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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 | climate change, payers, population health, Top 25 Minority Executives in Healthcare, clean air, clean water, Flint, gun violence, lead, Modern Healthcare, providers, Blog, American Public Health Association, APHA, 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.”

 

 

Georges Benjamin: Apathy, political agendas threaten progress in public health

By | April 22 nd,  2016 | climate change, payers, population health, Top 25 Minority Executives in Healthcare, clean air, clean water, Flint, gun violence, lead, Modern Healthcare, providers, Blog, American Public Health Association, APHA, zika | Add A Comment

 

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.”

 

 

Karen Ignagni: The post-ACA landscape offers a blank slate for visionary leaders

By | September 2 nd,  2015 | Affordable Care Act, AHIP, care coordination, consolidation, Healthcare, payers, population health, pricing, Modern Healthcare, pharmaceutical, providers, Blog, CEO, costs, disease management, EmblemHealth, insurers, Karen Ignagni, leadership, transparency, Top 25 Women in Healthcare | Add A Comment

 

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

 

The healthcare industry is in a time of historic change. Hospitals and health systems are merging and acquiring each other; health insurers are doing the same. The provider and payer worlds themselves are converging as health systems create their own health plans and insurers are affiliating with providers.

 

But no one should read into what is happening now as a guarantee of what the industry will look like when the tectonic plates stop shifting, says Karen Ignagni, the new CEO of EmblemHealth who recently completed an incredibly influential run as CEO of America’s Health Insurance Plans (AHIP). Ignagni spoke with Furst Group during her final days at AHIP and before taking over at EmblemHealth.

 

“The way to think about convergence is that it’s the beginning of numerous possibilities,” she says, “and how it evolves will be dependent upon individual market dynamics and individual stakeholder leadership.”

 

Despite the uncertainty, it should be an exciting time for innovators, Ignagni notes.

 

“It’s crucial to be open-minded and not think the past is prologue,” she says. “Some folks love that idea; others who are looking to continue a strategy charted some years ago are terrified by it. There’s no handbook for where we are today. As a leader, you need to understand that and be willing to take out a blank piece of paper and create your vision.”

 

Ignagni leaves no uncertainty as to where she stands on that issue.

 

“If you can think about this as the best of times, then you’ll have an opportunity to make an enduring contribution.”

 

She says it was her desire to make a new kind of contribution that led to her decision to leave AHIP, the organization she had forged, and take the reins at EmblemHealth.

 

“First of all, leading AHIP is one of the best jobs in the country with the best team in the country,” Ignagni says, “But I’m excited about this new chapter. I’m thankful to the Emblem board for the opportunity to move from representing what our companies are doing to actually doing the work and taking an operations role in a health plan serving working families, seniors and the medically underserved.

 

“For me, it is coming full circle,” she adds, noting that she worked for the AFL-CIO in the ‘80s, where one of her roles was fighting for health benefits for union members.

 

More recently, of course, Ignagni was a pivotal player in the reform debate. Her advocacy was a signature moment in a career that saw her as arguably the most powerful payer voice for more than two decades – she previously led the American Association of Health Plans and guided AAHP’s merger with the Health Insurance Association of America that formed AHIP.

 

Despite the changes that the Affordable Care Act has brought, Ignagni agrees that the entire health care industry still has a long way to go to begin to meet consumers’ expectations.

 

“The health arena has to become much more like Amazon,” she says. “When I go on Amazon, they know who I am, I don’t have to re-enter all of my information, and things come overnight. That’s the customer-service standard that we in the health care arena need to emulate—everything needs to happen in real time.”

 

The status quo, she warns, won’t fly with consumers any more.

 

“Health care stakeholders need to embrace transparency,” Ignagni says. “For example, how much does a drug really cost? Right now, it is a black box of pricing. With pharmaceutical companies, the rhetoric is all about innovation. But how much of the price consumers are being asked to pay is for innovations, marketing and sales, and profit-taking? In the health plan community, consumers know precisely the answers to these questions. Now regulators will use the reporting structure for health plans to ask pharmaceutical companies similar questions.”

 

Payers have outed providers by revealing hospital pricing during the unprecedented wave of health-system mergers, and also has taken the pharma industry to task for what it views as price-gouging, like $84,000 Hepatitis C treatments. Ignagni, as the payers’ chief lobbyist, has led that charge.

 

“Our motivation as health plans is to get the price of the premium as affordable as possible for consumers. That’s a very different objective than a large pharmaceutical company charging whatever it can, or a hospital consolidating so it can raise all of its pricing to the level of the highest priced hospital in the network.”

 

She acknowledges that, under the new paradigm of convergence, payers and providers will need to work together. But payers must be equal partners in the arrangement, she warns.

 

“Health plans have an advantage in population health,” she says. “We’ve already written the book on it. It’s not a future state we’re evolving to -- we're there with our focus on disease management and care coordination. Now the question is, how do health plans bring these skills together with clinicians and hospitals to create new payment arrangements that result in more efficiency and effectiveness for patients?”

 

To get the industry to where it needs to go in these areas, Ignagni says, will take a new level of leadership. Leaders, she says, will need “resilience, agility, and the ability to handle a significant amount of unpredictability, because we are talking about writing a new chapter.”

