people together; it is making them feel good about contributing toward specific goals together.”


Being open to dialogue. “I think you have you have to be receptive and responsive to feedback. You have to be able to put yourself in the other person’s shoes.”


Getting comfortable with ambiguity and imperfect processes. “I’m pretty good at taking the hill, but the issue of ambiguity is you’re not really sure whether that’s the hill on your left or your right. You may have to start out on the journey and have a few less than optimal experiences to inform your thinking about what is the best hill to take.”


Making diversity a map for improving care. “We’ve got to be committed to the principles of diversity and inclusion, not just in developing leadership teams but in eliminating healthcare disparities, being mindful that it isn’t just about running a financially successful business model if we can’t improve our communities too.”


With all of these qualities, Borgstrom says, the days of “command and control” leadership have disappeared. That even applies to how health systems operate, she adds.


“The future is going to require that we pursue partnerships rather than try to control everything in healthcare. We don’t have the competencies, the experience or the balance sheet to put together the ideal integrated delivery system. I think well-conceived and well-structured partnerships are going to end up being integral to an integrated healthcare system where the focus has to be on providing the best value to patients.”



Leah Binder and Leapfrog Group put pressure on healthcare providers to deliver on quality

By | August 12 th,  2015 | Healthcare, Leah Binder, Leapfrog Hospital Survey, patient safety, president, Blog, CEO, executive compensation, Hospital Safety Score, Leapfrog Group, quality, Top 25 Women in Healthcare | 1 Comments


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



Patient-safety organizations have proliferated in the last decade, from the respected National Patient Safety Foundation to numerous groups founded by patients or their relatives who have experienced pain and loss from medical errors. Yet few have the muscle that the Leapfrog Group does, using its research and clout on behalf of businesses that pay for their employees’ healthcare coverage.


That marriage of safety and statistics, with a streak of blunt boldness, is personified by Leapfrog President and CEO Leah Binder, who has led the organization since 2008. She is a friend to many in the industry, but notes that Leapfrog fiercely guards its watchdog status.


“I think a lot of people who are involved in the healthcare industry also have tentacles into a lot of different interest groups that they need to maintain strong ties to,” she says. “And while we also like to maintain strong ties to and collaborate with our colleagues in healthcare, we maintain a strong independence from the industry. And that has enabled us to talk about reality in a way that is different from what others who are within the system feel able to do.”


While she is a champion of the quality care that many systems and physicians provide, she’s not afraid to take them to task when she feels U.S. consumers and their employers aren’t getting stellar treatment. Leapfrog’s voice has been getting louder and more urgent lately, Binder notes, because it hasn’t always seemed that the healthcare industry has been paying attention.


“When I am speaking from the perspective of a purchaser who is spending more money on healthcare than they earned in profits last year, they expect tough talk,” she says. “They want to make sure their employees are safe and healthy and they get the right value for their money. It’s just been very difficult to get that message out to the healthcare community that employers want change and expect it.
“I’ve certainly had to begin to communicate in ways that make clear that the business community considers this to be serious business.”


Binder got to know the Leapfrog Group when she was vice president of Franklin Community Health Network, a healthcare system in Maine that participated in Leapfrog’s surveys on quality and safety. Prior to that, she was a senior policy advisor to then-New York City Mayor Rudolph Giuliani. She began her career as public policy director for the National League of Nursing.


Her life-changing encounter with the importance of safety came when her infant son was sick, and she and her husband couldn’t get their pediatrician to listen to them.


“When he was 3 weeks old, he was misdiagnosed with acid reflux. The actual diagnosis was that he had pyloric stenosis which, if it goes untreated for too long of a period, can be dangerous if not deadly,” Binder remembers. “And it was only because of my husband’s aggressiveness in insisting on a re-evaluation of him that we were able to get him in for emergency surgery. And that probably saved his life.”


The episode made a deep impression on Binder and her family.


“It just showed me that when ordinary people like me make mistakes – perhaps we miss an appointment or forget to get milk from the grocery store – they don’t have a huge impact. But when you’re in healthcare, even minor mistakes can have catastrophic effects for people. That’s a lot of pressure on people who work in the healthcare system and it is a lot of responsibility. It made me realize just how important it is for us to respect that and to make sure that vigilance continues.”


The Leapfrog Group conducts its vigilance through the Leapfrog Hospital Survey, an annual report that tracks hospitals’ performance on safety, quality and efficiency. Its Hospital Safety Score also assigns letter grades – from A to F – to more than 2,500 U.S. hospitals.


