What healthcare leaders need to know now

 

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

 

Delvecchio Finley doesn’t shrink back from a challenge.

 

That’s one of the reasons his last two jobs have been leading California public health organizations with different but significant issues. But as he surveys the changes needed not only within his own health system but throughout the nation as a whole, he is adamant that healthcare is only part of the solution for what ails the U.S.

 

“Even though access to care and the quality of care is important, access to stable housing, food sources, education and jobs play a greater influence collectively on our overall health,” says Finley, CEO of the Alameda Health System. “I think the evolving research in the field is making it a lot more evident to all of us that those issues are significant social determinants of health.”

 

The interconnectedness of all those factors makes health disparities harder to eradicate, Finley says, but one way to begin is to address the lack of diversity in healthcare leadership and the healthcare workforce as a whole.

 

“Making sure that our workforce is representative of the community we serve – that people who are coming to us for care aren’t just the recipients of that care but can also play a major role in providing or facilitating that care – is what starts to provide access to good jobs and stable housing, and in turn begins to build a good economic engine for the community.

 

“Thus, you’re reinvesting in the community, and that’s how we start to get at the root of this and not just through the delivery of the services.”

 

Finley has some life experience along those lines. He grew up in public housing in Atlanta, where access to healthcare was poor even though the actual care was excellent when he and his family received it. In his neighborhood, he says, the three fields of employment that offered paths to upward mobility were healthcare, education and law enforcement. He was a strong student, and enjoyed helping people, so he was eyeing a future as a physician during his undergraduate years at Emory University, where he earned his degree in chemistry.

 

“Upon finishing my degree, I realized that I loved science but wasn’t necessarily as strong in it as I needed to be to become a doctor,” he says. “But I still loved healthcare and wanted that to be something I pursued.”

 

He explored other avenues and ended up earning his master’s in public policy at Duke University. Finley was the first member of his family to graduate from college and to get a graduate degree as well, but not the last, he is quick to point out.

 

“The thing that I’m most proud of is that, while I was the first to graduate from college, that achievement has set a path for my cousins, nieces and nephews, who have continued to shatter that ceiling for our family.”

 

He says it was also within his family – and within public housing – where he first began learning leadership skills that would result in him becoming one of the youngest hospital CEOs in the country.

 

“I spent a fair amount of my childhood being raised by my aunt, and she was a force of nature,” Finley says with a laugh. “She served as president of the tenant association and she used that position to strongly advocate for reasonable services and humane treatment for people who were in a very challenging circumstance. I learned from her that we have a responsibility to use our gifts – and to use our voice and our station in life – to help people.”

 

That was certainly the impetus for taking the helm at both Alameda and his previous post as CEO of Harbor-UCLA Medical Center.

 

“Both of them are safety-net organizations that serve a disproportionately underserved community,” Finley says. “That resonates with me from both a personal and professional standpoint. They have both provided a chance to work with a team to get our hands around some of these issues because of the very important work and role that these organizations play in their communities.”

 

At Harbor, the bigger challenges were regulatory, not having good, documentable evidence of the quality and safety of the care that was being provided, “which we were able to fortunately surmount and proceed from there,” he says.

 

The difficulties that Finley and his team at Alameda have had to address are different, he says. “A lot of it was short-term economic hardship combined with the growing pains of going from a historical health system that had grown exponentially through recent acquisitions of two community hospitals. We’re just beginning to stabilize and right-size the ship.”

 

The elements for achieving lasting change, both for the health system and the community, are within reach, he says. Alameda’s skilled nursing facilities recently outperformed a lot of private organizations in earning a 5-star rating from CMS, something Finley hopes can be replicated systemwide with a new strategic plan that promotes greater “systemness” and a focus on access, quality, patient experience, and innovative approaches to care delivery.

 

Alameda Health System is also a benefactor of the a state Medicaid Waiver called Medi-2020, which is a partnership between CMS and the State of California that aims to promote continued transformation of the safety-net delivery system for Medi-Cal recipients. And, internally, Finley plans to bring more Lean management processes to Alameda in the next fiscal year.

