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APR.MAY.JUN 2017

Caring is Sonia Chen Arnold changed her life to answer it

a Calling


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COVER

P. 42

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Cover and this photo: Kristin Deitrich

Eli Lilly’s Sonia Chen Arnold changed career paths from music to law to chase her passion for helping others.

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CONTENTS

American Healthcare Leader APR.MAY.JUN 2017

P. 8 Facility Spotlight P. 174 The Vitals

Life

P. 177 People & companies index P. 178 Stat Sheet

P. 54

AHL APR.MAY.JUN 2017

It’s been a decades-long journey, but Hollywood Presbyterian Medical Center’s Janice Klostermeier has made it to the C-suite, and now she reflects on the path she took and the challenges women face along the way

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P. 18 Trent Taher seeks to end mystery meat with healthier and tastier school lunch options

Photo credits: Ilisa Ailts (Trent Taher), Kristin Deitrich (Janice Klostermeier)

Pulse


CONTENTS

Prognosis Impact P. 120

P. 72 Gina Knox and her team at Little Company of Mary Hospital take a proactive stance in assessing risk, responding to legal actions, and educating all staff members at the hospital

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Photo credits: Kristin Deitrich (Gina Knox)

The prospect of getting lifesaving pharmaceuticals to market faster is what motivates AstraZeneca’s deputy general counsel, Mariam Koohdary

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AHL TEAM

CREATIVE

VP of Creative Kathy Kantorski Editorial Directors Megan Bungeroth Cyndi Fecher Design Director Joshua Hauth Senior Editor Adam Kivel Editors Steven Arroyo Danny Ciamprone Jonas Weir

Peter Castaldo Lauren Cavers Danielle Cole Abbey Cunningham Mike Gortowski Erin Malone Kate Pfau Kemp Pile Director, Executive Success Anna Jensen Executive Success Manager Justin Joseph Josh Rosen

Senior Designer Holly Leach Designers Lauren Keeling Juliet Desnoyer Photo Director Caleb Fox Photo Editor & Staff Photographer Kristin Deitrich Contributors Matt Alderton David Baez Stephanie S. Beecher Dan Caffrey Denise Dooley Joe Dyton Peter Fabris Amanda Garcia Chris Gigley Michael Hernandez Mary Kenney Russ Klettke Sarah Kollmorgen Kelli Lawrence Keith Loria Bridgett Novak Urmila Ramakrishnan Jeff Silver Kathryn Silverstein

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Guerrero Howe, LLC CEO Pedro Guerrero Executive Assistant Jaclyn Tumberger Managing Director of Marketing Sean Conner Director of Digital Products Bettina Lindner Lippisch Recruitment Director Elyse Glab Circulation & Reprints Director Stacy Kraft Events Director Vianni Busquets

One of the most common insights I hear from the individuals we feature is something to the effect of, “the only constant is change.” At AHL, we aim to bring you the stories of leaders who are not only enacting change in how they provide care, but also those who followed different, unorthodox paths into leadership. For some, change had been a recurring theme long before they stepped into the field of healthcare. “If I hadn’t taken risks and embraced opportunities to lead, I wouldn’t be where I am today,” says Sonia Arnold, the subject of our latest cover story (p. 42). It sounds obvious, but Arnold isn’t talking about your runof-the-mill, steady capitalizations up the rungs of one ladder. Arnold has jumped across several ladders on her way up. As a violin student at Vanderbilt University, Arnold thought that she was on her way to being a full-time musician, until a mentor inadvertently dissuaded her with one sentence: “The only people who should be musicians are those who can’t live without it.” That initiated a series of pivots: into music publishing, then into studying entertainment law at Indiana University, then private practice, and ultimately, her current position as assistant general counsel at Eli Lilly. Had she viewed each of these changes as a setback, Arnold might have exhausted herself before getting the chance to answer her true calling. Instead, she kept the faith that progress isn’t always a straight line; as she stresses to her mentees today, “[Don’t] be so focused on what you ‘should’ do.” In other words, real opportunity is often at odds with opportunism. Trying on different passions and interests, inconvenient as they may be from a careerist standpoint, cultivates a sense of your best self, which will lead to your best work. Today, Arnold gives back to all the different cultures that helped her on her way up, serving on boards for the International Violin Competition of Indianapolis, Indiana University’s Lilly Family School of Philanthropy, and the Asian American Alliance. They’re all a part of her, just as we’re all products of our past experiences—something that we kept in mind as we produced the stories of everyone in these pages, and we hope you will, too.

Client Services Director Cheyenne Eiswald

VP of Sales Kyle Evangelista

Senior Client Services Manager Rebekah Pappas

Director of Sales Operations Philip Taylor

Client Services Manager Katie Richards

Managing Director Kim Harrington

Financial Analyst Mokena Trigueros

Content and Advertising Managers Megan Apfelbach

Junior Analyst Amanda Paul

Steven Arroyo Editor

SUBSCRIPTIONS + REPRINTS

For a free subscription, please visit ahlmagazine.com. Printed in China. Reprinting of articles is prohibited without permission of Guerrero Howe, LLC. For reprint information, contact Stacy Kraft at 312.256.8460 or stacy@guerrerohowe. com. AHL Magazine® is a registered trademark of Guerrero Howe, LLC.

Kristin Deitrich

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SALES & ACCOUNT MANAGEMENT

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Big ideas can come from anywhere.

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FACILITY SPOTLIGHT

Planned Parenthood Queens: Diane L. Max Health Center Queens’s first Planned Parenthood center opened in September 2015, giving the reproductive health nonprofit a location in every New York City borough.

AHL APR.MAY.JUN 2017

Photos by Michael Moran / OTTO

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The space was designed to make visitors feel welcome, but protected.


FACILITY SPOTLIGHT

Stephen Yablon Architecture converted the two-story center out of a former lumberyard facility.

Bold colors and natural light brighten simple, open floor plans.

