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Halee Fischer-Wright recalibrates MGMA to give it a more resonant voice in healthcare

By | April 27 th,  2017 | chief executive officer, cost, Back to Balance, MGMA, physician, Blog, compensation, Halee Fischer-Wright, leadership, MACRA, provider, Collaborate in Practice, culture, Medical Group Managment Association | Add A Comment

 

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.

 

The energy that Halee Fischer-Wright, MD, brings to the Medical Group Management Association is palpable.

 

She is on a mission to not only transform the venerable medical association she now leads as president and CEO, but to help steer the healthcare industry in a better direction. She came into her role at MGMA in 2015 with a track record as a successful pediatrician and president of a medical group who also served as a chief medical officer within Centura Health, a large health system in Colorado and Kansas. In addition, she spent several years as a management consultant and co-authored the book, Tribal Leadership. “My passion is in culture and leadership,” she says.

 

Like many storied organizations, the 90-year-old MGMA needed to reassess and reinvent itself. It made its mark developing the cost and compensation surveys for physician practices in the U.S. “If you’re hiring a physician, you need to look at our survey,” Fischer-Wright says. “And if you’re going to buy or sell a practice, you are probably going to buy data from us. That was our claim to fame.”

 

But the pace of change in healthcare had diminished the brand to some degree, and Fischer-Wright gave it the jolt it needed. She and her team have developed the MGMA Stat text-messaging service that gathers instant feedback from its membership and gives them a unified – and increasingly powerful – voice to the marketplace, among other initiatives.

 

“I’m very much of a fan of disciplined innovation,” she says. “When I was a consultant, we did work with IDEO in San Francisco. So, that idea of prototype often, fail often and inexpensively, be willing to learn from your mistakes and focus on the end user – that’s what we’ve brought into MGMA. I view MGMA not as a not-for-profit healthcare association, but as a for-profit, well-funded startup at this point in time.”

 

The results so far have earned Fischer-Wright a 2016 Maverick of the Year trophy from the Stevie Awards, the international business competition. It’s also helped open doors for Fischer-Wright and MGMA that might not have been as pliable not so long ago. When the University of Miami School of Business Administration convened a panel on “National Election Impact on Health Care Sector” a few months after the 2016 election, the luminaries opining on the way forward included American Medical Association CEO James Madara, AHIP leader (and former CMS chief) Marilyn Tavenner, American Hospital Association CEO Rick Pollack, HFMA head Joseph Fifer – and Fischer-Wright.

 

“What really hit me when I served on that panel is that all of us want the same things, even though the ways we approach them are dramatically different,” she says.

 

The way to achieve lasting change in healthcare, she adds, is to stop thinking the top-down approach will work – it has to bubble up from the grass-roots level.

 

“I think most of the change we’re talking about is cultural, and I actually think we can provide analytics that show it’s possible for physicians to have more time with patients, decreased cost, increased quality and increased satisfaction, which are the goals we all aspire to.”

 

Fischer-Wright points to successes in this vein at Geisinger Health, Cleveland Clinic, Intermountain Healthcare and Virginia Mason as disparate examples of how these outcomes can be achieved. But she cautions that each practice is different, and that what works for one may not work for another.

 

“Every practice has to figure out what that looks like for themselves. We need to stop looking for the cookie-cutter approach because it’s not valid,” she says. “But there are some guiding principles, and they tend to be cultural, and they center on hiring. It’s like the Jim Collins approach in Good to Great – get the right people on the bus.”

 

The pressures on physicians are huge. The introduction of electronic health records has many benefits, but it has increased doctors’ paperwork and decreased their time with patients to a 2:1 ratio. The coming MACRA regulations appear to be especially burdensome for independent physicians and those affiliated with smaller practices – and physicians won’t get feedback from the government on how they’re doing for 12 to 18 months. It’s perhaps not too surprising that 83 percent of physicians say they wish they had considered alternative careers, and that the role of physician, which used to be the most respected profession bar none, has dropped to #6 in a recent poll.

 

“Physicians will report that they spend 13 to 16 minutes with each patient; patients say they actually get eye engagement from a physician for only three of those 13 to 16 minutes,” Fischer-Wright notes. “Providers are increasingly being held accountable for the outcomes of their patients – so if I don’t have much of a relationship with my patient but need them to keep their blood sugar in check, manage their diabetes and do routine care, what’s the likelihood that the patient is going to engage in that?”

