T H E M O N U M E N TA L TAS K O F T R E AT I N G A D D I C T I O N PENNY MILLS IS FIGHTING TO CHANGE MINDS IN MEDICINE AND BEYOND
Putting the “human” back into HR p. 52
In defense of the doctor p. 32
Five questions for business development p. 64 Turning data into action p. 102
Rising premiums and reduced benefits have employers seeking healthy alternatives to conventional fully-insured health plans. Self-insured health plans offer employers custom benefit plan designs and manageable healthcare costs. Plans are available for employers in New York and New Jersey.
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FROM THE EDITOR
My dad always told me I could be anything I wanted to be. At a young age, I never gave it much credence— or maybe I just took the notion for granted. Either way, deciding what to do when I grew up was of little concern to me when I was younger. I figured that all careers were callings that came naturally—that they were easy to figure out and that everything would fall into place eventually. At least it seemed that way for my dad, who’s been an orthopedic surgeon for almost four decades. It’s who he is. It defines him. So when I started college and he revealed that he’d originally wanted to be a chemist, not a physician, I was thrown. Both are scientific endeavors, sure—but to think of him as anything other than what I knew him to be shifted something. It forced me to look through a different lens. It made me understand that no profession comes easily or is merely handed to you; whatever you’re meant to do, when all is said and done, you still have to make a choice. You control what direction to steer yourself in. You alone hold the key. It’s a notion that applies to every executive featured in this issue of AHL. Each and every person made a choice to enter healthcare—to affect lives for the better in one way or another, whether it’s via human resources, finance, legal, IT, or any number of management services focused on advancing treatment and helping patients experience better care. One of the best examples of this comes in our cover story on Penny Mills, CEO and executive vice president of the American Society of Addiction Medicine (p. 78). Tirelessly taking on one of the country’s most widespread epidemics, Mills is working to equip physicians with the proper training and tools for addiction treatment, to change regulations in Washington, DC, and to shed the stigma associated with the deadly disease. It is a colossal task because it is a colossal problem, but Mills’s choice to undertake it has led to some remarkable results in all phases of medicine, law, and public opinion. Mills’s role, and all the roles examined in this issue, is more than a job—it is a vocation. And Mills, like so many others, willingly chose to answer that call. Few professions come with as much weight, responsibility, and impact as healthcare. But that’s just the nature of choosing to work in this industry, and today’s top leaders understand that.
Michael Danaher Senior Managing Editor
AHL APR.MAY.JUN 2016
How CFO Mike Burke helped NYU Langone Medical Center bounce back after Hurricane Sandy
How an upbringing in healthcare propelled Elizabeth Lewis to improve patient advocacy
HonorHealth aligns its financial and business strategies with a new, unique management position
Elizabeth Cushing explains how an interest in Broadway and litigation led to a legal career at CRICO
Cindy Turner invests in state-ofthe-art facility upgrades in her commitment to her community
DHIN’s Mark Jacobs finds meaning in today’s incredibly unique and increasingly complex industry
Terry Manna reshapes New Jersey healthcare with products focused on quality and efficiency
Hamilton Medical Center revamps with a new ICU and twenty-firstcentury tech capabilities
How Sean Whelan manages finances as Diplomat Pharmacy’s very first CFO—and why it’s about much more than numbers
National Healthcare Access uses the transformative Affordable Care Act to thrive as a small insurance organization
Dr. Giesele Robinson Greene discusses her path to healthcare and how she streamlined SCHS’s EMR process
Novia Strategies has redesigned patient care, thanks to founder Nancy Lakier
How Judy Lefkovitz turned a passion for math, tech, and healthcare into a career
With substance abuse and addiction cropping up in epidemic proportions in the United States, ASAM’s Penny Mills is shedding the stigma associated with the deadly disease—giving patients a fighting chance
Cover and above photo by Caleb Fox
Debra Plousha Moore tackles HR for the third-largest nonprofit healthcare system in the country
CFO Chris Bergman ensures consistency throughout The Christ Hospital Health Nework’s locations
102 Krishna Ramachandran discusses
Garrick Stoldt discusses his career journey and how it affects his approach at Saint Peter’s Healthcare System
Dr. Meika Neblett enhances internal systems to improve care at CarePoint Health-Hoboken UMC
UC Irvine’s Susi Takeuchi strategically transforms her department Leslie Yendro asks and answers five questions that all business development executives need to know Roben Nutter spearheads risk compliance activities at East Alabama Medical Center
Cempra Inc. introduces new products to the market with Sebby Borriello at the helm
Cindy Essl takes human resources in a new direction, beyond mere operations and into true wellness
Cindy Peterson shares how Henry Mayo Newhall Hospital remains on the cutting edge of technology
AMC Health uses its employees to spur continued growth, especially in the realm of telehealth
How Dr. William Jacobs and Bluff Plantation are effecting better results in the treatment of drug and alcohol addiction
107 Dr. Shirish Parikh connects with patients at Community Care Physicians through the latest innovations in telemedicine
109 Rodger Ford explains why
ReliantHeart’s HeartAssist5 is so unique and how it’s changing patients’ lives
DuPage Medical Group’s comprehensive IT components and initiatives in virtual care
5thCOLUMN, 106 Accenture, 16 Alkermes, 83 Allscripts, 108 Amerigroup Corporation, 21 Armada Health Care, 68 athenahealth, 59 Audacious Inquiry, 36 Bluff Plantation, 99 Cadient, 73 Cardinal Health, 43 Cerner, 23 Clinical Intelligence, LLC, 48 Dawson Logistics, 67 Deloitte, 15, 18 Diplomat Pharmacy Inc., 40 Dominion Diagnostics, 82 Draffin & Tucker, LLP, 18 DUALIS MedTech GmbH, 111 The Executives’ Club of Chicago, 57 Express Employment Professionals, 75 Fidelity Investments, 63 Fort Washington Investment Advisors, Inc., 85 KeyInfo, 93 Linda Crawford & Associates, 33 LSG Insurance Partners, 41 LYNLY Insurance, 97 MagnaCare, 2
Somerset CPAs and Advisors, 71 Takeda Oncology, 31 TD Bank, N.A., 14 TMT Strategies, 34 Towers Watson, 55 Wells Fargo, 16 Yarbrough Electronic Sales, Inc., 110
Senior Managing Editor Michael Danaher
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Associate Editor Kelsey E. Ingram Contributors Melissa Anders Taryn Barnes Joe Dyton Peter Fabris Amanda Garcia Maura Keller Keith Loria Bridgett Novak Urmila Ramakrishnan Jeff Silver Kathryn Silverstein Tina Vasquez
SALES & ACCOUNT MANAGEMENT VP of Sales Kyle Evangelista Director of Sales Operations Philip Taylor
Senior Designer Mary K. Delaware Photo Editor & Staff Photographer Caleb Fox
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Financial Analyst Mokena Trigueros Finance Client Services Coordinator Katie Richards Receptionist Amanda Paul Executive Assistant Jaclyn Tumberger
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Northeast Ohio Medical University, 45
PFS Group, 87 PowerHealth OnDemand, 91 SAP, 56 Sisters of Charity Health System, 43
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ASTORIA PRIMARY CARE
LOCATION: New York, NY COMPLETED: 2015 ARCHITECT: Michielli + Wyetzner Architects
Located in the Astoria section of New Yorkâ€™s famous Queens borough, the Astoria Primary Care clinic is part of a series of new practices associated with New York Hospital Queens. The facility seeks to provide everyday care for shortand long-term illnesses to as many neighborhood residents as possible. The staff of private physicians also aspires to create individual relationships with its patients. Photo by Alexander Severin
The remodeled facility incorporates a bold, geometric design that features a circulating corridor, which allows for more natural light in patient waiting rooms. New exam and consultation rooms help the clinicâ€™s mission to create a greater connection between physician and patient.
Photo by Alexander Severin
AHL APR.MAY.JUN 2016
With a grow business an compliance brought on we’ve had to of investme
ing d the added issues by the ACA, make a ton nts ... PULSE
WEATHERING THE STORM How Mike Burke helped NYU Langone Medical Center bounce back after Hurricane Sandy and find sturdy financial footing
Mike Burke TITLE
Senior Vice President, Vice Dean & Chief Financial Officer ORGANIZATION
NYU Langone Medical Center
Mike Burke knew something had to be done. When it comes to adapting to the times, change is just a fact of life. And within the medical arena, Burke, who serves as senior vice president, vice dean, and corporate CFO at NYU Langone Medical Center, has embraced guiding the healthcare systemâ€™s financial team to improve its business function and profitability while staying ahead of the game. During the past ten years, technology has dramatically changed how the healthcare industry does business. Technology advancements have driven hospitals and other healthcare organizations to reinvent themselves and their internal processes. Burke knows this too well. Since 2008, when Burke joined the team at NYU Langone, he has worked diligently to improve the credit rating of the medical center (including the medical school) and to initiate a financial turnaround that has allowed the leading-edge healthcare system to experience profitability once again. That success is, in part, thanks to his wealth of extensive experience from other leading financial positions in such renowned medical establishments as Tufts Medical Center, in Boston, where he was senior vice
Photo by John Abbott
BY MAURA KELLER
president and chief financial officer; Duke University Hospital, in Durham, North Carolina, where he also worked as CFO; and KPMG’s healthcare consulting division, where he worked as a senior manager. But it was after Superstorm Sandy caused extensive damage at NYU Langone that Burke recognized the inherent need to get the medical center back on solid ground. Many of the issues facing NYU Langone are about regulating healthcare costs while maintaining and controlling quality. Burke’s twenty years of experience have instilled in him a deep understanding of the effort it takes to make a healthcare system streamlined and profitable. But when there is a need for complete campus transformation as a result of nature’s wrath, managing profitability takes on a unique perspective. Because of the extensive damage caused by the storm in October 2012, NYU Langone was reduced to limited operations for several months. One of the biggest impacts the storm had on the academic medical center was forcing it to close its full-service emergency department and rely solely on several off-site urgent-care centers. Closing an ED for more than eighteen months can wreak havoc on a medical center’s bottom line. In April 2014, NYU Langone opened a new, full-service emergency department and had treated more than 6,700 patients by May 31, 2014—adding a significant boost to the organization’s profitability. In addition, thanks to a FEMA grant, NYU Langone has turned its attention to rebuilding other areas that were destroyed by Superstorm Sandy in its medical school. While being thankful for $1.13 billion in federal funds to help rebuild, Burke recognizes that the $400 million in lost revenue that NYU Langone incurred as a result of Sandy’s destruction may never be recovered. But it doesn’t mean Burke won’t continue to try. Rather, for Burke, managing risk, establishing a robust financial system, embracing new technologies, and ensuring future revenue streams are key tactics to turn NYU Langone Medical Center’s financial situation around. He has also upgraded the
NYU Langone Medical Center sustained numerous damages to its facilities as a result of Hurricane Sandy. One of the most crucially hit areas was the medical center’s emergency department. organization’s IT platform and has overseen the medical center’s ERP integration. And his efforts have paid off. Only two years after Superstorm Sandy inflicted damage to the region and the medical center, the organization returned to profitability and has since maintained its bond rating while issuing new debt to complete the center’s campus transformation. Using a value-based management program, including recognizing unnecessary spending throughout the organization, Burke has helped NYU Langone
reduce costs and improve profitability. In addition, his prowess in all facets of financial management has meant that he has embraced many broad initiatives that NYU Langone has established in its facilities—from growth strategies in clinical areas to structural alignment and streamlined care management. In a recent interview with Becker’s Hospital CFO, Burke stressed that focusing on a healthcare organization’s revenue system and clinical documentation is key to main-
Photo courtesy of NYU Langone
Legendary innovation. It’s our goal too. Thank you, Mike, for your leadership and dedication to the healthcare industry and for choosing TD Bank as a partner. We look forward to continuing to serve exemplary institutions such as NYU Langone Medical Center.
AHL APR.MAY.JUN 2016
To speak with a healthcare banking expert, call 1-212-918-4165 or connect to tdbank.com/healthcarebanking
taining a healthy margin. Of course, the healthcare industry continues to face a myriad of challenges and an uncertain future regarding forthcoming revenue streams. Hurricanes and acts of nature aside, Burke understands that it is vital to ensure there is still enough revenue to pay off debt, maintain markets, and monitor the risk that the healthcare organization may be facing. In fact, it is in keeping with risk-management structures and ensuring profitability that has helped NYU Langone move forward in its merger with Brooklyn-based Lutheran Medical Center. This merger not only allows Lutheran Medical’s patients access to NYU Langone’s specialists, but it will also greatly improve NYU Langone’s balance sheet with the addition to Lutheran Medical’s assets. While the changes in the leadership structure at NYU Langone are still to be seen, one thing’s for sure: Burke will continue to work to improve profitability and establish the required technology systems needed for increased margins, all while benefiting the care bestowed to the organization’s patients. AHL
Navigant Consulting, Inc. is an independent, specialized, global professional-services firm that combines deep industry knowledge with technical expertise to enable companies to defend, protect, and create value. With a focus on industries and clients facing transformational change and significant regulatory and legal issues, the firm serves clients primarily in the healthcare, energy, and financial-services sectors. Professional service offerings include strategic, financial, operational, technology, risk management, compliance, investigative solutions, dispute-resolutions services, and business process management services. Navigant is proud of the partnership we’ve forged with NYU Langone Medical Center’s CFO, Mike Burke, and his finance team.
Shaping change into opportunity. The transformation of health care may require you to identify new strategies your organization can implement today to deliver new models of care. At Deloitte, we offer extensive industry experience, demonstrated strategies and innovative business models to help your organization drive down costs, improve margins and deliver better care. Take the opportunity to shape your organization into tomorrow’s system of care. www.deloitte.com/us/healthcareproviders
As used in this document, “Deloitte” means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting. Copyright © 2015 Deloitte Development LLC. All rights reserved. Member of Deloitte Touche Tohmatsu Limited
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Wells Fargo brings together investment banking professionals and highly specialized bankers into one team, offering an integrated holistic approach that centers our business around you. • Education & Nonprofit • Energy & Corporate • Government Finance • Housing • Healthcare • Transportation • Taxable & Tax-exempt Debt • Direct Purchases • Swaps & Caps • Limited Placements With Wells Fargo’s reputation, nationwide strength, and 17 capital markets local offices, our team provides you with the expertise of a national firm and the regional coverage of a local bank.
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The Hybrid Healthcare Executive HonorHealth is doing more than changing the management model for its healthcare portfolio—it has created a unique hybrid position to tightly align its financial and business strategies BY JEFF SILVER
Chief Finance & Strategy Officer
Although CFOs have long been involved in strategy, the CFSO designation has created a new environment in which strategic ideas are discussed more stringently in relation to business plans and financial analytics.
ue-based model has put new requirements on HonorHealth’s IT infrastructure. It must now facilitate communication between acute-care facilities and nursing homes, long-term care, home-health care, and others. “It’s an entirely new level of information management and exchange that goes beyond medical details to how we receive global payments and how they are disbursed to various entities throughout our system,” LaPorte explains. “Those responsibilities used to be the insurance companies’, but now we have to own them.” HonorHealth is on track to integrate all offices and systems within the organization to a uniform technology platform by the end of 2016. It has already combined 225 employed physicians into a single system, but it must still integrate all five of its hospitals onto one platform from the two-system network that currently exists. Two years into transitioning to risk-based management, HonorHealth has already posted significant savings and care improvements: pilot programs with Accountable Care Organizations within its own employee health plan have reduced costs by 10 percent; service to Medicare Advantage Plans has produced a savings of 6 percent; its Medicare Shared Savings program, which serves 14,000 Medicare beneficiaries, saved the Centers for Medicare and Medicaid Services $3.6 million; and, in one instance, savings of $65,000 were realized for a single patient, compared to the previous year’s costs for multiple acute-care emergency treatments. This last element is indicative of the new approach helping to identify high-risk patients in order to provide innovative solutions, such as improving home conditions or social support rather than focusing exclusively on direct medical care. “Our vision has expanded to include overall health and wellness, as well as follow-up care,” LaPorte says. “In those situations, replacing or updating an inadequate air-conditioning system, for example, can be just as important as medical intervention. It can prevent a patient’s condition from wors-
When Scottsdale Healthcare and Lincoln Health Network merged in the fall of 2013, they did more than create a system with more than 10,000 healthcare professionals serving the metropolitan Phoenix area. HonorHealth—the name of this new organization—also created the unique but essential position of chief financial and strategy officer (CFSO). “The CFSO title is an acknowledgment of the evolving healthcare environment and how new priorities are required to thrive within it,” says Todd LaPorte, who today inhabits the crucial role. “As HonorHealth moves to a population management approach, it is also emblematic of the significant financial planning that’s essential to make our new strategic direction successful.” This new approach (also known as riskbased contracting) requires HonorHealth to manage and coordinate a much broader range of care than ever before. Rather than focusing only on acute hospital treatment, care now encompasses pre- and post-acute services, as well as follow-up across the full continuum of care. “Risk-based management means we have to open our eyes to what goes on outside the walls of our hospitals,” LaPorte says. “That includes forging new relationships and coordinating the financial investments and business planning that accompany those new strategies. You can’t get too far ahead of your capabilities. That means we have to ensure that financial contracting functions are also in sync with the development of new capacities and resources.” Although CFOs have long been involved in strategy, the CFSO designation has created a new environment in which strategic ideas are discussed more stringently in relation to business plans and financial analytics. Furthermore, by having finance and strategy combined under one umbrella, HonorHealth has ensured the coordination of the two as well as the streamlined development of processes needed to support the transition to a population-management scenario. The continuum of care implicit in a val-
Who is monitoring the health of your business?
Building the future
Focusing on new models of care that provide better results in cost, quality and outcomes for your patients is the new future for a better quality of care. At Deloitte, we offer extensive industry experience, demonstrated strategies and innovative business models to help your organization drive down costs, improve margins and deliver better care.
ening and eliminate the need for emergency care later.” CFOs are accustomed to making decisions based on facts, historical outcomes, and other types of hard evidence. But the new healthcare environment often requires decisions to be made when there is simply no history to draw from. “The challenge is how to make the best judgments without perfect information,” LaPorte says. “How do we manage risks that were never our responsibilities before? We’re still learning techniques to bridge gaps in the resources available to us.” As CFSO, he predicts that in five years, HonorHealth will grow significantly in its numbers of locations, services, and lives under risk-based contracts. “Our model for achieving those goals may not be the most common, but I’m positive that the transparency and structured discipline it provides will help us get there faster than any other traditional approach,” he says. AHL
One step at a time. Transforming your business into tomorrow’s system of care. www.deloitte.com/us/ healthcareproviders
As used in this document, “Deloitte” means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.
AHL APR.MAY.JUN 2016
Copyright © 2015 Deloitte Development LLC. All rights reserved.
Member of Deloitte Touche Tohmatsu Limited
With more than 70% of our business focused on the healthcare industry, Draffin & Tucker, LLP has been a leading provider of accounting and reimbursement services for more than 65 years.
At Deloitte, we focus on helping organizations transform their vision into healthcare solutions that work. With more than seventy years of industry experience and the innovation, deep understanding, and commitment of more than 3,000 professionals, we provide a range of technical and advisory services to help clients transform their business. Wells Fargo is proud to be a long-term financial partner of HonorHealth. We support its mission of improving the health and well-being of its communities. Wells Fargo also shares a crucial historical trait with HonorHealth: trustworthiness. CFO Todd LaPorte’s fulfillment of that promise, plus his leadership and strategic direction, has positioned HonorHealth for future success.
Albany | Atlanta www.draffin-tucker.com 229-883-7878
The Community Caregiver One CEO is doubling down on her commitment to the population she serves, investing state-of-the-art facility upgrades BY KEITH LORIA
Chief Executive Officer
Bacon County Hospital and Health System
the then-CEO decided to leave, and again I was asked to fill in and, after a few months, was promoted to the position full-time.” As CEO, Turner has a hand in all of the organization’s initiatives, but one of the most notable is Bacon County Hospital’s recent renovation. The result has enhanced the patient experience and improved the community at large—a strategic plan that has been in place for more than twenty years. “We built a building in 1992 to join the hospital and long-term-care facility under one roof, and departments such as environmental services, plant services, and the other services in that area could work more efficiently and better serve both sides of the facility,” Turner says. In 2009, the hospital began building a second story to that building, which would become its inpatient unit. The addition would have twenty-five additional beds, four of which would serve as ICU beds. “When that was completed,” she adds, “we went back downstairs to what was then the inpatient unit of the hospital and gutted and renovated it into an observation unit—expanding lab and x-ray departments,
For more than thirty-five years, Draffin & Tucker has concentrated its practice on healthcare organizations and currently serves more than 150 healthcare clients—more than 70 percent of our practice. As a result of this concentration, we are capable of dealing with the regulatory, reimbursement, and tax issues affecting healthcare organizations in today’s changing environment.