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“Kids recognize repetition. If they keep seeing the same fifteen items, they say, ‘What are you going to show me that I haven’t seen yet?’” P. 18


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BRENNAN TORREGROSSA VP, Associate General Counsel GlaxoSmithKline

The Move to Kill the Billable Hour 12

By Bridgett Novak

Rebecca Henasey

AHL APR.MAY.JUN 2017

The tide of legal billing processes in pharmaceuticals is turning toward value-based systems, according to Brennan Torregrossa, VP and associate general counsel for GlaxoSmithKline


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tional request for proposal. Torregrossa describes it as a “reverse eBay process.” “The firms can’t see who they are bidding against, but they can AFA ACCLAIM see the bids and where they rank, which usually inspires them to GlaxoSmithKline's alternative fee lower the cost of their proposal,” arrangements and use of the Outside Torregrossa says. Price is not the Counsel Selection Initiative was only factor on which GSK bases named a Value Challenge award its decision, though. “Our manwinner in 2012 by the Association aging attorneys assign scores to of Corporate Counsel. As the judges various aspects of the propossaid, “The clear objective to move all als—e.g., the law firm’s expertise of GSK's legal work to value-based in a legal area and jurisdiction, fee arrangements and the use of key impressions of how they technology and a scorecard to select would handle the case or project, outside counsel are novel and have the diversity of their team. All led to substantial cost savings.” those things are factored into an overall score for each firm. Our goal is to get the right lawyer or law firm for the right case at the right price.” Torregrossa realizes that this is a direct challenge to the way most law firms operate, with annual increases in salaries, billable rates, and hourly quotas. “The pressure to bill an incredible number of hours is, well, incredible. I want to lift that weight off lawyers. I want to get back to building some results together and want our outside law firms to have that same commitment,” he says. “When Don Draper in Mad Men worried about accountants wielding too much influence in the company, he asked, ‘What are we doing here? Why are we spending so much time trying to turn a dollar into a dollar [and] ten [cents]? Who’s in charge?’ That’s how the billable hour can make you feel,” Torregrossa continues.

“We want to reward outside counsel for the work they do, not for the hours spent doing it.”

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Brennan Torregrossa loves a challenge. “I enjoy trying things that have never been tried before. Just because something is easy or ‘the way it’s always been done’ doesn’t mean it’s right,” he says. As vice president and associate general counsel in charge of GlaxoSmithKline’s (GSK) Global External Legal Relations Team (GELRT), Torregrossa’s mandate is to redefine the way the pharmaceutical giant pays its outside law firms. “To put it simply, we’re trying to kill the billable hour. But it’s really more nuanced than that. We’re trying to establish win-win relationships, obtain excellent legal representation, and work with firms that deliver great value and are willing to work with us outside the billable hour model,” he says. They’re not alone in this effort. According to Altman Weil’s 2015 Law Firms in Transition survey, 93 percent of law firms in the United States offer some type of alternative fee arrangement (AFA) or value-based fee arrangement (VBF), and 81 percent of lawyers believe non-hourly billing has become a permanent trend in the profession. These numbers make the practice appear more widespread than it really is, though. While the number of corporate legal departments experimenting with AFAs has increased, the overall amount of work being done on a non-hourly basis has remained steady the past several years at just 9 percent, according to the Enterprise Legal Management Trends Report. While the trend is evident—and had received a major spark following the 2007–2008 recession—GSK’s dedication to the goal is revolutionary. In 2008, when GSK’s general counsel, Daniel Troy, asked Torregrossa’s predecessor Bob Harchut to implement the plan, 97 percent of the company’s legal work was paid by the hour. Today, it is just 15 percent. “When you pay by the hour, you pay for the time, not the service, which can lead to lots of inefficiency,” he explains. “We want to reward outside counsel for the work they do, not for the hours spent doing it.” To make this viable, GSK has broken its legal work into tasks, describing the desired results rather than the duration. But how does Torregrossa’s team know how to price various legal tasks? He admits it has been, and continues to be, a learning process. One of the solutions they’ve hit upon is an online bidding program called the Outside Counsel Selection Initiative (OCSI). Launched in 2010, the program, which was borrowed from GSK’s procurement department, invites certain law firms to submit proposals for specific matters, quite similar to a tradi-

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OCSI BY THE NUMBERS

$5,000,000

GlaxoSmithKline tracked the results of six recent cases where it hired outside firms for counsel on a flat-fee bidding basis, finding that each resulted in dramatic savings compared to its original budget as a result.

$4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0

AHL APR.MAY.JUN 2017

Budget Value

14

This approach has been well-received by his colleagues: “We appreciate Brennan’s approach to his new role. Success in this model requires an open dialogue with the inhouse and law firm lawyers, and it does require adjustment over time," Gordon Cooney of Morgan Lewis notes. “We believe that we can all benefit from a model that rewards efficiency and successful outcomes.” GSK has reduced its legal spending by roughly 20 percent since switching from the billable hour to mostly fixed or flat fees, but Torregrossa says the payoff doesn’t stop there. “It’s never been just about saving a dollar because we can, but because we should. We believe this allows us to better align our interests with those of our law firms. And every dollar we save on legal fees can be returned to shareholders, spent on research and development to discover important new vaccines or other drugs, or used to help lower the cost of our consumer products,” he explains. The switch has also enabled GSK to reduce inefficiency in-house. Where they used to spend an abundance of time reviewing law firm bills, checking hours, and keeping an eye out for budget overruns, GSK’s attorneys now receive quarterly reports from the law firms they’re working with and will soon use dashboards to track the status of their projects. But have any of their go-to firms declined to make the switch? “Certain firms have more of a challenge to play in this environment than others, but most firms know that the tide has turned and clients are demanding flexibility in the way they pay for matters,” he says.

Revised Initial Offer

Final Offer

“The companies leading this revolution away from the billable hour have one thing in common: general counsel who make the mission an absolute priority.”


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www.morganlewis.com © 2016 Morgan, Lewis & Bockius LLP

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And what about those lawyers who can charge whatever they want? “Some lawyers have an extraordinary amount of cachet in certain areas of law, enabling them to set their own rates,” he says. “It’s hard to push against that if the market is willing to pay it. But even some of those attorneys have been willing to try a new model.” Torregrossa says that companies that wish to make task-based billing work must have clear direction from the top: “The companies leading this revolution away from the billable hour have one thing in common: general counsel who make the mission an absolute priority.” “I believe this is a far better way to pay for legal services,” he says. “It can be exhausting fighting against something as ingrained as the billable hour, but we now feel there is more of a match between what we’re paying and the value we’re getting. It is all about building strong relationships with firms we trust to represent us and who trust us to compensate them fairly.” AHL

Phillips Lytle congratulates Brennan Torregrossa for the recognition of his commitment, creative vision and strong leadership.

AHL APR.MAY.JUN 2017

We appreciate firsthand the environment of collaboration he fosters in his client-attorney relationships.

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Phillips Lytle attorneys are involved in the scientific defense of pharmaceuticals, biologics and medical devices. Our expertise, developed over 25 years, is recognized and relied on by counsel – domestically and internationally. © 2016 Phillips Lytle LLP

13761 PL American Healthcare Leader Congrats Ad 2/3 page ad 4.775” x 10.2” CMYK

King & Spalding is an international law firm that represents a broad array of clients, including half of the Fortune Global 100. With more than 900 lawyers in eighteen offices around the world, King & Spalding was recently chosen by Law 360 as the "Law Firm of the Year" for product liability and LMG Life Sciences selected the firm as one of the finalists for “Regulatory Firm of the Year” in 2015. www.kslaw.com Morgan Lewis offers life sciences and healthcare companies sophisticated, integrated, and cost-effective counsel covering all of their unique needs. We advise clients on litigation and dispute resolution; business transactions and joint ventures; US federal, state, and local regulation; coverage and reimbursement; fraud and abuse; and compliance. We also counsel life sciences and healthcare companies on intellectual property, antitrust, public policy advocacy, real estate, and labor and employment issues. Shook, Hardy & Bacon is nationally recognized as a preeminent firm for complex litigation, particularly in science, medicine, and technology. Shook has represented dozens of pharmaceutical clients, including each of the top ten pharmaceutical companies worldwide—Bayer, GlaxoSmithKline, Johnson & Johnson, Pfizer, and Sanofi, among them. Shook’s Pharmaceutical and Medical Device Team partners with companies to navigate complex operational, technological, and regulatory challenges, manage emerging threats, and overcome potential obstacles.