 

Fischer-Wright and MGMA believe there are ways to restructure medical practices to change the status quo. That’s also the premise of her new book, Back to Balance: The Art, Science, and Business of Medicine.

 

“One of the things we highlight in the book is asking the right questions,” she says. “We’re not asking the right questions in healthcare to get to the outcomes we want. We’ve tried a lot of top-down change without achieving a lasting impact. Where we really need to work to sustain change, as we’ve said, is at the grass-roots level.”
To that end, MGMA also has partnered with the AMA the past two years on the Collaborate in Practice conference.

 

“Instead of trying to identify one specific constituency within a practice to leverage change, if we can fundamentally get the leadership – which is both the administrator and the provider – engaged and on board, then we’re going to see meaningful change within the practice that helps us get toward our Triple Aim goals,” Fischer-Wright says.

 

Fischer-Wright says many physicians have felt disempowered over the last decade, but believes the pendulum is swinging back, due to economic constraints and new generations of workers, like millennials, who have little patience for sticking with processes that don’t have the end user in mind. “This entire $3.4 trillion healthcare system really starts with a provider with a patient in a room. And that’s what we need to remember. It’s all predicated on that.”

 

But she’s quick to note that wishing wistfully for bygone days profits no one.

 

“A lot of my colleagues will talk about that we need the art of medicine independent of business and science, but that doesn’t work,” she says. “Healthcare is increasingly eating our gross domestic product, and so to say, ‘I just want to see patients,’ is not a sustainable attitude in this day and age. However, to say it’s in our business’ best interests to bring back more of the art of medicine is absolutely a valid argument, and we can demonstrate why that’s important.”

 

 

SIDEBAR: Shifting our thinking on how to improve healthcare

 

If the healthcare industry could flip a switch tomorrow and change several things to improve the quality of care, what should it do? Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association, has some ideas about that and covers them in her forthcoming book, Back to Balance: The Art, Science, and Business of Medicine.

 

  • Ask the right questions. “We keep asking how we can make things better incrementally,” Fischer-Wright says. “But I don’t think that’s the right question. I think we have to ask ourselves, ‘What do we want?’ ”
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  • Focus on the outcome instead of the process. “Because business has been driving healthcare, we’re getting very process-driven instead of outcomes-driven,” she says. “Because of that, we keep getting layers and layers of process, as opposed to really looking at the outcomes we want and reverse-engineering the processes to get us to those outcomes.”
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  • Be willing to surrender the things that aren’t working. “A lot of health systems put things into place and then we have an unwillingness to let go of them even though they may not be working for us. We must be willing to let go and move in a different direction than what we know and are comfortable with.”
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    Penny Wheeler: Even in value-based care, leaders of varying backgrounds can thrive

    By | August 6 th,  2015 | Allina Health, health systems, Modern Healthcare, physician, providers, Blog, CEO, clinical care, collaboration, leadership, Penny Wheeler, value-based care, 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.

     

    In the era of value-based care, many health systems are looking for ways in which they can develop their physicians into administrative leaders who can guide the organization, not just a physicians’ group.

     

    While Allina Health CEO Penny Wheeler, MD, can certainly relate to such endeavors, she’s not ready to brand the clinician-to-chief-executive transformation as the sole formula for all organizations.

     

    “Some doctors are scrambling to get their MBAs, but I wonder if there is going to be a time when people who have been in the administrative ranks will get certifications in clinical care process and care model design,” says Wheeler, an obstetrician/gynecologist who has led Allina Health to a Truven Analytics ranking as one of the top large health systems in the country.

     

    Both types of knowledge are needed in the C-suite, Wheeler says, and can come from an administrator who has an empathetic mindset and has spent time learning how to reduce clinical-care variations, or from a physician who has accumulated experience in finance and operations.

     

    “There is a convergence these days,” she notes, “of needing to understand clinical-care models and clinical-care processes, and having the operational and financial acumen to know what kind of team you have to assemble to lead.”

     

    The learning curve can be steep regardless of which side you begin on. Wheeler was named chief clinical officer of Allina in 2006 and freely admits it took her time to adjust.

