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Physician leadership profile: Dr. LaMar Hasbrouck brings rare perspective to healthcare’s most vexing issues

By | December 5 th,  2018 | physician leadership, healthcare executives, population health, value-based care, leadership traits, healthcare disparities, mission-based leadership | Add A Comment

Hasbrouck-LamarAt a time when the healthcare industry is putting a premium on physician leadership, while seeking to address the disparities threatening value-based care, few executives are better positioned at the convergence of those streams than LaMar Hasbrouck.

 

Hasbrouck, who holds an MD and an MPH, is Senior Advisor for Strategy and Growth with the American Medical Association. He helps design and build the association’s equity portfolio, as well as cultivate corporate and private foundation relationships. He also guides the association’s chronic disease initiatives and heads efforts to improve internal team cohesion.

 

“I describe my job as a strategy whisperer,” he says. “I’m a fresh set of eyes to look at problems in healthcare and advise the Group VP where we should be putting our resources and what types of talent we should hire.”

 

But don’t be fooled; that fresh set of eyes has experienced a lot. Hasbrouck has worked at the local, state, federal and international level in healthcare. He worked at the Centers for Disease Control and Prevention for 11 years, first as a senior medical officer and later as the director of its work in Guyana, South America.  He was health commissioner of New York’s Ulster County, leader of the Illinois Department of Public Health and CEO of the National Association of County & City Health Officials.

 

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That’s a rare perspective on some of healthcare’s most vexing issues. As such, he finds that the various entities don’t often work well together. That’s a challenge, because all hands are needed to try to solve the tenacious problems in healthcare.

 

“The local level works best with the state level, and the state works well with the federal, but the local and federal levels don’t work well together,” he says. “Then, at the global level, there tends to be a real disconnect in that the U.S. government tends to be one small layer in a very large pool with a lack of fluidity.”

 

Despite his distinguished track record, Hasbrouck is bold in championing solutions outside traditional thinking and is eager to bring his experience to bear on a wide range of issues. His international experience, from South America to Africa, also has molded his views.

 

“What I have learned in my travels is that innovation is essential for solving problems, yet it’s the simple things that you take for granted,” he says. “For instance, when I was in Uganda, we had problems getting medications into hard-to-reach areas. We considered flying the medicine in, but then we came up with the idea of a motorcycle tag team using dry ice to keep the medicine cool.

 

“We didn’t stop there. We trained some laypeople as health workers to address the most common side effects with the patients.”

 

Hasbrouck grew up in a world where preventive health didn’t exist. His family, led by a single mom, was, for a period, reliant on welfare to survive.

 

“It might be surprising to some people, but it was a very happy time,” he says. “We were materially poor, but spiritually and culturally rich. We were inventive in our play because we didn’t have material things. I didn’t know I was deprived, although there were clearly not a lot of male role models who were white-collar professionals.”

 

Yet it’s precisely that upbringing that gives Hasbrouck his mission in stamping out inequity in care.

 

“I have lived that experience and it gives me credibility,” he says. “I’m very driven by my personal narrative. I have chosen roles carefully by the impact I can have through my skills and competencies.

 

“That’s who I am.”

 

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Industry Report: Impact of Digital Transformation on the Patient Life Cycle

By | November 13 th,  2017 | Blog, Data-related job titles, Digital Impact on Healthcare, healthcare executives, Industry Reports, leadership, population health, Technology and Healthcare | Add A Comment

 

Impact of Digital Transformation Industry Report Cover

In a series of interviews with senior executives and thought leaders from around the world, IIC Partners, Furst Group and other members of the IIC Partners’ Healthcare and Life Sciences group, provide an anecdotal look at the impact of digital technologies on healthcare organizations and how it affects patient care.

 

The insights gathered during these interviews deliver a comprehensive look into how advances in technology are digitizing the industry, and subsequently changing the talent requirements and overall landscape.

 

Read and Download: IIC Partners' Industry Report on the Impact of Digital Transformation on the Patient Life Cycle

 

Outside of the IT department, many organizations are redefining leadership structures and the types of roles needed to help bridge the gap between data and performance. Some of these modified and newly created roles are:

  • Chief Digital Officer
  • Chief Medical Information Officer
  • Population Health Liaison
  • Data Protection Officer
  • Chief Performance Officer

In addition to exploring the influence on talent management, the report explores the impact of digital transformation on several other aspects of the patient life cycle, including:

  • Patient-Ownership of Health Data
  • Growth Drivers in Population Health Initiatives
  • Evolving Skillsets for Providers
  • Development of Telehealth Programs
  • Cultural Shifts Required for Digital Adaptation

Are you finding similar challenges and trends in your organization? We’d love to hear your thoughts below in the Comments section.