 

He had begun to explore Lean several years ago when he was at Harbor-UCLA. He and leaders from a number of systems – including Alameda – took trips to watch Lean in operation at ThedaCare in Wisconsin, Virginia Mason in Washington, and Denver Health in Colorado.

 

“I appreciated that Lean wasn’t just a performance improvement methodology and the flavor of the day, but it was an operating system,” he says. “I think my other takeaway from the trip was that Lean is very hard to do. You’re going to have fits and starts, but if you commit to it, it can lead to some very transformative outcomes for your organization and for the community you serve.”

 

Transformative outcomes? Finley personally knows a thing or two about that.

 

 

 

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.”

 

 

 

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.”

 

 

 

Delvecchio Finley doesn’t shrink back from a challenge.

 

That’s one of the reasons his last two jobs have been leading California public health organizations with different but significant issues. But as he surveys the changes needed not only within his own health system but throughout the nation as a whole, he is adamant that healthcare is only part of the solution for what ails the U.S.

 

“Even though access to care and the quality of care is important, access to stable housing, food sources, education and jobs play a greater influence collectively on our overall health,” says Finley, CEO of the Alameda Health System. “I think the evolving research in the field is making it a lot more evident to all of us that those issues are significant social determinants of health.”

 

The interconnectedness of all those factors makes health disparities harder to eradicate, Finley says, but one way to begin is to address the lack of diversity in healthcare leadership and the healthcare workforce as a whole.

 

“Making sure that our workforce is representative of the community we serve – that people who are coming to us for care aren’t just the recipients of that care but can also play a major role in providing or facilitating that care – is what starts to provide access to good jobs and stable housing, and in turn begins to build a good economic engine for the community.

 

“Thus, you’re reinvesting in the community, and that’s how we start to get at the root of this and not just through the delivery of the services.”

 

Finley has some life experience along those lines. He grew up in public housing in Atlanta, where access to healthcare was poor even though the actual care was excellent when he and his family received it. In his neighborhood, he says, the three fields of employment that offered paths to upward mobility were healthcare, education and law enforcement. He was a strong student, and enjoyed helping people, so he was eyeing a future as a physician during his undergraduate years at Emory University, where he earned his degree in chemistry.

 

“Upon finishing my degree, I realized that I loved science but wasn’t necessarily as strong in it as I needed to be to become a doctor,” he says. “But I still loved healthcare and wanted that to be something I pursued.”

 

He explored other avenues and ended up earning his master’s in public policy at Duke University. Finley was the first member of his family to graduate from college and to get a graduate degree as well, but not the last, he is quick to point out.

 

“The thing that I’m most proud of is that, while I was the first to graduate from college, that achievement has set a path for my cousins, nieces and nephews, who have continued to shatter that ceiling for our family.”

 

He says it was also within his family – and within public housing – where he first began learning leadership skills that would result in him becoming one of the youngest hospital CEOs in the country.

 

“I spent a fair amount of my childhood being raised by my aunt, and she was a force of nature,” Finley says with a laugh. “She served as president of the tenant association and she used that position to strongly advocate for reasonable services and humane treatment for people who were in a very challenging circumstance. I learned from her that we have a responsibility to use our gifts – and to use our voice and our station in life – to help people.”

 

That was certainly the impetus for taking the helm at both Alameda and his previous post as CEO of Harbor-UCLA Medical Center.

 

“Both of them are safety-net organizations that serve a disproportionately underserved community,” Finley says. “That resonates with me from both a personal and professional standpoint. They have both provided a chance to work with a team to get our hands around some of these issues because of the very important work and role that these organizations play in their communities.”

 

At Harbor, the bigger challenges were regulatory, not having good, documentable evidence of the quality and safety of the care that was being provided, “which we were able to fortunately surmount and proceed from there,” he says.