     

    “You can go from feeling pretty adept at doing a complex hysterectomy with a lymph-node dissection in the operating room to feeling like you don’t know how to run your email account,” she says with a laugh. “When you’re relatively good at something you trained your whole life for, and then all of a sudden you feel like you’re on a separate orbital plane, that’s hard.”

     

    What kept her going, she says – and what led to her growth as an executive that ultimately put her in charge at Allina – was the purpose and mission she had, which did not change in the move from the exam room to the administrative offices.

     

    “It’s just a sheer privilege that we get to be in a role where, by our actions, we can improve the lives of thousands,” Wheeler says. “That’s an incredibly fortunate position to be in.”

     

    The opportunity to make a larger impact on communities in breadth and scope is an important consideration for physicians who are considering a move into an administrative role, she adds. Just as critical is the understanding that a clinical background provides a necessary balance in an organization’s decision-making.

     

    “This is what turned the equation for me,” she says. “Instead of emphasizing what you don’t know yet about business or operations, emphasize what you do know. There was one time when a light bulb went on for me in a meeting of the executive leadership team. I was the only physician in the room and realized, ‘I am the only one that has been next to a patient for 20 years and knows what it feels like to provide their care when you have 23 other things going on that you need to attend to.’ ”

     

    Wheeler’s advice for new physician leaders is just as applicable for all administrators:

     

    Realize that you can’t do it all. “As physicians, we’re used to being the one that our patients put their trust in. But in a business environment, you really have to rely on those around you, so you need to assemble a team that thinks differently than you do and complements your skill set.”

     

    Time is your most precious resource. “Your time is your currency. A lot of people make demands on your time and you have to think about what’s important – advancing the performance in terms of our mission – so you should spend your time on what is most impactful.”

     

    Invite your team to be truthful. “When you get in these positions, people want you to be happy and want to highlight the good performance we’ve had. They might be more reticent to talk about where things aren’t going well or failing, so you actually have to ask for difficult messages. Invite people to be open and honest because, if they’re not, somebody’s life could be affected adversely.”

     

    Wheeler has been instrumental in championing Allina’s collaborations with other providers, from an accountable-care alliance with HealthPartners to transitional care facilities built with Presbyterian Home & Services and Benedictine Health System.

     

    “I really hope collaboration between systems beats out competition, so we can avoid unneeded duplication of services,” Wheeler says. “When we say we compete in healthcare, I think sometimes other countries look at us like we have an arm growing out of our head. I think that, to the extent we can do it effectively, collaboration is important. Even when you see acquisition and merger activities occurring in healthcare, I think it’s going to be more about adding complementary services across the continuum.”

     

    Yet the transition from a fee-for-service to a value-based model brings its share of growing pains. Wheeler points to a recent program Allina developed to provide care coordination for cancer patients. In terms of care, it was a huge success – it kept 95 people from needing to be readmitted to the hospital and saved the community $1.2 million. There was just one problem: Allina lost $600,000.

     

    “Right now, we’re in an environment where you actually lose money by doing the right things sometimes,” she says. “It is a conundrum for all of us in healthcare. I think we’re going to experience some whitewater rapids getting to where we need to be, but it will be good for the people we serve when we do.”

     

    Still, Wheeler says, these and other winds of change stirred up by reform “make it an exciting time to be a leader. There’s no better time to be in healthcare because the sails are up in the air and you can turn this big Queen Mary of healthcare in a better direction for the people we serve.”

     

     

    Quality, safety fuel Pujols McKee's drive at The Joint Commission

    By | October 6 th,  2014 | chief medical officer, Furst Group, Healthcare, Penn Presbyterian Medical Center, physician engagement, Top 25 Minority Executives in Healthcare, executive, Modern Healthcare, patient-centered care, patient safety, physician, Ana Pujols McKee, Blog, diversity, leadership, The Joint Commission, quality | Add A Comment

     

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

     

    Ana Pujols McKee’s passion for quality and safety existed long before she joined The Joint Commission as executive vice president and chief medical officer. She previously served as the CMO and associate executive director of Penn Presbyterian Medical Center, in Philadelphia, and as a clinical associate professor of medicine at a teaching hospital in Philadelphia. Pujols McKee has championed for years the need for transparency and patient-centered care.