 

Find out how others are experiencing this impact in the full industry report, “Impact of Digital Transformation on the Patient Life Cycle.”

 

Delaware Valley ACO's Katherine Schneider uses population health to improve patients' lives, one at a time

By | May 16 th,  2017 | accountable care organization, AtlantiCare, Blog, CEO, chief executive officer, clinical imformatics, clinical integration, clinician, community benefits, Delaware Valley ACO, family medicine, Healthcare, Jefferson Health, Katherine Schneider, Main Line Health, Medecision, Middlesex Health system, Modern Healthcare, physician executive, population health, president, Top 25 Women in Healthcare | 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.

 

Katherine Schneider, MD, the president and CEO of the Delaware Valley ACO in the Philadelphia region—an accountable care organization owned by Main Line Health and Jefferson Health—has long been ahead of the game in whatever pursuit she has chosen.

 

She was part of the first group of U.S. physicians to earn subspecialty certification in clinical informatics. She led the implementation of value-based payment models at Middlesex Health System in central Connecticut, long before “value-based” was a common adjective in the healthcare lexicon. She was the senior vice president of health engagement at AtlantiCare, leading its pioneering move to accountable care and co-designing a value-based insurance benefit for 10,000 employees. She also served as executive vice president and chief medical officer for Medecision, which provided population health technology for health systems and health insurers.

 

That’s a lot of trailblazing but, to Schneider, it’s just a steady progression along the path of transforming care.

 

“Whether you call it community benefits, clinical integration, population health or accountable care, this concept of a health system being responsible for more than just transactional care is really what this is all about.”

 

Major achievements started early for Schneider, who skipped from sixth to ninth grade as an adolescent, ending up in college at 15 and in medical school four years later.

 

“When I was 11, we moved from New York City to Austria due to my father’s work,” she says. “I went from a very good private school in Manhattan to a very small, hands-on international school.

 

“I had the threat of ending up at an Austrian convent school hanging over me,” she jokes, “so I did really well.”

 

Though she was much younger than her medical-school classmates, she can’t resist some more self-deprecation.

 

“Yes, I was 19 when I went to medical school, but I made up for it because I spent nine years in medical and graduate school,” she says of the combination MD-PhD program she enrolled in. “To make a long story short, I became much more interested in public health and policy. So, I actually switched into the epidemiology program at Columbia University.”

 

She also chose family medicine, not one of the higher-paying specialties.

 

“Family medicine seemed to me a great fit for someone interested in population health and policy,” Schneider says. “It’s womb to tomb, broad clinical experience.”

 

That made giving up the practice of medicine difficult when she eventually had the opportunity to potentially impact more lives in a different kind of role. Not that she doesn’t have some regrets about not seeing patients anymore.

 

“I do miss it,” she admits. “But there are a lot of really good doctors out there. I was a good doctor too, but I have a skill set that not a lot of people have, which is a combination of the population-health aspects and the clinical experience. I’m seeing opportunities to transform the healthcare system to improve population health outcomes. That’s been my career niche since the day I finished my residency training.”

 

Schneider finds her role leading one of the nation’s leading ACOs to be inspiring, but also challenging at times.

 

“I was recently at a fireside chat featuring Michael Dowling, the CEO of Northwell Health, and he said that, to be in healthcare, you have to be an optimist but you almost have to be chronically unhappy with the status quo.”

 

Schneider says she wouldn’t describe herself as an optimist, but says she “is pretty resilient and determined,” traits she learned from her mother who fought—and beat—tuberculosis as a young woman. “What I learned from my mom is the power of perseverance against the odds.”

 

The perseverance these days comes from battling that persistent status quo—part of the marching orders for an ACO—where so many factions in healthcare have lobbyists to protect their interests, even when change can streamline care or bring about better outcomes.

 

“What one person calls waste is someone else’s lunch,” she says. “If you’re going to get waste out of the system—even through innovation—that’s still taking money away from someone and they’re going to fight it tooth and nail. We’re not going to solve this problem unless we’re willing to admit that and take it on.”