For nearly thirty-five years, Cindy Turner has worked at Bacon County Hospital and Health System, in Alma, Georgia, transitioning from the night shift in admissions to the business office, to CFO, and eventually to CEO. But her association with the rural community hospital goes back even further. Not only was she born at the hospital, but as the middle child between two rough-and-tumble boys, the self-described tomboy had her share of hospital visits when she was young. “I always did whatever my brothers dared me to do, and my family doctor told me I had more stitches than any boy he had ever seen, so I was in the ER quite frequently as a child,” she says. “I grew up on a farm, picking tobacco and growing corn, and we always would end up in mischief.” From a young age, Turner understood the importance of community. In fact, her grandfather was chairman of the county commissioners, and her family instilled in her a spirit of selflessness and civic duty early on. “I love helping people, and I feel any position in healthcare is a calling—it’s not just a job,” she says. “I have great love for the people of this community and the team that we have here. We are taking care of friends, neighbors, and family members, and it brings me great joy to be able to provide high-quality healthcare to our community.” Given the trajectory of her career, the journey to becoming CEO began a while back. It was early in her career that Turner began learning and studying about healthcare reimbursement, when a tertiary hospital that was managing Bacon County Hospital sent her down to Jacksonville, Florida, so she could work in the accounting department and learn how to prepare budgets and financial statements. “At the same time, I was taking college courses, and that ultimately led me to be chief financial officer, which I [remained] for almost twenty years,” she says. “During the time I was CFO, I filled in as interim CEO for almost three years, fulfilling duties of both. The hospital was going through a difficult period at the time, and we were trying to get things back on track. In December of 2004,
adding two new endo-rooms that are also used for the latest in Femto Laser Cataract surgery.” The third phase of the project came about after the city allowed the hospital to close a street where the front entrance once sat and relocated it to face a major highway. The space of the old front entrance was then used to build two new state-of-the-art operating rooms—both 600 square feet—plus a recovery area, a patient waiting area, and a surgery entrance. Additionally, it added brand-new, cutting-edge CT and MRI capabilities to its facilities. This phase was completed in 2011. “We didn’t want it to look stark and sterile, like most hospitals built in the ’50s, so we went with warmer colors—more of a hospitality feel, incorporating some nice artwork— and everyone was impressed,” Turner says. “We kept being asked when we would start on the nursing home, so our board decided to start constructing a new entrance and lobby in 2014, and also added a chapel.” An entire wing was also added onto the nursing home, with private rooms and private baths, this past May. And the last piece of the $23.4 million project, completed in November, was a third phase that involved gutting and renovating the wing that had resident rooms, the rehab department, the activities department, and the vacated former entrance and lobby. With those changes, the facility now offers a total of twenty-nine private rooms. Such attention and investment in Bacon County Hospital is reflective of Turner’s commitment to her roots—because if there’s one thing she has learned in her career, it’s that you can’t put a price on the value of a community-minded hospital. During her more than three decades in the industry, she’s seen hospitals in the region close, only to watch those communities dry up. “For most rural hospitals, they are the largest employer in the community, and we employ about 450 people in our healthcare system,” she says. “We play a vital role. I’ve had family members come into our ER in the middle of a heart attack, and they would have died had we not been here. Our community deserves to have the kind of care that they would have if they were living in Macon or Augusta or Savannah—that’s the reason I have stayed here so long.” AHL
A MORE SUSTAINABLE FUTURE With commercial incentive-based products focused on quality and efficiency, Terry Manna is helping to reshape healthcare in New Jersey BY MELISSA ANDERS
You oversee managed-care revenue, primarily under a fee-for-service model. What’s your latest product strategy? Terry Manna: The commercial incentive-based product strategy differs in concept from typical attribution models that exist in the market. Our product strategies result in benefit plan designs with significant member copayment and coinsurance differentials to utilize the providers that are part of Meridian Health Partners. A key element of our product designs is for the providers in Meridian to provide the care in a clinically integrated manner. The network receives care coordination payments and upside shared savings opportunities for meeting certain quality and efficiency objectives.
AHL APR.MAY.JUN 2016
How is this incentive-based strategy helping Meridian migrate to risk-based reimbursement?
TM: Early in my career, when I worked for a large payer in Chicago, I would visit with the physician boards of various IPAs/PHOs and share data with them that was 90 days old. A requirement for Meridian Health Partners is collaboration with our payers to provide us with real-time data. This data includes timely claims, eligibility, and member attribution feeds from the payer(s) that gets integrated into Meridian’s enterprise data warehouse. This actionable data arms our physicians with real-time utilization, claims, quality performance, and attribution information on their patients to improve the quality of care while reducing out-migration of service that otherwise may have been provided within network providers. The combination of having real-time clinical and utilization data and the collaboration with our physicians and payers to provide care in a clinically driven environment, with aligned quality and efficiency incentives, are the basic ingredients for population health, value-based contracting, and migration to risk-based reimbursement.
What is Meridian doing differently when contracting with payers in New Jersey? TM: Our payer negotiations are moving away from “traditional haggling” over feefor-service payments. Meridian has an allpayer strategy when developing value-based initiatives. Recently we launched two incentive-based product agreements with two significant payers in our market: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth of New Jersey through Meridian Health Partners. Both products have similar attributes in that they offer our network on a narrow banded Tier 1 basis that allows members in our catchment area to seek services from our providers while incurring lower out-of-pocket expenses. Both products will offer Meridian Health Partners’ network to business segments, including both small and large group employers, and individuals on the marketplace exchanges with competitive premiums. Meridian will be introducing additional incentive-based product collaboration with payers in the near future. What are the value-adds to the patients? TM: The strategies we develop with the health plans introduce products at certain competitive premiums. These products expand the access for our patients to utilize Meridian hospitals, physicians, and partner companies that make up Meridian Health Partners at lower-cost opportunities. The patients have access to an integrated, high-quality healthcare delivery system on a Tier 1 basis where they incur lower out-ofpocket expenses.
Vice President of Managed Care
Meridian Health System, Inc.
cial product strategy is consistent with Meridian’s mission to manage populations in a clinically integrated manner with physicians. How does Meridian work together with the plan to lower costs?
TM: Lowering the cost of care must be in concert with our physician partners. Each of our product designs has established quality How does this approach in contracting set and efficiency matrix targets. The Quality Meridian apart? Committee of Meridian Health Partners selects the HEDIS ambulatory measures to TM: A lot of our competitors are doing attri- track. If the network’s performance achieves bution models with their ACOs, without the established quality and efficiency objecbenefit-plan designs or member incentives. tives and care was provided in a high-quality, Meridian is building the infrastructure to cost-effective way, we share in the savings manage population health. Our commer- opportunity.
So this is a step toward a risk-based model? TM: Meridian is on track with building the infrastructure and integrating with our providers to manage a future riskbased environment. Why did you decide to take this approach? TM: We tested the product concept when the first marketplace products were offered several years ago in New Jersey. Meridian was one of the few providers that contracted with payers and participated in the exchange products. However, the initial exchange products pilot for Meridian did not include any of the clinical-integration components that we require today through our network. Meridian hospitals were offered on a narrow network Tier 1 basis, which resulted in a significant growth in volume. How do these new plans yield effective results and contracting opportunities? TM: Our commercial incentive-based products launched on January 1, 2016. We are highly optimistic that the products will yield the same success Meridian witnessed under the marketplace products. However, the vast differences are that our new product models include value-based clinical-integration components and will be offered to expanded business segments to self-insured, fully insured, small and large group, and ON/ OFF the marketplace exchanges. We are very encouraged the products will yield growth, clinical value, and sustainability. AHL
providers.amerigroup.com/NJ â– 1-800-454-3730
MagnaCare, a healthcare-services company, is proactively reducing the cost of healthcare by offering self-insured options to employers in New Jersey and New York. The company offers access to a broad provider network, predictive modeling analyses, member outreach programs, and integrated solutions that include full plan management services. A true business partner, MagnaCare shares a professional relationship with Terry Manna, vice president of managed care at Meridian Health. MagnaCare benefits from Terryâ€™s can-do approach in developing innovative solutions and overcoming obstacles. By joining forces, both MagnaCare and Meridian Health are able to thrive in todayâ€™s increasingly complex healthcare environment.
We commend Meridian Health for the instrumental role they play in the communities we serve.
The Operational Overhaul Jeff Myers is leading the major revamp of Hamilton Medical Center with twenty-first-century tech capabilities, a new ICU, and a problem-solving health information exchange
AHL APR.MAY.JUN 2016
BY TARYN BARNES
Not many people would sign on as CEO of a company facing troubled times. Then again, not everyone is Jeff Myers. With a career evenly split between hospital operations and managed care, Myers left his position as CEO of Alliant Health Plans to take on the role of CEO at Hamilton Medical Center (HMC). Before he could take HMC to the next level, however, he had to fix revenue matters. Up against a recession in Dalton, Georgia— one so great that most of the United States paled in comparison—Myers had his work cut out for him. “When the economy went down, we wound up with the second-highest unemployment rate in the country,” says Myers, “and that carried on for nearly a five-year period, so that was a significant challenge.” Myers quickly set up shop and collaborated with his team in an effort to find a pragmatic solution. “The one thing we really had to do was look at our operation and become maximally efficient,” he recalls. “We went through a process that lasted six to nine months, and we took our time with it. The line in the sand was that we wouldn’t compromise on quality or service on the initiative we took to reduce cost.” Myers and his team accomplished just that, effectively reducing Hamilton Medical Center’s costs by 7–8 percent. “It kept us [in the] black through the whole process, and we actually didn’t lose any money,” he says. “I think that operating philosophy—that we’re not going to compromise on service—laid a foundation for what became the next five years, in terms of progression on our quality scores.” But Myers didn’t stop there. Realizing that HMC needed more contracts, he focused on its strategic growth. HMC didn’t yet have a lot of contracts with national payers, so it began negotiations with Blue Cross, Aetna, and Cigna in 2010/11. In addition, Myers and his team hunkered down to improve hospital operations. “We put a big focus on service lines and looked at each one from a facilityand physician-complement standpoint and focused on targeted growth in each one of the arenas,” he says. These initiatives paid off, literally, as HMC saw investments in its facilities to
the tune of $35 million, with another $40 million within the next two years, allowing for a much-needed revamp of HMC’s ICU. Built in 1962, the ICU desperately needed an upgrade—something HMC completed this past October. “We really exist specifically to meet the healthcare needs of our community, and in order to continue doing that, we needed to expand up to fourteen beds and to upgrade the area,” Myers says. “That was really the motivation behind it.” He also took the initiative to adopt and implement new technologies to improve HMC’s overall functions for its physicians. “We started our Clinical Integration Network in 2009, in partnership with the medical community, and each one of the physicians have at least one protocol that they’re responsible for,” Myers says. “We loaded software on 100 percent of the physicians’ practices and the hospital to extract all of our data into one central depository. Each one of the physicians receives a monthly report on the compliance.” This program allows physicians to better partner with their patients to provide optimal care, which is important to Myers. “That, for me, is the foundation of population health,” he says. “The fact that we own our own health plan [means that] we have an aligned incentive to improve health status over the population, so that’s what that really is all about.” Utilizing that partnership gave way to a new program—HMC’s health information exchange, which HMC is preparing to roll out. Ultimately, the program will look to increase the organization’s functionality. “It’s a real-time data exchange between physicians related to a given patient in their care, to reduce duplication of services,” Myers says. The health information exchange stands to help reduce operating costs while providing the best care to HMC’s patients. With these advancements, it’s not surprising that HMC has managed to win several prestigious awards, including Truven Health Analytics’ Everest Award, which only seventeen hospitals in the country received this past year. This success is something that Myers attributes to the skillfulness of his team. At the end of the day, HMC thrives due to its
Chief Executive Officer
Hamilton Medical Center
“The line in the sand was that we wouldn’t compromise on quality or service on the initiative we took to reduce cost.” leadership and the efficiency of its team, with continued focus on the patient experience. “I think, foundationally, we are here to take care of the health needs of our community, whether it’s prevention, acute treatment, [or] postdischarge in their home environment,” Myers says. “We continue to look for what opportunities there are to better serve our community.” AHL
Connecting what matters
Cerner proudly supports the success of Jeff Meyers, as President and CEO of Hamilton Health Care System. We look forward to a long, successful and collaborative relationship.
Visit cerner.com ÂŠ 2015 Cerner Corporation
Jeff Meyers President & CEO
INSURANCE & BENEFITS
Reform Equals Opportunity As the stress of complying with the Affordable Care Act puts some smaller employee-benefits brokers out of business, National Healthcare Access has used the transformative law as a chance to thrive
AHL APR.MAY.JUN 2016
BY MELISSA ANDERS
It started more than twenty-five years ago. Two brothers, Michael and Frank Caparso, had been working for major insurance companies when they were recruited to do contracting with a managed-care company. However, the extensive travel took a toll on their young families, so after a few years they decided to set off on their own—and National Healthcare Access Inc. (NHA) was born. NHA started off as a managed-care consulting firm but has evolved to derive most of its revenue from selling health plans to employers. With clients in twenty-five states and about forty employees in offices throughout Ohio, Nevada, and California, it generally works with groups of fifty employees or more. Since its founding, it has adapted with the changing healthcare environment and developed a track record of success, recently landing on the Inc. 5000 list of the nation’s fastest-growing companies. Harnessing that growth has become one of the company’s main areas of focus. The company has been busy the last few years keeping up with new Affordable Care Act (ACA) provisions while continuing to expand, and it plans to double revenue by 2020. That aggressive growth will require acquisitions of smaller firms, which NHA already has done. “With a growing business and the added compliance issues brought on by the ACA, we’ve had to make a ton of investments internally in software, technology, and additional personnel, just to support the clients we have on the books,” says Michael Caparso. The company has actually doubled in size since the ACA was passed, thanks to the firm’s sole focus on employee-benefits plans. Prior to reform, employers may have purchased health insurance from the same agent who wrote their car insurance, but the ACA has demanded more attention from brokers to ensure companies are in compliance and getting the best value for their money. “It’s obviously put a lot of stress on the organization,” Caparso says. “We’ve had to really invest in resources to accommodate that.” Much of the investment has centered on technology and creating online platforms as the industry transitions to become more
“We kind of got ahead of that a little bit and started investing in technology a few years back, when we saw this wave coming,” Caparso says, “but we continue to do so.” Larger employers are increasingly conscious of the compliance issues associated with the ACA, and many are transferring the responsibility to their employee-benefits broker. NHA has had to contract with outside law firms and has brought attorneys on staff to handle those needs. In addition, it has spent the last three years conducting educational seminars across the country, helping current and prospective clients gain a better handle of the law and its implications. All of these initiatives are reflective of the company itself, which has a history of taking changing landscapes in stride. NHA was able to weather the recession better than some of NAME TITLE ORGANIZATION its competitors, since it didn’t have exposure Michael Cofounder National in a lot of the markets that collapsed, such as Caparso Healthcare construction or casinos in Las Vegas. Access Inc. “It wasn’t something that we were conscious of—that we said, ‘Oh, let’s not insure casinos or contractors’; we just didn’t have any,” Caparso says. “So it kind of buffered us when the economy fell apart. And when it started picking back up again, since we were a survivor, we actually started getting those types of accounts.” NHA has set itself apart from competitors by concentrating on a single line of insurance. Caparso and his brother started off in health because that’s all that they knew, and though they were tempted to diversify, they never got to the point where they thought they’d be able to branch out while maintaining credibility. “The fact that we’ve strictly stuck with employee-benefit plans—that has really done more to have us stand out in the field than all the investments we’ve made,” he says. Caparso also credits the success to quality personnel and a low turnover rate among both employees and clients. Its customer retention paperless. For example, enrollments and rate is more than 90 percent. “That’s really been the cornerstone of our modifications are done electronically now, and clients have a one-stop solution for HR company,” he says. “You get to a size where functions as they pertain to benefits. One such it’s no longer a by-product of whatever efforts initiative that NHA implemented in 2015 is Frank and I have made. It’s more of a by-prodcalled the Employee Navigator mobile app. uct of what our entire team has done.” AHL
“The fact that we’ve strictly stuck with employee-benefit plans–that has really done more to have us stand out in the field than all the investments we’ve made.”
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AHL APR.MAY.JUN 2016
I’m all abo sure that we’re doin we’re doin year from
ut making whatever g today, g better a now . . . DRIVE
Selling Life As the daughter of an ophthalmologist, Elizabeth Lewis grew up seeing how to improve patient advocacy firsthand. Today, at Takeda, sheâ€™s taking that notion to the next level, immersing her time and energy into making more-meaningful connections.
Photo by Liz Linder
By Urmila Ramakrishnan
On an early Saturday morning, a young Elizabeth “Liz” Lewis climbs into the car to join her father on his weekend rounds. While ophthalmologist Dr. Harvey Lewis checks on his patients, Liz heads to the pediatric ward. She talks to patients, entertains them with stories, and does favors for them. It’s those moments—those stories—that stick with her throughout high school, when she would come to work for her father at that same hospital. Lewis was born to be in healthcare. As the daughter of a physician, she learned the value of patient advocacy at a young age. Today those patient stories drive her to succeed as a leader and patient advocate at Takeda Pharmaceuticals. Lewis is the head of patient advocacy and chief counsel of the global oncology business unit, and she ensures that the patient is the center of everything Takeda does. “What I really like about my role is the direct access to patients,” Lewis says. “I love understanding and learning from them. We know more about their needs—about the
potential impact our medicines may have on them. You can’t understand a patient without that access. You need to know what their journey looks like, what their struggles are, and what works for them.” As a leader, Lewis has worked to make that more commonplace across the entire company. Patient advocacy has become more deeply established within the company since she came on board in 2002. Takeda has encouraged and ingrained the patient story into everything it does—from drug discovery and development to the marketing process. Lewis remembers one specific case with a former professional football player who had multiple myeloma. He came in to talk to the company’s sales force before speaking to the company’s executive team. Lewis was impressed by his speech. “I’ve heard patients before—we’ve had lots of patients come in—but he really captured it for me and the company,” says Lewis. “He said, ‘What you do is sell life.’ Seeing that level of emotion and gratitude and willingness from a
Elizabeth Lewis TITLE
Chief Counsel & Head of Patient Advocacy, Global Oncology Business Unit ORGANIZATION
Takeda Pharmaceuticals International Co.
AHL APR.MAY.JUN 2016
Lewis helps kick off 2015’s Rushing Towards a Cure, an annual initiative in which Takeda donates $1,000 for every 100 rushing yards gained by the New England Patriots. The money goes to the Leukemia & Lymphoma Society to help fund vital cancer research, patient services, and education programs.
“It’s challenging, but you just have to get out of bed the next day and figure out what more you have to do. We can’t just stop. We can’t just stop because for every patient that passes away, there’s another person that’s diagnosed who needs help.”
former pro athlete encouraged us to keep doing what we do. I think it was a real turning point for us.” It’s stories such as those that have helped Takeda to raise awareness and push new initiatives. And Lewis needs to have the ability to communicate and advocate for those initiatives. There are often challenges between wanting to do something and figuring out how the company can do it. Her legal role influenced the company to figure out how to move forward with new patient initiatives. She is tasked with extending the company’s ability to innovate through patient-driven care, and she also has to collaborate with external advocacy organizations. To do that, she needs to know what the issues are and how to communicate them to her team as well as those outside the organization. She has to be open to all perspectives because it’s that one voice that sees the issue differently and can improve patient advocacy. It ultimately lies on understanding how it might impact the patient. That means establishing best practices and building strong relationships that translate to operating a company with the highest level of integrity. “I think that when you have trust and respect, that translates into the ability to do more and really work with patients to do as much as we can to help them on their journey,” Lewis says. Integrity always circles back to patients’ stories. This can be a challenge at times, but it’s what gets Lewis out of bed every morning. “I’ve had an incredible opportunity to have met so many patients,” she says. “But this is cancer. Even though the prognoses for myeloma patients have improved since I came on board in 2002, it’s still not a curable disease. It’s always very sad when we have a patient that we’ve worked with pass away. It’s challenging, but you just have to get out of bed the next day and figure out what more you have to do. We can’t just stop. We can’t just stop because for every patient that passes away, there’s another person that’s diagnosed who needs help.” Helping others is central to Lewis’s personal mission, so mentorship is something she is extremely passionate about. She believes her legacy is the people that she has mentored and developed along the way. “For me, being a mentor is helping other individuals really achieve their potential,” Lewis says. “Everybody has had a boss that’s really helped them move to the next level or really furthered their career. I also think mentoring is helping people to be their best.” For Lewis, that mentor was Lynn Shapiro Snyder. Lewis worked with Snyder right out of law school in 1998. On Lewis’s first day, Snyder gave her three major pharmaceutical projects that would come to define Lewis’s career. She always comes back to that moment when she mentors her team for success at Takeda. As for Lewis’s future, she wants to continue advocating for patients. “I hate the question about the five-year plan,” says Lewis. “I’m so fortunate to have a job I love. So few people can actually get up in the morning and say they have a job they really love and love coming to every day. So what’s my five-year plan? My five-year plan is to make this function of Takeda even stronger and better than it is today—to evolve it to the next level.” AHL
Image: Colored scanning electron micrograph (SEM) of a lung cancer cell.
One focus: a shared commitment to improve the lives of cancer patients everywhere. At TAKEDA ONCOLOGY, we endeavor to deliver novel medicines to patients with cancer worldwide through our commitment to science, breakthrough innovation and passion for improving the lives of patients. This singular focus drives our aspirations to discover, develop and deliver breakthrough oncology therapies. By concentrating the power of leading scientific minds and the vast resources of a global pharmaceutical company, we are finding innovative ways to improve the treatment of cancer. We’ve built a portfolio of paradigm-changing therapies and a leading oncology pipeline. Though we’ve made great strides in our fight against cancer, we are determined to do more – to work harder and to reach higher. We continue to seek our aspirations with the same passion, agility and entrepreneurial spirit that has sustained our patient-centric culture and has made us the leaders in oncology that we are today. We know that our mission is not a quick or simple one, but we are up for the task: we aspire to cure cancer.
To learn more, visit us at takedaoncology.com. ©2015 Millennium Pharmaceuticals, Inc. All rights reserved.
