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What healthcare leaders need to know now

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

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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



With King vs. Burwell decided, bold leadership becomes a mandate for healthcare delivery and financing

By | June 29 th,  2015 | Furst Group, Healthcare, Supreme Court, Bob Clarke, health systems, hospitals, King, King vs. Burwell, affordable care, Blog, Burwell, CEO, leadership, transparency, quality | Add A Comment


By Bob Clarke

CEO, Furst Group


The King vs. Burwell decision once again had healthcare leaders, both payers and providers, holding their collective breath to see if years of work would be undone. Now that the Supreme Court has weighed in, by a surprising 6-3 margin, to uphold the ACA and its subsidies, there still remains a lot of work to do. So the question for the healthcare industry is, how can CEOs and boards best demonstrate leadership to their organizations and their communities going forward?


Regardless of where one falls in the political debate, this decision was anxiously anticipated by all. Our industry has had more than its share of uncertainty over the years and having this decision behind us will allow for the great work that organizations have done thus far to continue. Without a doubt, patients and families are seeking access to quality care at an affordable cost, all wrapped in a package of transparency. Significant strides have been taken toward this goal but the threat of constant change and disruption of the payment system doesn’t allow an organization to focus or to plan too far ahead.


However, we have seen some leaders be very bold and stake their future on this continuing trend. They have been very proactive in creating services and pricing schemes that are consumer-oriented. Their vision has allowed for open discussions with others about potential partnerships and collaborative models. These are trends that need to continue.


These are times of uncertainty, to be sure. Bold leadership, however, seizes on this as opportunity. Teams that come together to think about what can be realized serve their organizations and constituents far better than teams that focus on market protection and guarding the status quo. The latter often find themselves holding on to a model that quickly becomes outdated and stagnant.


Patients want and deserve excellent care in a system that is far less complicated than what we have had in the past. May the evolution (or rather, the revolution) of healthcare continue and bring our delivery and financing system to a level that was only dreamed about not too long ago.



Profiles in Leadership: Intermountain’s Linda Leckman aims for consistency, transparency

By | August 8 th,  2011 | Healthcare, surgeons, Top 25 Women, ACO, consistency, executive, Modern Healthcare, accountable care, Blog, CEO, transparency, Utah, Linda Leckman, physician leadership, quality | Add A Comment

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


Linda Leckman was in her car – again – driving up to Ogden, Utah, from Salt Lake City, to meet with a group of thoracic surgeons. Road trips like this one – which Leckman actively seeks out to keep in touch with her colleagues and staff -- are common for the vice president of Intermountain Healthcare and the CEO of the Intermountain Medical Group.


“I’ve learned the value,” says Leckman, a general surgeon herself, “of sitting down face to face and actively listening to people.”


While Leckman’s reputation precedes her as one of the Top 25 Women in Healthcare, she is transparent about her growing pains in moving from a career as a surgeon in private practice to an administrator. Listening, she says, was actually something she had to grow into.


“One of the things I did not do very well, initially, was to listen. I guess, as a cliché, you could say, ‘Well, what would you expect from a surgeon?’ ” she jokes. “But I also got some bad advice in regard to approaching a contract situation, and I learned from that.”


Leckman is not one to waste a lesson. These days, the people around her know “listening” is a Leckman staple. Another is consistency.


“The medical group is spread across the whole state of Utah,” she says. “We have more than 130 clinics, so my management structure is geographic. My managers need to be able to make decisions on their own that will be consistent across the organization, so it’s very important that I be consistent, that we set up procedures and standards that are consistent.”


What’s also consistent is the way Leckman diverts attention away from herself and toward Intermountain.


“I believe one of the reasons I was recognized by Modern Healthcare was because I work for Intermountain Healthcare,” she says simply. “I take it as much of an acknowledgement of Intermountain’s role in leading clinical quality development as of anything that I specifically did. But that’s OK, because I’m a real cheerleader for my organization.”


Intermountain was in the spotlight several months ago when it was one of several prestigious systems, along with Mayo, Cleveland Clinic and Geisinger, to announce it had no plans to sign up for the government’s ACO program as it was then structured.


“The idea of accountable care is one that we totally support, the idea that quality needs to be improved and costs need to be reduced – that’s something we’ve been doing for years,” Leckman says. “One of the big concerns was that we were going to be measured basically against ourselves in terms of whether there is improvement or not. And since we have been working on it for a long time, a lot of what would be considered as potential gains for managing better are things we have already achieved. And so we really had more to lose than gain from being involved.”


If such a stance surprised the industry, it was not out of character for Intermountain, or for Leckman, who has been something of an unintentional pioneer. After graduating from Texas Christian University with a degree in history (and a minor in combined science, which included pre-med classes), Leckman enrolled at the University of Nevada to work on a master’s in history. It didn’t last. In her second year, she decided she really wanted to become a physician. A surgeon, no less.


“But this was the 1960s, and it was unusual for a woman to go to medical school,” she says. “And I was raised by my mom to be a housewife.”


Undaunted, she got her M.D. from the University of New Mexico in Albuquerque and became the first woman resident to finish the surgery program at the University of Utah.


“That’s been a pattern in my life – I end up in areas dominated by men,” Leckman says with a laugh. “But it’s worked out OK.”

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