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

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


One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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



SIDEBAR: Shifting our thinking on how to improve healthcare


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


  • Ask the right questions. “We keep asking how we can make things better incrementally,” Fischer-Wright says. “But I don’t think that’s the right question. I think we have to ask ourselves, ‘What do we want?’ ”

  • Focus on the outcome instead of the process. “Because business has been driving healthcare, we’re getting very process-driven instead of outcomes-driven,” she says. “Because of that, we keep getting layers and layers of process, as opposed to really looking at the outcomes we want and reverse-engineering the processes to get us to those outcomes.”

  • Be willing to surrender the things that aren’t working. “A lot of health systems put things into place and then we have an unwillingness to let go of them even though they may not be working for us. We must be willing to let go and move in a different direction than what we know and are comfortable with.”


    Tejal Gandhi: Push for quality, safety needs to come from boards

    By | July 24 th,  2015 | Lucien Leape Institute, patient safety, physicians, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, directors, National Patient Safety Foundation, Partners Healthcare, Tejal Gandhi MD MPH CPPS, culture, quality | Add A Comment


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


    The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.


    “We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”


    The move away from fee-for-service payment in healthcare makes this even more critical, she adds.


    “If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”


    Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.


    “I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”


    One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.


    “For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.


    “At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”


    Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.


    “We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”


    As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”


    Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.


    She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.


    “The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”


    While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.


    “The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”



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

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


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


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


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


    Click here to read the article.


    Profiles in Leadership: Proctor puts priority on outcomes

    By | August 30 th,  2011 | Healthcare, St. Joseph Health System, strategy, Top 25 Women, faith-based, hospital, Modern Healthcare, outcome, Blog, CEO, leadership, safety, culture, Deborah Proctor | Add A Comment

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


    Outcome vs. strategy: which takes the lead?


    Deborah Proctor, president and CEO of St. Joseph Health System in Orange, Calif., makes it clear where she stands on that age-old business dilemma.


    “One of the things that I learned in my career is that most people will develop a strategy and then measure how well they’re accomplishing that strategy. To me, that’s an insufficient process,” she says. “I think you have to first determine what outcomes you’re trying to achieve and then develop strategies to get to those outcomes.


    “But you keep measuring the outcome and you adapt the strategies if they’re not getting you to the outcome.”


    Proctor’s belief in outcomes colored the strategic plan that she and her staff created in 2006, and she made sure it was tangible and accessible for all St. Joseph employees.


    “Instead of sharing strategies like improving financial performance or aligning with physicians –which are certainly important – we focused on talking to employees about outcomes,” she says.


    St. Joseph identified three goals “that every employee could relate to,” says Proctor:


    **That the employees of our system would strive to provide perfect care.


    **That the communities served by St. Joseph Health System and its hospitals would be among the healthiest in the nation.


    **That every encounter with patients, community members, and one another would be a sacred encounter.


    “Perfect care” sounds like an unattainable goal but, to Proctor, who began her career at St. Joseph Hospital in Orange, California as a registered nurse, it has to do with focus.


    “Obviously that’s a very tough standard to live up to,” she admits. “But what are you going to say, that I want to give people the best care 90 percent of the time? I don’t think we can say the aim is anything less. Perfect care doesn’t mean perfect outcome, but it means that everything that’s within our control will be done exceptionally without errors.”


    Proctor’s insistence on a culture of safety stems from her experience in another health system.


    “We were having a strategic meeting and, in the middle of the meeting, one of the physicians got a phone call that informed him of an unnecessary death had occurred in one of our facilities,” she remembers. “From that time, it really became a focus area for me.”


    To make it tangible, St. Joseph Health System set out to improve its record with ventilator-associated pneumonia, which was straggling behind more than 60 percent of other U.S. hospitals. In one year, it moved up to the top 10 percent in the country.


    “Quality,” she says, “has always been given an equal standing with finance in terms of what executives are held accountable for on their goals.”


    If Proctor sounds like a decisive executive, it’s because she is. But the faith element of her career is never far below the surface.


    “My faith is a critical part of my life,” she says. “That ability to have coherence between my personal values and what I’m doing at work – to me, there’s nothing better because it’s so much more than a job.”


    And St. Joseph Health System’s mission, “extending the healing ministry of Jesus in the tradition of the Sisters of St. Joseph,” is key to Proctor’s motivation.


    “I use all my best business knowledge. But to me, working in a faith-based system is more fulfilling because I’m very clear about our mission and what we’re trying to accomplish – which then makes the business decisions have more relevance and meaning.”

    Profiles in Leadership: In Detroit, Schlichting’s success story is one to celebrate

    By | July 5 th,  2011 | chief executive officer, Detroit, Healthcare, risk, Top 25 Women, Modern Healthcare, Blog, finances, Henry Ford Health System, leadership, leadership academies, Nancy Schlichting, culture | Add A Comment

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


    If you ask Nancy Schlichting about what sparked the most professional growth in her career as she rose to become chief executive officer of Henry Ford Health System in Detroit, she is quick to point to people other than herself.


    “Having strong mentors has probably been the most important element of my career,” she says.


    The two key ones, she adds, are Al Gilbert and Gail Warden, who led Summa Health System in Ohio and Henry Ford, respectively.


    “They are two individuals who had profound impact on my career,” Schlichting says. “Al Gilbert appointed me at the ripe old age of 28 to be executive vice president and chief operating officer of a 650-bed teaching hospital. That was what launched my career in so many ways.”


    If there is one skill Schlichting learned from her mentors, and one that she made all her own, it is taking risks. In Schlichting’s case, she opened a new, $360 million hospital, West Bloomfield, during the worst economic downturn since the 1930s in a region of the country that has not seen an abundance of success stories in recent years. She topped off that move by hiring a non-healthcare executive to run the place.


    Gerard van Grinsven became president and CEO of West Bloomfield after a successful career as vice president of the Ritz Carlton hotel chain. Schlichting calls his hiring one of her best moves.


    “Gerard is my poster child for taking risks on people,” she says. “He came to us through his involvement on our board. I got to know him. He told me he did not want to be traveling as much for personal reasons. I had no clue what to do with him at first.


    “But the more I thought about it, I realized that he had opened more than 20 hotels around the world and was an incredible leader of people – smart and competitive.”


    In two years, West Bloomfield has surpassed all of Ford’s financial projections, and Schlichting says van Grinsven’s work has been “nothing short of phenomenal.” Simultaneous to West Bloomfield’s debut was a renovation of the Detroit flagship hospital that cost $300 million. Revenue has doubled in the last ten years.


    No wonder, then, that Fast Company co-founder William C. Taylor talked about Schlichting’s work in transforming her health system in his new book “Practically Radical: Not-So-Crazy Ways to Transform Your Company, Shake Up Your Industry, and Challenge Yourself” (William Murrow).


    Given her successes, Schlichting believes that financial acumen is an overlooked but mandatory part of an up-and-coming executive’s skill set. “Many of my colleagues, both male and female, need to have a more in-depth understanding of finances. We are running very large enterprises. How we use resources affects the overall financial health of a hospital.”


    The other key to focus on, she says, is simple – people. “Healthcare organizations are very people-centric,” she says. “Having good relationship skills is important. It’s about creating a positive environment for people to work in and helping everyone reach their potential.”


    To that end, Schlichting has launched several leadership academies to develop leaders and help retention in a market that has its challenges.


    “If you don’t have a good culture,” she says simply, “you’re not going to be successful.”

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