Defending the Doctor Elizabeth Cushing wasn’t thinking about medical malpractice when she first stepped out of law school. She wanted to be a litigator, and she wanted to sing on Broadway. Those two paths were critical in shaping who she is today, and they continue to propel her in her profession.
I’ve always had a great affection for the medical community, so it was a perfect mix for me. It wasn’t just insurance defense for huge companies; it was real people with real issues. If I reach back, as a young attorney in my late 20s, the one case that made me say, ‘This is it for me,’ was a meeting with a chief of cardiothoracic surgery at one of our Boston institutions. I went there feeling very [much] in awe of whom I was about to talk with. I was nervous that I didn’t know about the medicine as much as he did. I got there, and we started talking about the case. He couldn’t have been more wonderful or thoughtful. Suddenly he started to cry. I looked at him, and it struck me at that moment how personally involved these doctors are with their patients. They aren’t just scientists looking to get Nobel prizes. They try to cure people and save lives. I never appreciated the depth of their pain until that moment. That experience defined my career path and made me more empathetic. These aren’t Wall Street brokers. They’re not just playing the game every day. They’re actually using an incredible amount of education, experience, and heart to try to make people better. The lawsuit hits them with particular force because their whole life has been devoted to not making mistakes, to not being less than stellar. That grabbed me, and it’s never left me to this day. As I’ve continued with this career path, there are many more moments like this that create the core values of CRICO. We’re there to help doctors get back caring for patients and to saving lives. I didn’t know I would end up at a company like this, ini-
Elizabeth Cushing TITLE
Vice President of Claims ORGANIZATION
Photo by Ken Kotch Photography
AHL APR.MAY.JUN 2016
As told to Urmila Ramakrishnan
Congratulations to Beth Cushing on this recognition of
“Suddenly he started to cry. I looked at him, and it struck me at that moment how personally involved these doctors are with their patients.”
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tially. I graduated law school in 1990, and at that time, I was given a clerkship at the Massachusetts Supreme Judicial Court. I then went to Martin, Magnuson, McCarthy & Kenney, a prominent professional liability defense firm in Boston, which I loved. They were a wonderful group of attorneys, and I learned a great deal there about the ethical and committed practice of law. But I was young, and I wanted to go to Broadway. I’m a singer/actress, and I thought I wanted to go to New York to give it a shot. So I studied at the Juilliard School Evening [Division] for two years and worked in musical theater. I recognized that I couldn’t make enough money to live in New York City as an actress, so I accepted a position at a highly regarded medical malpractice insurance company in New York, FOJP Service Corporation. I stayed in New York for three years before coming back to Boston to work for CRICO. The New York experience molded who I am today. My acting classes were where I learned about myself. Acting isn’t just a person standing in front of you, pretending to be somebody else and being “dramatic” to appeal to your emotions. You can’t be anybody legitimately, on stage or in a courtroom, if you don’t believe it. You’re just not going to connect with the audience. They’re going to know that you are acting, faking. It’s the same in the courtroom when people pretend to care about their client or pretend to know the medicine. Our doctors walk into a courtroom, and they believe in themselves. And we believe in the care they provided. Otherwise the case settles. When I’m looking at the clinicians we represent, I want to be very solid with that kind of authenticity. I’m asking
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AHL APR.MAY.JUN 2016
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them to tell me what they’re really feeling—tell me what they’re struggling with. I don’t want them to cry in my office, but I want them to tell me what’s really going on. It’s the same when you’re managing a team like mine at CRICO. A superb staff. You’re asking people to go into battle, in a way. It’s so different from the actual military example, but you need the general and you need the whole team to pull back the people when things aren’t going the way you hoped. In that way, it’s very collaborative. No one is out there on their own. In my fifteen years here, there’s no overreaching, broad management style that works with every single sector. I’m dealing with nurses, lawyers, doctors, and insurance professionals. My style shifts from one group to the other. I don’t micromanage. I would rather them be five days late on a report and focused on doing the right thing for the insured, who are going through this difficult time right now, than having them focused on a deadline. It’s all about getting a case to the best conclusion and supporting the client. I’m a big believer in mediation when it’s appropriate. I’m not taking cases to trial for the sake of it. We try a lot of cases, but there are times when you have to sit back and say, ‘The right thing to do for the family and for the doctor is to settle the case.’ At the end of the day, it isn’t about us. It’s about taking the burden off of their shoulders and saying, ‘You don’t need to worry about it. You need to just keep living your life, which you’ve worked so hard to do, keep giving good care, and let it go.’ I know they never let it go. It lives with them day in and day out, but if we can ease that burden by even the slightest measure, I’m happy. One case that really speaks to that, especially with disclosure and apology. It was back in 2007. Mary White, then a 45-year-old woman, had the misfortune of having a pathology report mistranscribed. She ended up with an unnecessary hysterectomy. We told her she had cancer, but she did not. Everyone was more than willing to provide all the appropriate information for mediation. I met with her. She was reasonable but very upset, understandably. It was a big loss, but you can’t negotiate with an individual who doesn’t even know what to say about it. Initially, she didn’t want to talk to the doctor. She did not want to let him ‘off the hook’ in any way for what she was suffering. I got that. It was very fresh, and the idea that she was going to make him feel better because he apologized was angering. He was a pathologist who did all the right things, but then it got mistranscribed. He came to the mediation, and, in the end, they wanted to meet privately and had this very heart-to-heart forgiveness. That’s the part I love. AHL
“My primary concerns have always been people, processes, and technology— in that order.” Mark Jacobs explains how, through his role, he finds meaning in today’s incredibly unique and increasingly complex industry By Tina Vasquez
In 2007, the Delaware Health Information Network (DHIN) made history, becoming the first live, statewide health information network in the nation. By creating efficiencies for doctors and patients alike, DHIN has effectively eliminated the need for expensive, sluggish delivery methods while also enhancing patient privacy. Mark Jacobs started his career in healthcare in the late 1970s as a data and research analyst. As the industry evolved, so did he. Today, as the organization’s chief information officer, he may specialize in technology, but his focus is always on patients. Here the CIO talks to AHL about the value proposition, keeping costs in line, and his continued passion for IT.
be easily shared in a way that we expect, as the release of such information may violate ethical and legal boundaries. Another thing—and one that’s a constant struggle in healthcare—is the moving away from paper. Pushing in that direction is forcing healthcare into a direction it doesn’t want to go. How so?
MJ: The Center for Health Transformation, with an introFrom an IT perspective, what do you have to take into duction by Newt Gingrich, published a book called Paper account that you might not have to outside of health- Kills, which outlined—in order to drive modernization of healthcare and gain efficiency—the value and reduced care? costs needed to move away from paper. From my perspecMark Jacobs: It’s important to understand that health- tive, healthcare finds itself, in 2015, still trying to moderncare is a unique, unusual sector of the economy with a ize around health IT, yet it has not fully transitioned and is gatekeeper: a physician, who manages the patient’s entry still burdened by manila folders, paper referrals, X-ray film, for care, tests, and medical services, and the patient/con- consent forms—all of which are known to cause medical sumer. At DHIN, we have to constantly look at the value errors, waste, and higher costs. The Affordable Care Act, proposition and take cost into account while also ensuring unbeknownst to some patients, is really healthcare reform that patients receive quality care, that we reduce medical where we are taking the patient, physician, hospital, and errors, and that our patients are safe and happy. The sen- other transitions of care through the biggest face-lift in sitive nature of patient information being shared—and US healthcare history—all while expecting care not to be the issues surrounding the sharing of that information—is disrupted. It’s a monumental effort to implement health something that is paramount, and something not all indus- information technology with the hope of adopting the best tries deal with. Specifically, such information requires practices in care with a focus on prevention, wellness, and consent and has no convenient, built-in way to allow it to early detection. As my son Joe tells me, “Dad, you are all
trying to take healthcare where it really does not want to go on its own.” It sounds like you have your work cut out for you. What are the biggest challenges you face as CIO, and how do you navigate around those issues? MJ: The CIO position in a health information exchange isn’t the same position as a hospital CIO. We are not just moving data from point A to point B; we’re a network for data-sharing [and mobilizing] data electronically across multiple healthcare organizations in a community, region, or state. My position is sort of an extension of that mission. The biggest challenge is that much of our technology innovations and projects, at times, entail doing work no one else has done. The major ambition is creating an electronic ecosystem with a community health record, but it requires a monumental effort to normalize/standardize data and a lot of consensus and agreement. We’re not totally there yet; it’s time-consuming and quite expensive, but we’ll get there. To me, it is more affordable than a hospital or health system going it alone. Tell me about your federated data model. MJ: I’ll explain it this way: We collect data in DHIN, in separate databases per data source. The model is about bringing data together in a single place for caregivers to be able to receive and query. For example, data also comes in from ambulatory practices—in the form of care summaries, hospitals, labs, and from long-term-care centers. We store it, distribute it, and the providers can query to access patient information at point-of-care. We’re basically a big, protected distribution center, like a post office. In our community health record, we have seven years’ worth of patient history, not just from the state of Delaware anymore, but at least one patient from every state in the nation.
AHL APR.MAY.JUN 2016
How does DHIN’s federated data model make it possible to deliver high-quality medical care more quickly and at a lower cost?
MJ: DHIN is really a hybrid model that allows doctors, nurses, pharmacists, other healthcare providers, and patients to appropriately access and securely share a patient’s vital medical information electronically— improving the quality and cost of patient care. We now have our own integration infrastructure; therefore, we handle our own inbound and outbound data without dependencies of an outside service vendor. We keep everything in line through tight management as well as project
Mark Jacobs TITLE
Chief Information Officer ORGANIZATION
Delaware Health Information Network
“It’s important to understand that healthcare is a unique, unusual sector of the economy with a gatekeeper: a physician, who manages the patient’s entry for care.” cesses, and technology—in that order. Technically I’m a tech person, but I’m also very much a people person. As CIO, you’re so busy, and you can get lost in planning and processes and implementation. You rarely get to see how all of it comes to fruition for patients. In this role, I do get to see how it impacts people’s lives, because my family What fuels your passion for IT in healthcare? and I are also patients. It’s exciting to come into work at a place every day where I get to see the fruits of our MJ: My primary concerns have always been people, pro- labor. AHL
management. We’re not trying to provide everything to everyone; we’re only concerned with providing what’s needed to those in need. I was hired at the same time as our CEO, in 2011. She knew the clinical side, and I knew the technology side, and there was perfect synergy.
AHL APR.MAY.JUN 2016
Chief Financial Officer ORGANIZATION
In 2010, Sean Whelan was named Diplomat Pharmacy’s very first CFO—after the company surged from $25 million in revenue to $3 billion. A look at how he manages the financials and why it’s about much more than numbers. By Tina Vasquez
Whelan’s time at Ford was a formative experience, he says, and it made him a “well-rounded finance person.” He says that without that experience, he wouldn’t have been prepared for the next iteration of his career: healthcare. Today Whelan is CFO of Diplomat Pharmacy, the largest independent pharmacy in the country, recently recognized as one of the country’s fastest-growing healthcare companies. He was named the company’s first CFO in its thirty-five-year existence, and he observed his fifth year with the company last year as Diplomat celebrated its fortieth
In the mid-1990s, after obtaining his CPA license while working in public accounting at Deloitte & Touche, Sean Whelan was lucky enough to get a job with Ford Motor Company. Like many of the success stories who have gone through the company’s doors, Whelan was placed in Ford’s now-famous rotational program, which places promising individuals in various departments, providing them with well-rounded, hands-on, company-wide experience. It was no different for Whelan, who held eleven different roles during his twelve years with the company.
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AHL APR.MAY.JUN 2016
1. Average capped MPR across specialty therapeutic categories. Diplomat Adherence Reporting, 2014. Copyright © 2015 by Diplomat Pharmacy Inc. Diplomat is a registered trademark of Diplomat Pharmacy Inc. All rights reserved. MARK-002123-0915
anniversary. When Whelan joined in 2010, his presence couldn’t have been more needed: Diplomat had gone from $25 million in revenue to $3 billion in just ten years. Interestingly, it wasn’t the first time Whelan found himself as the first CFO of a healthcare company. Before joining Diplomat, he was hired as the first CFO of a small healthcare company that had just gone public a week previously. “I guess I’m just a glutton for punishment,” Whelan says, laughing. “Being the first CFO of a company can be challenging. It’s a bit of a baptism by fire because it’s decidedly harder when you’re starting from scratch. At Diplomat, we just didn’t have the financial infrastructure in place to support the massive growth we were experiencing.” Whelan says that his entire career has been predicated on change, so making the modifications needed at Diplomat Pharmacy wasn’t as overwhelming a task as it might have been for someone who had a more traditional career path. The “financial infrastructure” that Diplomat needed translated to three key components: people, processes, and systems. And because it’s healthcare, Whelan takes something into account that CFOs outside of his industry don’t have to. “From top to bottom, the focus is on the patient,” he says. “My goal from the get-go was doing things as efficiently as we can, with as little expense and inconvenience to the patient as possible.” All of Diplomat’s competitors are much larger companies, but because Diplomat has “worked smart”—competing with existing service models, hiring the right people, and making thoughtful acquisitions—the little Flint, Michigan-based company is thriving. He’d never say it, but part of the success over the last five years can also be attributed to having such a hands-on CFO. Upon being hired at Diplomat, Whelan decided to spend his first week in operations in order to fully understand the role of employees, their greatest challenges, and, more broadly, to get a better feel for the company and the “specialty pharmacy” industry as a whole. “It’s easy to get caught up with what your competitors are doing,” he says. “To some degree, it’s good to know
what they’re doing, but not to the detriment of your own company. I prefer to look inside our own company to see what we’re doing, what’s working, and what’s not. Personally, I’ve found that to be more effective.” Given the enormous growth of the company, it seems looking inward is working. And, as Whelan points out, it helps to have an amazing team that you can trust. “You want a team with all of the technical capabilities, but they also just have to be the right fit for your company and its culture,” he says. “I have one of the greatest finance teams. I couldn’t function or do half of what I do without them. They’re the reason I’m able to sleep at night.” Whelan measures success in a way other CFOs often don’t, even in his industry. He has the usual concerns—pleasing shareholders, turning a profit, and managing growth—but at Diplomat, he says, success is, again, doing the right thing for patients. That’s harder than it sounds. For Whelan, it means that the right patient has the right drug at the right time. Not doing that, he says, not only harms the customer but costs more money. Going forward, Diplomat Pharmacy is beginning to focus on how to manage total cost of care, a growing concern for many in the healthcare industry. According to Express Scripts Lab 2014 Drug Trend Report, spending on specialty drugs in the US grew 31 percent in 2014, and it’s expected to grow more than 20 percent annually for each of the next three years. “I want long-term success and sustainability,” Whelan says. “I’m all about making sure that whatever we’re doing today, we’re doing better a year from now—and I can honestly say I think we will be.” AHL
Thinking differently. It’s what led Sean Whelan and Diplomat Pharmacy to be the nation’s largest independent specialty pharmacy. And as one of Michigan’s largest independent agencies, we’re proud to provide Diplomat with innovative, single-source insurance solutions so they can remain focused on one single thing: their patients.
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Thinking out of the box for clients that outpace the industry.
Highlighting the personal and professional accomplishments of Dr. Giesele Robinson Greene is a challenging task— because there are so many. Here she offers a glimpse of how she developed an interest in medicine, streamlined the health system’s EMR process, and helped give a friend a new lease on life. By Bridgett Novak
What prompted you to go into medicine?
working at St. Vincent Charity Medical Center.
Giesele Greene: There were several things. Two of my sisters were born with congenital heart defects. One died when she was nineteen. I was eleven at the time and witnessed her sudden death due to natural causes. The other sister had open-heart surgery, which was just developing then, when she was twelve. Initially my sister was untreatable, but the doctors arranged for her to be part of an early, experimental open-heart procedure study. They believed it would help her, and it did. She ended up living into her sixties. Then, in high school, I worked as a receptionist in our doctor’s office to help cover my family’s healthcare bills. There I learned how physicians can make a difference in people’s lives. Academically, I was good in math and science, and I received great encouragement from several teachers to pursue a career in medicine.
How long were you there?
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You went to Northwestern University for your undergraduate work and then Howard University for medical school, right?
GG: Eleven years. I left the medical center in 1993 and became the medical director of Personal Physician Care Inc., one of the first minority-owned-and-operated HMOs in Ohio. I then worked for a number of different insurance companies before becoming the medical director of UnitedHealthcare of northern Ohio. For more than eighteen years, I also had an independent private practice, specializing in internal medicine and geriatrics. How did you end up back at St. Vincent, and what are your primary responsibilities? GG: St. Vincent is part of the Sisters of Charity Health System, which includes five Catholic hospitals, three grant-making foundations, two elder-care facilities, and six outreach organizations. I was recruited back in 2010 to become the chief medical officer of the entire system. I am responsible for quality of care, patient safety, clinical outcomes, and medical-staff oversight at the hospitals. I am proud to say that our hospitals’ and elder-care facilities’ quality of care and patientsafety ratings are high, and they have received national recognition.
GG: That’s right. A valedictory scholarship from Tuesday Magazine provided 45 percent of my tuition, room, and board at Northwestern. Loans, work study, and part-time jobs made up the difference. To help pay for medical school, I joined the National Health Service Corps. The government paid my tuition and residential costs and then required me to work in a “health man- You’ve tackled some major hospital improvements. power shortage area.” Cleveland was where I did my Tell us about the overhaul of the electronic medical residency and one of the HMSA cities, so I ended up records system.
Dr. Giesele Robinson Greene TITLE
Senior Vice President & Chief Medical Officer ORGANIZATION
Sisters of Charity Health System
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HEALTH CARE MINISTRIES Mercy Medical Center, St. John Medical Center*, St. Vincent Charity Medical Center, Providence Hospitals, Light of Hearts Villa, Regina Health Center, Independent Physician Solutions FOUNDATION MINISTRIES Sisters of Charity Foundation of Canton, Sisters of Charity Foundation of Cleveland, Sisters of Charity Foundation of South Carolina OUTREACH MINISTRIES Building Healthy Communities, Catholic Community Connection*, Early Childhood Resource Center, Healthy Learners, Joseph’s Home, South Carolina Center for Fathers and Families *Joint ventures with partners
A Ministry of the Sisters of Charity of St. Augustine
“Having a centralized and consistent procedure for the entire system has resulted in better-coordinated care and quality monitoring.” GG: At each of our five hospitals, I set up a steering committee and one of the lead physicians was named as chief medical information officer to manage the project. Each steering committee established five subgroups, chaired by physicians and facilitated by hospital staff. They were: (a) communications, which kept the staff informed of the project’s progress and resulting changes; (b) work flow and devices, which produced descriptions of how certain tasks would be performed electronically and what equipment was needed; (c) order sets, which created physician orders in accordance with evidence-based guidelines by specialty; (d) training and support, which determined who needed to be trained and then developed the necessary training programs; and (e) benefits and metrics, which established the parameters for measuring the project’s success. The subgroups functioned for about two years, creating the model that is still in place today. Having a centralized and consistent procedure for the entire system has resulted in better-coordinated care and quality monitoring.
AHL APR.MAY.JUN 2016
In addition to improving processes inside the hospitals, I understand you do a lot of work in the community through the Sisters of Charity Foundation of Cleveland.
GG: That’s right. The Sisters of Charity Foundation of Cleveland is dedicated to addressing the root causes of poverty, and I joined the foundation’s board prior to joining as chief medical officer. Let me tell you about just one of our projects. In 2009, the foundation launched the “Cleveland Central Promise Neighborhood” initiative to create a pipeline of high-quality, coordinated health, social, community, and educational support to help transform the lives of Central neighborhood’s youngest residents. The Central neighborhood has the largest concentration of impoverished residents and public housing in the city, and it’s where the Sisters of Charity opened their first hospital, St. Vincent Charity Medical Center, in 1865. On behalf of the foundation, I serve as the Promise Neighborhood Advisory Board chair. I am also active in the Cleveland community in other ways beyond my work with the foundation. For example, I provide community service through various organizations, including Alpha Kappa Alpha Sorority Inc. and The Links Inc. I understand you’re teaching an innovative course to medical students, too.
GG: Yes. I am an assistant clinical professor at two medical schools—Case Western Reserve University and Northeast Ohio Medical University (NEOMED). I teach a course to first- and third-year medical students at NEOMED named “Reflective Medicine.” It encourages students to be more patient-centric and reflect on their own feelings. Assignments include reading about patient and doctor experiences and writing and talking about how the readings affect them. Students need a place where it’s okay to discuss their private thoughts and receive feedback and mentoring. There is also emphasis on working together as teams, since interdisciplinary medicine will become more common in the future. As if this isn’t a full-enough schedule, you also ran a marathon, right? GG: Well, “walk” would be a more accurate description. One of my very good friends underwent triple bypass surgery and went from being a very outgoing, adventurous woman to becoming afraid of life. Another friend and I found out that the American Heart Association/ American Stroke Association was sponsoring the Power to End Stroke marathon in Kona, Hawaii, in June 2004. We thought participating in a twenty-six-mile walk might help her regain her self-assurance, so the two of us cajoled her into walking it with us. We started training in January, which, in Cleveland, means we were going out in some really crazy weather. We did the marathon, and each of us finished in a little over eight hours. We raised $16,000 for charity, but the real prize was that it ended up giving her back her confidence, strength, and desire to be physically active. She doesn’t hesitate anymore, and that is so rewarding to see. Even though that was the only marathon, we are all still avid walkers, and I now serve as a member of the Cleveland Metro Board of the American Heart Association. AHL
The NEOMED-CSU Partnership for Urban Health aligns well with The Sisters of Charity Health System: It addresses the unmet needs of individuals, families, and communities. We develop students as physicians who meet the needs of underserved Cleveland communities. We both benefit from Dr. Giesele Greene’s advocacy for improving patient outcomes. She helped build our innovative partnership into a flourishing relationship, developing our first clerkships and facilitating connections for the partnership with neighborhood health centers. A member of our Community Advisory Board, Dr. Greene also chairs our curriculum committee and continually engages our program to understand the needs of Cleveland’s underserved.