 

Schneider, for one, is ready to wade into the fray.

 

“I truly believe that we can do better and that most of us want to do better to serve our community and our country.”

 

 

SIDEBAR: In a sea of data, the power of stories

 

Katherine Schneider is a national leader in clinical informatics, but she’s a big believer in the power of stories. That’s why she and her team at Delaware Valley ACO open their meetings with a value-based story of impacting the life of a patient or a provider.

 

“You can talk all you want about care management and Triple Aim but, ultimately, if you can tell the story of how you’ve changed a patient’s life or a physician’s practice, people get it,” she says.

 

One example: A 92-year-old woman has been to the emergency room numerous times because she can’t get out of her bathtub. She calls her friends from the tub, who call 911. Over and over. Delaware Valley steps in and, within 24 hours, has connected her to free services in her community that come in and install grab bars and railings and retrofit her home. She doesn’t need to call for help anymore.

 

“Not everything we do is that simple,” Schneider cautions. “We also work with some extremely overwhelming, complex patients and make some small wins for them. A win is not like a cell in a spreadsheet. It’s not a graph on a PowerPoint. It’s really in the stories.”

 

 

Top 25 Minority Executives in Healthcare--Philip Ozuah: Healthcare leadership is a calling, not merely a job

By | December 19 th,  2016 | ACA, Albert Einstein College of Medicine, Blog, chief operating officer, health disparities, healthcare system, Modern Healthcare, Montefiore Medical Center, Nigeria, pediatrics, Philip Ozuah, physician executives, population health, Top 25 Minority Executives in Healthcare | Add A Comment

 

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

 

The plan was relatively straightforward.

 

After he entered medical school at age 14 in Nigeria and eventually earned his M.D., Philip Ozuah’s objective was to get extra training in the U.S. or the U.K. before returning to his homeland to collaborate with his father on building a hospital, which the younger Ozuah would run.

 

But the plan hit a snag when Ozuah became smitten with his pediatrics work in the Bronx at Montefiore Medical Center and Albert Einstein College of Medicine, where he has spent his entire career and now serves as chief operating officer.

 

“I was always driven by the desire to make a difference, and to make a difference in underserved populations,” Ozuah says now. “That was actually one of the factors in remaining and practicing in the Bronx, because I realized I could serve an underserved population right here in New York, and that deepened the resolve and the passion for doing that work.”

 

Ozuah’s father was an engineer and his mother was a school principal in Nigeria. They stressed the importance of education to their children, and Ozuah’s older brother was the first member of the family to travel to America to attend university. When Ozuah came to the U.S., he set to work on a post-doctoral fellowship at the University of Southern California and eventually earned a doctorate in leadership. But the degree of poverty in the U.S. surprised him.

 

“Obviously, I came to the U.S. from a place where there’s immense poverty on the one hand and immense wealth on the other, and they could be juxtaposed right next to each other,” he says. “But there is an image of the U.S. as the richest country in the world, which it is. And so, the extent of some of the privation here can initially be puzzling. You say, ‘How can this be?’ ”

 

Eliminating health disparities has been a lifelong focus for Ozuah, so he is pleased to see population health taking on much greater prominence under the ACA. And, if some of that emphasis has its roots in fiscal issues, he’s fine with that. Just alleviate suffering, he says.

 

“I’m not surprised as much as gratified because I think the focus on population health is long overdue,” he says. “Of course, it’s being driven as much out of necessity as a sense of mission, but it doesn’t matter to me what the motivating factors are. As a nation, I think we need to focus more on keeping people well and not simply figuring out how to do more things to them when they are ill.”

 

Ozuah made his mark as a world-class pediatrician, with a special interest in asthma, obesity, and environmental exposure. He once told the New York Daily News that the knee-jerk response to counsel poor families to get rid of their cats because of the allergy/asthma factor was overlooking the fact that having a cat had the significant health benefit of eliminating rodent issues.

 

It was that type of astute medical knowledge combined with an uncanny common sense that accelerated Ozuah’s rise. And, in addition to his administrative acumen, he won a slew of teaching awards for his work training the next generation of physicians at Einstein, where he also served as professor and university chair of the pediatrics department.