     

    “I’ve had my own personal experience with injury as a patient, and I think what began to propel me in this area were some of the unfortunate patient injuries I had to deal with as a chief medical officer. Seeing up close how deep the injury extends to the patient and family is truly overwhelming,” she says.

     

    The physicians and nurses who are involved in an incident when a patient is harmed suffer too, she is quick to add.

     

    “What we don’t always talk about is what we now refer to as ‘the second victim,’ and that’s the clinician and staff that are injured as well. It’s a tough situation.”

     

    Being able to make strides in that area, Pujols McKee says, has been one of the highlights of her career.
    “When you work at an organization and you start to see those injuries decrease, and you start to see your infection rate come down and you start to see (patient) fall rates come down, there is nothing more rewarding than that – to know that you’re making a difference.”

     

    From the time she was a child, she says, she knew she wanted to not only become a doctor but to run a large clinic – “all those altruistic dreams of taking care of people and making people well,” she says with a chuckle.

     

    Pujols McKee’s prospects on the surface looked daunting – the world in which she grew up had some prejudicial obstacles blocking her way. She remembers constantly visiting a high school counselor to obtain information on college admission, only to have the woman continually tell her that she was busy or had no guidance for her.

     


    “One day, I walked in on her as she was sitting in a circle with students who all were white, along with a gentleman in a suit,” she relates. “She jumped up from the chair and started to dismiss me when the gentleman said, ‘No, let her come in. Remember? I told you I was looking to recruit minority students.’ ”

     

    It was, she says, a devastating experience, but not uncommon. “I have been told similar stories from many people of color. I’m not unique in any way. This is the way things were back then – and I believe they are, in some situations, not very changed.”

     

    Besides being a driven student, Pujols McKee says, her parents were a strong cheering section. In her Puerto Rican family, her father was an electrician and her mother was a teacher. Together, they taught her the importance of perseverance as she grew up in the South Bronx.

     

    “If I came home and said, ‘They closed the door on me, Dad!’, my dad would say, ‘Go right back out and open it.’ ”

     

    She is hopeful that the changing face of The Joint Commission, which she joined in 2011, opens many doors for hospitals to achieve their full potential.

     

    “When I got to The Joint Commission and I started to see how Dr. (Mark) Chassin, our president, was transforming our organization, I found it extremely exciting,” Pujols McKee says. “He has boldly said that accreditation is really the floor for transformation. We want to help organizations go above and beyond that.”

     

    To that end, The Joint Commission enterprise has expanded its offerings by adding a new affiliate to its portfolio, the Center for Transforming Healthcare, to help health care organizations improve patient safety through the use of Robust Process Improvement™ tools including Lean Six Sigma and change management. The commission also partnered with the American College of Physician Executives to begin an academy for chief medical officers.

     

    “One of the things I’m doing at The Joint Commission is leading a strategic initiative to support our physician leaders and provide them with the skills and resources that they need,” she says. “We recognize the need to support physician leaders as critical since, when we see a high-performing organization, we almost consistently see a high level of physician engagement.”

     

    Pujols McKee’s own journey from clinician to C-suite executive has been typical of physician leaders, she says – one that included some growing pains.

     

    “In today’s world, there’s so much transition that has to occur in an organization from the administrative to the clinical side,” she says. “I think we’re coming close to a time when it’s almost impossible to make that transition without being mentored or being part of a succession plan that includes spending time with finance, quality, and the operations team.”

     

    Such transitions, she says, need to thoughtfully include more diverse leaders to improve healthcare and to more accurately represent the diverse communities they serve.

     

    “The pipeline for future physician leaders has a fair number of women, but in terms of African-Americans and Latinos, the outlook is not very promising. There are some who believe that until we improve diversity in health care leadership, disparities in health care are not going to be fully addressed.”