FUTURE OF HEALTH CARE EDUCATION N E O M E D - C S U PA RT N E R S H I P F O R U R B A N H E A LT H
Preparing primary-care physicians to meet the unique health care needs of underserved urban neighborhoods.
medicine students interprofessionally with students in other health professions to provide better team-based and patient-centered care
greater cultural and linguistic competency with an Urban Health (CSU) and an Urban Primary Care Concentration (NEOMED)
ENGAGE AND IGNITE
the various neighborhood health centers that serve as the student’s clinical home base
students to Cleveland-area communities, improving the likelihood that students will return to establish a practice in these areas as primary care physicians
For more information: csuohio.edu/sciences/neomed/neomed • neomed.edu • csuohio.edu
Advocacy is the Best Policy Twenty years ago, Novia Strategies set out to redesign care and to ensure patients get the right resources. Today the healthcare consultancy continues to deliver on that promise, thanks to the vision of its founder. By Maura Keller
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Ask any business owner from any industry and it won’t take long to determine they share a few common challenges: the rising cost of health insurance, ever-changing regulations, and a wealth of policies and programs to choose from. Add to that the various operational, quality, and financial systems and procedures within hospitals and healthcare organizations, and it’s no wonder that business executives, physicians, and the general public are collectively shaking their heads in dismay.
But Nancy Lakier, founder and CEO of Novia Strategies, Inc., and Novia Solutions, is working to change that. She and her team work side-by-side with hospital leaders, physicians, and staff members to help health systems redesign care, reduce costs, and improve quality throughout all facets of the organization, all the while having interim leaders available to support the changes needed today. Embracing Change Long ago, when managed care hit the healthcare industry, there was a business aspect that began to infiltrate an industry that didn’t have a lot of business savvy previously. But Lakier, as clinician, healthcare executive, and consultant, has always embraced the business of healthcare, coupled with the passion that is needed in an ever-changing industry. Prior to founding Novia Strategies and Novia Solutions twenty years ago, Lakier held positions as associate administrator, CNO, and a variety of internal consulting roles in hospitals and healthcare systems. Since starting Novia, she has grown it to become one of the nation’s longest-established clinician-owned healthcare consultancies, offering a wide range of consulting services. Eight years later, she established Novia Solutions, the interim management company, to fill the leadership gaps needed to support change. Much of Lakier’s career has focused on care coordina-
Nancy Lakier TITLE
Chief Executive Officer & Managing Partner ORGANIZATION
that we are still delivering good care but less expensively?” At that time, Lakier was working with an organization that was undergoing some significant changes. She was given the opportunity to lead those changes, reducing the dollars spent and enhancing patient-care outcome while improving patient, physician, and staff satisfaction. “People were stimulated and motivated to take better care of patients and make sure we were delivering positive outcomes,” she says. “What we were doing in San Diego was truly at the forefront of what many health systems and hospitals were facing across the nation.” The entire team, in turn, was motivated to improve care and reduce costs. Guiding Tenets Today Lakier and her employees embrace four key tenets throughout Novia. The first is: “Do good work.” “At the end of the day, we want to have a successful project and a good outcome for the client,” Lakier says. “If that means we don’t make money on that project, so be it. Because it is not about making loads of money or meeting shareholders’ expectations; it is about doing good work.”
tion, care redesign, integrated care delivery, productivity, pay practices, and operations improvement. In today’s healthcare environment, these are critical needs for hospitals and health systems, which seek to manage the health and wellness of entire population segments. Achieving this, while simultaneously delivering on financial and quality metrics, requires a degree of expertise that few consultants can provide. Novia also offers services in nonlabor, pharmacy, quality, and patient-safety technology, patient throughput, and surgical services. At the time of Novia’s founding, California’s healthcare industry was undergoing substantive changes and was hit by a lot of economic challenges. “At that time, we had a very traditional industry, but oftentimes I saw opportunities for improvement,” Lakier says. “I really love being a part of making things better. In fact, it was a perfect storm for us to say, ‘The industry and environment [are] changing, and at the end of the day, we still want to deliver excellent care, so we need to find the sweet spot of care delivery that is both high quality and efficient.’ So how can we do things differently to make sure
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Lakier also believes in putting strong teams together that comprise complementary experts, which is the firm’s second tenet. “Not everyone has to know everything, but we have to have a good team so that the individuals on that work team are going to complement each other—because then we bring the best to the client.” The company’s third tenet is to reward employees. “We believe we want employees to contribute to the success of the firm, and the firm, in turn, needs to contribute back to the employee,” Lakier says. Novia was honored this past year as one of Becker’s Hospital Review’s “150 Great Places to Work in Healthcare”—something Lakier credits to the first three tenets. Lastly, Lakier’s fourth tenet is to run a successful company, so she and her team embrace the idea of being fiscally responsible. But what has motivated Lakier in creating and maintaining one of the most successful healthcare consulting firms in the nation? Quite simply, it’s being productive and seeing positive outcomes while bringing teams together that stimulate each other. “It really is the work we do but also the people in our firm,” she says. “We have such great people. I find that I learn from our staff every day. Because we have such strong collaboration, it is very motivating to me. And this industry means that every day is a different day.” Moving Forward One of Novia’s key initiatives is something it pioneered two decades ago but one it’s currently seeking to perfect: redesigning care to reduce clinical variation and ensure the patient is getting the right resources—not too many and not too few—at the right time, in the right way. “There are times a patient could have a procedure in an ambulatory setting, or they could be discharged instead of staying in a hospital, so it’s really about restructuring all of that and to standardize care for patient populations where appropriate,” Lakier says. “Our pioneering efforts about care redesign during the past twenty years is where my passion lies. This is what the company was founded on, and we still have tremendous substantive success in this area for our clients.” For Lakier, the future looks bright. She sees it being about continuing to do good work and continuing to attract the best talent—all while positively impacting patient care for Novia’s clients. “When you do good work and attract the best consultants, it is a very fertile ground,” Lakier says. “I really want to continue to grow and expand doing what we do best.” AHL
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The IT Factor
for solving problems and finding the easiest and most-effective solutions—something she continues to do today at DSI Renal. “I learned very early in my career that I thrived on challenging myself, trying to exceed every goal I set,” she says. “Being the hardest critic of myself inspired me to push myself to be successful in everything I did.” To that end, Lefkovitz’s passion for solving problems and for listening has landed her at her current role at DSI Renal. Founded in 2011, the Nashville-based company provides access to state-of-theart dialysis care for more than 7,500 patients who suffer from chronic kidney failure and renal disease. DSI Renal is currently growing its national presence by acquiring new clinics and establishing additional joint venture partnerships with leading nephrologists for the clinic, hospital, and alternate settings. How Judy Lefkovitz turned a passion As executive vice president, chief administrative officer, and chief for math, technology, and healthcare information officer, Lefkovitz oversees the entire IT side of the DSI Renal’s operations. That includes the ongoing support of its propriinto a career with DSI Renal—and how it etary software for the corporate office and its 100 clinics, which are continues to fuel her everyday work throughout the United States, including Hawaii. “I usually tell people [who aren’t affiliated with DSI Renal] that I’m not the typical CIO,” By Joe Dyton Lefkovitz says. “I am a member of an executive team, so I am able to strategize our company goals and propose novel solutions, as well as interact with people from all areas of the company.” Lefkovitz has built an impressive résumé over the years, but despite For some people, it can take years to find the ideal career. But for being on top of her industry, she is constantly looking to improve her DSI Renal’s Judy Lefkovitz, the calling came naturally. Early in her craft and to keep learning new ways to perform her job more effeccareer, she landed a job consulting for a start-up EMR company, and tively. Some of her biggest thrills come when physicians tell her from there, she was hooked on the medical field. It was also at this that she has enhanced their quality of life by equipping them with time that she realized she thrived on the business administration side the right tools to execute their job more quickly and accurately, or as much as she did on the technical/IT side. “The more I did, the more when a reimbursement manager says that the system has enabled I wanted to do,” she says. “Working in healthcare was fascinating to them to consolidate while still exceeding their cash goals. “When me because it is something that touches every person; everybody can I’ve turned what seemed to be an impossible situation into a streamidentify with it. It doesn’t only impact lined, easy, and cost-effective solution, that person; it impacts every family, I feel a huge sense of accomplishment,” she says. “My love of learning, listening, every society, and every business on and problem solving, along with a strong so many different levels. To be a part of that seemed like a dream career.” desire to achieve, motivates me to keep Lefkovitz, who studied mathematdoing better and better.” ics in college, didn’t come to health IT Lefkovitz’s desire to constantly surpass expectations played a strong part in DSI in a traditional manner. While not the traditional way of selecting a college Renal’s merger with US Renal Care at the end of last year. Through her role of acclimajor, Lefkovitz’s education strategy paid off for her, readily preparing mating physicians as new IT solutions her for the high-level IT position she are implemented, she played a key role inhabits today, even if it’s not why she in integrating the two companies while initially chose that major. “I majored meeting the merger’s business needs. in mathematics at Tulane because, “There are always more tools that I’d like to see developed,” she says. “I always for me, it was the easiest major,” she want to strive to be innovative; I don’t admits. “I wouldn’t have to research or write papers—just work problems, want to be complacent, ever. I want to which I always considered fun. I also continue having opportunities to show had to listen, which is a skill I found to what an engaged CIO can do beyond just be extremely helpful later, since listenoverseeing the IT side of the company.” ing is key to implementing solutions. And that’s what propels Lefkovitz forward NAME TITLE ORGANIZATION It was truly why I did it. For most, as DSI begins a new chapter in 2016. “In Judy Executive Vice the course of my career, I became more mathematics would be considered a DSI Renal Lefkovitz President, Chief complicated major, but for me, I really confident and discovered the value of Administrative thought it was the most practical and teamwork,” she says. “I’m fortunate to Officer & Chief fun major.” have a very dedicated and involved team Information Her background in mathematics that plays a vital role in our IT successes.” Officer AHL also helped to reinforce her passion
Pushing to cutting ed means que traditions youâ€™ve hist done thing
remain ge also stioning or the way orically s. APPROACH
Putting the Human back into HR
Handling human resources for the thirdlargest nonprofit healthcare system in the country is no small feat.
Debra Plousha Moore is doing just that, tackling her work from a position of respect, empathy, and education.
By Tina Vasquez
ebra Plousha Moore is warm and kind, a person you immediately feel at ease talking to. She’s also humble, which means she’d likely not take credit for making Charlotte-based Carolinas HealthCare System (CHS) the employer of choice in the area, especially for the 34,000-plus employees in the Charlotte Metro region, but she’s definitely responsible for part of it. CHS has a lot to offer its patients as one of the nation’s leading healthcare organizations, featuring more than 900 locations that offer a full spectrum of healthcare and wellness programs in North and South Carolina, including academic medical centers, hospitals, healthcare pavilions, physician practices, destination centers, surgical and rehabilitation centers, home-health agencies, nursing homes, and hospice and palliative care. CHS also has a lot to offer its employees, including the inclusive, compassionate work environment that Plousha Moore has worked so tirelessly to cultivate as chief human resources officer and executive vice president. Plousha Moore entered human resources untraditionally—and accidentally—she says. Her entry point was academia. While working at the University of Dayton, where she received her master of science in education, in addition to teaching, she was part of a diversity/organizational, development/employee relations consulting group and was eventually recruited into healthcare, which Plousha Moore says redefined what “noble work” meant to her. She began her healthcare career by leading diversity and inclusion strategy, which forged her path into HR. “Healthcare is for—and impacts the lives of—all people at one time or another throughout the continuum of life,” Plousha Moore says. “The university system is more limited in whom it impacts: it is solely for those with academic abilities. I enjoyed academia, but healthcare is my home and has been for twenty years. I love the reach it has.” In her role, Plousha Moore pushes to make employees feel respected, valued, and heard because she has a deep understanding of the challenging nature of the work they do. After all, a 2014 CareerBuilder survey found that healthcare employees have the highest stress levels of any industry. It’s a notion that is not lost on the CHRO. With more than 11 million patient encounters each year, 80 percent of CHS’s workforce is composed of women, and the system has more than 9,300 nurses. Hospitals and other health-
Debra Plousha Moore TITLE
Chief Human Resources Officer & Executive Vice President ORGANIZATION
Carolinas HealthCare System
AHL APR.MAY.JUN 2016
“To be in this field is to be dedicated, educated, experienced, and developed. That takes passion, and this dedication should be respected. When you respect your workforce, it only moves the mission of your organization forward.”
Debra Plousha Moore
Executive Vice President and Chief Human Resources Officer Carolinas HealthCare System
Towers Watson applauds Debra Plousha Moore for her outstanding leadership and dedication to Carolinas HealthCare System and the communities it serves. Debra, we thank you for your vision, commitment to inclusion and compassion. We look forward to partnering with you and Carolinas HealthCare System for years to come.
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care organizations are a mixed bag, where families and members of the community are also stressed, waiting to hear news regarding life-changing events—sometimes joyful, sometimes not. The work, Plousha Moore says, becomes personal, and it is her mission to create a work environment where those who bear the brunt of these stressors feel supported. “I think this might illustrate the very special people we employ: When it snows here in North Carolina, most people leave work early to get milk and bread and then go home. On those same days, our healthcare workforce is driving to work,” Plousha Moore says. “To be in this field is to be dedicated, educated, experienced, and developed. That takes passion, and this dedication should be respected. When you respect your workforce, it only moves the mission of your organization forward.” At CHS, respecting your workforce takes shape in different ways. Competitive salaries and benefits are offered, of course, but Plousha Moore also now spends her weekends at work, offering CHS Saturday School to interested employees. Classes can focus on diversity and inclusion, leadership, financial education, and a number of other topics, including those personally requested by employees. “I come from higher education, so there’s a part of me that’s very much wired to always be an educator,” she says. “My thinking is this: if you are curious and express interest in learning and self-improvement, it is my job to provide the education and space for learning. We want to offer instruction in a way that broadens our workforce’s abilities and capabilities both in the workplace and in their personal lives. It’s really about providing the infrastructure to help people operate at their highest level.” Plousha Moore goes out of her way to offer these extras because she believes it’s important, but it’s also strategic. People need to work, she notes, to make a living, but CHS also needs top-notch employees to help the organization maintain its trusted reputation. This reciprocity, with both
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employees compose Carolinas HealthCare System, making it one of the region’s largest employers
of CHS’s workforce is comprised of women
affiliated or owned hospitals in North and South Carolina make up CHS
applications for employment come in to CHS each year
patient encounters occur at CHS annually
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the organization and its employees benefiting from what is being offered, has helped CHS’s HR department to move well beyond its administrative roots and become a business partner. The professional development offered is a way of involving the organization’s workforce in its long-term strategy. With passionate and capable people happily moving up the chain, CHS benefits from their talents. Part of being a lifelong educator is being a lifelong learner—something Plousha Moore readily identifies as. The CHRO says that part of being not just an effective HR leader but a successful one is having your finger on the pulse of all the industries that impact yours. For Plousha Moore, this means staying on top of what’s going on culturally, educationally, and technologically. Staying relevant, she says, is a way of keeping the organization relevant. “Pushing to remain cutting edge also means questioning traditions or the way you’ve historically done things,” she explains. “Change is hard and it’s scary, but unless you keep shifting and moving—not just for the sake of staying relevant, but to advance the organization forward and meet its strategic goals—you’re going to fall behind. And that’s not good for the organization, its workforce, or patients.” According to a 2008 survey report by the Society for Human Resource Management, the top five critical HR functional areas that contribute to organizations’ current business strategies were staffing, employment, recruitment, training and development, and employee benefits—and in the eight years since, a lot has changed. HR is quickly becoming a strategic business partner, and Plousha Moore is ready to push HR even harder and further. “I’m ready for HR to lead conversations,” she says. “The relationship between the employer and employee has shifted, and I want HR professionals to be able to shift with these changes. I want them to feel comfortable in their personal development and about expressing opinions regarding the workforce and workplace. I want HR to inform decisions and be seen and consulted with as an expert. This is how HR will continue to be relevant.” AHL
“It really comes down to creating trust.” Garrick Stoldt discusses his journey from public accounting to healthcare finance, and how the change not only affected how he approaches his work but also how he’s grown as a leader As told to Peter Fabris Garrick Stoldt of Saint Peter’s Healthcare System has learned some valuable and sometimes painful lessons in his thirty-six-year career as a healthcare financial professional. Over the years, he has altered his management approach from focusing on short-term results to taking a long view of employee development to build a loyal, highly capable team. While some of the work at his previous employer, a public accounting firm, mirrors his responsibilities at Saint Peter’s, the two roles differ in some striking ways. AHL recently spoke with Stoldt about the similarities and differences in the two environments and how he overcame some weaknesses as a manager. Here’s what he told us.
Garrick J. Stoldt TITLE
AHL APR.MAY.JUN 2016
Chief Financial Officer
Saint Peter’s Healthcare System
THEN In public accounting, I had teams for separate projects. Staff rotated out regularly. I might have worked with someone for a few months and then not see them again for six months. I was not very good at getting people committed to working for me. I was considered something of a slave driver. My focus was on getting things done on time or early. That sometimes made it difficult to persuade good people to work on my team. Other managers were also trying to have those same people assigned to their teams. There were other people in the firm that staff would gravitate to, and I couldn’t understand why. I assumed that everybody on the staff had as much knowledge in the subject matter as me. That was a bad assumption. People in professional life hate to announce their deficiencies, so they were afraid to tell me when they needed help. I should have inquired more about their experience and worked with them to improve where they were lacking. I used to be oblivious to people’s personal issues. It wasn’t something that I thought I should spend time on. I
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“I abhor the idea of anybody considering themselves an expert. There is always something you don’t know.”
AHL APR.MAY.JUN 2016
realized later that a manager needs to be more concerned with those issues. I went to a Jesuit high school where I learned about the concept of introspection. Years later, I read about the Jesuits and how they changed radically from the 1600s to today through introspection. So I adopted that concept in my own life and career.
NOW I changed how I approach managing people. I have a dedicated staff that works with me every day, and I work to establish trust between staff and me. I want people to feel comfortable coming to me with problems. With new regulations and marketplace trends changing often, I assess everybody’s abilities and when we might need outside help. I get to that much earlier in the process than I did before. What it really comes down to is creating trust between staff and me. I used to focus on leveraging my staff ’s strengths and not working on their weaknesses. I used to consider that a waste of time. I found out that if you help staff where they are deficient, you can accomplish your goals faster—maybe not in the short term but in the long run. I don’t think people can bifurcate home and work issues. If they want to go to their kid’s little-league game and work at night to make up for it, then I am okay with that. If you make it easier for people to handle their personal issues, that adds a big element of trust.
PROJECT MANAGEMENT THEN I managed a number of auditing and consulting projects, primarily for hospitals. I remember one project for a substance-abuse facility in Connecticut that was considering a sale. I had to do a projection on it. I remember pulling together all the people working on the project at certain times to assess where we were. We also needed outside support for certain technical elements and information we didn’t have readily available in the firm. I stayed very close to the selection process. NOW Today I would assign that selection process to someone else. I also send people out to seminars now to enlist information. I didn’t do that back then, and we probably should have. Training is a bigger piece of the process now.
HIRING PHILOSOPHY THEN I used to focus pretty much exclusively on skills when hiring. Technical skills meant everything when I made hiring decisions. NOW Today, when I hire, I value communication ability as much as technical skills. I’ve interviewed people with great technical skills and terrible communication skills, and I won’t hire them. All of us in different departments—reimbursement, the admitting office, medical records—have to deal with the government and managed-care companies. Each department has interrelated issues. We need people with good communications skills to get the word out on things so that we can start addressing them as quickly as possible.
SOLICITING STAFF INPUT THEN I had a very top-down, command-and-control approach to problem solving. NOW I abhor the idea of anybody considering themselves an expert. In the healthcare field, there is always something you don’t know. If you put five people in a room strategizing over an issue, nine times out of ten you’ll get a better result than if an individual does it. Someone brings something to the table that you hadn’t thought of that can be very helpful. Sometimes it can be your least-experienced person bringing a fresh set of eyes that provides valuable insight. AHL
Bringing an HR Department Back to Health By focusing on three key areas, Susi Takeuchi transformed her department at UC Irvine Medical Center from a low-functioning arm of the organization to a valuable, strategic partner When Susi Takeuchi took the reins of the human resources department at the University of California, Irvine Medical Center three years ago, the organization was in the process of going through major changes under new leadership. There was almost an entirely new C-suite and a new focus for the organization. However, the HR department was still working with the old model. “The department wasn’t going in the direction that was leading the rest of the organization,” Takeuchi says. Not surprisingly, the department was not well respected within the medical center. “I polled our internal clients to find out the reputation of the HR department,” Takeuchi says. “I got a consistent answer of, ‘HR doesn’t care what we want; they tell us what they’re going to do, and if we don’t like it, too bad.’” When she asked her clients to rate HR on a scale from one to ten, the average was 3.7. She realized that there was some major work to do.