 

“I’m one of those doctors who loves all aspects of medicine,” he says. “Even though I am a pediatrician, I enjoy surgery just as much, as well as adult medicine and psychiatry. I find medicine to be challenging, exciting, rewarding and gratifying.”

 

While he still sees some patients, Ozuah says his primary job “is to make sure the 6 or 7 million patient encounters that take place at Montefiore every year all go well. Now, if there were 600 hours in a day, I would still be a full-time clinician and full-time teacher and researcher as well.”

 

With his Ph.D. in leadership, he has enjoyed the move to the administrative side, a transition that more and more clinicians are embracing these days.

 

“I always enjoyed reading the autobiographies of military or industry leaders,” he says, “because there were always nuggets about management in there. When I was asked by the hospital to take on my first role in leading the medical student training program, I found that I not only seemed to have an aptitude for it but also that I actually enjoyed the challenge of solving problems and trying to figure out solutions when there were not an infinite amount of resources.”

 

Perhaps someday Ozuah’s story may end up in a biography too. He himself admits that “it is a kind of a miracle” that an immigrant from west Africa could, in two decades, become the COO of a multi-billion-dollar healthcare system in the U.S. But the short version of his tale includes plenty of difficulty that’s easy to gloss over more than 20 years later.

 

“The fact of the matter was that I had saved the resources to pay for my first semester at USC, but it wasn’t clear how I was going to actually pay for the rest of my education,” he says.

 

Ozuah eventually earned an academic scholarship to pay for USC. But even when he came to Montefiore as an intern and resident, he found that his status as a foreign-trained physician caused some to question his abilities.

 

“Sometimes, the assumption was that you were incompetent until proven otherwise,” he says. “But I found those things to be motivating and welcomed the chance to prove that I belonged.”

 

Now, he is lionized as a national leader and continues to urge young people to consider medicine as a career despite the concerns that clinicians have about reimbursements, EHRs and regulations.

 

“I think that the next generation is going to move the needle a lot farther than we did. There is no other field where one can make as much of a difference on a daily basis as in medicine. I’m buying medicine stock all the way. I’m all in, because I think it’s a wonderful career.”

 

 

2016 Top 25 Minority Executives in Healthcare--Bruce Siegel: Diverse leadership is a must on the road to equity of care

By | December 14 th,  2016 | academic medical centers, America's Essential Hospitals, Blog, boards, C-suite, Center for Health Care Quality, CEO, diversity, Equity, healthcare disparities, Johns Hopkins, Modern Healthcare, population health, president, risk adjustment, safety net, Top 25 Minority Executives in Healthcare | Add A Comment

 

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

 

Thirty years ago, Bruce Siegel had what he calls “a rude awakening,” running headlong into the perplexing spider web of health disparities as a young MD. It’s been something that he’s spent his entire career trying to solve, albeit not with a stethoscope.

 

“I went off to medical school and started my internship, and I was stunned by what I encountered,” says Siegel, now president and CEO of America’s Essential Hospitals. “I worked in the clinic at our hospital, and it was just a tidal wave of diabetes, heart disease and lung cancer. Most of it was preventable. And the other thing I noticed was that it was mostly affecting communities of color.”

 

It was a frustrating experience, one that led Siegel to pursue a master’s in public health at Johns Hopkins University and try to find public-policy solutions to the nagging issues he saw as a physician. “I felt like I was running an assembly line that never ended. I’d see 200 people with these problems. I’d send them back out and they’d be back a month later.”

 

The New Jersey Department of Health helped pay for Siegel’s education at Hopkins, so he owed them some time when he graduated. He did so well that he eventually became a very young state commissioner of health, then parlayed that experience into running New York City’s health system and a Tampa, Fla., hospital. His early years in leadership after being a clinician were rocky, he admits.

 

“It was a crucible in many ways,” he says. “Sometimes, it was very uncomfortable and I was probably in over my head at points. But it’s where I began to learn that leadership is about giving people space. I really think a leader’s job is to create a safe space for talented people and tools to help them move forward. If I’m giving orders, then I’m failing.”

 

Siegel joined America’s Essential Hospitals in 2010 after eight years as a professor and the director of the Center for Health Care Quality at George Washington University. But at each step of the way, his thoughts went back to those diverse patients in the clinic who found little hope in healthcare. “I had so many patients of color for whom the system simply wasn’t working, but I didn’t understand why.”