 

The difficulties that Finley and his team at Alameda have had to address are different, he says. “A lot of it was short-term economic hardship combined with the growing pains of going from a historical health system that had grown exponentially through recent acquisitions of two community hospitals. We’re just beginning to stabilize and right-size the ship.”

 

The elements for achieving lasting change, both for the health system and the community, are within reach, he says. Alameda’s skilled nursing facilities recently outperformed a lot of private organizations in earning a 5-star rating from CMS, something Finley hopes can be replicated systemwide with a new strategic plan that promotes greater “systemness” and a focus on access, quality, patient experience, and innovative approaches to care delivery.

 

Alameda Health System is also a benefactor of the a state Medicaid Waiver called Medi-2020, which is a partnership between CMS and the State of California that aims to promote continued transformation of the safety-net delivery system for Medi-Cal recipients. And, internally, Finley plans to bring more Lean management processes to Alameda in the next fiscal year.

 

He had begun to explore Lean several years ago when he was at Harbor-UCLA. He and leaders from a number of systems – including Alameda – took trips to watch Lean in operation at ThedaCare in Wisconsin, Virginia Mason in Washington, and Denver Health in Colorado.

 

“I appreciated that Lean wasn’t just a performance improvement methodology and the flavor of the day, but it was an operating system,” he says. “I think my other takeaway from the trip was that Lean is very hard to do. You’re going to have fits and starts, but if you commit to it, it can lead to some very transformative outcomes for your organization and for the community you serve.”

 

Transformative outcomes? Finley personally knows a thing or two about that.

 

 

 

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.”

 

 

 

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.”

 

 

 

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

 

For healthcare leaders today, it is clear that the big challenge, and the big opportunity, is to invest in the evolution of what has been a cottage industry into a true system of care. One in which efficient, integrated healthcare services are aligned with the ways in which care is paid for; where both provider and patient accountability matter.

 

While Marna Borgstrom, CEO of Yale New Haven Health System, believes we are moving in this direction, she notes that few systems, if any, are “there” yet. Many providers are not organized to take risk for populations of patients. Many payers can’t accurately and effectively take and manage capitated payment or significant risk arrangements. And the state and federal governments aren’t aligned on what or how they pay for care.

 

As Yale New Haven Health System is on its journey to provide unparalleled value to those it serves, Borgstrom stresses that at the same time health systems must continue to provide life-saving care and invest in the research and technical advances that have turned many terminal diseases into manageable chronic conditions. Borgstrom says, “We don’t want to lose that which has made us great in our quest for a more sustainable, comprehensive system of care.”

 

This need to thrive in both worlds – improving the health of the population while also healing the sick – demands effective, committed and innovative leadership in healthcare that can navigate these changing dynamics. This is a topic Borgstrom has been returning to often lately as she works with her own leadership team and her board and begins to build a template for the type of leadership that Yale New Haven will need in the years to come.

 

To that end, she has begun collecting her thoughts to share with the organization on developing executives who can guide a large, complex enterprise like Yale-New Haven. Some qualities, she says, are must-have standards that make sense in any business climate:

 

• General leadership abilities. “You have to be able to get people to follow your vision and prepare for the future before change is upon us, while weighing the risks. You also have to be able to hold people accountable – sometimes we tolerate cultures of optionality that haven’t delivered well.”

 

• A mastery of complexity. “Be able to juggle a lot of things as you evaluate decisions. Have an understanding that it’s not going to be linear and ambiguity rules.”

 

• Able to balance “what” vs. “how”. “You can’t just say, ‘We’re getting this done at all costs.’ You can’t leave bodies in your wake; you can’t sacrifice the culture of an organization to achieve a single goal. You have to play for the long term but perform well and consistently in the interim. It’s not easy.”

 

• A knack for partnership. “It’s all about partnership today . . . partnerships within your organization and with other businesses. To be a good partner, a leader needs individual qualities like integrity; like being a thoughtful listener. And you’ve got to enjoy working with others.”