By Kathryn Silverstein
ENGAGING EMPLOYEES THE CHALLENGE
With the task of making the human resources department a valuable and important piece of the medical center, Takeuchi was faced with changing a culture of apathy. “When I got here, HR was very compliance- and administrative-focused,” she says, “and missing opportunities to be more strategic in managing the talent and culture of this organization.” THE SOLUTION
One of the first things Takeuchi did was to put a strategic plan in place that the department worked on as a team. Every single work group within HR went through a transformation. Instead of just focusing on compliance and administrative tasks, she reframed the department as a client-focused, strategic partner that provides consultation to achieve the broader goals of the organization. A great example of that transformation was in the area of talent acquisition. In the old model, HR just directed prospective employees to the employment website and passed résumés to the hiring managers. The new HR department actively sources and prescreens new talent, understands the needs of the department, and works with the hiring manager to identify key qualities and areas of expertise needed to fill specific roles. “All this consulting wasn’t happening before,” Takeuchi says. THE OUTCOME
Since implementing a new framework and focus for the HR department, Takeuchi’s team experienced an 80 percent turnover in staff with a fresh, client-focused outlook. This past year, she polled the organization to find out how effective they rated the HR department, and the result was a nine out of ten. “We’re all on the same page now,” Takeuchi affirms.
coursework. “We wanted to shift the attitude around training courses from just something they had to complete for a requirement to a valuable lesson that could be directly applied on the job,” Takeuchi says. Doing so helped to make the most out of the new learning programs offered for employees. THE OUTCOME
The leadership development plans have helped human resources to prioritize its training and development efforts to make sure it is investing in the right people to lead the organization. It also sets a clear path for those in training to take on leadership roles. “I would love to see a pipeline of leaders sitting on the bench ready to move into jobs,” says Takeuchi, who sees the broader goal just a step ahead. “I feel like we’ve got the foundation laid. Ultimately, when you have a leader in place who can train a talented successor, it creates a positive impact because there are no holes in the leadership of the organization.” NAME
HR AS STRATEGIC PARTNER
Susi Takeuchi TITLE
Chief Human Resources Officer
The biggest hurdle that Takeuchi faced when she entered her position at UC Irvine was fundamentally changing the purpose of the HR department, from being “paper pushers” and “order fillers” to an integral part of advancing the mission of the medical center.
UC Irvine, UCLA
“One of the key things we’ve done is aligning people in HR specifically with client groups so that they have a person they can turn to as their internal HR business partner,” Takeuchi says. She explained the new structure to internal CREATING LEADERSHIP OPPORTUNITIES clients, aptly, in medical terms. Think of your HR business partner as your primary-care physician, she told them. THE CHALLENGE Either they can consult with you on finding HR solutions When Takeuchi entered the organization, there was no real to your business issues or refer you to an HR subject-matleadership program or succession planning in place for ter expert who can. employees. This made it hard for leaders to feel they had Each client’s assigned HR business partner started to a future beyond their current role and to understand their attend their meetings to better understand their business, trajectory within the organization, ultimately impacting in order to advise and support their clients. That laid the employee retention and engagement. foundation of HR being a strategic partner that could help each assigned department reach its business objectives.
AHL APR.MAY.JUN 2016
Takeuchi started at the director level to assess leadership talent. She put into place a nine-box assessment for the C-suite to evaluate where their directors stood in relation to their performance and potential. “This helped us understand who the really high-performing and high-potential people were and how to create a development plan to nurture them as leaders,” Takeuchi says. Next year, the organization is rolling out the plan at the manager level. In tandem with the nine-box assessment, development dialogues with directors are occurring around the “70/20/10” model. The model is based on the idea that 70 percent of one’s development and career advancement experience comes from learning on the job, 20 percent from observation and coaching, and 10 percent from
“I know from experience that HR is the group that can really help an organization be successful,” Takeuchi says, noting that they are now able to fulfill that role by providing guidance to their 4,700 supported employees. “Right now we’re feeling really good,” Takeuchi says of the mood in the HR department. “I asked every HR employee to rate us between one and ten. We rate ourselves a 7.6. I love that our clients rate us a nine out of ten, but I’m glad we rated ourselves lower—because we know we have room to grow.” AHL Editor’s Note: At time of press, Susi Takeuchi accepted a new position at UCLA.
I’ll look forward to the night shift. SM
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5 Questions for your VP of Business Development
AHL APR.MAY.JUN 2016
Growing by nearly 250 percent over a three-year period, Avella Specialty Pharmacy recently found itself listed on the Inc. 5000. Helping to harness that growth is Leslie Yendro, who here shares five key questions that she—and all business development executives in healthcare—needs to consistently ask and answer to stay ahead.
By Maura Keller | Photo by Caleb Fox
Leslie Yendro TITLE
Vice President of Business Development ORGANIZATION
Avella Specialty Pharmacy
HOW DOES BUSINESS DEVELOPMENT SUPPORT THE OVERALL STRATEGY OF THE ORGANIZATION? First of all, an organization needs to develop a strategy. Once the company settles on a strategy, business development is one of the key components to secure the tools to advance that strategy. In Yendro’s role, within specialty pharmacy, that means securing access to limited-distribution drugs within their target disease classes, negotiating viable contracts, and ensuring that Avella meets or exceeds the metrics the company sets for performance within their agreements. “Business development is also responsible for looking into the future to make recommendations on areas for growth that the organization may want to consider,” Yendro says. “You can do a wide variety of things that you feel your customers want, or you can focus on doing the things they actually need better than anyone else. That is what I try to do in my role—constantly keep us focused on what is important to our customers and will drive the most value for Avella.”
AHL APR.MAY.JUN 2016
ARE YOUR CONTRACTING STRATEGIES COMPLIANT WITH GOVERNMENT REGULATIONS?
Companies need to focus on meeting government regulations throughout all facets of their business. Yendro works to ensure that the enhanced services Avella contracts for are within established fair-market-value parameters. “I always joke that I am a lawyer by osmosis because I have absorbed so much knowledge handling contracts in various capacities,” Yendro says. “At Avella, I work with our inside counsel as well as outside counsel in regulatory matters to ensure our contracts are in compliance with established regulatory guidelines. This is important because the fines and penalties by the state and federal government would be detrimental to our business.” In fact, Yendro has rejected contracts that may have paid Avella more revenue, but that could be seen as noncompliant with regulations. “Many regulations are left for interpretation, and although we may be conservative in this interpretation, I feel it is important to protect not only Avella but also our customers,” Yendro says. “It is important that Avella has a strong reputation of doing things the ‘right way.’ Ultimately, that helps our business grow because customers choose to partner with us, knowing that we have their best interest in mind as well as our own.”
HOW DO YOU ENHANCE THE EFFECTIVENESS OF OUR CUSTOMER RELATIONSHIPS?
Effective customer relationships—or lack thereof—can make or break a company. It’s a notion that Yendro doesn’t take lightly. “Specialty pharmacy is a very competitive market,” she says. “Customers still have a great deal of choice in who they partner with.” Yendro’s role is to help Avella go beyond basic drug dispensing and to differentiate Avella as a best-in-class specialty pharmacy partner. To ensure the effectiveness of the company’s customer relationships, Yendro asks key questions such as, “How can I assist the brand manager in making strategic decisions for their product? How can we partner with small start-up biotech companies to stretch their resources and feel important among other larger companies in the launch phase and beyond? How can we utilize innovative technology to enhance the end user with various complex therapies?” “Business development is the front line to the pharma manufacturer relationship,” she says, “and my goal is to have them see us as a partner invested in their success.” She also tries to make sure customers understand Avella’s business. “We need to be transparent with them about what we can do—and what it costs to do it—so that we can structure agreements that meet the needs of both partners,” Yendro says. “I don’t want to promise something up front only to determine we do not have the infrastructure to support it at the cost we agreed upon. It takes a long time to build a positive relationship but a very short time to lose it.”
“Human interactions are still the best way to gain information and develop relationships that endure.”
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When Yendro was a district manager at a pharmaceutical company, each month she would receive a large box with pages of sales reports for her sales territories. “They were two months delayed in the data, so by the time they got to me, they were somewhat irrelevant,” Yendro says. “But it was all I had, so I would sit and pore through them to try to extract trends.” As Yendro points out, today’s business environment is changing so rapidly that it is vital to keep up on new information in real time—making the above box of data seem archaic. Today Yendro is fortunate to have various pipeline analysis tools to help identify new agents to target as well as help forecast what Avella’s potential financial exposure could be. “Our pharmacy operating systems and data-collection portals continue to be enhanced, which allows my team to provide in-depth quarterly business reviews that go beyond volume reporting, [showing] what trends in payers or adherence rates are impacting the drug,” Yendro says. “Even with all the technology available to us, I still place value on a face-to-face meeting with my team and our customers. Human interactions are still the best way to gain information, understand the underlying needs of an organization, and develop relationships that endure.”
Armada is a Congratulations proud supporter of Avella Specialty Pharmacy and the entire Avella Specialty Pharmacy Team
We salute Leslie Yendro
for setting the standard of
extraordinary patient care to those in need. Robert Irene
AHL APR.MAY.JUN 2016
President Armada Health Care
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WHAT IMPORTANT EVENTS OR CHANGES SHOULD WE BE ANTICIPATING IN THE NEXT ONE TO THREE YEARS? With the rapidly changing dynamic in healthcare, an organization must not only evolve but must anticipate changes well ahead of time in order to adequately prepare. “For example, the recent move from ICD-9 to ICD-10 codes impacts reimbursement but also impacts our data reporting to manufacturers,” Yendro says. “These are changes you cannot make overnight. Forward-looking pipeline analysis is also important. While we can gain access to various drugs, I have to assess if our organization has the necessary infrastructure to adequately support it as well as have a positive overall margin.” The professional development of Yendro’s team is an important future plan. As such, Yendro asks herself how she can develop her account managers to obtain new skills to enhance their effectiveness with their assigned accounts, or take on larger roles within Avella. “I am also constantly trying to find areas that I could improve my knowledge and seeking ways to gain that,” Yendro says. “I am fortunate that I work with a very talented group of people that challenge me to think differently and look at things from various angles.” AHL
A Healthy Variety From risk management to medical-staff services, Roben Nutter wears multiple hats for East Alabama Medical Center (EAMC). Here she speaks about spearheading risk-compliance activities and how she played a key role in the institution’s first major acquisition.
By Peter Fabris As EAMC’s sole in-house attorney, what day-to-day issues are the most pressing for you? Roben Nutter: Compliance and regulatory issues take up most of my time. There are a lot of regulatory pressures in the healthcare environment right now. There’s a lot of regulatory focus by the government and RAC auditors who are looking for various ways to recoup payments. I serve as compliance officer for the whole organization. There are also, of course, general legal issues. I’m spending time providing guidance, researching, and working with outside counsel, as well as on contract reviews and transactional issues.
I think we have an advantage being a small organization to get on top of issues like that quickly and to intervene sometimes; whereas if I wasn’t readily available, then maybe people would make certain decisions that I would have advised against them making. What about the disadvantages?
RN: Some disadvantages are balancing available resources, being the only attorney, and juggling many different duties and responsibilities. And it’s a challenge in the healthcare environment generally—not just at EAMC. I’ve got a great team of people, and I rely on them heavily. I also rely on outside counsel fairly extensively, and I couldn’t do my job What are the advantages of working for a small, without them. regional healthcare system? Outside counsel was essential to one of your key RN: We have about 3,000 employees in our system. I’m accomplishments—guiding the legal process of a located in the main hospital facility, and I’m very accessi- major acquisition. What were your major challenges ble. People know who I am. They see my face and the faces in EAMC’s acquisition of Lanier Memorial Hospital? of other administrators, including our CEO, who is walking the halls every day. That probably translates into a comfort RN: That was a huge transaction from a legal perspective. level in discussing issues, raising issues. There may be a It’s biggest thing that I’ve worked on over the past few little bit more of a family feel as compared to much larger years. We weren’t looking to acquire anybody; we were organizations. People are free to come by, talk to me, and approached by representatives of that hospital in October raise questions. So I feel like I have a lot of access and 2013. We closed the deal in a relatively short time frame. knowledge about what’s happening in the organization. It was completed on February 1, 2014. Yesterday I received calls from our security department. Our CEO had talked about this abstractly. If the opporA person came in [claiming] that she was pregnant. When tunity ever came up, he’d be interested in an acquisition. she was taken to our delivery unit and staff began examin- We talked through some of the issues around that and ing her, they found that she was not pregnant. When the whether we thought that would be good for our organizastaff realized that, it raised a lot of alarms and potential tion. So when the opportunity came up, we were able to issues. They had questions for me about how far we can move quickly. go in our questioning of her. Can we call law enforcement The financial state of that hospital was one of the biggest officials? What is our responsibility here? What can we do issues for EAMC to consider. Did we think we could turn given the constraints around HIPAA? it around? From a legal perspective, the biggest issue was
Roben Nutter TITLE
General Counsel & Corporate Compliance Officer
East Alabama Medical Center
“I think we have an advantage being a small organization to get on top of issues quickly and to intervene sometimes.” assuming the liabilities of that facility. The due diligence period was so important, to make sure that we tried to uncover everything that we could that might be out there. We used a firm—Maynard Cooper & Gale, out of Birmingham—that we had a long-term relationship with. They were essential to the success of the deal. How has the Affordable Care Act impacted your work?
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RN: One of the ways it impacts me the most involves increased auditing and the government’s attempts to recover funds for things that they might consider fraudulent or in error. Across the country, we’re seeing increased pressure for billing compliance. There are so many regulations surrounding billing for Medicare, Medicaid, and commercial insurance carriers, and it’s hard to stay on top of all the new rules and regulations that seem to surface daily. The Recovery Audit Contractors are making sweeping record requests, looking for opportunities to see if something was billed incorrectly so they can recover those funds. The system became so backlogged with appeals that the administrative law judges who worked for the Centers for Medicare & Medicaid Services (CMS) got so far behind that it was taking years to get appeals resolved. CMS is making changes that we all hope will improve the process. There’s been a moratorium, especially as it relates to medical necessity of inpatient stays—that’s the real big one—where they were denying payment for visits to the hospital when the physician said an inpatient stay was necessary. Before the moratorium, a lot of my time and my staff’s time was spent on hearings before administrative-law judges, defending with the attending physician or physician reviewers that a denied payment was appropriate. AHL
Better Pharma, Better Launch Faced with the task of promoting Cempra’s new products, Sebby Borriello is helping the young pharmaceutical company enter the market in the right way
By Keith Loria
AHL APR.MAY.JUN 2016
Vice President of Marketing Development ORGANIZATION
ebby Borriello knew early on that he wanted to be in a profession that would help people; he even knew that it would come from commercial-business side, not anything to do with medical school. “I wanted to be on the business end and the pharmaceutical or medical-device areas, which would fulfill that piece of bringing a product to market, selling a product, or marketing a product that would eventually help people get better, no matter what their ailments would be,” he says. When Borriello joined the small but up-and-coming Cempra Inc. as its vice president of market development in 2014, he was immediately tasked with helping to launch two new antibiotics that the young pharmaceutical company was in the process of developing. “The first product that we are aiming to bring to market is Solithromycin, which is for community-acquired pneumonia, targeting the antimicrobial resistance, and safety issues,” he says. “Resistance to antibiotics are big issues, so that’s one of the products that will address some of the resistance issues that are out there today in the marketplace with some antibiotics.” Microbiologist Prabha Fernandes, Cempra’s CEO, developed a compound from a library of compounds that another company had owned. She’s the one who examined the compound from a clinical perspective and from a drug-development perspective, taking it from preclinical through clinical development. The product is currently in phase three. “Phase three [includes] your last trials, when they’re in sick humans,” Borriello says. “If it’s safe and effective and it meets the clinical end points that were laid out in the study—if all goes well—then a company can file what is called a NDA [New Drug Application] and the FDA will review it. And if they deem it appropriate, they will approve it,” Borriello says. “Our IV and oral studies are now complete and ready for NDA. Both trials were safe and effective in treating CABP.” As vice president of market development, Borriello’s
“The biggest lesson I’ve learned in launching new products is that you can never prepare enough.”
EMBRACING DIGITAL IN TAILORING THE HUMAN EXPERIENCE A relentless focus on synthesizing the human insights and technology that lie at the core of crafting meaningful experiences in life sciences.
main responsibility is to ensure the proper preparation of the marketplace, readying it for the launch of each of the new products, meeting with key opinion leaders and top physicians, gaining insight on how to best bring a product to the market, and determining what makes a successful launch. One of Borriello’s strategies for discerning the market’s need for the new products is to answer a few key questions: “What is the market using now for the disease state? Are there some unmet needs in that armamentarium or that disease state with the current therapies that are being used? Does your product fulfill some of that unmet need? That’s sort of what you do for an internal kind of review,” Borriello says. “Then part of the external review is that you conduct a series of advisory boards where we bring in experts across all medical fields, and that includes infectious disease, primary care, pulmonary critical care, PharmD in infectious disease, hospitalists, and emergency-room-medicine physicians, and we show them the product profile.” In those meetings, Borriello, along with members of the Cempra R&D and clinical team, discusses clinical trials that were completed, shows them the products’ safety and efficacy, and picks their brains about what they think about the product and where it fits in the current landscape of pharmaceuticals. Then the conversation zeros in on the advantages it may have, some disadvantages it may have, what the opportunities are, what the strengths and weaknesses are, and what threats will be faced when launched. “We take them really through a SWOT analysis— strengths, weakness, opportunities, and threats—and we let them advise us on what they think of the product,” Borriello says. “It’s totally gaining insight from future potential users of the product, and it helps us start to formulate what it is that we need to communicate so that the medical community understands exactly what the product does and does not do.” Building relationships with all the key medical societies is also part of his responsibility, making sure that the company secures exhibit spaces at all the big medical conferences. “I’m also tasked with developing educational programs for when the product is launched, programs where we can get physicians together to educate them on the product, its safety, the efficacy, the clinical data that’s been published with them, and to create an atmosphere where people get educated and have the ability to also ask questions,” he says. Over Borriello’s twenty-seven-year career—seventeen of which he has spent in the pharmaceutical arena—he has successfully launched more than twenty-five products. But that extensive know-how doesn’t come without some hard-won knowledge and experience. “The biggest lesson I’ve learned in launching new products is that you can never prepare enough,” he says. “I think one of the lessons we’ve learned is that once you think you’ve done all the premarket launch activities, there’s always something that comes up that’s unforeseen. I think the lesson learned is you’ve got to be able to either solve or react to that unknown that may pop up.” AHL
The People Professional Cindy Essl approaches her work in a different manner—taking HR beyond mere operations and into the wellness component of East Texas Medical Center’s EMS division
By Keith Loria
AHL APR.MAY.JUN 2016
hances are, if you’re in need of emergency medical care in the vicinity of Tyler, Texas, Cindy Essl will be one of the people who help save your life. To clarify, Essl isn’t a doctor, and she certainly won’t be dolling out the emergency care herself, but as director of human resources at East Texas Medical Center (ETMC) for the past seven years, she has been responsible for hiring the best people for the ETMC’s hospital-based ambulance service (EMS), and she takes her job very seriously. “What I like about my job is that I can make a difference in someone’s life,” Essl says. “If an employee comes in and I talk with them about their problems and concerns, I think it makes me a better person and lets me appreciate my life and how blessed I am.” EMS is one of the largest rural not-for-profit ambulance service in all of Texas, offering both ground and air support. It has a staff of highly trained emergency support and was accredited with ACE (Accredited Center of Excellence) and CAAS (Commission on Accreditation of Ambulance Services) as a mobile ICU provider. Essl’s day-to-day responsibilities involve employee relations, handling everything from training management to investigating harassment. She also works closely in the payroll and compensation department, dealing with a wide variety of different shifts and hours that the EMTs and paramedics work. “A great deal of what I do is administrative,” she says. “I may answer questions on benefits, work-related injuries, or talk to employees about problems and issues that may arise.” A big part of her job is to provide support and be there for all employees, ensuring they are aware of the medical center’s employee-assistance program and working with them when they might have a difficult call or are having
trouble processing what happened. “We have a pretty close-knit organization,” Essl says. “There are times when employees may not process a call with the assistance they need and then later in their lives they are affected by it, so working with them to assure they receive the care they need is probably my main thing. Getting them the help they need helps them be successful in the end, too.” Another chief part of the job involves recruitment, which isn’t an easy task since EMS must fight for experienced applicants. To help her, Essl has a retired military recruiter on staff, who is responsible for approaching the colleges. “Everyone knows him, and he even [helps] people who aren’t EMTs find jobs,” she says. “He attacks all nearby colleges, and uses social media to find qualified applicants.” A selling point in working for ETMC’s EMS is that it offers certification and recertification through its education department. This streamlines the process, even though turnovers are still to be expected. When new hires come in, it’s up to Essl and her staff to make sure everyone understands everything and it’s a smooth transition. “Most of our orientation revolves around education,” says Essl. “Our general manager discusses the history and how we came to where we are today. We have outlined the things we feel are important and the protocols for making them successful. EMTs will do several ride-outs with a field-training officer, while paramedic training is a little longer. At the end of all classes, everyone will understand what Dr. Moore, our medical director, expects of them.” Yet the biggest challenge that Essl faces is with the constant change of the healthcare industry and how to properly align ETMC with the new regulations and what’s expected to be filed to the IRS. But overcoming challenges is just part of the job. Over her years at ETMC, Essl has helped to institute a new timekeeping system using a finger-scan system and the
Cindy Essl TITLE
Director of Human Resources ORGANIZATION
East Texas Medical Center
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same job codes as the hospital itself, which has helped the department run more smoothly. Although she admits setting goals isn’t her greatest strength, looking ahead, Essl plans to maintain an effective relationship with ETMC, making sure all is compliant with the Affordable Care Act, and to make her department more integrative with the hospital’s overarching vision. “This position fell into my lap, and I feel like I’m doing God’s work,” she says. “I’m doing something I love, and anytime I can assist our employees with their concerns, either personal or business-related, I feel a great accomplishment, and I couldn’t imagine anything better.” AHL
Photo by Spectre Images
“Most of our orientation revolves around education.”