 

In recent years, Siegel has begun to see a change as he leads the nation’s essential hospitals, his association’s term for public and other non-profit hospitals with a safety-net role. The association’s members often are a driving force, he says.

 

“It’s great to be in the company of change agents,” he says. “Our members have leaders who care about these problems and are working to fix them. Equity is now front and center in the American agenda. We’re not there yet, but at least today we have the tools.”

 

At times, it’s still a tough slog, he notes. One of the must-haves on the road to equity is diverse leadership, and the effort to improve that is stalled. Medical schools are failing to enroll minority communities, and boards have been far too quiet on the lack of diversity, Siegel says.

 

“I don’t think our boards of directors are demanding this,” he says. “They need to be unequivocal that this is an expectation, not just a nice thing to do. But I don’t think our hospitals are going to look diverse in the C-suite if our boards don’t.”

 

Lack of diversity, Siegel says, is short-sighted because it is harmful to patients and harmful to an organization’s bottom line.

 

“The slow walk on diversity is just bad business,” he says. “We’re not going to succeed if our leaders don’t fully understand the lives of our community and their priorities.”

 

America’s Essential Hospitals is working with the Robert Wood Johnson Foundation on a population health project, and Siegel sees a disconnect between some healthcare executives and the communities they try to serve. “I’ve been in communities where, if you ask the CEO, he or she will talk about chronic disease management as their main concern on population health. But if you ask the people, they’ll say their most pressing need is a safe street for them to walk on, and safe playgrounds for their children. We’re not going to get to population health without addressing what people think of as health.”

 

In the same way, he adds, population health can’t be attained if you weaken the academic medical centers which comprise much of the association’s membership. The AMCs, with their three-legged stool of clinical care, education and research, sometimes feel the ACA is applied like a wildly swung ax, Siegel says.

 

“These are places in America that do what no one else does,” he says. “They attract the sickest people who have the greatest social and economic challenges. Home may be a homeless shelter. English may not be their first language. These patients may have a harder time navigating the healthcare system, and they may be readmitted through no fault of the hospital.”

 

Siegel’s association is pushing Congress for a risk adjustment for these hospitals, which, he notes, had an aggregate operating margin slightly in the red for 2014. Compare that to, say, the pharma industry, which banks about 20 percent profits each year.

 

“To me, the future of healthcare is that hospitals will be at risk for dollars they get. I accept that,” Siegel says. “We’ll do everything we can to make that better, but we also need the regulators and the payers to do their part.”

 

The challenges of America’s Essential Hospitals’ members are personal to Siegel. He and his sister were both born in a public hospital. Their mom emigrated to the U.S. from Haiti. “My family very much depended on a safety net when they came to America. So these issues are near and dear to me and my loved ones.”

 

 

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

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

 

 

Revisiting the Top 25: Georges Benjamin says apathy and political agendas are threatening to roll back progress on public health

By | October 6 th,  2016 | American Public Health Association, APHA, Blog, clean air, clean water, climate change, Flint, gun violence, lead, Modern Healthcare, payers, population health, providers, Top 25 Minority Executives in Healthcare, zika | Add A Comment

 

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

 

Georges Benjamin has led the American Public Health Association as executive director since 2002, but he has never been busier or more vocal.

 

“I think we’re in an environment where the forces doing things that are opposed to the public’s health are more active, and so we’re more active,” he says.

 

The issues are numerous, from climate change to gun violence -– and a few things that didn’t used to be controversial at all.

 

“When you look at clean water and clean air, there’s an effort to push back on a lot of the things that public health has done over the years to make the environment safer for us and to make us healthier,” he adds. “We’re having to weigh in on things that, in our minds, were settled.”

 

Some threats he sees as audacious.

 

“The misinformation around the Affordable Care Act continues to be a concern and the lack of national recognition of the prevention aspects of the law are absolutely amazing,” Benjamin says.

 

Others, he says, are the result of apathy and inattention.

 

“We lost 40,000 public health workers across the country through the last recession and they haven’t been replaced,” he notes. “We’re losing programs because the funding has been cut. And then there’s public health preparedness. We spent a lot of money getting ourselves prepared after 9/11. Not only have there been reductions in funding for the preparedness of our nation to deal with biological attack, but our preparedness for everyday emergencies is not as good as it used to be.”