 

• Solid professional skills. “You need good strategic positioning skills and, in our case, a passion for academically based healthcare. You also need a depth of knowledge of healthcare as a mission and a business, and the public policy that goes with it.”

 

But then there are other intrinsic, less-obvious traits that she says are becoming just as essential given the landscape of the healthcare industry.

 

Among them, Borgstrom says, are:

 

• Building cohesion. “You have to be able to bring out the best in other people because this is increasingly a team sport. It’s not just bringing people together; it is making them feel good about contributing toward specific goals together.”

 

• Being open to dialogue. “I think you have you have to be receptive and responsive to feedback. You have to be able to put yourself in the other person’s shoes.”

 

• Getting comfortable with ambiguity and imperfect processes. “I’m pretty good at taking the hill, but the issue of ambiguity is you’re not really sure whether that’s the hill on your left or your right. You may have to start out on the journey and have a few less than optimal experiences to inform your thinking about what is the best hill to take.”

 

• Making diversity a map for improving care. “We’ve got to be committed to the principles of diversity and inclusion, not just in developing leadership teams but in eliminating healthcare disparities, being mindful that it isn’t just about running a financially successful business model if we can’t improve our communities too.”

 

With all of these qualities, Borgstrom says, the days of “command and control” leadership have disappeared. That even applies to how health systems operate, she adds.

 

“The future is going to require that we pursue partnerships rather than try to control everything in healthcare. We don’t have the competencies, the experience or the balance sheet to put together the ideal integrated delivery system. I think well-conceived and well-structured partnerships are going to end up being integral to an integrated healthcare system where the focus has to be on providing the best value to patients.”

 

 

 

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

 

As a board member of the American Hospital Association and chair of its Equity of Care Committee, Eugene Woods has an opportunity to see up close how health disparities affect far too many people in the U.S.

 

“We know beyond a shadow of a doubt that significant inequities exist,” he says, noting a recent study by the Institute for Diversity in Management that indicates only 22 percent of hospitals have utilized data to identify disparities in treatment and/or outcomes between racial or ethnic groups by analyzing one or more of the following: clinical quality indicators, readmissions or CMS core measures. While this is an increase from 20% in 2011, Woods says he wants to see more results from the industry.

 

“The incidence of infant mortality, diabetes and colorectal cancer are in some cases twice as high among African-Americans as compared to whites. We can, and simply must, do better.”

 

Woods, who also serves as executive vice president and chief operating officer for the 33-hospital Christus Health system, comes at the issue of diversity from an interesting angle. His worldview was partially formed through his early years growing up in his mother’s hometown in Spain.

 

“What I learned is that similarities between cultures are much greater than the differences,” he remembers. “And also that, rather than it being something that separates us, we should celebrate our differences because of the richness they bring to human experience.”

 

His own family today reflects those beliefs, he says.

 

“My wife and I come from four distinct cultures – Mohawk (Native American), Spanish, African-American and Dutch. And while each has very unique traditions, all share many of the same important values. So when I look at the work I do in healthcare, though we serve people from all different walks of life, the common denominators are our values with respect to human dignity, respect and compassionate care.”

 

Woods came to Christus after a number of years in Lexington, Ky., where he was CEO of St. Joseph Health System while also serving as Senior Vice President of the Catholic Health Initiatives system. One of the things that drew him to Christus, he says, was the commitment to diversity of CEO Ernie Sadau. In three years, he says, the percentage of diverse leaders at Christus has grown from 10 to 25 percent. Woods played a key role in launching Christus’ inaugural two-year minority fellowship program as well as its executive-in-residence diversity program.

 

“What I appreciate most is that Ernie has made diversity one of his top priorities and that has set a new tone within Christus in a very short period of time,” Woods says. “He walks the talk and the significant advancements we have made at diversifying our board and leadership team, for example, are directly due to his commitment and passion.”

 

Along with growth and clinical integration, diversity is one of three key strategic priorities at Christus.