     

    Profiles in Leadership: Top 25 Minority Executives Ben Chu helps Kaiser Permanente make quality count

    By | July 6 th,  2012 | American Hospital Association, change management, Furst Group, Healthcare, population health, health system, hospital, Modern Healthcare, physician, Blog, CEO, diversity, healthcare reform, Kaiser Permanente, leadership, chairman-elect | Add A Comment

    Chu

     

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

     

    Benjamin Chu, MD, MPH, MACP, oversees Kaiser Permanente Southern California and Hawaii as group president. In the seven years since he arrived, Kaiser Permanente has amassed many awards for quality. He also is chairman-elect of the American Hospital Association and will begin serving in that capacity in 2013.
    Prior to joining Kaiser, he was president of New York City’s Health and Hospitals Corp., the largest public health system in the country. He also served as associate dean at both Columbia University and New York University.

     

    Following is an edited transcript of the conversation:

     

    You have a Bachelor’s degree in Psychology. What spurred you to go for an M.D.?

     

    I think I always was going to be a doctor. Unlike a lot of people who have a core basic science orientation, I was always more interested in the human side of medicine. Psychology, child development, and anthropology are more in line with things I was thinking about. As you know, in medicine, there are a lot of behavioral and developmental aspects. In order to be effective, you have to understand the cultural determinants of health. All of these factors led me to pursue work in a field where I could actually help people. There is a whole sociology and culture of medicine that one cannot fully understand unless viewed from the psychological perspective.

     

    You spent most of your life out East before moving to California. What spurred that move, and has it worked out as you expected?

     

    I was running the NYC public hospital system under Mayor Bloomberg. It was an incredible experience and an incredible job. We were doing very innovative things in that system. It is a huge system that cares for 1.3 million NYC residents. When the opportunity arose to move to California and run a large chunk of Kaiser Permanente, the prospect piqued my interest. How far can you take a systems approach to delivering on improving the health of the population under the care of a large system? In Southern California, Kaiser Permanente has 3.6 million members, three times the size of the population we were caring for in NYC. The nice part about it is that the components and pieces are linked in a large multi-physician group that only works with the health plan and the hospitals. The health plan allows for pre-payment for care of the population. There is an entire delivery system under us that allows us to decide how to parcel resources in order to achieve the goal of maximizing the health of the population we serve.

     

    How do you get a big system like KP to deliver on its promise and to take healthcare to a whole different level?

     

    That was both the challenge and the fun part of coming to KP & California.
    I didn’t know many people when I was coming to Kaiser – primarily George Halvorson [chairman and CEO] and Ray Baxter [senior vice president for Community Benefit, Research and Health Policy]. It’s been an incredibly rewarding experience. We had to put systems in place – our electronic health record and other systems – to allow us to look at our performance in a very open, honest, and critical way. We had to reconfigure the system. KP had been better than average on quality and outcome for our members. Now, because of what we’ve been able to do with tools, reconfiguring our system, and getting complete alignment of our systems, components and people (including the 60,000 employees in Southern California), we are pretty close to leading the country on many metrics.

     


    From Leapfrog to NCQA, KP across the board has achieved some remarkable ratings for quality.

     

    There has been a steady progression over the last half dozen years. We’ve taken a systematic approach. We engaged every member of our staff, from doctors to non-doctors and from professionals to frontline workers, to get to that point. It has been very rewarding and a lot of fun to do.

     

    The last six years coincide with your arrival. What role did you play in these changes? What role did you leadership team play? What did you look for when bringing a new leader on board?

     

    To tell you the truth, I don’t think I have brought anyone new in, believe it or not. I spent time getting to know the people here. We have a wonderful leadership group, and there have been very few changes. The changes were largely to replace people who left. What would be the key to our success? It hovers around getting complete alignment over what we wanted to do.

     

    Much of the alignment was around trying to make sure we did everything possible to benefit our members. It was not a financial decision. While financials are important, they aren’t driving our goals at this point. The larger point was to make sure everyone understood that at the end of the day, it is our members and patients, and how we perform for them, both in the individual aspect and aggregate aspect.

     

    People rallied to this message of reaching for the higher mission. It’s hokey to think about in that way, but you’d be surprised. Everyone comes into healthcare to make a difference in another person’s life. One of the things we did as a leadership team was to galvanize everyone’s desire to make a difference and reminded people of this. I think this is the key to leadership overall. I am blessed to have a lot of incredible people working with me on much of this.