King & Spalding joins in honoring the great work of our friend Brennan Torregrossa, GlaxoSmithKline’s Vice President and Associate General Counsel. Congratulations on your continued success.

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www.kslaw.com

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Out of the Deep Fryer Trent Taher brings nutritious, creative cuisine to school cafeterias

AHL APR.MAY.JUN 2017

By David Baez

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As time goes by, the old stereotypes surrounding school cafeteria food continue to dwindle. While those who came of age decades ago will surely recall the iconic lunch lady dishing out such standbys as sloppy joes, grilled cheese sandwiches, and tater tots, there are some students today who sit down with a spectrum of nutritional foods that could, if Taher, Inc. is the vendor, include pork belly ramen, fresh slices of mango, and yucca, a South American tuber. This notion isn’t new. It started to gain traction back when Trent Taher’s father, Bruce, founded the food service company in 1981. It was then that the company began focusing on health, an initiative that was set in place well before the wave of nutrition consciousness hit—especially after former First Lady Michelle Obama’s changes to the requirements in the federal government’s National School Lunch Program (NSLP) in 2012. The NSLP is a longstanding program through which the government subsidizes the cost of food for schools, so they can sell it at reduced or no cost to low-income students. Today, Taher serves as director of wellness, nutrition, and culinary development for the company, where he is in charge of developing the menus and working with on-staff nutritionists to green-light every ingredient

that goes into the recipes. When working with production partners, Taher checks ingredients against a long list of banned items, including certain artificial colors, artificial sweeteners, high fructose corn syrup, and partially hydrogenated oil. If a food contains any of these ingredients or others on the list, Taher won’t accept it. Meat has to be free of antibiotics and hormones as well. At the same time, Taher also works with a list of artificial ingredients that are considered less harmful and acceptable in the short-term, but still result in being flagged. The offending ingredients are then replaced as soon as possible. The company’s nutritional policies fall under the umbrella of their Food4Life initiative. Not only does Taher make sure to meet the requirements of the NSLP—which postdates the company’s initiative—but it continues to push the envelope. Case in point: in 2008, the company voluntarily ceased using all foods with trans fats not only for school lunches, but also for the corporate clients they serve. As Taher explains, making all this happen often requires educating the company’s manufacturing partners. “As the NSLP has taken off, producers and manufacturers are more versed in what the requirements are and are catching up,” Taher says. “But we always meet with producers about what they need to change in the project.


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“We are constantly finding ways to make what we have healthier and cleaner.”

One group was trying to sell us a packaged snack, but it contained red dye. I told the CEO that they were standing outside of our Food4Life initiatives and that we’d have to flag it. A month later, he told me that based on our conversation, they had changed their formula and also pulled corn syrup.” As part of the changes to the NSLP in 2012, every two years in some states or every three in others, any school that is being funded by the program has to open up the bidding process to other vendors. In many cases, the current operator will put in a bid, and quite often, other vendors will choose to bid against it. In one such case, Taher was ousted by the lowest bidding vendor. But a few months into the school year, the community was disappointed with the new company’s products and Taher returned. “You have districts that look at the school lunch program as a profit center,” he explains. “A portion of the sales that come from the lunch and breakfast program are commissions you pay to the school; the percentage is determined in the bidding process. Schools badly in need of money use these programs to generate income. Others are more focused on being healthy and clean. Those are the ones we prefer to work with. We thrive when we find ourselves in a community that wants healthy, diverse food, and the school administration is on board as well.” This can tend to lead to contracts with private and charter schools, though the company still works with a greater number of public schools. The ones the company avoids are the ones deemed to be mired in the “race to the bottom”—those looking for the cheapest execution possible to increase their bottom line. In addition to the health focus, Taher spends an abundance of time and energy diversifying its menus through

Taher prepares dessert featuring vanilla ice cream with farm fresh eggs, peanut butter chocolate chip cookies, and whole milk from a dairy farmer.

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Ilisa Ailts

TRENT TAHER Director of Wellness, Nutrition, Culinary Development Taher, Inc.

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Last fall, Trent Taher joined his father, Bruce (right), in addressing the crowd during a Farm Dinner in Wisconsin, where they prepared a five-course dinner.

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Taher gets ready to grill an entire pork flank, or matambre, as part of a reception dinner last fall.

Ilisa Ailts

AHL APR.MAY.JUN 2017

“Whether it’s internationally driven, or from menu teams I work with here, we’re always coming up with new things.”


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its Chef’s Council. The program was started about fifteen years ago to explore new geographical areas and find new foods. They started with trips to major cities in the United States, such as New York and San Francisco, and then began taking international trips. The group has gone on discovery missions to a variety of countries, including India, Italy, Israel, Vietnam, South Korea, Japan, Peru, Argentina, and Turkey. Taher says that the international trips are considered a corporate expense under innovation. Variety comes in a close second to health considerations in the company’s hierarchy. For the upcoming school year, Taher will launch more than twenty new menu items. “Whether it’s internationally driven or from menu teams I work with here, we’re always coming up with new things,” he says. “Kids recognize repetition. If they keep seeing the same fifteen items, they see the pattern and basically say, ‘What are you going to show me that I haven’t seen yet?’ We have to introduce new items throughout the year so it doesn’t become repetitive.” Each month, the company features a different fruit or vegetable, a different grain or legume, and an alternate herb as part of the Harvest of the Month program. In any given month, the Taher team will prepare a meal that mixes them all together, such as mango with cilantro. The company will also put up fliers in the school touting the health benefits of the featured items and do blind taste testing with students. Taher says that food services is easily one of the most competitive industries in today’s business world. The way the company stays on top is by keeping its focus on health and variety and finding the schools and districts that are like-minded. “Our drive as an organization is to always get the freshest and best food we can buy,” he says. “We are constantly finding ways to make what we have healthier and cleaner.” AHL FMS Foodservice, a member of Affinity Group, is proud to be associated with Trent Taher and Taher, Inc. “Food4Life” is not just a slogan but a mission for Trent. Together we review better nutrition food items that don’t sacrifice quality and taste; often at more expense than traditional school foodservice items. Taher uses ingredients from leading manufacturers like Jennie-O and Marzetti. Thank you Trent for teaching students healthy foods can also be delicious!