While numerous groups create “top hospital” rankings each year – so much so that a provider can pick and choose which report shows it in the most favorable light – Binder says she believes one factor elevates Leapfrog’s reach beyond the others: transparency.


“Our transparency is absolute,” Binder asserts. “We make everything public by hospital and there are a number of groups working with hospitals that specifically do not make that data public. They collect it in order to work with it internally to improve the safety profiles of their members, and that’s certainly one model. We believe that transparency actually galvanizes improvement faster, but we support the fact that these other groups are working on it and we know they have had success.”


The other pressure that the Leapfrog Group brings to bear on safety and quality is financial in nature.
“We are working from the perspective of the purchaser, so we want to bring value-based purchasing into the equation,” Binder says. “We really want to start to tie payment to performance on key safety and quality metrics. Employers want to see results.”


Binder said she believes the industry has made significant progress on quality and safety, although she admits that the pace of change is uncomfortably slow. She is concerned about consolidation among providers and payers because she says the trend “traditionally has meant lower quality, higher costs.” But lasting change, she adds, has to come from the top, and she is not convinced healthcare CEOs have made safety the priority it should be.


“For me, when we start seeing CEOs believe their jobs are on the line if they can’t get the safety record better, that’s when we’re going to see rapid change,” she says. “I have heard directly from some CEOs who say that it was a very significant moment in their career when they saw the Leapfrog letter grade that reflected poorly on their hospital, and that spurred them into action. I’ve also seen some hospitals or systems that are putting CEO and senior-level compensation at risk based on their letter grade or their safety record, and that’s also a very positive sign. But we’re not there yet.”



Donna Lynne: Healthcare leaders need to be able to manage crisis, volatility

By | July 30 th,  2015 | health plan, Healthcare, reform, women in leadership, Donna Lynne, president, Blog, Colorado, Kaiser Permanente, matrix, 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.


Kaiser Permanente’s success in Colorado when the federal insurance exchange launched in January 2014 was a perfect example for Donna Lynne and her team of the new type of leadership needed under reform.


Lynne, president of Kaiser’s Colorado health plan and the EVP who leads its Pacific Northwest and Hawaii regions, said Kaiser was anticipating perhaps 3 percent growth when the new era began. Instead, Kaiser’s membership in the state grew a whopping 14 percent overnight.


“We recognized that we were beginning to have a situation that required extraordinary measures,” she says. “As a leader, you need to be nimble and you need to be confident that the people who are working for you can execute.”


Lynne’s leaders put together rapid-response teams to tackle needs like customer service, ID cards, appointment-setting and billing. “These were people who had not had healthcare before,” reasons Lynne, “and if their first experience with a health plan was not a great one, then we ran the risk of them making a different decision a year later.”


The approach was successful, says Lynne, and helped her team develop new skills.


“The primary characteristic of what people need to be able to manage in healthcare reform is volatility,” she says. “You need to be able to deal with ambiguity but you also need to have the skill set to be able to manage in a crisis environment.”


Crisis is nothing new to Lynne. She began her career more than 30 years ago working for the New York City government at a time when the city was bordering on bankruptcy. But she witnessed a remarkable thing. Leaders from government, business and labor unions set aside their own agendas and worked together to bring the city back from the brink.


“Everybody had to give a little to rescue the city from a crisis situation, and that taught me a lot,” she says. “You realize very quickly how interdependent you are on other people.”


Ultimately, Lynne spent 20 years working for New York City. She’s fiercely proud of that time in public service. “Sometimes people poke fingers at people who work in government, but I felt very committed to excellence in government. I wanted to make a difference on behalf of the millions of people served by New York City,” she says.


She was renowned as a labor negotiator, and that led to the next step in her career as she began to see from her dealings with unions that healthcare was as important as wages and pensions to the middle class.


“I felt very committed that, if I could do anything to make healthcare affordable, it would be a great pursuit,” Lynne says. She worked in operations for a health system before moving to managed care and rising to CEO of Group Health. Then she joined Kaiser Permanente.


The move to Colorado enabled Lynne to turbo-charge her already active lifestyle. She began climbing mountains and has tackled major peaks in Colorado and overseas. She’s also a skier who has done marathon ski events for charity.


“I think I like on-off switches, if you understand what I mean. I completely turn the work button off; I have to, because most of my pursuits involve risks so I need to concentrate,” she says.


Lynne grew up playing every sport under the sun – softball, field hockey, volleyball and tennis – and says sports were a natural training ground for leadership development.