• medical records clerks • billing clerks, • medical front office, • admitting • administrative support • human resources professionals
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THE UNITED STATES IS FACING A DEADLY
EPIDEMIC: 24 MILLION PEOPLE SUFFER
ABUSE ADDICTION ON A DAILY BASIS.
BUT THE MEDICAL COMMUNITY
HASN’T GIVEN IT THE TREATMENT IT
EVERYWHERE. DESERVES. AND THE DISEASE HAS BECOME
MISALIGNED IN THE MIND-SETS OF THE
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GOVERNMENT AND THE MEDIA. UNTIL NOW.
ASAM’S PENNY MILLS IS CHANGING THE WAY WE THINK. BY KATHRYN SILVERSTEIN | PHOTOS BY CALEB FOX
Penny Mills TITLE
Chief Executive Officer & Executive Vice President AHLMAGAZINE.COM
American Society of Addiction Medicine
THREE HUNDRED AND FIFTY PEOPLE DIE FROM ADDICTION-RELATED ISSUES EVERY DAY*. IT’S NOT A STAT THAT PENNY MILLS, CEO AND EXECUTIVE VP OF THE AMERICAN SOCIETY OF ADDICTION MEDICINE (ASAM),
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*Results from the 2013 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration.
In fact, every time she reads another study pointing at the gap between those seeking help for addiction and the availability of treatment, or an article detailing the complicated and often tragic struggle of addiction sufferers and their families, she adds it to her arsenal in the fight against America’s most significant public health issue. “There are more and more scientific studies showing that addiction is a chronic brain disease, and there are effective treatments for patients,” says Mills. “But we are still dealing with the stigma of both the medical establishment and the public thinking that it’s a problem of will power. As Senator [Daniel] Moynihan said, ‘You’re entitled to your opinion, but you are not entitled to your own facts.’” Addiction is a particularly important topic to Mills, not only professionally, but personally. Her son, who began struggling with depression at the age of ten, started to use marijuana, alcohol, and other substances throughout his adolescence. “It wasn’t until he had moved out of our home and then dropped out of school that he called and said he wanted help,” says Mills, who had been working with ASAM for about six months at that point. Her son didn’t want to consider a residential program, so Mills contacted an ASAM colleague, who evaluated him and got him admitted to an intensive outpatient program. “The treatment changed his relationship with using, and he recognizes that while it may have been fun to use, it wasn’t getting him anywhere,” she says. Today Mills’s son gets “wicked” high from fishing and is an award-winning barista. With that personal connection in mind, Mills works tirelessly with her members and multiple stakeholders in the government, in healthcare, and in the media, to ensure that patients suffering from addiction have reliable access to quality treatment. To accomplish this, ASAM’s plan is threefold: improve education for pro-
viders and specialists, create quality standards of care for addiction treatment, and ensure that treatments are covered by insurance and accessible for those seeking help. “There are simply not enough trained providers,” Mills says, though the reasons behind that are quite complicated. Nurses and doctors don’t regularly learn about how to deal with and recognize addiction in their training. Additionally, those who might encounter patients battling addiction during an emergency-room rotation often don’t want to be involved with those patients because they see it as a fault of the patient instead of an actual medical issue. Another barrier to training professionals appropriately is that addiction medicine has not historically been recognized as a medical specialty, which has made it hard for physicians to get paid. In addition, payers only recently have been required to cover addiction benefits “at parity” with medical benefits, creating additional barriers to adequate compensation for treatment. All these issues are stacked against training enough providers to effectively manage America’s drug epidemic. To battle the problem, ASAM has launched a major education initiative—The Fundamentals of Addiction Medicine—to ensure that providers are better trained to understand and treat addiction patients. The initiative has included developing a curriculum that is delivered through a live course, online trainings, and a collaboration with a telehealth learning program called Project ECHO. “Training to improve the confidence and skills of primary-care physicians, nurses, and other health professionals who may encounter patients with addiction is important, since one out of five Americans have faced an addiction problem at least once in their lifetime,” Mills says.
“I want every parent, spouse, and family member to know who to call when their friend or family member is ready for treatment—and that when they are ready, they have access to quality care. That personal experience drives me every day.”
In addition, ASAM spun off another organization, the American Board of Addiction Medicine (ABAM), to spearhead an initiative to see that addiction medicine is recognized as a medical specialty by the American Board of Medical Specialties (ABMS)—so that physicians who want to become addiction specialists will be recognized by health insurers, Medicaid, and other payers. ABAM is collaborating with the American Board of Preventive Medicine to include addiction medicine under the organization’s umbrella. “More academic medical centers are opening up to train doctors in addiction medicine,” Mills says. “Right now, it’s mostly privately funded, but we hope to see that change once it is officially recognized by ABMS.” ASAM has also created national treatment guidelines on medications to treat addiction involving opioid use. These guidelines signify the first time all of the available medications have been addressed together in a single document, with additional focus on special populations such as pregnant women and adolescents. ASAM is also the leader in the development of patient placement criteria, also known as The ASAM Criteria, helping to match a patient’s severity to the appropriate treatment. “Research has validated that treatment at the wrong level of care can result in worse outcomes,” Mills says. “That’s why nationally recognized criteria are critical to ensure patients are getting the treatment they need in order to get better.” The ASAM Criteria is required in more than 25 states for payment for publicly funded care, and many private payers use them as well. ASAM has also created an electronic version of The ASAM Criteria, which is being incorporated into electronic health records and will take the guidelines one step further to becoming a national standard. ASAM has also moved into the area of performance measures for the care delivered by addiction specialists so that treatments can be recognized and covered by payers such as Medicare and Medicaid. Mills is starting to see the impact of her work pay off, as illustrated by a huge growth in educational activities and increased annual-conference attendance. Patients generally have little information to go on when they are evaluating treatment options. ASAM wants to ensure that people seeking help for addiction have a way to identify quality treatment. Other specialties, like diabetes care, offer guidelines and ratings for patients seeking help, and Mills is working on an initiative to create the same resources for addiction patients. Another issue ASAM is tackling is the limited access to effective treatments to treat addiction involving opioid use, since there are significant dosage, access, legal, and regulatory constraints. “In terms of practice issues, some very effective, evidence-based medications for addiction treatment, like buprenorphine, are highly regulated in contrast to the medications that can get patients addicted in the first place. To prescribe this medication, you have to be a certified addiction specialist or complete a mandatory eight-hour training course,” says Mills. “Once these requirements have been met, physicians can only treat thirty patients in their first year and then, if they apply, up to a maximum of 100 patients.”
STAT SHEET Membership has grown from
A Leader in Clinical Diagnostics and Information Advancing Patient Care Through Trusted Diagnostics
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Dominion Diagnostics provides clinical drug monitoring solutions, actionable clinical information and innovative support services to a variety of medical specialties.
At Dominion Diagnostics, we’re committed to ongoing research, discovery and development of diagnostic solutions that advance patient care and improve treatment outcomes.
3,700 under Mills
The number of education activities and programs has quadrupled since
Annual conference attendance has grown more than
in the last four years Net assets have grown from
to more than
since Mills took over as CEO
She notes that there are no limits on the amount of oxycontin prescriptions a doctor can provide, and no specialized training course is needed to prescribe it. ASAM is supporting the TREAT Act, which is cosponsored by Senators Rand Paul and Edward Markey, along with a companion bill on the House side. Secretary of Health and Human Services Sylvia Burwell’s office is also revising the regulations on these prescribing limits, a direct result of ASAM’s advocacy efforts. And yet, with all of that in the works, Mills still finds the time to leverage the media to fight the stigma against addiction patients. ASAM supported a march on Washington, DC, this past fall to raise awareness about the disease of addiction and to build a movement about this pressing public health issue. Her team also uses articles published in respected news outlets detailing the struggle of individuals and their families to get the attention of lawmakers and to change public opinion. “The opioid epidemic is not just in the inner cities anymore,” Mills says. “It’s in the suburbs. It’s in rural areas. It’s in the middle class. It’s in every ethnic group. It’s everywhere.” Battling such problems in America is a monumental task. But under Mills’s leadership, ASAM is doing everything in its power—addressing the media, governmental bodies, healthcare policy, and more—to ensure that it can mount an effective battle on behalf of patients and their families. Fixing the problem begins with addressing the stigma, and Mills won’t rest until it’s been eradicated once and for all. Not just because she’s the leader of ASAM, but because she’s a mother. “I was lucky, as a parent, that I knew who to call,” she says of her own experience. “I want every parent, spouse, and family member to know who to call when their friend or family member is ready for treatment—and that when they are ready, they have access to quality care. That personal experience drives me every day. My son recently said that he feels guilty that his life affected the direction of my career. I told him that his life gives meaning to what I do every day—and I thank him for it.” AHL
Alkermes is a leader in innovative medicines that address the unmet needs and challenges of people living with debilitating diseases—including alcohol and opioid addiction. As a fully integrated global biopharmaceutical company, Alkermes applies its scientific expertise, proprietary technologies, and global resources to develop products that are designed to make a meaningful difference in the way patients manage their disease. Just like Penny Mills, we are committed to bettering the future of patients who suffer from addiction. And her dedication, leadership, and never-ending pursuit of awareness of addiction-related issues are a source of inspiration to our company.
How many Americans has Penny Mills helped? About 24 million. Addiction-related issues affect more than 24 million Americans and claim the lives of 350 each day.1-3 As CEO of the American Society of Addiction Medicine, Penny Mills has dedicated her career to the fight against this significant public health issue and continues to spearhead solutions for patients.
For her commitment, leadership and never-ending pursuit of awareness in this national epidemic, Alkermes is ever grateful. Learn more about Alkermes and addiction medicine at alkermes.com.
References: 1. Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. 2. Fact sheets: alcohol use and your health. Centers for Disease Control and Prevention website. http://www.cdc.gov/alcohol/fact-sheets/ alcohol-use.htm. Updated November 7, 2014. Accessed October 1, 2015. 3. Prescription drug overdose data. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugoverdose/ data/overdose.html. Updated April 30, 2015. Accessed October 1, 2015. ALKERMES is a registered trademark of Alkermes, Inc. ÂŠ2015 Alkermes, Inc. All rights reserved. OT-001264 Printed in the U.S.A.
The Community Commitment A leader in cardiovascular care, The Christ Hospital Health Network takes its role in the greater Cincinnati area seriously. That’s why Chris Bergman ensures there is continuity and consistency throughout the organization’s 181 locations. By Tina Vasquez
or some, it’s difficult to think of hospitals as businesses, but they certainly have to be run that way—and they’re the most complex businesses in the United States. As vice president and CFO of The Christ Hospital Health Network, Chris Bergman has a complex web to oversee: the providers who offer care are sometimes employed by The Christ Hospital and sometimes not, and the consumer is considered the patient, but it can also be the patient’s family. There’s also the tricky question of who pays for the services provided. Sometimes it’s an insurance company, sometimes it’s an employer, and sometimes it’s the government. Add to that complicated regulations, and you have a very interesting business environment, to say the least. Here, in metrics, we examine how The Christ Hospital is making a meaningful difference throughout Greater Cincinnati.
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Vice President & Chief Financial Officer ORGANIZATION
The Christ Hospital Health Network
125 years of service, 1 goal
The industrialist James Gamble would eventually cofound Procter & Gamble Company in 1837, but first he assisted his wife, Elizabeth Ann, in making The Christ Hospital a reality 125 years ago. The initial goal—one that continues today—was to help underserved people. “It has always been about providing access and taking
Celebrating INVESTING IN: OUR EMPLOYEES care of those who need it; it was about compassion,” Bergman says. “That said, I don’t want to downplay how important the research and education component has become. We’re a leader in cardiovascular care. Just to give you the idea of the scope of it, as the region’s leader in heart and vascular care, The Christ Hospital has conducted over 1,200 clinical trials and introduced most of the new techniques in cardiovascular medicine over the past 25 years.”
Among the 6%
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When Bergman first moved to Cincinnati, where The Christ Hospital is based, he would often find himself out with his kids, running errands. When talking to his new community members, the question of what he did for a living would inevitably come up. When Bergman shared he was with The Christ Hospital, time and time again he was met with overwhelming positivity. “That’s the best hospital,” neighbors would say, or, “My father receives excellent treatment for his heart there.” It makes sense when you consider that The Christ Hospital is among only 6 percent of hospitals in the country awarded Magnet recognition for demonstrating the highest-quality patient care, nursing excellence, and innovation in nursing. Bergman says this can truly be attributed to the hospital’s commitment to care, and sometimes it’s about small gestures. “It might sound like a minor thing, but it’s been pointed out to me several times by our patients that our employees will always walk them where they need to go, rather than just pointing in the direction,” he says. “This isn’t something we’ve trained employees to do; it’s simply what they do. Again, it sounds small,
“We have 181 locations because providing access to our patients and their families in their own neighborhoods is incredibly important to us.” but it says so much about the people who work here. They are so caring. We have an extraordinary staff.”
A Top-50 Hospital
For the past sixteen years, The Christ Hospital has been recognized as one of the top fifty hospitals in America by U.S. News & World Report. For nineteen years, it’s also been named “consumer choice” for healthcare in Cincinnati by the National Research Corporation. Given the hospital’s 125-year history, it’s hard for Bergman to pinpoint exactly when the hospital began to develop a reputation for excellence, but its reputation holds a lot of weight in the community, and it’s something that means a great deal to Bergman and that elicits a great deal of pride among the staff. “We’re not The Christ Hospital; we’re The Christ Hospital,” says Bergman with a laugh. “We’ve spent a great deal of time trying to get things right, and we’re always trying to elevate the patient experience. We have a strong Patient and Family Advisory Council that we work with closely, and with the feedback we receive, we’ll evolve our patient-care model to be best in class.”
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Located throughout Greater Cincinnati, The Christ Hospital Health Network’s biggest challenge, Bergman says, is making sure there is continuity and consistency at each clinic location. From a financial perspective, he has to ensure the infrastructure of each location is managed efficiently. “For our patients, efficiency is really important, and so is convenience,” he says. “We have 181 locations because providing access to our patients and their families in their own neighborhoods is incredibly important to us.”
From 1993 to 2008, The Christ Hospital was part of a health system that was formed by the hospital. Bergman says the hospital’s biggest concern was quality, and it was hard to maintain quality in a big, complex system. Since leaving the system in 2008, its revenue has grown by 10 percent each year. The CFO asserts The Christ Hospital is still complex, but the services most central to its patients can now be found at its main hospital. “I have a great foundation for managing all of these complexities,” Bergman says. “I have the support of my wife, I have my faith, and both of those things help me deal with the rigors of the job. As I get older, I understand that life isn’t just about work, but I sincerely enjoy my work, and I want to do the best job possible.” AHL
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The Culture Warrior Dr. Meika Neblett does more than take care of patients. She focuses on enhancing internal systems to ensure that their care is always improving. Here she discusses her priorities as chief medical officer, the importance of cultural awareness in effective healthcare delivery, and her slightly unorthodox path to leadership as a successful African American woman.
By Jeff Silver
Dr. Meika Neblett TITLE
Chief Medical Officer ORGANIZATION
CarePoint Health-Hoboken UMC
When did you decide you wanted to be a physician? Meika Neblett: I’ve never wanted to be anything else. I read medical books when I was young, explained various childhood illnesses to my friends, and once, when I was seven years old, even took care of my mother’s arm that was gushing blood. Nothing too heroic, but it was a pivotal moment to me. Wanting to be a doctor also influenced other decisions I made—I chose to learn Spanish so that I could be a bilingual physician and took a speed-reading class to prepare for medical school. During your residency, you started gravitating toward administration and policy, which isn’t typical for young doctors. How did that come about? MN: In the emergency department, I concentrated on improving process flow rather than just “moving the meat” and getting charts out of the rack without focusing on patient care, quality, and customer service. But to make changes, I needed to be in a leadership position. That meant I needed more training to learn how to be a good administrator, how to earn people’s trust, and how to be an effective leader. I love clinical work but knew that being an administrator was the way to have greater impact and to be able to make meaningful changes in policies and processes. Now that you’re in a position to make changes, what are your priorities?
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MN: There are many, but the top three, in no particular order, are cost containment, quality care, and patient satisfaction. For cost containment, standardization strategies for supplies and equipment are key. Efforts to improve and ensure quality care are ongoing to monitoring length of stay and decrease readmissions. We are actively engaging without outside consultants to maintain and improve patient satisfaction. I perform daily leadership rounds on patients and staff to ensure that I address and solve problems in real time, and ensure that I stay up-to-date on all innovating treatments for our patients.
CarePoint emphasizes 360-degree care. What does that mean from the patient’s point of view? MN: It’s the idea that we can provide comprehensive care, no matter what specialty is needed. We’re located just outside New York City, and many patients think that’s where they have to go for advanced types of treat-
ment. But our system, which combined Bayonne Medical Center, Christ Hospital in Jersey City, and Hoboken University Medical Center, can help them navigate from the ER or a private physician’s office [to] surgery, rehabilitation, cancer care, or orthopedic services, among many others. They don’t have to leave Hudson County. Aside from your administrative and public-health training, were there specific experiences in your medical career that helped prepare you for a leadership position? MN: Howard University College of Medicine, which is a predominately African American school, left an indelible mark on my development. It was an empowering experience to be educated and mentored by such brilliant African American physicians and professors. There were also some less-than-positive experiences that shaped my career. A male supervisor told me that I would never be a successful administrator because I am not a calm, quiet, and passive woman. And once a surgeon asked me to leave her operating room after she found out that I was a Howard Medical School student and not from the elite school she thought I had attended. She felt that she shouldn’t waste her time with me. Those experiences, though, made me even more determined to succeed. My parents instilled in me the idea that, as an African American woman, I’d have to work harder to prove myself every single day, at every stage of my career. It’s just a fact. Did episodes like that make you more sensitive to the role that culture plays in treating patients? MN: Yes. I have practiced in a wide variety of hospital settings and have worked with patients from different backgrounds—from affluent patients to patients from poor neighborhoods, in remote rural areas, large urban cities, and areas that served large immigrant populations, as well as in third-world countries. The challenge is to understand and appreciate the norms and needs of the different cultures so that you can communicate appropriately. That’s crucial to providing effective care. You have to know whether patients prefer direct eye contact, whether or not to shake their hands, whether they like knowing all the medical information or just the basics. In some instances, there were patients who were not comfortable with a black female physician, so I had to prove myself to them. To be effective, we need to make each patient feel special—treat them individually and on their terms.
“The challenge is to understand and appreciate the norms and needs of the different cultures so that you can communicate appropriately. That’s crucial to providing effective care.” Can you describe any system-wide initiatives within CarePoint? MN: Like most organizations, we’re working on many projects to help improve healthcare delivery. We’ve been involved in Medicare’s bundle program, a readmission reduction initiative, and promoting and enhancing new innovations like robotic surgery with the da Vinci and MAKO robots. In connection with the CMS Meaningful Use attestation and using technology to make improvements, we actively focus on encouraging patients to utilize our patient portal so they can have quick access to their medical records. Another initiative that’s unique to CarePoint is an ongoing effort to create a more unified culture between our three institutions that were previously in competition with each other. Old habits are hard to break, but we encourage collaboration through system-wide activities so that former competitors get a chance to work together. Because you’re so passionate about making systemic improvements, do you have an idea of the kind of legacy you want to leave years from now?
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MN: Even though I directly affect the lives of my patients, I’d still like to achieve something that has a lasting impact for generations to come. I know I won’t create a new antibiotic or cure cancer, but I’ll keep striving to achieve something great. AHL
Creating a Better Tomorrow Cindy Peterson is keeping Henry Mayo Newhall Hospital on the cutting edge of technology, ensuring that it’s at the top of its game in providing patients the most effective and efficient services possible By Jeff Silver
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ou may have never heard of Henry Mayo Newhall Hospital (HMNH), but the 238-bed not-for-profit community facility is a model for how new innovations should be implemented in today’s evolving healthcare environment. This is due, in large part, to vice president and chief information officer Cindy Peterson, her information-solutions team, and their processes for launching new technologies. When Peterson arrived in 2001, HMNH’s IT department had a staff of ten, no enterprise-wide architecture or Internet, five interfaces, IBM AS400, two servers for a handful of stand-alone systems, fewer than twenty software applications, and a budget of $1.9 million. Today its operations have grown into a staff of sixty-five (including biomedical, compliance, and a full group of analysts and informaticists), more than 275 interfaces, 286 servers, 1,249 workstations, fully standardized institutional software (including MEDITECH for fully integrated electronic medical records) and a budget of more than $9 million. This growth—and how HMNH achieved it—earned Peterson a spot on Becker’s Hospital Review’s “100 Hospital and Health System CIOs to Know” in 2014. She modestly suggests that being under budget and on time in approximately 95 percent of its technology initiatives might have had something to do with being added to the list. “We’ve been able to achieve that kind of success because of our planning and structured approach to
project management and how we involve all stakeholders from the very beginning,” Peterson says. “That way we aren’t viewed as working on ‘IT projects’ but on operational improvements.” She points out that early engagement means stakeholders are involved from the very beginning in prioritizing and approving projects, as well as allocating funds. Once decisions are made, her technical planning approach then involves executives, department directors, and staff in project implementation. This includes planning, training, go-live, and follow-up analytics that rely on a matrix of specific goals that are used to measure success at six-, eighteen- and thirty-six-month intervals. For example, when the hospital launched its computerized physician order entry (CPOE) system, physicians had helped develop order sets, reviews, and coordination with all medical specialties. Their “ownership” in the project was also supported by technology “red shirts” who were available to provide immediate support, if needed, after the system was launched. As a result, CPOE use grew by 12 percent in the first month and now exceeds 80 percent. Peterson uses a philosophy of “service-enabling clinicians” to identify appropriate new initiatives. “What can we do to save steps, improve work flows, make processes more efficient, and create more time for physicians to spend with patients?”