Like Jennie-O, Trent Taher is committed to making items available to more kids. That’s why we’re proud Food4Life initiative with better-for-you products that and delicious for kids to make smarter food choices in

nutritious food to support his make it easy the lunchroom.

* Except for those that occur naturally in celery juice

Learn more about JENNIE-O® Turkey Franks at: jennieofoodservice.com/k12

*Compared to our regular turkey frank **Except

for those that occur naturally in celery juice ©2016 Jennie-O Turkey Store, LLC

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One such product is our JENNIE-O Reduced Sodium Smoked Uncured Turkey Franks. With only 240 mg of sodium per 2 M/MA serving and no allergens, gluten, nitrates, or nitrites added*, our turkey franks are a nutritious alternative. Learn more about JENNIE-O Turkey Franks: jennieofoodservice.com

Nitrites Added.

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A Lean Expansion for Reading Health System David Schlappy implements lean design systems for the construction of the new, $346-million Reading HealthPlex for Advanced Surgical and Patient Care

AHL APR.MAY.JUN 2017

By David Baez

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The concept for the new Reading HealthPlex for Advanced Surgical and Patient Care was conceived in 2010, two years before David Schlappy came on board at Reading Health System. As it turned out, however, a discussion that the current vice president and chief quality officer had with executive leadership would set the course for the eventual design and functionality of the tower—a $346-million expansion project that opened in the fall of 2016. Prior to joining Reading Health, Schlappy worked with another hospital expansion using a process called lean design. Leadership at Reading Health gave Schlappy the greenlight to bring in lean consultants to meet with the executive team and put together a sound proposal. The consultants conducted preliminary walk-throughs, data collection, and interviews to assess the situation. Based on what they learned, they determined the workflows that would benefit from the lean approach. From there, a steering committee organized project teams and began scheduling process redesign meetings. The concept behind lean, in simplistic terms, is to design space and processes with an eye for reducing, if not eliminating, waste. The goal is to boost the efficiency of the hospital and its workers, a benefit which trickles down to the patients themselves. “When I talk about waste, I’m talking about things that add no value to patient care delivery, but still cost time and money,” Schlappy says. “If we have a process that creates a problem and we have to spend time and energy to fix it, the better process is to never have the problem in the first place. Lean is about finding out where the waste is and setting up processes and physical space to eliminate it.” Schlappy says an example of this occurred at another hospital when it came to lab specimens. The specimens arrive at the lab by tube and get checked in at a space forty-five feet away. That forty-five foot jaunt by a technician may not seem like much, but consider the fact that hundreds of thousands of samples are processed each year. One can now see the degree of waste involved in these thousands of miles of extra walking every year, which does nothing to convert that sample into meaningful results for the doctor and patient.

A key principle in coming up with the lean design is the importance of input from staff members directly involved in the processes, rather than relying on outside consultants. Schlappy and his team would have meetings with twenty to thirty employees at a time broken down by department and workflows to walk through the state of the current system. These teams would locate examples of the lean philosophy’s types of waste and decide how things could be done differently. “Once you’re trained to see waste, you see it everywhere,” he says. There was a session with perioperative staff members, one for the emergency department, and another for patient care units. Medication administration, physical therapy, occupational therapy, materials management, and lab and diagnostic services all had their own sessions, too. In short, everyone on the front lines was involved. “The staff and physicians know the waste; they see the symptoms every day,” he says. “They really were empowered to work with the consultants to redesign workflows. And there is much better adoption when you have staff providing input, as opposed to a consultant dictating changes.” Each group met for three consecutive days, and at the end of each session, members of the team would report back to the steering committee. One may presume that workers who were accustomed to a certain way of doing tasks might grumble over the changes, but Schlappy says that because of their involvement in the process, almost all the feedback was positive. “We pulled them out of their regular job and asked them to help us work on this,” he says. “So they felt valued and also knew that the process they were helping design would make their work better and better for patients.” These sessions resulted in brand new workflows, with compass documents stating all the major steps in every workflow. The training itself was also designed around the new workflows. In some cases, processes just needed tweaking, and in other cases, a complete redesign was in store. Schlappy says he foresees an enormous impact from the design. “It will improve workflow and decrease wait times for patients in the emergency department or for those waiting for surgery,” he explains. “The other people it will affect are the staff. If we can decrease the

DAVID SCHLAPPY VP, Chief Quality Officer Reading Health System


HPP Ad_AHL_One Third Pg_CMYK.pdf 1 7/28/2016 1:45:21 PM

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amount of wasted walking, searching for supplies and equipment, or dealing with avoidable problems—which is time away from a patient—that equates to more time spent with the patient. By getting waste out of the system, we can apply our clinical care more effectively.” Perhaps just as important, Schlappy believes the mentality of the organization and its staff has undergone a change through the collaborative process of coming up with the design. He says when most people talk about lean, they focus on the tools, which he believes is a mistake. “It’s about engaging the staff; valuing and respecting the individual,” he says. “People will go to a seminar and talk about huddle boards, standard work, or other techniques to drive improvement in patient care, but those are just the tools. The tools support the desired behaviors, but tools are not the end goal. The principle is to engage and respect the staff’s contributions by guiding continuous improvement efforts at the front line and aligning each employee’s work with the organization’s purpose. When you do that, you’ve tapped into something about human nature that makes us want to do better. It’s like fireworks going off.” AHL

The new tower is a 476,000-square-foot surgical and inpatient facility in Reading, Pennsylvania.

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Robert Polett

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Medicaidʼs Systematic Transformation John O’Hearn and Medical Center Health System use the Medicaid 1115 Transformation Waiver to expand services for those most in need

AHL APR.MAY.JUN 2017

By David Baez

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John O’Hearn likes to say that he’s been in healthcare since he was a toddler. His father was an internist, and his mother was a social worker who served on the board for Medical Center Health System (MCHS), based in Odessa, Texas. “I’ve been in or around healthcare most of my life,” O'Hearn, the vice president of strategy and development for MCHS, says. In O’Hearn’s lifetime, healthcare has seen some dramatic shifts. After a spell in pharmaceutical sales, he returned to working for hospitals with MCHS in 2011— right on the heels of the seismic changes created by the Affordable Care Act. As Medicaid is a poor payer in terms of reimbursement (O’Hearn says that MCHS gets about 40 cents on the dollar), MCHS and other hospitals were working at a deficit from the beginning. Recognizing this, the government stepped in and created the Upper Payment Limit (UPL) program to make up the deficit, and everyone was content. But then, in 2012, Texas adopted managed care for Medicaid across the state, which made hospitals suddenly ineligible for the UPL and sent them back to the deficit. “Every CEO and CFO ran for the hills because funding was crucial to our bottom line,” O’Hearn recalls. “We all counted on this funding.” The state had to circle the wagons and figure out how to recuperate the lost money back into Texas. In one of the rare occasions where one saw Texas follow California, the state applied for a waiver through the Social Security Act that California had been using. The Medicaid 1115 Waiver is basically a fund that pays for uncompensated care, along with a Delivery System Reform Incentive Payment (DSRIP), a progressive initiative that encourages hospitals to find unique projects that increase access to care, improve infrastructure, and provide better quality care and better access to that care at a lower cost. Texas not only replaced the UPL funding, which was about $15 billion, but was fortunate to increase the funding pool to $29 billion with the introduction of the DSRIP pool.