 

“We sincerely believe that will be a differentiator for us,” Woods says. “We serve such a very diverse demographic that having a culture that is inclusive and an organization that is representative of the many communities we serve is very top of mind for us.”

 

Personally, Woods says ministry is top of mind for him as he navigates his successful career in healthcare. It’s one of the reasons he made the jump from one faith-based system to another.

 

“What I love about both faith-based organizations I have served with is that they were founded by Sisters who remain involved and, above all, help keep you very grounded as a leader. They are all about serving those in greatest need.”

 

A sense of mission also was impressed upon Woods back in 2001 as well. When the 9/11 attacks happened, he had only been on the job for a few days overseeing operations for the Washington Hospital Center. People wounded in the Pentagon attack were brought to the hospital, and Woods remembers many heroes from those days, including two material management workers who drove non-stop from the nation’s capital to San Antonio and back – because all U.S. airports were closed – to pick up supplies needed to treat burn victims.

 

“But perhaps the key leadership reflection for me afterwards was that it shouldn’t take a crisis to bring out the best in people,” he says. “So my leadership approach has been focused on how to build excellence in day-to-day work.”

 

On the AHA’s Equity of Care Committee, Woods says he has had the opportunity to watch a number of healthcare providers create a high bar for standards of care when it comes to eliminating disparities. He ticks off a list of outstanding hospitals – Massachusetts General in Boston; University Hospitals in Cleveland, Ohio; Henry Ford Health System in Detroit; Lutheran HealthCare in Brooklyn, N.Y.; and Kaiser Permanente in Oakland, Calif.

 

“These systems are doing some incredible things around diversity with great outcomes and are leading the field with best practices,” he says.

 

He’s hopeful that these hospital’s examples can be a rallying cry for the industry – and a turning point.

 

“While pockets of progress are evident,” he notes, “we still have a lot of work to do.”

 

 

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

 

Marna Borgstrom was shopping for vegetables at a farmers’ market recently when an acquaintance approached her to say, “I just can’t thank you enough for the Smilow Cancer Hospital.”

 

It was a moment for the president and CEO of the Yale-New Haven Health System to reflect on why, ultimately, she was involved in healthcare. It didn’t matter that Yale-New Haven could boast that it was one of the largest systems in the country or that she’d enjoyed a productive career and interesting work that spanned more than three decades. It came down to one family finding the help it needed at a critical time. Just as all good healthcare does.

 

“Her kids went to school with my kids,” Borgstrom recalls. “And she was standing over the asparagus telling me about her husband’s diagnosis and the treatment. But she was really talking about all the talented people at Smilow who have been making a difference in their lives.”

 

Making a difference. That was the example she got from her parents, both of whom were first-generation Americans from families who did not have the benefit of much formal education. Borgstrom’s father became an ophthalmologist simply because the Army was doing manpower planning during World War II and they told him to go to medical school.

 

“When my dad was in private practice, house calls were de rigeur, and we’d all pile into the station wagon after church on Sundays and go to house calls to his patients, most of whom were older,” she says. “My mother would be home making a big Sunday lunch for us and extended family, and my dad’s older ethnically diverse patients would all feed us too, so we were rarely hungry when we got home.”

 

But what she and her siblings took away from those trips was much more than a full stomach.

 

“I think what we learned was that some of the real joys of healthcare are people and relationships. I have people who come up to me even now and say, ‘Your dad did my surgery.’ (He’s 90 years old and hasn’t performed an operation in 25 years.) And I don’t think that’s all that different from a lot of the people who work here now.”

 

Those warm memories help keep her going when faced with issues like the 2013 Connecticut legislature taking $550 million out of hospital-based reimbursement over a biannual budget, as it did the night before she paused to discuss her selection as one of the Top 25 Women in Healthcare as chosen by Modern Healthcare.

