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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.”


    Tim Frischmon: Leading by influence in a matrixed organization is key for leaders in the payer space

    By | January 15 th,  2016 | Furst Group, executive, Tim Frischmon, Aine Cryts, Blog, Changing Face of Healthcare Leadership, leadership, Managed Healthcare Executive, matrix, provider, payer | Add A Comment


    Furst Group principal Tim Frischmon is interviewed in the new issue of Managed Healthcare Executive, commenting on how the rapidly changing healthcare industry has created a huge need for executives to adapt and evolve as well.


    In the article by Aine Cryts, "The Changing Face of Healthcare Leadership," Frischmon notes that leaders will need to use their influence to lead in organizations that increasingly have a matrix structure. And those that succeed will be the ones who are able to help their staffs tune out all the speculation about consolidation that has been occurring in the payer space.


    "The challenge," he says, "will be to keep employees focused on executing on [their work], despite all the noise going on about the expectations the outside world has about the mergers."


    Leaders also will need to pay attention to the convergence that is building between payers and providers, Frischmon notes. And one thing that won't change as a measure of a CEO's success is revenue.


    "Payers still have to be profitable. Leaders will still have to demonstrate how they build deep, solid relationships with providers," Frischmon says. "They'll also need to demonstrate how they're able to identify and build some stickiness with their brand among members, and they'll have to measure their success."


    Read the full story by clicking here.



    As Chief Administrative Officer Shirley Weis prepares to retire, her fingerprints are all over Mayo Clinic's success

    By | May 30 th,  2013 | women in leadership, C-suite, CAO, governance, John Noseworthy, Lean In, Mayo Clinic, Mayo Clinic Health System, Minnesota, Shirley Weis, Blog, CEO, Denis Cortese, Destination Medical Center, leadership, Mayo Clinic Care Network, provider, payer, Rochester, 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)


    It’s a busy time at Mayo Clinic. Plans for the new Destination Medical Center are in full swing. New affiliates are being added to the Mayo Clinic Care Network. A new partnership with Optum Labs is taking the venerable institution into the realm of big data. So why would Chief Administrative Officer Shirley Weis decide to retire now?


    Because, she says simply, that’s been the plan all along.


    “One of the hallmarks of Mayo is excellent succession planning,” she says. “We’ve put even more attention into it in recent years, making sure that we have a good stable of folks ready from all different backgrounds of diversity and talents.”


    And, for those keeping score at home, she says, you’ll notice a pattern to their planning. Weis was named to the No. 2 role at Mayo about halfway through the tenure of then-CEO Denis Cortese, MD. Weis is leaving four years after John Noseworthy, MD, succeeded Cortese. Mayo’s initiative of staggering C-suite entrances and exits keeps disruption to a minimum.


    “People don’t understand that Mayo has a term-limit process for these top jobs,” Weis says. “Usually, you’re in these roles for about six to eight years as CEO, CAO or department chair. It’s one of the ways we keep ideas fresh. In some settings, you’ll see people who are named to a role and they’re in it for 30 years. That may work for some organizations but I think that after six or seven years, you’ve done what you came to do.”


    Among the tasks that Weis says she is gratified to have accomplished since she stepped into the CAO role seven years ago is changing the structure of the company.


    “I have really felt proud of the fact that we were able to get our governance in good shape,” she says. “We went from being a holding company to an integrated operating company. Most of the things I wanted to get underway are now, in fact, underway and are in good hands.”


    One of those key ventures is the Mayo Clinic Care Network, in which health systems and physician groups affiliate with Mayo, extending the clinic’s reach beyond its bases of the upper Midwest, Arizona and Florida to the rest of the country. The idea had been created during Dr. Cortese’s tenure but truly came into being about two and a half years ago under Dr. Noseworthy’s leadership, Weis says.


    “We have built a very successful Mayo Clinic Health System in the upper Midwest but we understood that merger and acquisition was probably not the best course for us,” she says. “We came up with the idea to start building a network, but we also found more and more hospitals and physician practices approaching us – they wanted to be affiliated.”
    Mayo is up to 18 affiliate agreements but Weis sees a limit to the system’s capacity.


    “We do guard our brand jealously. It’s one of the most trusted names in healthcare and part of the promise we have to our patients,” she says. What helps, she adds, is that “the patients are very savvy and sophisticated. They understand that these groups are not Mayo Clinic – they simply have a connection to Mayo Clinic.”


    Mayo staff are consulting via phone and doing some cases together electronically. “We think it’s going to be a real model for the patients’ network of care,” Weis says. “Eventually, there may be some insurance products that go on top of the network.”


    The blurring of lines between providers and payers is accelerating in the healthcare industry, and Weis has been a key person to lead that charge at Mayo. She was the chief operating officer at Blue Care Network of Michigan, a large HMO, before coming to Minnesota.


    ”I feel blessed that I had 10 years of actual care delivery with my emergency-room background, and that I followed that with 10 years in the payer industry,” Weis says. “I wouldn’t trade that for anything. I think it’s helped the organization and, frankly, it is probably why I was selected for this job seven years ago.”


    Weis says both providers and payers need to focus on what’s best for the patient – and both need to collaborate more.


    “The payer world has the claims information but they don’t have a lot of rich clinical data. The provider world has the rich clinical data but they don’t know what happens after the patient leaves the hospital or the outpatient center, or after they pick up their prescription.”


    No matter what happens with healthcare reform, Weis adds, “there’s no more money, so it makes it more incumbent on all of us to figure out how we’re going to meet those patients’ needs and how we can engage the patients better.”


    Working with fewer dollars is something Weis experienced a few years ago during the recession when she put in place an administrative shared services program and an enterprise project management office, while also implementing cutting-edge tools for financing and reimbursement. All those things, and a few more, helped Mayo weather the recession without layoffs, though some employees shifted jobs and some changes were made to benefit packages and retirement plans.


    Weis had originally come to Mayo in 1995 to lead the Clinic’s managed care division. She resisted the overtures from a recruiter for a time, but finally agreed to a visit.


    “I already had a career path, thank you very much,” she says. “But I came to Rochester and started to meet folks, and I was struck by how patient-centered the organization was.”


    As she got to know Al Schilmoeller, who was her first boss, she noted that one of his daughters was a pilot and another worked for the Department of Natural Resources. That convinced her that here was a man who knew how to support women in their varied career aspirations. She remembers that, she says, as she mentors early- and mid-career women and men.


    “For women or men, for anyone to make it to the next level in your career, you have to be willing to take some risks,” she says.


    But she notes that young executives who only know the sound-bite version of Sheryl Sandberg’s “Lean In” best-seller do need to consider work-life balance.


    “I would not be where I am today if I didn’t have a supportive husband. Period. I see many people who want to have that balance, and the one thing I know for a fact is that you can’t always have it all. You can have it all in stages. But I do think that as long as women are in a traditional caregiver, chief household operating officer role, it’s tough to balance that.


    “So, particularly with families with young children, I always encourage them to put those kids first because they’re only there for a few years. And then your career is still there.”


    Weis came of age at a time when she often was the only woman on the leadership team, and she says progress has been made in gender equity – progress, but not equality.


    “I’m a tennis player, and I think of the days of Billie Jean King when Virginia Slims was a sponsor with their slogan, ‘You’ve come a long way, baby.’


    “We have come a long way. But I don’t think we’re there yet.”

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