JOHN O’HEARN VP of Strategy & Development Medical Center Health System


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Over the years, MCHS has invested in the Ector County Independent School District (ECISD) for health education, including at San Jacinto Elementary in San Jacinto, Texas. The health education platform from MCHS provides teachers with physical activity lessons they can teach their students. Since the launch, ECISD has logged an additional ten million minutes of physical activity.

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What happened in Texas was distinct from what had occurred in California, in which a total of twenty-one public hospitals participated. In Texas, there are more than 300 providers involved. This waiver opened up funds to mental health authorities, county health departments, and academic physician practices, among others. It represented a sea change from the UPL, leading to a fundamental transformation of care rather than just making up a loss. There are currently more than 1,400 statewide projects designed to increase access and decrease cost. “The UPL was kind of an accounting function. This is true system transformation,” O'Hearn says. “Because of the structure of the regional healthcare partnership (RHP), it brought us all to the table to discuss what the region’s needs really are.” The program reorganizes the state into regions (MCHS is in region fourteen, thus RHP 14) that are similar in scope and size. It also assembles a group of providers. In RHP 14, MCHS was made the anchor institution, and O’Hearn took on the role of program director. He also serves as a liaison among all the providers in the region by coordinating reporting and sharing best practices. RHP 14 has fifty-five projects and nearly $270 million in incentive payments it can attain. The waiver allows MCHS to serve uninsured patients (20 percent of all patients in Texas) more creatively and broadly in ways that reduce the financial burden on the system. Prior to this waiver, MCHS only had one lowincome family clinic, which was often overrun. The waiver has now allowed MCHS to greatly expand care to the population by opening a second clinic. When an uninsured patient walks into the hospital, he or she is assigned a navigator who assesses immediate social and physical needs, begins the process of assigning the patient a primary care physician, and works on providing the patient with low-cost medications, sometimes even a year’s worth of drugs for free. “This doesn’t stop during the visit,” he says. “It could be a ninety-day relationship we form with these patients,

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“If something didn’t make money before, it was hard to convince people to dive into it. Now we’re incentivized to create programs and services that meet a community need.” trying to get them on the right course.” O’Hearn adds that since the waiver was instituted, he’s seen incredible changes in the system, unfolding each day. He also directly attributes 70,000 primary care visits to the waiver across the region. Texas recently completed the fifth year of the waiver and is now working underneath a fifteen-month extension through December 2017 until an agreement can be reached between the Texas Health and Human Services Commission and Centers for Medicare & Medicaid Services (CMS) on the structure and design of a new waiver. In the periphery of that discussion will be the debate surrounding Medicaid expansion in Texas, which CMS is pushing for, but that idea has been a non-starter in the Republican-led Texas legislature. “The worry amongst Texas hospitals is that we will be between a rock and a hard place,” he says. “Both sides are pretty consistent in their views, and unfortunately, the only people affected are the patients that have been impacted by these programs. Without Medicaid expansion or a continuation in waiver funding, many of these patients and the facilities that serve them will be severely lacking in funding.” O’Hearn adds that the waiver offered the opportunity to try things that they’d wanted to do for a long time. “We had all these great ideas that were sitting in the regional hospitals,” he says. “If something didn’t make money before, it was hard to convince people to dive into it. Now we’re incentivized to create programs and services that meet a community need but aren’t reimbursed. The amount of lives impacted has been remarkable.” AHL


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Lahey Health Combats Cancer with Compassion Linda Weller-Ferris sees the Lahey Health Cancer Institute’s new Oncology Care Model as a balance of empathy, diligence, and research By Dan Caffrey

many of whom are facing side effects outside of the direct symptoms of the disease. CMS is aware of this, and as a result, it requires that all healthcare facilities involved with the OCM screen every patient for clinical depression. Weller-Ferris and her team are more than up for the task. “There’s been some research that suggests 50–65 percent of cancer patients, at some point during their cancer experience, will have become clinically depressed,” she explains. “We actually have oncology-specific social workers and a behavioral psychologist who help a lot with the decision-making.” She uses the decision to have a prophylactic mastectomy as an example. She says many patients don’t realize how much their body image and sexuality will be compromised after the procedure. “We try and slow it down and have our behavioral doctor meet with [them],” she says. “We have lots of support like that. We have acupuncture for pain. We have pet therapy. We do music therapy. It’s asking, ‘How do we get them through this experience with the greatest amount of support?’” Weller-Ferris applies this philosophy not only with patients themselves, but also with patients’ families and the caregivers she works with on a daily basis. “I have to worry as much about the caregiving team burning out as I do the patients,” she says. “The MAs care as much about these patients as anyone else. That’s how it should be. It’s not like you’re a surgeon, and after one post-surgery, you’re sort of fine. This is a very relationship-based subspecialty that is very emotionally charged.” In fact, these relationships often go beyond the typical model for care. Weller-Ferris explains that she and her coworkers have even planned anniversary dinners for many of Lahey’s cancer survivors. When it comes to the frequently elaborate requirements of the OCM, the logistical side of the project is just as important as the emotional one. In order for all

LINDA WELLERFERRIS VP of Lahey Health Cancer Institute Lahey Health

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When Linda Weller-Ferris speaks about her work, she might take up the better part of ten minutes answering a question, which is a noteworthy compliment. Not every executive is so enthusiastic and informative about the work they’re doing. But she has to be because, to put it lightly, her work is quite complex. As vice president of Lahey Health Cancer Institute, she’s helping to implement an innovative Oncology Care Model (OCM), a “five-year demonstration project” put forth by the Centers for Medicare & Medicaid Services (CMS) that involves improving the patient experience and reducing the cost of healthcare. Lahey is one of only 196 national practices to be selected for this initiative. The selection criteria—not to mention the scope of the project itself—is extensive. In a nutshell, Medicare patients are paid at the normal service rate, with Medicare paying an additional $160 per beneficiary, per month, over a six-month period during any intravenous and oral chemotherapy treatments. But all of this hinges upon Lahey supplying data on its patients almost around the clock, all in an effort to ultimately prevent emergency room utilization and unplanned inpatient admissions. In other words, it’s an abundance of heavy lifting for everyone involved. But Weller-Ferris is the perfect person to accomplish this. Her background has given her a comprehensive outlook on an intensely complicated disease and the equally complicated treatments that coincide. Her background in mental health has been a vital asset. With a bachelor’s degree in psychology, a master’s in clinical psychology, and a PhD in educational and psychological studies, Weller-Ferris credits her experience with helping her to be a more empathic leader. “You really start to put yourself in the shoes of the patient,” she says. As Weller-Ferris points out, this kind of emotional support is crucial to working with cancer patients,