 

“They’re taking as much out of hospital reimbursement in 24 months as the entire industry in the state is taking under the sequester in 10 years,” she noted. “When you make dramatic cuts and you make them too fast, what you cause is more reactionary behavior than thoughtful behavior. Our system happens to be the largest provider system in the state, and we also are the largest providers of care to the medically indigent, so we got whacked disproportionately in this.”

 

No one in the industry, she adds, is arguing the contention that healthcare costs too much and that it is not always delivered in the appropriate way. Borgstrom says Yale-New Haven will weather the storm, but Connecticut healthcare as a whole may be damaged irreparably.

 

“I’ve said to members of the legislature here that there are some hospitals that will not make it with these cuts. And the irony is that some legislators think we will go in and buy them. We aren’t everybody’s savior. It’s a bad business strategy. So what the legislature may have to do in the next two years is go back and put money back in the budget to help the organizations that are really struggling. It just doesn’t make sense.”

 

Compounding the issue are an aging population and health disparities in the state.

 

“We have an older-than-average population, and we also have more people below the federal poverty level, ironically, in a very wealthy state, than most states in this country,” Borgstrom says. “A lot of what we see are diseases in the elderly that come from years and years of excess, and what we see in the younger populations are diseases and problems that come from socioeconomic disparities.

 

“Those aren’t going to change this year or next year just because somebody decided they were going to pay us less.”
The solutions that the healthcare industry is searching for under reform are pretty comparable from hospital to hospital, state to state, she adds.

 

“In this industry, I would contend that everybody has similar strategies,” Borgstrom says. “We’re all trying to get better on the value equation, we’re trying to build scale because it will help us with our business model, and we’re trying to integrate and align with other providers, most notably our physicians.”

 

The difference, she says, is in execution.

 

“The holy grail is in execution, and how people execute, I think, is based mostly on organizational values. And those have to be values that people lead by.”

 

In Yale-New Haven’s case, Borgstrom can rattle off those values pretty quickly: patient-centered, integrity, respect, being accountable, being compassionate. She learned them from her mentor, former CEO Joe Zaccagnino, who saw leadership qualities in her early on.

 

“He was somebody who gave me real and real-time feedback about what I was doing and how I was doing it. Sometimes, it really stung,” she allows. “But I knew he was not giving me the feedback for any other reason than to make me better at what I did and how I was perceived at doing it.”

 

Ultimately, she succeeded Zaccagnino as president and CEO when he retired in 2005. She’s been the architect of numerous major projects at Yale New Haven, including a children’s hospital, the cancer hospital and the recent acquisition of St. Raphael Hospital, a 520-bed facility that was teetering on the brink of bankruptcy. The Sisters of Charity of St. Elizabeth in charge of the hospital ultimately decided that Yale-New Haven was the best fit among St. Raphael’s suitors even though they gave up their Catholic affiliation in the process, a move that Borgstrom calls “one of the most courageous I’ve ever seen.”

 

Yet she is quick to deflect credit and to use self-deprecating humor to minimize it. “I’m the orchestra conductor,” she says. “I don’t do a whole lot. I just stand up in front and try to keep everybody playing and singing in harmony.”
One key, she says, is hiring good talent and then getting out of their way. Another is ensuring that the staff has a work-life balance that they are comfortable with, a prominent discussion especially among women leaders since the publication of “Lean In” by Sheryl Sandberg.

 

Borgstrom said she recently interviewed a candidate for an executive role and spent most of the time on that topic. The woman had become the breadwinner for her young family. She wondered if Yale-New Haven would be a good fit since she would have to move away from the support of extended family.

 

“What I said to her is, there’s no one answer to this, but I fundamentally believe that you cannot be a good executive if you aren’t happy and also able to manage your personal life. Because long after these jobs are gone, the people who will hopefully be in our lives will be that partner we’ve spent significant time with, our children and our extended family.

 

“If it’s the right person, the right job and the right organization – and both parties live up to their end of the bargain – I think you can have a successful and happy career and personal life. And happy is really important.”