Cindy Peterson TITLE
Vice President & Chief Information Officer ORGANIZATION
Henry Mayo Newhall Hospital
Cindy Peterson earned a spot on Becker’s Hospital Review’s “100 Hospital and Health System CIOs to Know” in 2014.
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she asks. “First we gain a full understanding of how they’re doing things today; then we look at alternative approaches so they can do them better tomorrow.” This approach was applied to enhancing emergency-department work flows when a new emergency-department management solution was implemented in 2010. Having completed a full assessment of the current work flows—processing and identifying areas needing improvement (such as 4 percent of patients who left the emergency department before being seen)—Peterson and her team decided to implement the new solution and other adjustments (including the logistics of how and where patients are greeted and triaged) in a single phase rather than the vendor’s recommended two. This resulted in improved efficiency and patient experience, including an 80 percent reduction in patient time to triage; a 60 percent reduction in patient time from triage to room; a 63 percent reduction from room to physical exam; and an 83 percent reduction in patients leaving the emergency department without being seen, which resulted in an accompanying $2 million increase in revenue. The single-phase implementation also saved $363,000 in project costs. Peterson oversees a strategic plan that constantly evolves through ongoing interactions with hospital executives, board members, clinicians, vendors, and organizations such as HMMS and CHIME to identify existing challenges and current trends. “It’s all part of our efforts to make sure that whatever is rolled out has a positive impact on overall quality of care,” she says. “After all, that is our mission: to positively impact the care of our patients.” Projects under the current strategic plan include a system for monitoring blood transfusions, a telehealth project, deployment of a smart-device initiative, and a community portal to improve communications between physicians’ office staff, medical groups, and the hospital. Preparation is also under way for the February 2017 launch of MEDITECH 6.16, a totally redesigned platform for EMR management. “The new system is completely rewritten with a new OS fully integrated and requires all new hardware and software, so we can’t maintain any of the old system,” Peterson says. “It’s a ‘big bang’ approach, where everything has to change simultaneously.” She is quick to point out the contributions of HMNH’s IT team to all of the hospital’s past and future successes. “They continue to surpass my expectations every time and deserve all the credit for operationalizing the strategic plan we create,” she says. “I don’t make all this happen on my own.” AHL
The Trajectory to Success AMC Health is at the forefront of disruptive technology in telehealth. Gail Thakarar explains how she and her team are harnessing the potential of its greatest asset—its employees— to spur continued growth.
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y connecting patients with their care teams in real time, AMC Health is transforming healthcare delivery: It is expanding delivery of care beyond the walls of hospitals, doctors’ offices, and outpatient settings. It is moving the patient experience from episodic to continuous monitoring and engagement—providing a 360-degree narrative of the patient’s health that is easily accessible by the provider and extended-care team at any time. Building on more than a decade of experience in telehealth, AMC Health solutions are also being used in pharmaceutical clinical trials to register more patients, improve their engagement and compliance with protocols, and collect more-robust patient data. Chief human resources officer Gail Thakarar uses her experience working with national and international companies to elevate this early-stage company to a global organization. Key to executing this strategy is AMC Health’s greatest asset—its workforce. Prior to
her joining the company, human resources was primarily viewed as administrative support. She quickly sought to change that misconception. Her plan focused on three strategic imperatives for the human resource management—building company culture, attracting and retaining talent, and developing strong teamwork skills. Though telehealth has been adopted by many healthcare organizations for more than a decade, in many ways the market for telehealth is still emerging. In that time, AMC Health has been implementing programs for all types and sizes of healthcare organizations. It knows exactly how to ensure patient compliance and seamless clinical integration. And it embraces the latest disruptive technologies to lead healthcare organizations into the future.
Cultivating an Inclusive Company Culture
Thakarar’s primary goal is to take this early-stage company and elevate it to a global organization. She
Photo by Annie Watson Photography
By Brogan Russell
Gail Thakarar TITLE
Chief Human Resources Officer ORGANIZATION
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says that a key factor in fulfilling this goal is attracting and retaining the right people. Culture plays a pivotal role—more and more talented professionals are looking for a “culture fit” as part of their requirements for joining a company. Thakarar has been working on cultivating company culture that is patient-focused, entrepreneurial, innovative, and inclusive, wherein all employees are assured that their voices are heard. AMC Health’s patient-focused, entrepreneurial, innovative, and inclusive company culture starts with employee engagement—built off a defined organizational structure with clear roles and responsibilities that contribute both to the employee’s and the company’s success. Thakarar took the lead in streamlining this process through various initiatives: a clear organizational structure, specific and appropriate job descriptions, a relevant employee handbook, and additional benefits such as a 401(k) matching plan, competitive bonus plans that support accountability through MBOs, and consistent compliance with state and federal regulations. She also conducted an employee-engagement survey and provided transparent feedback to all employees at a town-hall meeting and was pleasantly surprised at the positive response. She feels confident that all these efforts are paying off. Not stopping there, Thakarar was instrumental in creating an online company portal for direct employee access. The portal is the first thing employees see when they sign on to their computers. Helpful employee information such as employee benefits, payroll, company announcements, and the employee handbook are all accessible through the portal. Employees are also able to see work anniversaries and birthdays. By having direct access to this information, AMC Health reinforces its inclusive company culture, overcoming the challenges of having a mostly remote workforce. “We want everyone to interact and socialize online, if they choose to do so, because we don’t have the proverbial water cooler where conversations usually occur in a typical office,” Thakarar says. “The portal is an excellent tool to communicate with our employees and keep them connected.” It will also be a channel for employees to provide suggestions for improvement and to bring to attention any issues or topics that need to be discussed. “An engaged workforce helps the company keep its focus on the patients it serves,” she adds, “and helps to keep company morale high as well.” In addition, Thakarar has implemented a new onboarding process to enhance assimilation and shorten the learning curve of new employees. She also spends time coaching employees for further advancement and stronger performance, and she listens to employee suggestions to ensure the company continues to stay on track for success. In order to successfully cultivate and maintain the
company’s culture, AMC Health CEO Nesim Bildirici and Thakarar believe employees need to have a stake in the company. Contrary to the norm, Bildirici supports every employee owning a part of the company through stock options granted to all employees at every level. “As owners of the company, our employees are passionate about their work,” says Thakarar. “They want to make a difference and work diligently to ensure the company is successful.” Clear channels of communication and a sense of ownership make for a more supportive environment internally, which ultimately manifests itself in the superior customer service our patients receive. Employees feel like they can make a difference, and they provide patients with excellent care. “They’re passionate about the work,” says Thakarar. “They don’t look at the clock and say, ‘Oh gosh, it’s five o’clock. I have to go.’” Thakarar cited many instances where employees went the extra mile for a patient, though they didn’t have to. “They did it because they cared about the patient and the company,” says Thakarar. “They didn’t expect a reward. They didn’t expect a bonus.” That care ties into owning a stake in the company and, in turn, creates and supports the culture surrounding it.
Hiring the Right People for Growth
Always ahead of the curve, AMC Health is currently developing a disruptive technology platform for telehealth, which enhances connections between patients and care teams. AMC Health hires clinicians, patientand customer-centric service employees, and other talented professionals that play a role in delivering first-class telehealth solutions. A key characteristic that is prevalent among AMC Health employees is the ability to evolve with the company as it grows. Thakarar wants AMC Health to be the employer of choice. She matches the right talent with the right need, and hires them accordingly, always looking to hire for growth and ability. “We have to have a strong business focus on hiring,” she says. “We take a progressive look at how these employees will affect growth three, five, even ten years down the line.” Thakarar views herself as a businessperson first, and her ability to combine a business viewpoint with human-capital management creates an advantage in hiring the right people, who will want to stay with the company for years to come. She created an interview and assessment process specific to critical positions that would be working with the potential hire. Through this process, the applicant gains in-depth knowledge about the company, its culture, and strategic objectives for the short and medium term. Conversely, the hiring team gets to know the potential hire and is able help the new hire succeed more effectively within the company. History has shown that hiring the right people produces results. Over the past decade, AMC Health has
remained successful, mostly due to its employees. This success has resulted in numerous published outcomes in peer-reviewed journals. These outcomes have shown significant improvements in hospital readmissions, blood glucose levels and blood pressure levels, and reductions in costs of care. These accomplishments can only be achieved when you have a talented workforce committed to providing the best-available remote patient monitoring and engagement solutions. And the biggest winner in all this would be the patients that have AMC Health as their partner as they work to improve their health and quality of life.
Creating Clear Channels of Communication & Engagement
A majority of AMC Health employees work remotely. This presents a challenge when trying to foster communication and teamwork. “About 80 percent of our workforce is remote,” says Thakarar. “We have a lot of people at the senior level who work remotely from their homes. This adds to the challenge of ensuring that everyone feels connected and communication remains consistent. Thakarar facilitated a series of initiatives to increase employee engagement. AMC Health has cross-functional teams that prioritize customer programs sometimes constrained with limited resources and that funnel critical information to the leadership team. The company has also instituted weekly senior leadership meetings to discuss company-wide strategy and progress on initiatives, and Thakarar encourages communication downstream to individual teams to ensure consistency across the entire company. This bidirectional communication stream has contributed to both company morale and increased employee productivity. Employee engagement is an essential part of the company’s continued growth and success. Another strategy that has improved employee engagement is the adoption of regular semimonthly town-hall meetings. AMC Health CEO Nesim Bildirici speaks at each of these town halls, sharing the latest developments so that employees know what is happening in the company and any other strategic decisions that affect it. This is another effective channel of communication for employees, especially for those who are remote, providing an accessible venue for dialogue and interaction. Building soft skills through workshops also fosters team building. In order to do that, AMC Health has a blended approach through learner-centered training. It offers interactive, video training, and distance learning opportunities to its employees. As AMC Health continues to evolve to meet the challenges of the emerging telehealth market, it will continue to build its workforce. And Thakarar and her team will continue to harness the potential of its greatest asset, spurring continued growth and success for the company. AHL
Bluff Plantation helps pave the road to recovery. By melding research, education, and a holistic methodology to treat drug and alcohol addiction, Dr. William Jacobs and his team are effecting better results for the patient. By Urmila Ramakrishnan
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Dr. William Jacobs
Medical Director ORGANIZATION
hen one patient first came to Bluff Plantation, he had already tried twelve different treatment centers in the previous nine years. In his mid-twenties, he was taking a slew of psychiatric medications and was unable to stay sober. After he was hospitalized at Georgia Regents University’s (GRU) Medical College of Georgia, a team of psychiatrists minimized his psychiatric medications, and they were able to stabilize him to successfully complete residential treatment at Bluff Plantation. He’s now in transition at the outpatient program in Athens, Georgia, and his family says this is the best he’s ever been. Another patient came to Bluff Plantation as a thirtyyear-old man with psoriatic liver failure. He had been to multiple treatment facilities, and he was denied a liver transplant because he, too, was unable to stay sober. After Bluff Plantation admitted him to a hospital, the staff consulted with a GI specialist (a hepatologist) to maximize his medical therapy for his liver failure. He also had to have knee surgery due to infection. Because of the connections Bluff Plantation has with GRU, it was able to consult an orthopedic surgeon and infections-disease specialist, as well as a gastroenterologist, to aggressively treat these serious medical problems that could have killed him. Today he’s alcohol-free, healthy, and back on the liver-transplant list. These are just two examples of how Bluff Plantation and its medical director, Dr. William Jacobs, make a difference in the addiction treatment community. The facility aims to make addiction treatment more than just abstinence. “It’s not that they just abstain from drugs but that they actually get sober and in recovery for happy, healthy, successful lives,” says Jacobs. That’s why the program incorporates complete medical and psychiatric evaluation and treatment, specialized diets, yoga, and individualized exercise as part of all treatment plans. With its GRU affiliation, Bluff Plantation provides appropriate evaluation and treatment with co-occurring psychiatric and medical illnesses, such as chronic pain. The advantage of the affiliation goes beyond pain management. Say, for example, that a patient has been injecting heroin intravenously and has developed bacterial endocarditis—an infection of the surface of the heart, which can include heart valves. Jacobs can consult a GRU cardiologist with a minimal wait time. Normally, if the patient were to go into a freestanding detox or psychiatric facility, getting that consult as an outpatient can take weeks—and that’s weeks the patient doesn’t have. “I’m at the main teaching hospital for the Medical College of Georgia, where I can call the cardiologist, and they’ll be down the hall seeing my patient that afternoon, making recommendations and starting treatment immediately,” Jacobs says. Such sound practices have helped to facility to expand recently—increasing the number of beds to treat more patients and adding a new program in Savannah, in addition to its locations in Augusta, Atlanta, Athens, and Macon. The goal is to improve the field of addiction medicine and addiction psychiatry. “Our facility at Bluff Plantation is unique,” Jacobs says. “We’re going back to some of the foundations that Betty Ford championed as a layperson for addiction treatment in this country. When she first created the original Betty
William S. Jacobs, MD
“It allows me the three things I love: taking care of patients, advancing addiction medicine knowledge through teaching, and research.” Recovery Begins At Bluff Plantation Spanning 178 beautiful acres in Augusta, Georgia, Bluff Plantation is the most comprehensive residential treatment program on the East Coast for alcohol and drug dependency, dual disorders and pain medication addiction. Led by William S. Jacobs, M.D., a renowned triple board certified physician in Anesthesiology, Pain Medicine and Addiction Medicine, the team at Bluff Plantation utilizes a proven, chronic disease management model to deliver superior outcomes and accelerate recovery.
(844) 529-2596 bluffplantation.com A RiverMend Health Recovery Program
Ford Center, she found a beautiful, secluded location out in the desert in California. We’ve followed the same guidelines for Bluff Plantation.” The south Augusta campus spans more than 170 acres on the Savannah River with private cottages. The lush grounds and services—including five-star chefs—add to the evidence-based treatment by providing a peaceful, healing place to live while patients can focus on their recovery. Bluff Plantation looks at addiction treatment from all angles. It isn’t just treatment centers that see addicts— it’s hospitals, OBGYNs, physicians, nurses. With Jacobs’s experience in academia and the private practice, he is able to combine the two to both educate and improve the addiction medicine community. Bluff’s legal affiliations with parent company RiverMend Health and the Medical College of Georgia at GRU allow Jacobs the best of both worlds. He gets to be in an academic position, teaching addiction medicine as the chief of addiction medicine at GRU, while also treating patients in private practice as the medical director at Bluff Plantation. “It allows me the three things I love: taking care of patients, advancing addiction medicine knowledge through teaching, and research,” says Jacobs. To that end, the organization recently received approval to begin the first-ever clinical trial in addiction at the Medical College of Georgia, and it has created an addiction medicine fellowship program to train more specialists to treat patients suffering from substance-use disorders. The initiatives will help Bluff to continue its emphasis on the need for individualized addiction treatment, which Jacobs says is vital. “I think one of our biggest challenges in the industry is to understand the need to tailor the intensity and length of treatment specifically for each patient,” he says. “It’s like diabetes—there are varying severities of the illness. The more severe your diabetes is, the more intense your treatment needs to be. It’s the same with addiction. There shouldn’t be a one-size-fits-all approach. A lot of the patients that we’re seeing have very severe addictive disorders as well as significant co-occurring psychiatric and medical disorders. They can’t all be treated successfully in a cookie-cutter outpatient approach a couple of hours a day, a few days a week, for a couple of weeks. If you treat them in a residential setting, you can give them more hours of treatment in a single day than they get with a full week in the usual intensive outpatient treatment setting.” And with Jacobs at the helm of Bluff, hope for better treatment is more than just a notion—it has become a reality. AHL
We need to ly ask ours do we align with opera improve th for the orga
constantelves, “How technology tions to e outcomes nization?” INNOVATE
PROGRESS In today’s tech-infused healthcare environment, it’s not the information you collect but what you do with it. Through comprehensive IT components and initiatives in virtual care, DuPage Medical Group is putting data into action.
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By Maura Keller | Photos by Caleb Fox
Krishna Ramachandran TITLE
Chief Administration Officer ORGANIZATION
DuPage Medical Group
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ew words capture the health information-technology sector more than “change.” Anyone with even a casual understanding of health IT recognizes that change is constantly afoot. And within the medical arena, Krishna Ramachandran, chief administration officer at DuPage Medical Group, has embraced technological innovations to solve complex business problems in healthcare to ultimately enhance patient care.
DuPage Medical Group is a 450-doctor group in the western suburbs of Chicago, with approximately $600 million in revenue. The medical group covers more than fifty subspecialties at seventy locations. In his role, Ramachandran oversees most everything that happens outside of the clinical realm—from IT to quality improvement, from case management to coding. In addition, he is the chief administration officer of Midwest Physician Administrative Services, a wholly owned subsidiary of DuPage, where he works with such heavy hitters as the University of Chicago and Northwestern University to provide back-office billing and managed-care services. During the past ten years, technology has dramatically changed how the healthcare industry does business. Technology advancements have driven hospitals and healthcare organizations to reinvent themselves and their internal processes, and DuPage Medical Group is no exception. “The healthcare system is shifting from a ‘fee for service’ to a ‘fee for value’ approach,” Ramachandran says. “We are trying to move from per-service mentality to an approach of ‘how are we taking care of our patients in a broader sense?’” As such, Ramachandran continually uses technology to drive change within DuPage and the healthcare system as a whole. For Ramachandran, some of the biggest technological advancements that provided the stepping-off point for the next phase of advancements came in 2010, when DuPage introduced physician dashboards. These dashboards were created to help measure DuPage’s outcomes so that the medical group can manage change and move from mere data to actual action. Doctors can now use these metrics to determine how they are doing in terms of clinical quality and how they are working with DuPage’s patients. “These are dashboards that provide data so doctors can see how they and their peers are performing,” Ramachandran says. “The dashboard system has been well received by our physicians and staff as a way to communicate transparently about progress. We are using this technology in the new landscape of value-based care, allowing us to show, using metrics, how we are doing in the cost
arena as [it pertains] to readmissions, generic medications, clinical-quality outcomes, or even how accessible we are for our patients for online appointments. They are used to make our performance transparent.” By making use of its data, the problem DuPage is trying to solve is this: 80 percent of healthcare costs that the United States pays for comes from 15 percent of patients, many of whom suffer from multiple complex conditions. “If you can use data to tackle some of these complicated illnesses in patients with multiple conditions, we can use our clinical expertise to get them better,” Ramachandran says. “We will not only enable our patients to lead better lives, but we will have a great opportunity to save the healthcare system a whole lot of money.” Using his technology background in electrical and computer engineering, coupled with an MBA from Northwestern University’s Kellogg School of Management, Ramachandran is able to collaborate with DuPage’s physicians and clinical staff. “The IT components of the systems we are implementing have a lot of touch points throughout much of the organization, so I have to rely on others to also embrace the growing role of technology in healthcare, to make it more efficient and to look at more opportunities,” Ramachandran says. “We need to constantly ask ourselves, ‘How do we align technology with operations to improve the outcomes for the organization?’” As such, Ramachandran is always looking for innovative ways to improve DuPage’s internal processes, resulting in improved, efficient healthcare for patients. For instance, DuPage has recently embraced e-visit technology, whereby patients can use the group’s patient portal, or app on their phone, to be “seen” by a doctor about acute conditions such as cough, colds, fever, etc. Patients can also schedule a video visit with a doctor, who will see a patient through a secure video feed with a secure messaging component. “Virtual care has been a big recent focus at DuPage,” Ramachandran says. “It is a key component of our three pillars: quality, efficiency, and access. E-visits help us be more accessible to our patients. We want to meet our patients where, when, and how they want to be met. It is
â€œWe will not only enable our patients to lead better lives, but we will have a great opportunity to save the healthcare system a whole lot of money.â€? 105
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an efficient way of delivering care to patients with certain conditions. It won’t replace face-to-face clinical care. Rather, we want it to be a partnership between patients, technology, and clinicians.” As part of his goal of staying innovative within the industry, Ramachandran advises a number of healthcare start-ups, who keep him abreast of the problems that the start-up community is trying to solve. Ramachandran recently partnered with one that offered a charge-capture solution for its physicians, who were using paper slips to submit fees when seeing their patients in inpatient hospital settings. “The start-up created an app for us that allows our doctors to open up and drop in the fee for the services they perform on an inpatient basis, which subsequently interfaced to our practice management system,” Ramachandran says. DuPage Medical Group extended its work with this start-up to create a secure texting program that would allow physicians to communicate with each other about patient care when managing cases. “Our doctors began texting each other when comanaging a patient or when they needed to communicate about a specific case,” Ramachandran says. “It was far more efficient than working through each other’s staff to get phone messages to the other person.” However, he adds, although it was a great solution, it was ultimately not secure. So the start-up company was brought back in to devise a secure paging system and secure texting feature within that system. Because the system was similar in construct to the charge-capture application originally designed for DuPage, there was a seamless integration for DuPage’s staff. These initiatives have helped create a culture of innovation throughout DuPage Medical Group—one that Ramachandran is happily taking the reins on as chief administration officer. And it’s a culture that is not looking to stop anytime soon. “I enjoy using technology to drive change,” Ramachandran says. “I’m very passionate about this. I’m eager to see how we can further use technology to help innovate the healthcare system and further improve patient care.” AHL
Medicine’s Social Network Connecting with patients through the latest innovations in telemedicine, patient portals, and more, Dr. Shirish Parikh is creating a twenty-first-century model of care By Urmila Ramakrishnan
Dr. Shirish Parikh TITLE
Founder, Chairman & CEO ORGANIZATION
uses its communication channels so the patient can be seen without coming into the office and is reassured that everything is fine. The last tier deals with people who may not have the time or means, like transportation, to see the doctor. In these cases, the patient can use technologies like the patient portal to securely e-mail their CCP doctor to ask if they should be concerned about a persistent cough. “We’re just trying to utilize every avenue of communication with the patient so that they don’t feel like there’s any abandonment just because they can’t come in to see the provider,” Parikh says. The newest implementation to this is the use of Facebook and other social media platforms to create more direct interaction with patients. In doing so, the company has been able to educate patients and communicate newer services available in the system. “We know that social media is well known and well used, so it was a good avenue for us to immediately provide new information about new services, new doctors, and it provides a face to the company,” Parikh says. “We’re also actively trying to gauge the sentiment and feelings of our patients, so we found that social media is a good way to monitor what’s going on in the community.” Though many of these implementations are still in their infancy stage, Parikh foresees more innovation in telemedicine and sees it as a way to monitor patients’ vitals at any time from anywhere. He believes that having devices attached to a patient’s mobile phone is the future in terms of tracking EKGs in older patients, gauging temperature, or checking their blood pressure. The company also offers concierge services and free exercise programs for overweight adolescents.