     

    Obviously we had to put in the systems to give us the information to know if we were making a difference in people’s lives. Once we got that in place and held that mirror up, the ideas came flowing out, and we could tap into this wellspring of creativity and desire to do the right thing. I am a doctor by training in a non-clinician role right now, but it is a pleasure to see that marriage of clinical outcomes and my public health background on population health outcomes come together in a delivery system.

     

    As you look at your role at the American Hospital Association as chairman-elect beginning in 2013, do you get the sense that part of what they are looking to you for is to help other hospitals across country pick up on what Kaiser has done and get the quality scores up and make a difference nationally?

     

    If you actually talk to the hospital leaders and members of the boards across the country, there is an enormous amount of energy working to find ways of taking care of their communities. Part of this is the quality agenda. Thousands of hospitals have joined the hospital engagement networks that are forming right now and are trying to learn from each other and optimize the quality of care given in the hospitals themselves. Hospitals are beginning to see that they play a pivotal role in their communities.

     

    Rather than be passive and wait for people to get sick and come in, there is a role to be played more upstream – to make a difference in the community’s fabric and in its health. Some of it has a lot to do with impacting the developing ACOs. It is an often misunderstood, yet often used, term. The idea is to get an organization and care delivery system to care for a population and try to go as upstream as possible to find strategies that lead to good health and mitigate things that lead to bad health, not just treat emergency situations. It means partnership with providers who work in the upstream levels. Doctors who see patients in an outpatient setting tied to the hospital or in their practices – we need to link the two together.

     

    There is a lot of energy in the hospital world. One of the reasons I was asked to chair in 2013 is that there are tremendous, yet uncertain, changes that are happening. There are also these powerful positive forces that can help hospitals and health systems come together in a better way to take better care of their communities. I think I was asked to chair so we can engage in a system-wide and country-wide dialogue to help each other overall.

     

    Given the uncertainty around reform – does that make leadership harder for you and the people running hospitals round the country?

     

    It depends on what you mean by harder. It certainly makes it much more interesting. The pathways to choose are much more ambiguous. In uncertain times, leadership needs to focus energy on the right things. I think that is why the AHA is working with our member hospitals to determine the higher-order outcome. If we dive into the weeds and get into the arcana of legislation and stay there, we will get lost. That is not to say reimbursement and policy changes aren’t important, but if that is all we think about, there is no ability to guide organizations through a field of uncertainty.

     

    If you can’t pick up your head to see where you are going, you cannot mobilize physicians and institutions to move in the same direction, and we will be mired in the field and will not get anywhere. That is the difference between someone who is good operationally and a leader who can engage people in dialogue to get everyone to a place where we want to be.

     

    There seems to be a growing consensus among healthcare leaders that we are on a course of change that will continue whether mandated or not.

     

    I think that is absolutely correct. Healthcare is changing in a good way, I think. I know people worry about losing the good things in uncertain times. When you think about what we are capable of doing and how many people we are capable of doing things for, I am convinced that with a little change in perspective and focus, we can utilize the dollars we spend in healthcare and create a lot more healthy communities. It is a journey in a lot of ways – a very uncertain journey. I think the focus is changing. Payment reform is happening. A lot more transparency is coming. There will be changes to tell us how we are really doing. Once you are confronted with that information, it is a compelling force driving changes that could get us to a better place.

     

    I think that in the best framing of what is happening now, that is the direction the country’s healthcare systems is headed. Probably the direction the world’s healthcare system is headed. Even though we are making a difference, how do we know we couldn’t be making a bigger difference? When you think of disparities in healthcare and how uneven results are, I think in this day and age, there is little the systems cannot tackle. We won’t all get there at the same time, but if we focus right, there’s a lot more good that we can do.

     

    There seems to be an increasing interest in physician executive leadership. As a doctor and physician yourself, what is your take on that?

     

    The lesson we’ve all learned is that in order to take on the larger tasks, the triple aim, all of the key pieces must be aligned. Physicians and other healthcare professionals have to be integrated into the whole system. We are trained to be separate. Even though hospitals are a part of the action where people are treated and where doctors do what they do, they are still only a piece of the puzzle. To integrate the perspectives, many places are looking towards physician leadership, whether as an administrator or at a Medical Director/CMO level.
    We need voices there and to be open and honest about the larger goal. We cannot just see hospitals as a doctor’s workshop. That will only get us so far. Obviously, we want someone to care for patients and bring their expertise. However, it is not just a single doctor, but multiple healthcare professionals. We want to see the larger role for the community.