 

Even with her new role, don’t be surprised if Ignagni is one of the primary co-authors of this next passage for the healthcare industry.

 

 

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.”

 

 

At HealthPartners, Mary Brainerd's leadership approaches solutions from a nuanced angle

By | August 5 th,  2015 | Affordable Care Act, delivery, merger, payers, Triple Aim, financing, Modern Healthcare, organizations, ParkNicollet, providers, Blog, cancer, CEO, Head + Heart Together, Institute for Healthcare Improvement, leadership, Mary Brainerd, Northwest Alliance, safety, HealthPartners, quality, Top 25 Women in Healthcare | Add A Comment

 

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

 

While HealthPartners CEO Mary Brainerd is pleased that more people now have insurance through the Affordable Care Act, you’ll have to excuse her if she’s a little frustrated with how the law has had a rocky start in Minnesota, where innovations that already existed were scuttled by Obamacare.

 

For example, Minnesota residents who had pre-existing conditions already had insurance coverage through a special high-risk pool that included businesses as well as individuals. It had been functioning just fine for 30 years. The ACA shut the program down. Those individuals were forced to buy insurance products on the clunky exchange and now, in Year 2, are facing rate hikes of more than 50 percent because the risk pool is too small.

 

“That’s a federal issue, and we wish it would change,” Brainerd says. “But it appears no one has the political will at the federal level to ask, ‘What’s not working, and how can we help make it better?’ The more you segment the market when people have serious health conditions, the higher the costs are both for these individuals and for these smaller funding pools that are responsible for covering their costs.”

 

It’s an intriguing patient-centric perspective on Brainerd’s part, and comes from an angle that’s a little different than the typical healthcare-industry party line. But perhaps that’s to be expected from a respected executive with a degree in philosophy (as well as an MBA).

 

“I think there are actually a lot of areas in which both philosophy specifically and liberal arts in general add value, and that is that you spend time studying many different perspectives on the same topic,” she says. “So when you’re faced with challenges and decisions, you’re less likely to think there’s a formulaic right answer. Instead, you’re more likely to think there are many perspectives on this issue to explore and understand before moving to quick decisions.”

 

A 2013 merger with the ParkNicollet system was significant for HealthPartners because it doubled the organization’s patient base to more than 1 million and expanded the payer-and-provider capabilities that the company had been executing for 50 years. Other healthcare organizations are now jumping into the payer-provider mix, and Brainerd has some advice for them.

 

“I think the challenge for organizations that are just creating those capabilities is not to think of them as two separate businesses but instead to look at them as very integrated, synergistic businesses that have the same strategy. We have the same strategic plan for our delivery system as we do for our health plan, and it’s focused on people as our chief resource and asset.”

 

Yet the enormity of merging two large organizations was a challenge.

 

“There are 23,000 people making decisions across our organization every minute of every day, and so what we do and how we do it has to come from that shared sense of value and a common sense of purpose,” Brainerd says.

 

As the vehicle for that mission, HealthPartners’ culture is known as “Head + Heart, Together.” Internally, it has helped build cohesion. Externally, it has encouraged the organization get in front of the trend toward collaboration. For example, HealthPartners, Allina Health and a physicians’ group were all thinking about building an MRI center in one region of the Twin Cities metroplex. Instead, they worked together and built one center that they all utilize.

 

HealthPartners and Allina also joined forces in an initiative called the Northwest Alliance, with a view to achieving Triple Aim results in quality and health improvement, especially in urgent care and mental health services.

 

“Neither of us alone would have been able to bring that capability to the community,” she says.

 

The results, she says, have been so strong that HealthPartners and Allina are planning to extend the original 7-year agreement before it even expires.

 

Brainerd is equally committed to HealthPartners’ ties with the Institute for Healthcare Improvement, making, as in the case with the Northwest Alliance, the Triple Aim its overarching view of care. The Triple Aim’s focus on quality and safety is an area in which her personal experience has shaped her.

 

More than a decade ago, she was a patient in her own system as she dealt with breast cancer. Her care was excellent, but there were some less-than-stellar interactions with the system that made her re-evaluate what HealthPartners’ patients experience.

 

“I think anyone I know who has worked in healthcare and then has encountered the healthcare system as a patient, either themselves or a close family member, is changed by that experience,” she says. “Still, to this day, I almost viscerally recall that feeling of vulnerability that you have, and also the understanding that the physical challenges of treatments and surgeries is in many respects not even half the challenge of the emotional and psychological impact of a serious illness.

 

“It was a life-changing experience for me, and I hope it made me a better leader for our organization.”

 

While Brainerd says she believes the healthcare industry had made significant progress in safety, she also wonders what other blind spots exist.

 

“If, 10 years ago, we didn’t see those issues in patient safety, what are the things we’re not seeing today that future leaders will reference and say, ‘Why weren’t they focused on that?,’ ” she says. “For example, in our aim to minimize pain, we’re actually creating an environment where there are many worse health consequences as the result of the abuse, misuse and overuse of narcotics. More than 80 percent of the world’s narcotics are prescribed in the United States. And then I wonder what tomorrow’s example will be. I want to look for it.”

 

 

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

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

 

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

 

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

 

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

 

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

 


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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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