C-Suite Conversations

What healthcare leaders need to know now

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.”



Profiles in Leadership: Jeffcoat at ease under reform’s pressures

By | August 23 rd,  2011 | Boise, delivery, finance, Healthcare, reform, Saint Alphonsus, Top 25 Women, health system, hospital, Idaho, leaders, Modern Healthcare, operational effectiveness, patient safety, president, Sally Jeffcoat, wellness, Blog, CEO, clinical, leadership, operations, preventon, quality | Add A Comment


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


A lot of the dialogue about healthcare reform is focused on cost, but Sally Jeffcoat, president and CEO of Saint Alphonsus Health System in Boise, Idaho, says she thinks there’s an equally important element that is being overshadowed.


“Health reform has really taken shape in the form of financing reform, but what we haven’t done yet is the care-delivery reform that’s required,” she says. “This gets to the heart of operational effectiveness: how are we going to reorganize care delivery that shifts patients to lower cost environments so that we can still deliver better quality than what we have today?”


To do that, she says, some of the responsibility needs to shift to the patients.


“A focus on prevention and wellness is where we need to reform the system because, right now, there really aren’t any incentives and reimbursement for that type of care,” Jeffcoat says. “It’s difficult to manage the transition unless we reward our providers to deliver that kind of care and we shift some of the risk for those expectations to those patients and populations that we are trying to serve.


“Healthy behaviors are really where we can address some of the problems of our healthcare system today.”


All of that speaks to change, and that is something that Jeffcoat is comfortable with herself. A native Texan whose father was an Army surgeon, she worked for many years in her home state and Arizona, rising to a CEO position in the Ascension system, before taking her current role with Trinity Health.


“I’ve had the blessing of working in organizations that have a strong management development program, but I would not have been able to advance if I wasn’t willing to take on different roles that I had to grow into, or move to different locations,” she says. “Working in different environments shapes you as a leader, because you learn from the positive and negative experiences and integrate them into your leadership style.”


Strategic vision tops the list when Jeffcoat lists the qualities that rising female executives need in today’s environment. But vision must work in tandem with operational effectiveness, she says.


“You need to have the ability to take strategic vision and operationalize it,” she says. “You need to be connecting the dots from strategy to effective implementation to be successful. I also think the ability to communicate vision – the what and the why – is important for a female executive. If you can’t get people wrapped around the why, it makes it more difficult to implement your vision.”


Jeffcoat is known for her dedication to quality and safety, traits that were shaped not only by her pivotal role in Ascension’s “Journey to Zero” program but also by her history as a nurse.


“It’s so important to never get too far away from the bedside or from direct patient care,” she says. “I probably get a lot of my satisfaction from being able to interface directly with the caregivers who are on the front lines. The other thing I derive from that is the teamwork it takes to produce the kind of high reliability that we are all trying to achieve as an organization.”


And a clinical background, she says, can sometimes help a female leader shine.


“It’s important to have the business skills necessary to perform a CEO role. But some of the characteristics of women leaders that bring a balance, such as compassion and collaboration, are very important, particularly in an industry in which 50 percent of the workforce is made up of clinical caregivers.”

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