Photo by Skip Dickstein
Community Care Physicians, P.C.
Picture this: A patient comes into Community Care Physicians, P.C., presenting symptoms of pneumonia. The physician puts the patient on antibiotics to break the fever and stop their cough. However, a week later that patient sees a rash on his back, and he’s not sure if it’s from the medicine he’s been taking or not. Instead of coming in and paying another copay of forty dollars, the patient uses telemedicine to have a virtual face-time consultation with his physician. He shows the doctor the rash, and the doctor tells the patient to take plenty of fluids and a Benadryl to help with the itch. The doctor tells the patient not to worry, and the patient clicks the screen off to continue with his day. This scenario is just one way in which Dr. Shirish Parikh, chairman and CEO of Community Care Physicians (CCP), is making patient care easier by creating a twenty-first-century model of medicine through technology. The company’s founding philosophy of “deploying technology” has been the impetus for artfully blending technology with traditional care. It was one of the first, in 2005, to embrace enterprise-wide electronic medical records in New York state. Today CCP’s use of technology has improved communication with patients through social media, a patient portal, concierge services, and—soon—telemedicine. “It’s based on what the patients require,” Parikh says. “By establishing a tiered system, you can provide patients options for how to be seen. There are some who want to be seen by the provider, in-person, even if it’s a follow-up for a bout of pneumonia and they’re feeling fine. They’re so anxious, so they want to come in.” The second tier of people are those who might think that cost is a big issue, but they need to be seen and don’t want an in-person visit. That’s when CCP
“I’m a clinician and an administrator. This helps me innovate because I’m in the trenches, so I understand the plight of the providers. I understand the plight of patients.”
Flexibility and adaptability— how does your IT partner measure up?
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Concierge medicine gives patients another outlet to ask questions and help navigate the healthcare landscape, if needed. Free programs, such as the exercise course, are publicly communicated through the offices and patient portals, so patients know they can come in and exercise without any additional cost. These are value-based services that keep them healthy. “It’s very important for us not to treat people because they’re sick but to keep them healthy,” says Parikh. CCP also improves care by implementing a once-amonth new-patient orientation, which tells patients what they can expect from the company. It’s also looking at utilizing telemedicine to better care for snowbirds who go to warmer states in the winter. Patients who go to Florida or Arizona can reach out to their primary-care providers at home, who know them and have access to their medical information. However, incorporating technology in the healthcare space doesn’t come without its share of challenges. The biggest hurdle is working with regulations and oversight. Many insurance companies require prior authorizations for tests, so a patient who needs an MRI can’t get one until there’s enough documentation. Sometimes this can take up to twenty minutes and can be a fairly subjective process. Parikh hopes that better regulation and technology will work to improve the standard healthcare system. “I’m very passionate about creating a system that is physician-patient centric, not hospital centric or insurance-product centric,” says Parikh. “It has always been a passion of mine over the years, and I want to continue [pursuing] that. I’m a clinician and an administrator. This helps me innovate because I’m in the trenches, so I understand the plight of the providers. I understand the plight of patients. Technology is a great solution to help us to continually enhance our product.” AHL
A System of the Heart ReliantHeart is on the cutting edge of mechanical circulatory assist technology, having developed the most advanced Left Ventricle Assist Device in the world. Rodger Ford explains why the HeartAssist5 is so unique and how it’s changing patients’ lives. By Amanda Garcia
What part of heart failure does ReliantHeart specialize in? Rodger Ford: After a patient is diagnosed with heart failure, if the left ventricle isn’t vital enough to pump enough blood into the patient’s body, a system of support comes in called a Left Ventricle Assist Device, which is what we make. And when the left ventricle needs assistance, what do you do?
Rodger Ford TITLE
What else makes it unique? RF: Our competitors know how much power a pump requires and how fast it goes around. But in addition to those two variables, our pump measures the amount of blood going through the pump in real time. We have a patented Doppler flow-measurement probe on the outflow end of the HA5. Because we monitor all three variables
How does all that data get to a place where it can help the patient? RF: Our pump is the only realtime, remotely monitored medical device in the world. The controller is outside the body and works like a cell phone. It collects data from the pump all the time and sends it to a cloud site called VADLink.com. Clinicians visit the site to get realtime data about their patients, and when something goes wrong, they receive text or e-mail alerts so they can intervene quickly. That is amazing. RF: And it gets better—VADLink also tracks INR [the amount of time
Chief Executive Officer
RF: We have this little pump called the HeartAssist5 [HA5]. When the human heart can’t pump enough blood to the body, our pump is inserted into the left ventricle to increase flow. Like the ocean, with every heartbeat the human heart sends a wave of blood through the HA5, providing . . . a continuous flow pump with a natural human heartbeat. The HA5 is a super charger that harmonizes with and works symbiotically with the human heart.
of blood flow, speed, and power all the time, we can triangulate the information to predict and address potential flow problems before they become dangerous. We are the only company that measures the true flow of blood.
“Because we monitor all three variables of blood flow, speed, and power all the time, we can triangulate the information to predict and address potential flow problems before they become dangerous. We are the only company that measures the true flow of blood.”
a patient’s blood takes to coagulate]. Our system tests the INR, records the number, and if it is not between 2.2 and 3.0, it will alert the clinician. The website also monitors the patient’s blood pressure and weight, and it will inform the clinicians of potential heart issues caused by unusual changes in either.
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This all sounds great for doctors, but how does it improve patients’ daily lives?
RF: The patients have the comfort of knowing they are monitored and observed at all times. Also right now there’s a driveline from the pump that leaves the body and goes into a controller. That wire is uncomfortable and can become irritated and infected. It also causes problems if the patient wants to go to the beach or wrestle with his grandson. So our pump, just this year, is being further evolved so it will require only three watts of energy—half the power that it currently requires—so that it will be able to be powered by an internal battery. By the end of [this] year, the pump won’t require the external wire. Instead, there will be a coil inside the body and a coil outside that transfers power into an internal battery that will work for up to six hours at a time on a single charge. That seems like a serious game changer for patients. RF: It is, but it gets even better. By the end of this year, all of our pumps will have forward compatibility to the new technology in process. New patients will have pumps that are upgradable, and in the meantime, if they develop a
driveline infection, the wire can be removed without removing the entire pump. What we’re making today will work with what we make tomorrow—thus forward compatibility. All of this is so innovative, but do you ever feel limited by regulations? RF: You know, the perception of regulators sometimes causes people to be pessimistic. But we shouldn’t do what we do to please regulators; we should do it to get results. At ReliantHeart, we simply work with the system. Good businesses—no matter what the industry—need to begin with good business systems so that people are free to support the customer and innovate [through] technology. It’s my responsibility to create an atmosphere that allows for just that.
Pioneering medical technology
RELIANTHEART’S VENTRICLE ASSIST DEVICE 1. Works in symbiotic harmony with the human heart 2. Monitors actual flow of blood 3. T racks indicators of possible heart failure in real time 4. Sends information and alerts to clinicians via cloud-based software 5. Will soon no longer require an external driveline but will be powered by an internal battery—which means no wires
What advice would you offer others who are trying to build a healthy business system?
DUALIS is an innovative development service provider for medical devices. We offer support to our customers from the idea stage all the way through to certification of tailor-made systems and products. One of our key competencies is the wireless energy and charging technology, MedBase®, used for active implants such as cardiac support systems.
RF: If you’re going to do it, do it right. Be creative, and be curious enough to say, “We can do this.” Create the foundation for success—build it like you’re going to have a thousand more just like it. Make sure the system is so firm that it surpasses expectations. Use the system to trap the chaos, analyze it, turn it into order, and identify exceptions and emerging patterns. And never accept a compromise—ever. AHL
With absolute precision and unmatched know-how, we proudly develop solutions for extraordinary quality of life improvements.
Yarbrough Electronics Sales, Inc. congratulates Rodger Ford for his commitment to high-quality patient care and development of innovative medical technology. For over a decade, we have been proud to be a strategic partner with ReliantHeart and its team of professionals. Rodger, thanks for your vision, leadership, and dedication to success.
DUALIS MedTech GmbH Am Technologiepark 8+10 82229 Seefeld Germany
Visit www.dualis-medtech.de to learn more.
THE VITALS CHRIS BERGMAN, P. 84 Vice President & Chief Financial Officer The Christ Hospital Health Network
CINDY ESSL, P. 74 Director of Human Resources East Texas Medical Center
Bergman was named VP and CFO of The Christ Hospital in 2009 after serving as interim CFO for seven months. He previously worked for Sparrow Health, Centura Health, and as audit senior manager for Ernst & Young. For the past four years, he has been recognized in Becker’s Hospital Review as one of the country’s top CFOs.
Essl worked twenty-four years for Alcatel-Lucent before transitioning to the medical field seven years ago. She celebrated her second wedding anniversary this past September. Her new husband has opened up the world of fishing to her—even taking vacations to go deep-sea fishing in Florida. She also has five grandchildren and calls her time with them “the best times of my life.”
SEBBY BORRIELLO, P. 72 Vice President of Market Development Cempra Inc. After graduating from Saint John’s University, Borriello played professional baseball, having been drafted by the Minnesota Twins in 1981 and playing two years in the minor leagues before inuring his shoulder. He then worked for Ortho-McNeil Pharmaceutical, Ethicon, and Johnson & Johnson Health Care Systems, eventually earning a master’s from the University of Pennsylvania.
AHL APR.MAY.JUN 2016
MIKE BURKE, P. 12 Senior Vice President, Vice Dean & Chief Financial Officer NYU Langone Medical Center
RODGER FORD, P. 109 Chief Executive Officer ReliantHeart Inc. Ford founded two companies and worked as CEO of SynCardia Systems before taking on his current role as CEO of ReliantHeart. His creation of dynamic business systems has fueled his ability to anticipate change throughout his career. Off the clock, he competes nationwide as a world champion rodeo cowboy. MARK JACOBS, P. 35 Chief Information Officer Delaware Health Information Network
In addition to being a New York CPA, Burke is involved in several professional organizations, including the Healthcare Financial Management Association and the Association of American Medical Colleges. He also serves on the provider advisory board of UnitedHealthcare.
Jacobs is the first CIO for DHIN. He has amassed more than thirty years of health IT experience with several leading health systems, including Wellspan Health System, Lancaster Health Alliance, and Wyoming Valley Health System. He holds a master’s in health administration from Wilkes University and has attained the status of CPHIMS.
MICHAEL CAPARSO, P. 24 Cofounder National Healthcare Access Inc.
DR. WILLIAM JACOBS, P. 98 Medical Director Bluff Plantation
Caparso founded National Healthcare Access in 1990 with his older brother, Frank, following jobs in insurance and managed-care contracting. He earned his business degree from Malone University. He is married with two children and one grandchild, and he enjoys golfing and traveling.
Jacobs has worked in the pain- and addiction-medicine fields for more than thirty years. A Georgia native, he wanted to bring his private practice and academic expertise back to the state. He spent five years as an open-wheel race-car driver before pushing the brakes on it.
ELIZABETH CUSHING, P. 32 Vice President of Claims CRICO
NANCY LAKIER, P. 46 Chief Executive Officer & Managing Partner Novia Strategies, Inc.
Cushing started her law career in 1991 as a clerk for the Massachusetts Supreme Judicial Court. Her unique training in musical theater as a singer/actress taught her authenticity and credibility—two key traits in having a successful career in healthcare.
As the founder of Novia, Lakier has four decades of experience as a clinician, executive, and consultant. She has held executive leadership positions at Scripps Health and San Bernardino Community Hospital in California, Fort-Hamilton-Hughes Memorial Hospital in
Ohio, and Children’s Memorial Hospital in Nebraska. TODD LAPORTE, P. 17 Chief Financial and Strategy Officer HonorHealth LaPorte has worked in healthcare for more than thirty years. In 2013, he was listed on Becker’s Hospital Review’s “125 Hospital and Health System CFOs to Know.” He is a father to four daughters, who are all competitive swimmers at the collegiate level. JUDY LEFKOVITZ, P. 49 Executive Vice President, Chief Administrative Officer & Chief Information Officer DSI Renal (Dialysis Newco Inc.) Lefkovitz started as a programmer at Tennessee Valley Authority and taught math at the University of Tennessee. After a brief “retirement” to be a stay-at-home mom, she became a consultant with DSI, where she found her passion: IT, healthcare, and mathematics. In 2014, she was named one of Nashville Business Journal’s top CIOs in the large private sector for Middle Tennessee. ELIZABETH LEWIS, P. 28 Chief Counsel & Head of Patient Advocacy, Global Oncology Business Unit Takeda Pharmaceuticals International Co. Some would argue that Lewis was born into healthcare. As the daughter of an ophthalmologist, she grew up seeing how to improve patient advocacy firsthand. She often accompanied her father to the hospital where he worked to volunteer. In her free time, she tries to keep up with her husband and daughter on the slopes. TERRY MANNA, P. 20 Vice President of Managed Care Meridian Health System, Inc. Manna has worked in healthcare since 1988 and has been with Meridian since 2004. He has both payer and provider perspectives through his leadership and executive positions with large payers and with complex health systems, overseeing network management strategy, managed care, and riskbased reimbursement. Manna also spent one year working abroad on healthcare cost containment and strategy in Saudi Arabia. PENNY MILLS, P. 78 Chief Executive Officer & Executive Vice President American Society of Addiction Medicine
Stay in-network by getting to know the leaders composing this issue of AHL
Mills has spent her entire career in healthcare—managing addiction services and mental health for a hospital system, working with several health policy and consulting firms, and garnering fifteen years with the American College of Cardiology. “I’ve been touched by addiction in my own family,” she says. “When the position opened up, I knew ASAM’s mission was one I could feel passionate about.” JEFF MYERS, P. 22 Chief Executive Officer Hamilton Medical Center With a career split between hospital operations and managed care, Myers has developed a passion for positive partnerships between physicians and their patients. After leaving his CEO position at Alliant Health Plans, Myers signed on with HMC to do just that. DR. MEIKA NEBLETT, P. 88 Chief Medical Officer CarePoint Health–Hoboken UMC Neblett is in a position to increase awareness of cultural differences in effective healthcare delivery, having overcome numerous challenges herself. She has worked at hospitals around the country, in positions ranging from assistant professor to emergency department chair. ROBEN NUTTER, P. 69 General Counsel & Corporate Compliance Officer East Alabama Medical Center Nutter enjoys the environment of a small, regional organization. After demonstrating her abilities in medical-staff services and risk management, she was encouraged by management to pursue a law degree, which she did. After earning her JD, Nutter was named EAMC’s first in-house general counsel. DR. SHIRISH PARIKH, P. 107 Founder, Chairman & Chief Executive Officer Community Care Physicians, P.C.
CINDY PETERSON, P. 92 Vice President & Chief Information Officer Henry Mayo Newhall Hospital
DEBRA PLOUSHA MOORE , P. 52 Chief Human Resources Officer & Executive Vice President Carolinas Healthcare System Plousha Moore oversees recruitment, compensation, benefits, education, employee development, employee wellness, and diversity and inclusion at the third-largest nonprofit healthcare system in the United States. She is a former kindergarten teacher and a current member of The Links, Inc., a national organization for professional women of color, among other organizations. KRISHNA RAMACHANDRAN, P. 102 Chief Administration Officer DuPage Medical Group As young boy in his native India, Ramachandran once longed to be a zookeeper, but being chased by a monkey changed those interests. Instead he got his start in healthcare at Epic. Using his tech expertise to implement EHR systems for health systems across the country, he eventually moved to the provider’s side at DuPage to improve patient care. DR. GIESELE ROBINSON GREENE, P. 42 Senior Vice President & Chief Medical Officer Sisters of Charity Health System One of eleven children, Dr. Greene grew up in inner-city Chicago. Her parents owned a mom-and-pop grocery store, and the family lived in the back. All the children worked in the store after school and on weekends. “I learned how to count by selling penny candy,” Greene says. GARRICK J. STOLDT, P. 58 Chief Financial Officer Saint Peter’s Healthcare System Garrick Stoldt, CPA, FHFMA, presides over the financial workings of New Jersey-based Saint Peter’s Healthcare System. He oversees a staff of 140 people, and spends much of his time on an ICD-10 coding initiative and a strategic plan for Saint Peter’s financial division.
SUSI TAKEUCHI, P. 61 Chief Human Resources Officer UC Irvine, UCLA With 20-plus years of experience in human resources, Takeuchi brings a strategic and client-focused vision to UC Irvine’s Medical Center. “I sometimes pause in my work and watch a helicopter fly into the trauma center and realize that we’re in the business of saving lives,” she says, adding that working in healthcare and HR is doubly rewarding. GAIL THAKARAR, P. 94 Chief Human Resources Officer AMC Health Thakarar attended Wharton School of the University of Pennsylvania for her MBA and holds a bachelor’s degree in accounting from India. Her focused trajectory with multinational and global companies, experience with taking private companies public, and finance background have given Thakarar the wisdom and edge to bring AMC Health to the next level. CINDY TURNER, P. 18 Chief Executive Officer Bacon County Hospital and Health System At work, Turner helps the hospital in its core mission to provide the best, high-quality healthcare, while her time at home is devoted equally to care. Her free time is spent with her husband and three grandchildren; she enjoys time reading, doing church work, and helping at numerous community events. SEAN WHELAN, P. 38 Chief Financial Officer Diplomat Pharmacy, Inc. Whelan has twenty years of broad finance, operations, and leadership experience. He is a CPA with CFO experience in both publicly traded and privately held companies. LESLIE YENDRO, P. 64 Vice President of Business Development Avella Specialty Pharmacy Yendro earned a biology degree from Illinois Wesleyan University and a nursing degree from Saint Louis University. She worked as a clinical nurse at Rush University Medical Center in Chicago and has held various roles in sales, management, marketing, and national accounts for pharma companies. As a freshman in college, she accepted a dare to try out for the pom-pom squad and made it—never having danced before in her life.
Parikh knew he wanted to be a doctor at seventeen years old, but he never knew he would take on an administrative role. Today he uses the duality of his role to innovate for a better model of healthcare.
Peterson’s insight and expertise has grown over forty-plus years as a healthcare information systems executive. Today she provides solutions to help Henry Mayo Newhall successfully navigate the changing healthcare environment. Peterson relaxes by riding and showing Arabian horses with her daughter.
WHAT IS THE BIGGEST ISSUE FACING HEALTHCARE TODAY? “The biggest issue facing healthcare is security—protecting private patient data while still facilitating the smooth flow and sharing of information between medical professionals.” CINDY PETERSON Vice President & Chief Information Officer Henry Mayo Newhall Hospital
“Prices for drugs and services continue to rise, but how that is all going to be paid for is a question not many people have been able to answer.” LESLIE YENDRO Vice President of Business Development Avella Specialty Pharmacy
“The rising cost of healthcare is definitely the biggest issue. Those caring for their aging parents while still supporting their own children are the hardest hit.
AHL APR.MAY.JUN 2016
GAIL THAKARAR Chief Human Resources Officer AMC Health
“We need to manage [the public’s] full needs—wellness, their chronic illnesses, and their acute needs.” NANCY LAKIER CEO & Managing Partner Novia Strategies, Inc.
“Our industry needs to answer the question of how we can use the same innovation and intellect that develops life-changing therapeutics to also devise novel programs that ensure nothing stands in the way of patients having the opportunity to improve their health and quality of life.” ELIZABETH LEWIS Chief Counsel & Head of Patient Advocacy, Global Oncology Business Unit Takeda Pharmaceuticals International Co.
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