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of it to be successful, Lahey has to cater to both. The most striking example of this is perhaps Weller-Ferris’s background in accreditation: she was the first non-MD to serve six full years on the Accreditation Committee of American College of Surgeons, Commission On Cancer (ACOS). She views accreditation—a tricky balancing act of emotionalism and practicality—as essential to the OCM project. “It helped to shepherd in the patient-centered standard for accreditation,” Weller-Ferris says about her time at ACOS. At Lahey, they’ve “[flipped] into very patient-centered standards that have very stringent requirements, like you’re going to give every patient a treatment summary and you’re going to give them a surveillance plan of how they’re going to monitor their function after treatment.” She’s hoping that all of this will help everyone touched by cancer—patients, families, and caregivers—have an easier time fighting the disease. It makes sense that such a complex illness would require an equally complex remedy, a network that combines the seemingly disparate aspects of the humanism and the organization. “If you’re going to be in the cancer business, you’ve really got to attend to all of the details,” Weller-Ferris explains. “That goes for accreditation, but it also goes for what the expectations of Medicare and payers is going to be: ‘Here’s your money. I’m going to give it to you to treat this woman or this man.’ That’s where I believe we’re going to be headed. I think that’s where cancer’s headed long-term.” AHL

Over the years, I have had the opportunity to work with Linda Weller-Ferris on several committees and have always admired her energy and enthusiasm for patient care. Her leadership skills and vision for where healthcare is headed are inspiring. Congratulations on your accomplishments as a well–respected Healthcare Leader. –Toni Hare, VP, CHAMPS Oncology


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The Significance of a Well-Fitting Name Why chief intellectual property counsel Nadeem Bridi’s inclusion in Acelity’s rebranding efforts was critical to unifying the company By Chris Gigley

NADEEM BRIDI Chief Intellectual Property Counsel Acelity L.P. Inc.

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When Acelity L.P. Inc. invited its chief intellectual property counsel, Nadeem Bridi, to attend meetings about a major rebranding in 2014, he was more than ready to participate. As it turns out, his experience, combined with more than a decade of service, made him unusually qualified to help throughout the process. At the time, there was no unifying brand identity, and since 2011, the company operated as separate business units. At the core was Kinetic Concepts Inc. (KCI), which was founded in 1976 by emergency room physician Dr. Jim Leininger in a one-bedroom apartment in San Antonio. KCI later introduced the first commercialized negative-pressure wound therapy technology, V.A.C. Therapy, in 1994. Bridi joined KCI as a patent attorney in 2001. He has been in his current role since 2009, overseeing and driving its global intellectual property portfolio. Bridi jokes that the company wanted him in the branding meetings to represent the older generation. Participating employees shared stories about their experiences. He recalls learning about different perspectives from employees of LifeCell, which markets a unique tissue regeneration technology born out of treating burn patients. KCI acquired it in 2008. He also learned about the rich history of Systagenix Wound Management Ltd., the former wound-care segment of Johnson & Johnson that KCI recently acquired in 2013. “Then I told my story about my involvement with KCI. I talked about how V.A.C. Therapy treated some of the worst types of wounds you could imagine,” Bridi says.

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“Patients were literally on death’s door and had no other options. They’d try V.A.C. Therapy, and a couple of days later, surgeons would do a dressing change and gasp when they saw how well it worked.” He talked about meeting patients and doctors who had used V.A.C. Therapy. He recalls being in the room with researchers and scientists collaborating to improve the technology. He also told stories of times that KCI and its employees stepped up to help those in need by donating products and time. KCI has been charitable after terrorist attacks and natural disasters, including in the 2010 earthquake in Haiti and the September 11 attacks in New York City. “I shared all that as we tried to build a new identity for the company and realized we all had a common theme, which was accelerating healing and bringing families back together again,” he says. “Ultimately, we created a word that truly evoked what we were about.” In 2014, the switch to Acelity—the Latin root of the term refers to accelerated healing—became official, uniting the strengths of KCI, LifeCell, and Systagenix under one brand. “To be frank, it felt like before we were three companies stumbling along together, but when we branded as one, it felt like a family coming together,” Bridi says. “You can feel it when you walk the halls and go to different locations, meeting different people who are coming on board. It’s palpable.” When Bridi started, KCI was celebrating its twenty-fifth year in business. “My focus then was on V.A.C. Therapy products, which have had many advances over the years,” Bridi says. “I embedded myself with engineers and scientists and learned about the products they were working on so I could write the patents.” His responsibilities have grown with the acquisitions, but Bridi continues to stay close to product development to stay abreast of all new advancements. “I get to see ideas just created out of thin air from the best engineers and scientists in our industry,” he says. “My team and I work with them to extract those ideas, putting pen to paper for the patents. As a patent attorney, it is a privileged opportunity to be a part of a team that brings such amazing products to the market. As in-house patent attorneys at Acelity, we have the unique opportunity to see and influence how ideas become healing technology. Ultimately, we get to meet the patients whose lives have been made better by the work we have done.” Bridi loves every part of the process. He remembers his

PATIENCE PAYS first office at KCI fondly; he was seated down the hall from both Nadeem Bridi’s job has him on the lab and manufacturing facilthe move so much that the chief ity, and enjoyed the easy access intellectual property counsel of to both areas so he could learn Acelity L.P. Inc. calls himself an from everyone. “accidental globetrotter.” As such, Over the years, Bridi has not he’s learned how to deal with all just received an education from the hassles of travel. “Don’t stress engineers and scientists, but out over things you can’t control,” he’s also become their friend. he says. “I’ve been delayed and held And that has given him even over, and you feel like the whole more insights into the creative world is against you. My patience process. Often, Acelity scienlevel has grown, and I’ve learned tists will simply be chatting with that a warm smile and a kind word him over lunch about a solution is the best way to get where I need they’re mulling over for a particto be.” ular patient with a particularly challenging wound. “I can see the lightbulb go off and then a few engineers get involved in the conversation,” he says. “Often, I’m writing down notes as fast as I can, trying to capture as many ideas as I can.” Bridi says that when he started at KCI, only two bookshelves held its patent documents, and the shelves weren’t very full. Now, Acelity has about 2,700 patents issued worldwide and more than 2,000 others pending. Every once in a while, Bridi will find himself scanning the halls of Acelity’s research facilities, where those patents are memorialized in plaques and are a reflection of his work there. “It’s wonderful to see how much innovation has expanded,” he says. “Managing that growth has been both challenging and rewarding. As we’ve grown and been successful, we’ve become the gold standard in the field.” With this success, plenty of competitors have attempted to imitate the company, but Bridi remains undaunted. Those patents are tangible proof that his team’s skills at protecting the company’s technology may be as effective as the technology itself. AHL Harness Dickey has obtained more than 55,000 patents for our clients since our founding in 1921. We obtained 3,052 patents for our US clients last year alone, earning us a top ten ranking among the nation’s patent firms in a poll by IPWatchdog. Our team of 100-plus experienced intellectual property attorneys handle patent prosecution, litigation, trademarks, copyrights, and trade secrets on a global scale for clients that include Fortune 500 companies, private and public businesses, universities, inventors, artists, and entrepreneurs. Harness Dickey has offices in the metropolitan areas of Dallas, Detroit, St. Louis, and Washington, DC.  Visit www.hdp.com. 