     

    We need to make decisions on the deployment of resources and make a bigger difference than just delivering the best care in the ER. I’m not saying the best care shouldn’t be delivered in the ER, but when you think about it, it may not be the optimum expenditure of resources if you only concentrate on the ER.

     

    In my opinion, there should be more doctors at senior levels of health systems. Having everyone’s perspective is important and makes a difference.

     

    You spent time working in the office of Sen. Bill Bradley. What insights from that time guide your perspective in today’s healthcare climate?

     

    I’m not sure there is a tremendous amount of insight but, when I worked for Senator Bill Bradley, it was one of the last times for major Medicaid expansion. The American with Disabilities Act was passed the year I was there; we passed the Medicaid Best Price legislation for pharmaceuticals, and expanded Medicaid to children up to 133% of the poverty line and pregnant women up to 185% of poverty. That was really the last big expansion before the children’s health program came in.

     

    When I think of that era, it was a time of greater bipartisan collaboration. I worked for a Democratic senator when the first George Bush was president. There was a lot more collegiality. That’s not to say that cannot happen again, but I’m hoping after the upcoming, probably raucous, presidential campaign, that people will be more realistic in looking at the problems of our country and figure out how to solve them.

     

    Even if we concentrate on legislation, that’s not always where the action is. Many core changes are already starting to happen. Core systems changes are being worked on. I don’t think there is a way back. From the hospital perspective, one of the opportunities was finally being able to count on some sort of payment for care of the significant portion of uninsured patients that would come in to the ER and hospitals. This includes upstream care and hospitalization. From the community and hospital point of view, that was one of the best parts of healthcare reform. I hope that will continue. I know it presents problems for many aspects of the healthcare world, the Medicaid expansion, as well as the exchanges, but I hope that some sort of increase in uninsured care will continue. We will always muddle our way through. We always have muddled our way through, based on my experience with Senator Bradley. It was not always clear then (1989-1990).

     

    Healthcare organizations, particular in the inner cities, are creating senior housing, opening banking centers, farmers’ markets, and developing other innovative systems and ideas such as free surgery day. Some might think it’s a bit far afield of healthcare, but it seems to be a growing part of preventive care. Is this part of the equation at Kaiser Permanente as well?

     

    Every one of KP’s medical centers runs a farmers market. In fact, we run the only farmers market in Los Angeles. This is illustrative of what I was talking about earlier – the tremendous amount of energy spent in the hospital world trying to figure out how we go upstream. The medical model is individual – one person at a time. When someone is sick, you care for them and send them back out. This is an important function for every community. The underlying premise is that the sum of all the good one-on-one work will translate into a healthier community. Clearly, this model leaves huge gaps. The medical model really is not directly focused on the population’s and the community’s total health.

     

    There is a broader understanding that what makes a person healthy or not is as much about the health of the community and total health of the environment as it is to prescribing the right medicine. Eighty percent of the determinants of health are not linked to care. Smoking, exercise, drug use – these are things people need to think about if we are going to make a greater impact on the community and population health.

     

    At Kaiser, we have a theater troupe that goes into grade schools to do thousands of performances on healthy eating to influence kids on eating habits. Collectively, if 5,000 hospitals and health systems can get it together and start moving upstream together, it could be a very powerful force. To become a vibrant part of the community is key. We helped invest in parks. We have beautiful weather in Southern California, but unless you have good outdoor spaces, people will stay in their homes or in their cars to go from place to place. The built environment in the community makes a difference. Do people have the choice to make better decisions? We need to provide spaces to make better decisions.

    Profiles in Leadership: Top 25 Minority Executives Sam Ross just wanted to be 'the black Marcus Welby,' but life had bigger plans

    By | May 22 nd,  2012 | Bon Secours, population health, health system, hospital, physician, Samuel Ross, Blog, CEO, leadership | 2 Comments

     

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

     

    As a young man growing up in Texas, Samuel Ross says he wanted to be “the black Marcus Welby,” a family physician who returned to his hometown and found great success, just like the ‘70s TV doctor portrayed by Robert Young.