 

Benjamin's words may be finding an audience. On April 19, President Obama appointed Benjamin to the National Infrastructure Advisory Council.

 

The water crisis of Flint, Mich., is one example of the decay of public health, Benjamin says. So is a lack of funding to deal with mosquito-borne disease – not just zika, but dengue and chikungunya. Give him 10 minutes and he can tick off a variety of issues that need addressing, particularly in the corridors of Washington, D.C., where APHA is based. And, yes, he’d like to see hospitals and health systems get a little more vocal and visible on these issues too.

 

“The healthcare delivery side of the house needs to weigh in on a range of things that historically they have not weighed in on,” Benjamin says. “They always show up for the Medicaid hearing or the healthcare financing hearing. But we need them to show up at the hearing for the public health budget on lead, we need them to show up for the hearing on clean water. We need them to spend their healthcare dollars in a more objective way to address climate change.”

 

In many communities, hospitals are one of the biggest employers and have a large footprint. While some have made moves to address their carbon-dioxide emissions, it’s often done from a business perspective to get better energy rates, Benjamin says. “They also need to do it from a health perspective because it makes their community healthier. And they need to see it through that lens.”

 

If providers can become more public-health-conscious, he says, then they can begin to make a difference via population health.

 

“We have to make sure ‘population health’ isn’t just a buzzword and people don’t take what they’re already doing and rename it ‘population health,’ ” Benjamin says. “We want to make sure it doesn’t go the way of ‘managed care’ – the idea of the moment that, when it doesn’t achieve its goals because it wasn’t done right, people call it a failure.”

 

APHA works with payers as well, including partnerships with the UnitedHealth Foundation and the Aetna Foundation, and isn’t shy about criticizing insurers and providers alike. “When we think they’re off-track, we scream and yell and holler at them -– but we generally have the same goals around health and the well-being of our communities.”

 

With that community health in mind, Benjamin says he is glad to see more of his fellow clinicians stepping up to accept the mantle of leading administratively as well. “Having made decisions around patients gives you a unique perspective that you bring to the table. When you’re the COO or the CEO, the buck stops with you and you get to use those skills differently than you would if you were the medical director and in a more advisory role.”

 

But physician executives need to learn that leadership “is not giving people an order and expecting them to follow,” says Benjamin, himself a former military leader. “It’s setting goals, getting people aligned to go in a particular direction, and then giving them freedom.”

 

It’s a far different role than simply being a clinician, he says.

 

“One of the reasons I enjoyed being in an emergency position was that, most of the time, you saw results of your work right away. But in management, things are like a big battleship and they don’t turn very quickly. And so the gratification is much more delayed, much more subtle, and you’ve got to really understand what a win is.

 

“Sometimes a win is not what you would like. You have to accept progress and be comfortable with that. And then, realize you have to come back another day and try to move the boat a little further along.”

 

 

Philip Ozuah finds his life's calling as he works to eradicate health disparities in the Bronx

By | August 3 rd,  2016 | ACA, Albert Einstein College of Medicine, Blog, chief operating officer, health disparities, healthcare system, Modern Healthcare, Montefiore Medical Center, Nigeria, pediatrics, Philip Ozuah, physician executives, population health, Top 25 Minority Executives in Healthcare | Add A Comment

 

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

 

The plan was relatively straightforward.

 

After he entered medical school at age 14 in Nigeria and eventually earned his M.D., Philip Ozuah’s objective was to get extra training in the U.S. or the U.K. before returning to his homeland to collaborate with his father on building a hospital, which the younger Ozuah would run.

 

But the plan hit a snag when Ozuah became smitten with his pediatrics work in the Bronx at Montefiore Medical Center and Albert Einstein College of Medicine, where he has spent his entire career and now serves as chief operating officer.

 

“I was always driven by the desire to make a difference, and to make a difference in underserved populations,” Ozuah says now. “That was actually one of the factors in remaining and practicing in the Bronx, because I realized I could serve an underserved population right here in New York, and that deepened the resolve and the passion for doing that work.”

 

Ozuah’s father was an engineer and his mother was a school principal in Nigeria. They stressed the importance of education to their children, and Ozuah’s older brother was the first member of the family to travel to America to attend university. When Ozuah came to the U.S., he set to work on a post-doctoral fellowship at the University of Southern California and eventually earned a doctorate in leadership. But the degree of poverty in the U.S. surprised him.