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Keeping Kentucky Up to Speed The leadership of Carol Steltenkamp is fortifying University of Kentucky HealthCare— and the rest of Kentucky—with twenty-first century record keeping

AHL APR.MAY.JUN 2017

By Kelli Lawrence

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As University of Kentucky HealthCare’s CMIO for ten years, Carol Steltenkamp has gotten a daily dose of appreciation for how far IT has come during her lifetime. “When I went to college, IT was much more about large machines in basements of buildings with punch cards and all that,” she recalls, chuckling. In sharp contrast with that image is, of course, any snapshot of modern-day teenagers and young adults wielding portable electronic devices of all kinds with ease and expertise. “They would not consider doing things without using a computer,” she says of millennials. “It’s their expectation of having information at their fingertips for whatever it is they’re doing. It’s a given, and the healthcare industry needs to meet that expectation.” Steltenkamp has done her part and then some, as far as the State of Kentucky is concerned. A still-practicing pediatrician, she returned to school for her MBA, and there, she was exposed to IT and consequently grew excited for its prospects in medicine. “I could see the vision of how we could use IT to improve health and healthcare,” she says. Around the same time, UK HealthCare was in the midst of choosing an EMR for the first time. Steltenkamp’s involvement turned to leadership, which led to her roles at UK HealthCare, first as physician champion, then medical director, and finally as CMIO—the physician acting as a liaison between all other clinicians and the IT department. “Early in my career, that would be

someone who translates a clinician’s medical record into reality,” she says. “Now, it’s about leading the implementation of EMRs.” But Steltenkamp’s work has extended well beyond UK HealthCare’s ample boundaries. Steltenkamp also served as principal investigator for a grant received by the Kentucky Regional Extension Center (REC) that brought in more than $10 million so that smaller providers could implement, adopt, and use EMRs as well. The US Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the Affordable Care Act, allowed for the entire state to be covered. “That was incredibly ingratiating,” she says. “I really felt good that we were able to lead the Kentucky REC. The grant dollars are gone, but they continue in a nonprofit way now.” In addition to all of this, Steltenkamp is also cochair of the board for the Kentucky Health Information Exchange (KHIE), an organization that helps facilitate patient care when going beyond their hometown becomes a necessity. Plus, Steltenkamp only recently completed her term as chairperson of the international board of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), where she says she had the privilege of being involved in the nonprofit organization’s transition from national to international. The impact of HIMSS— which operates with the goal of using IT to improve healthcare rather than to simply make records more


accessible—can now be felt in Europe, Asia, and parts of South America and Australia. Regardless of location, Steltenkamp has found that clinicians in their forties and fifties tend to be the most difficult to convert to EMR technology. “It’s difficult to be an adult learner and change the way you do things,” she admits. But she knows how critical it is for that change to happen. “If you want to stay in the game of educating our next generation, you have to be on top of that, or the patients will go elsewhere,” Steltenkamp says. “That’s where the demand is. They have to shift. Even if the doctor is thinking, ‘Why change? It’s just between me and my patients,’ it’s not. It’s also about the residents and other younger personnel. You have to change for them.” Change in her home state is perhaps Steltenkamp’s greatest source of pride, with Kentucky REC and KHIE making it possible for people in smaller and/or more rural communities, such as the Appalachians of eastern Kentucky, to get EMRs. The goal, of course, is for the technology to manifest as improved healthcare. “To be able to step outside of the university while having UK’s blessing . . . what a great opportunity to go out and serve and help others,” she says. “Which is really the right thing to do for all our patients.” As for the future of UK HealthCare itself, Steltenkamp looks to continue putting it in a position to meet the needs of the Medicare Access, as well as the US CHIP Reauthorization Act of 2015 (MACRA)—to step up to that federal regulation, she says. Continuous evolution and optimization of EMRs is key to that process. “I also want to beef up educational offerings around health IT,” Steltenkamp says. “All six medical colleges at UK are within walking distance of each other, which allows for great collaboration possibilities.” Those collaborations can now be shared with the entire state. “UK HealthCare is truly dedicated to the citizens and the commonwealth of Kentucky,” Steltenkamp says. “That’s what makes it a privilege to serve here.” AHL

CAROL STELTENKAMP CMIO University of Kentucky HealthCare

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One Platform for a Mobile Migration With a recent switch to a Cerner Millennium platform, CIO Kent Hoyos is moving on a series of technology-integration goals at Pomona Valley Hospital Medical Center

AHL APR.MAY.JUN 2017

By Urmila Ramakrishnan

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From applications that can ensure the correct breast milk goes to the right baby to streamlining records across different departments, integrating technology is no small task for hospital systems today. For the Los Angeles-based Pomona Valley Hospital Medical Center (PVHMC), it’s all about accessibility to the end user. For CIO Kent Hoyos, that equates to a series of long- and short-term goals to replace antiquated technology with systems and applications that work across the enterprise to serve its diverse patient population. The hospital has been a long-standing customer of Siemens Health Services and its Soarian platform. In fact, it was one of the first systems after the advent of the Internet that was to be written from the ground up, Hoyos explains. “It just didn’t come to fruition across the whole board,” he says. “So we’re sitting here in a place where we have some holes, and at about the same time, Cerner purchased Siemens in 2014. They made a statement that they were going to do a like-for-like offering.” In November, PVHMC signed a contract to switch to the Cerner Millennium platform. “We found that the Soarian world of development felt a little slow, as you would imagine,” Hoyos says. “The other side of that was that it was beginning to feel like we’re some of the last rats on the ship kind of a thing, so we want to move as quickly as we can to get to what the future holds for us.” In order to do that, he developed the strategy to make his subsequent new goals fit the entire organization. For