     

    While Ross did indeed become a family physician in private practice, real life had different plans for him. He eventually served as chief medical officer, among other jobs, at Parkland Hospital & Health System in Dallas before becoming CEO of the Bon Secours Baltimore Health System. He also oversees Bon Secours’ Kentucky facilities and its system-wide Supply Chain.

     

    And, far from the middle-class patients Welby tended to, Ross’ experiences in the poor neighborhood surrounding Bon Secours sometimes have less to do with the medicine he studied, and more to do with population health. In the last twenty years, including time under Ross’ watch, Bon Secours has built apartment buildings for seniors and opened a banking center for the community. They don’t teach much about that in medical school.

     

    “These ideas came from the community,” noted Ross. “I’ve been influenced by the concept of Community-Oriented Primary Care that came out of South Africa by Dr. Sidney Kark. He built a number of facilities with the notion of one-stop shopping for the poor related to social determinants.”

     

    Bon Secours was on the brink of closing a couple years ago. Its safety net for the poor was fraying badly as residents without insurance comprised a disproportionate amount of the patients. In fact, Ross determined that 50 patients alone accounted for 2,287 visits in a three-year period.

     

    The state of Maryland came through with funding to right the ship, and Ross and his organization have done the rest. Ross is putting a focus on patient safety and quality and has announced plans to hire more physicians and other staff to develop a “primary care medical home.” Bon Secours has invested many dollars and a lot of hours in the community. “This is about the charism of the Sisters of Bon Secours to extend healing and compassion and liberation,” Ross said. But Ross is far from done and is determined that Bon Secours make a lasting impression, because the hospital – and West Baltimore – have been down this road before.

     

    “A lot of people and foundations and government agencies have come in before and tried to make things better for the community,” Ross said. “But when the money runs out and the programs go away, a lack of trust develops in the community. We need to be partners working with them, not doing it for them.”

     

    The needs are great in Baltimore, where the Sisters of Bon Secours came more than a century ago to begin to care for the sick. A study by the city of Baltimore and Johns Hopkins determined that life expectancy for a resident of West Baltimore is 20 years less than someone who lives in the affluent neighborhood of Roland Park.

     

    “That’s unacceptable,” Ross said.

     

    So Bon Secours went to the neighborhood and asked the residents what their needs were. The response wasn’t what the hospital expected.

     

    “Getting rid of rats and trash – that’s what people said was important,” Ross related. “There were a lot of vacant houses where those things were a problem for the whole neighborhood. So we helped the community get rid of those houses and build community gardens. Housing was a major concern too, and that’s where the senior apartments came from.”

     

    Ross hopes he and his staff have learned from their own and previous generations’ mistakes.

     

    “Oftentimes, we go in to the community with our statistics and say, ‘Here’s what the stats say your problems are.’ But the people don’t always agree. You can talk about heart disease and diabetes all you want, but first you have to get rid of the rats and trash.”

     

    Yet in the boardroom and in the community, Ross says he draws many lessons from his days as a family physician – he was a solo practitioner for five years before friends at Parkland convinced him to create a primary care clinic.

     

    “The life of a family physician is really about right relationships,” Ross said. “It’s through those relationships that opportunities and success come. You can’t accomplish anything alone. Communication is critical, especially when you’re trying to impact an organization and a community.”

     

    Ross says he was an accidental leader at first, but has grown to embrace the role.

     

    “I didn’t want to become an administrator,” he said. “People saw leadership things in me that I didn’t necessarily see in myself. But administrators and clinicians do speak a different language, and I saw that as a physician leader I had the ability to translate for them. I was able to discern the interests of both sides.”

     

    The obstacles Ross has faced in Baltimore are a long way from the made-for-TV crises that Marcus Welby faced each week, but Ross sounds a bit like his hero as he assesses the challenges, not only in Baltimore but in the industry as a whole.

     

    “I’ve heard it said that leadership is optimism beyond the available data,” he said. “If you look at the situation here in the U.S. with all the uncertainty around healthcare reform, you could become paralyzed in the face of the facts. But if you’re doing the right things with patients and their families in mind, you should be in a good position to adapt to whatever comes along.”

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