 

“Obviously, I came to the U.S. from a place where there’s immense poverty on the one hand and immense wealth on the other, and they could be juxtaposed right next to each other,” he says. “But there is an image of the U.S. as the richest country in the world, which it is. And so, the extent of some of the privation here can initially be puzzling. You say, ‘How can this be?’ ”

 

Eliminating health disparities has been a lifelong focus for Ozuah, so he is pleased to see population health taking on much greater prominence under the ACA. And, if some of that emphasis has its roots in fiscal issues, he’s fine with that. Just alleviate suffering, he says.

 

“I’m not surprised as much as gratified because I think the focus on population health is long overdue,” he says. “Of course, it’s being driven as much out of necessity as a sense of mission, but it doesn’t matter to me what the motivating factors are. As a nation, I think we need to focus more on keeping people well and not simply figuring out how to do more things to them when they are ill.”

 

Ozuah made his mark as a world-class pediatrician, with a special interest in asthma, obesity, and environmental exposure. He once told the New York Daily News that the knee-jerk response to counsel poor families to get rid of their cats because of the allergy/asthma factor was overlooking the fact that having a cat had the significant health benefit of eliminating rodent issues.

 

It was that type of astute medical knowledge combined with an uncanny common sense that accelerated Ozuah’s rise. And, in addition to his administrative acumen, he won a slew of teaching awards for his work training the next generation of physicians at Einstein, where he also served as professor and university chair of the pediatrics department.

 

“I’m one of those doctors who loves all aspects of medicine,” he says. “Even though I am a pediatrician, I enjoy surgery just as much, as well as adult medicine and psychiatry. I find medicine to be challenging, exciting, rewarding and gratifying.”

 

While he still sees some patients, Ozuah says his primary job “is to make sure the 6 or 7 million patient encounters that take place at Montefiore every year all go well. Now, if there were 600 hours in a day, I would still be a full-time clinician and full-time teacher and researcher as well.”

 

With his Ph.D. in leadership, he has enjoyed the move to the administrative side, a transition that more and more clinicians are embracing these days.

 

“I always enjoyed reading the autobiographies of military or industry leaders,” he says, “because there were always nuggets about management in there. When I was asked by the hospital to take on my first role in leading the medical student training program, I found that I not only seemed to have an aptitude for it but also that I actually enjoyed the challenge of solving problems and trying to figure out solutions when there were not an infinite amount of resources.”

 

Perhaps someday Ozuah’s story may end up in a biography too. He himself admits that “it is a kind of a miracle” that an immigrant from west Africa could, in two decades, become the COO of a multi-billion-dollar healthcare system in the U.S. But the short version of his tale includes plenty of difficulty that’s easy to gloss over more than 20 years later.

 

“The fact of the matter was that I had saved the resources to pay for my first semester at USC, but it wasn’t clear how I was going to actually pay for the rest of my education,” he says.

 

Ozuah eventually earned an academic scholarship to pay for USC. But even when he came to Montefiore as an intern and resident, he found that his status as a foreign-trained physician caused some to question his abilities.

 

“Sometimes, the assumption was that you were incompetent until proven otherwise,” he says. “But I found those things to be motivating and welcomed the chance to prove that I belonged.”

 

Now, he is lionized as a national leader and continues to urge young people to consider medicine as a career despite the concerns that clinicians have about reimbursements, EHRs and regulations.

 

“I think that the next generation is going to move the needle a lot farther than we did. There is no other field where one can make as much of a difference on a daily basis as in medicine. I’m buying medicine stock all the way. I’m all in, because I think it’s a wonderful career.”

 

 

Bruce Siegel: Hospitals need to listen to their communities to tackle health disparities

By | July 18 th,  2016 | academic medical centers, America's Essential Hospitals, Blog, boards, C-suite, Center for Health Care Quality, CEO, diversity, Equity, healthcare disparities, Johns Hopkins, Modern Healthcare, population health, president, risk adjustment, safety net, Top 25 Minority Executives in Healthcare | Add A Comment

 

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

 

Thirty years ago, Bruce Siegel had what he calls “a rude awakening,” running headlong into the perplexing spider web of health disparities as a young MD. It’s been something that he’s spent his entire career trying to solve, albeit not with a stethoscope.