“I felt very strongly that there were a lot of things that women either were told they couldn’t do or weren’t supported in doing. And I liked being a pioneer or even a little bit of a rebel,” she says. “By participating in sports, I understood the interdependence of all the positions on the field. In the business world or in government, you can work in your own silo and become an expert, or you can drive for change and try to get things done together.”


Lynne has chosen the latter, and says what some would call a matrix structure at Kaiser has served her well, helping her to focus more on the human side of leadership.


“I think some of it came with maturity,” she says. “Taking the time to engage and influence people is a critical part of leadership that I had to learn over a period of time, and Kaiser is in many ways the crown jewel in terms of a place where that really works.”


She’s also learned, she says, “to appreciate the importance of developing the leaders underneath you.” Kaiser has annual individual development plans for its executives, and that’s helped Lynne to “develop my leaders, who are now stronger and allow me to step back and do different kinds of things than I might have thought about when I came here 10 years ago.”


Leadership innovation is sorely needed, she says, as reimbursement models have caused upheaval in the industry.


“We’re all seeing less revenue because so many more of our members are coming from Medicare or Medicaid,” Lynne notes. “That’s creating tremendous pressure on us to reinvent the way that we do things.”


The turmoil has been felt among both providers and payers. Lynne says no one is sure how it all will play out, but both finance and delivery need to get along.


“I think the best way that payers and providers can work together is to acknowledge that, while we may have started out with different interests, we are ultimately trying to provide care to as many people as we can so that they’re healthy.”



With King vs. Burwell decided, bold leadership becomes a mandate for healthcare delivery and financing

By | June 29 th,  2015 | Furst Group, Healthcare, Supreme Court, Bob Clarke, health systems, hospitals, King, King vs. Burwell, affordable care, Blog, Burwell, CEO, leadership, transparency, quality | Add A Comment


By Bob Clarke

CEO, Furst Group


The King vs. Burwell decision once again had healthcare leaders, both payers and providers, holding their collective breath to see if years of work would be undone. Now that the Supreme Court has weighed in, by a surprising 6-3 margin, to uphold the ACA and its subsidies, there still remains a lot of work to do. So the question for the healthcare industry is, how can CEOs and boards best demonstrate leadership to their organizations and their communities going forward?


Regardless of where one falls in the political debate, this decision was anxiously anticipated by all. Our industry has had more than its share of uncertainty over the years and having this decision behind us will allow for the great work that organizations have done thus far to continue. Without a doubt, patients and families are seeking access to quality care at an affordable cost, all wrapped in a package of transparency. Significant strides have been taken toward this goal but the threat of constant change and disruption of the payment system doesn’t allow an organization to focus or to plan too far ahead.


However, we have seen some leaders be very bold and stake their future on this continuing trend. They have been very proactive in creating services and pricing schemes that are consumer-oriented. Their vision has allowed for open discussions with others about potential partnerships and collaborative models. These are trends that need to continue.


These are times of uncertainty, to be sure. Bold leadership, however, seizes on this as opportunity. Teams that come together to think about what can be realized serve their organizations and constituents far better than teams that focus on market protection and guarding the status quo. The latter often find themselves holding on to a model that quickly becomes outdated and stagnant.


Patients want and deserve excellent care in a system that is far less complicated than what we have had in the past. May the evolution (or rather, the revolution) of healthcare continue and bring our delivery and financing system to a level that was only dreamed about not too long ago.



Healthcare merger and acquisition is booming. A new article in AHA's Trustee magazine helps corporate culture survive and thrive once the dust has settled.

By | June 19 th,  2015 | American Hospital Association, Furst Group, Healthcare, merger, Bob Clarke, SSM Health, Blog, Joe Mazzenga, Trinity Health, Trustee magazine, acquisition, corporate, culture, executives, HonorHealth, IU Health | Add A Comment


As this is written, the country's largest health insurers are sizing each other up for merger and acquisition. The consolidation that has become commonplace among healthcare providers has come to payers as well, and the next several months should begin to determine what the terrain will look like once the dust has settled.


The financials are, of course, the driving force in any transaction like this. But the human factor should not be overlooked. Thus, we're proud to be part of a timely new article in Trustee magazine, published by the American Hospital Association, that talks to healthcare executives who have emerged from the experience with some advice and caution on tackling the thorny job of creating a new corporate culture out of two entities that may have done business very differently in the past.


Executives from organizations like HonorHealth, IU Health, SSM Health and Trinity Health share their stories with Trustee. Furst Group's Bob Clarke and Joe Mazzenga offer insights as well from their decades of experience.


Click here to read the article.