 

“I went off to medical school and started my internship, and I was stunned by what I encountered,” says Siegel, now president and CEO of America’s Essential Hospitals. “I worked in the clinic at our hospital, and it was just a tidal wave of diabetes, heart disease and lung cancer. Most of it was preventable. And the other thing I noticed was that it was mostly affecting communities of color.”

 

It was a frustrating experience, one that led Siegel to pursue a master’s in public health at Johns Hopkins University and try to find public-policy solutions to the nagging issues he saw as a physician. “I felt like I was running an assembly line that never ended. I’d see 200 people with these problems. I’d send them back out and they’d be back a month later.”

 

The New Jersey Department of Health helped pay for Siegel’s education at Hopkins, so he owed them some time when he graduated. He did so well that he eventually became a very young state commissioner of health, then parlayed that experience into running New York City’s health system and a Tampa, Fla., hospital. His early years in leadership after being a clinician were rocky, he admits.

 

“It was a crucible in many ways,” he says. “Sometimes, it was very uncomfortable and I was probably in over my head at points. But it’s where I began to learn that leadership is about giving people space. I really think a leader’s job is to create a safe space for talented people and tools to help them move forward. If I’m giving orders, then I’m failing.”

 

Siegel joined America’s Essential Hospitals in 2010 after eight years as a professor and the director of the Center for Health Care Quality at George Washington University. But at each step of the way, his thoughts went back to those diverse patients in the clinic who found little hope in healthcare. “I had so many patients of color for whom the system simply wasn’t working, but I didn’t understand why.”

 

In recent years, Siegel has begun to see a change as he leads the nation’s essential hospitals, his association’s term for public and other non-profit hospitals with a safety-net role. The association’s members often are a driving force, he says.

 

“It’s great to be in the company of change agents,” he says. “Our members have leaders who care about these problems and are working to fix them. Equity is now front and center in the American agenda. We’re not there yet, but at least today we have the tools.”

 

At times, it’s still a tough slog, he notes. One of the must-haves on the road to equity is diverse leadership, and the effort to improve that is stalled. Medical schools are failing to enroll minority communities, and boards have been far too quiet on the lack of diversity, Siegel says.

 

“I don’t think our boards of directors are demanding this,” he says. “They need to be unequivocal that this is an expectation, not just a nice thing to do. But I don’t think our hospitals are going to look diverse in the C-suite if our boards don’t.”

 

Lack of diversity, Siegel says, is short-sighted because it is harmful to patients and harmful to an organization’s bottom line.

 

“The slow walk on diversity is just bad business,” he says. “We’re not going to succeed if our leaders don’t fully understand the lives of our community and their priorities.”

 

America’s Essential Hospitals is working with the Robert Wood Johnson Foundation on a population health project, and Siegel sees a disconnect between some healthcare executives and the communities they try to serve. “I’ve been in communities where, if you ask the CEO, he or she will talk about chronic disease management as their main concern on population health. But if you ask the people, they’ll say their most pressing need is a safe street for them to walk on, and safe playgrounds for their children. We’re not going to get to population health without addressing what people think of as health.”

 

In the same way, he adds, population health can’t be attained if you weaken the academic medical centers which comprise much of the association’s membership. The AMCs, with their three-legged stool of clinical care, education and research, sometimes feel the ACA is applied like a wildly swung ax, Siegel says.

 

“These are places in America that do what no one else does,” he says. “They attract the sickest people who have the greatest social and economic challenges. Home may be a homeless shelter. English may not be their first language. These patients may have a harder time navigating the healthcare system, and they may be readmitted through no fault of the hospital.”

 

Siegel’s association is pushing Congress for a risk adjustment for these hospitals, which, he notes, had an aggregate operating margin slightly in the red for 2014. Compare that to, say, the pharma industry, which banks about 20 percent profits each year.

 

“To me, the future of healthcare is that hospitals will be at risk for dollars they get. I accept that,” Siegel says. “We’ll do everything we can to make that better, but we also need the regulators and the payers to do their part.”

 

The challenges of America’s Essential Hospitals’ members are personal to Siegel. He and his sister were both born in a public hospital. Their mom emigrated to the U.S. from Haiti. “My family very much depended on a safety net when they came to America. So these issues are near and dear to me and my loved ones.”

 

 

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

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

 

 

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