KENT HOYOS CIO Pomona Valley Hospital Medical Center

Hoyos, it’s really about discussion and communication with the organization’s associates to make sure his team is moving in the same direction, with the same priorities as the organization. Hoyos takes the time to involve his clinicians, physicians, and community. He leads with transparency in developing goals while keeping patient care in mind by surrounding himself with clinicians. Because of that, he’s been distilling the hospital’s many applications into one platform, which will eliminate the need for multiple devices. This makes the experience inherently easier for the end user to understand where to go for that specific application. The department also won’t have to manage different platforms, multiple updates, and multiple access points. “One way to do it is the better way to go for us,” Hoyos says. It also addresses the expectations people have surrounding technology. It's fair to say that everyone wants the latest gadget in tech, from the iPhone 7 to VR headsets. There’s an intrinsic want for the latest, greatest thing. But integration creates a sense of equality because everyone gets his or her applications this way. This means integrating an application that tracks breast milk to make sure it goes to the matching baby with mobile blood-draw applications with an alerting platform that indicates new results and admissions. By switching systems and integrating applications, Hoyos also has to focus on community connectivity. His goal is to get outside entities on board with the understanding that the data is good for their system, too. “We’re having people on one side who are used to


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certain applications and vendors,” he says. “It’s what they’ve learned to do, and it’s hard to change, even for IT folks. We want to keep those people and make sure they understand that they are part of our future.” There have been a lot of challenges presented with trying to create community connectivity. “We’re a not-for-profit hospital. We don’t own our doctors,” Hoyos says. Because of that, there are many systems out there with patients who might be on the same system—but they have different opinions on

“It’s not a Kent choice, or a one-of-my-staff choice. It’s an organizational decision that we really need to make as a team to ensure that these things are understood and evaluated so we can move forward.”

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how they want to use it. Hoyos is focused on how to make the environment meaningful for all—not just checking a “meaningful use” box. Another goal for Hoyos is updating the hospital’s data center. Being that it’s in the basement of the organization’s hospital in California, there are seismic upgrades and construction issues that go into the day-today use issues. On top of that, part of the data center is in a building that was constructed in 1972. Hoyos is working on a plan to create a new data center, and PVHMC is considering moving the servers into its own building or creating a multi-use building that houses data. It’s been all about choice: how much of the old does one keep while moving forward? “It’s not a Kent choice, or a one-of-mystaff choice,” he says. “It’s an organizational choice that we really need to make as a team to ensure that these things are understood and evaluated so we can move forward.” AHL

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An Educational Emphasis For St. Joseph Health's Dr. Jack Cox, teaching is key to placing patient well-being at the center of clinical progress By Denise Dooley

AHL APR.MAY.JUN 2017

JACK COX Chief Quality Officer, Senior VP St. Joseph Health

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When Dr. Jack Cox speaks of valuing every individual employee of the sprawling Providence St. Joseph Health (PSJH) healthcare network, he is not merely trading in platitudes. Cox speaks from experience. As a young man in Knoxville, Tennessee, he first worked in environmental services at Fort Sanders Presbyterian Hospital to put himself through college. One of his responsibilities included cleaning rooms, and he realized the key role of all healthcare professionals is the well-being and safety of patients. “If an infected patient leaves a room that is not properly cleaned, it jeopardizes the safety of the next patient using that room,” Cox notes. “Healthcare is a team sport. Every single employee contributes to the standard of care and to the hospital mission.” As he discusses his new responsibilities as senior vice president and chief quality officer at PSJH, it is clear that the scale of this 100,000-caregiver and fifty-hospital operation does nothing to diminish his passionate concern for the welfare of each patient. “Everyone who works at a hospital is a caregiver,” Cox says. “Even if you are not providing care to the patients directly, you’re caring for those who do. That’s important.” Cox followed his early mop-pushing days with a medical education at the University of Mississippi School of Medicine. After his eight-year US Air Force stint, which included a tour in England as the chief of clinical services and a teaching assignment at Travis Air Force Base, Cox was recruited to run a family practice residency program in Pennsylvania, followed by the development of a residency program at Intermountain Healthcare’s Utah Valley Medical Center. “Every job I’ve ever taken could be described as something that I haven’t done before,” Cox says. “You have to trust what skills you have, always look to learn new ones, and learn how to apply them to new challenges.” Teaching and learning are one and the same in his philosophy. “It is fundamentally our responsibility to train new phy-


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sician leaders,” he adds. “The Latin root for ‘doctor’ means to teach. The doctor’s role is always to be teaching and developing others.” His studies, teaching, and leadership brought Cox all over the country, and he picked up extensive systems experience and a business degree from Tulane University along the way. In Utah, he met Dr. Brent James, a trailblazer in clinical quality with whom Cox worked to develop and implement one of the first residency curricula that emphasized quality and performance improvement skills. These lessons served Cox well in his next role as senior vice president and chief medical officer for Premier, an alliance of 2,000 nonprofit hospitals, where he created its first Clinical Performance Improvement department and developed and implemented its strategic direction. Once again learning at the feet of other pioneers in healthcare quality and safety, including Dr. Don Berwick, Dr. Gene Nelson, Maureen Bisognano, and Carol Haraden, Cox’s team developed a method of identifying leading practices in specific clinical conditions and procedures, while sharing this knowledge through a collaborative model. The successes of this program led to the health quality improvement demonstration with CMS, a pioneer pay-for-performance model. Decreasing variation and improving the reliability of care was a driving force for this successful model. As Cox explains: “There is a false assumption that every person is different, that you can come to expect variation in the care provided. But it simply isn’t the case.” He believes that each patient should come to expect—and receive—safe and excellent care at every step along the way. After sixteen months as the senior vice president and chief medical officer, Cox switched roles to join the team tasked with guiding the St. Joseph Health and Providence Health & Services organizations through a major partnership merger, acting as the newly minted senior vice president and chief quality officer of PSJH. He is quick to note that this process is running smoother than many

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“The Latin root for ‘doctor’ means to teach. The doctor’s role is always to be teaching and developing others.”

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During a recent foundation event, Dr. Jack Cox (second from left) joined (left to right) Dr. Burt Eisenberg, Dr. John Lipham, and Dr. Louis VanderMolen for a discussion about cancer.

for a rather high-minded reason: the shared missions and values of the founding Sisters of St. Joseph of Orange and the Sisters of Providence align beautifully. Both orders emphasize service, access, and affordability. Generosity and excellence are crucial to Cox’s work, and his unique array of vantage points and work experiences in both lead and support roles help him to make these values tangible in each and every patient interaction that takes place. PSJH now comprises a major system of integrated medical services, which provide an array of healthcare services to more than twenty-two million people in seven states. The one factor this development makes certain is that Cox’s agile and energetic administrative talents will have a directly positive impact on millions of Americans, bringing professional support and excellent care to patients, doctors, and caregivers alike. AHL PerfectServe is honored to serve Dr. Jack Cox and his team at St. Joseph Health to enable clinicians to enhance the quality of care by speeding time to treatment. PerfectServe Synchrony is healthcare’s most comprehensive and secure care team collaboration platform. Its proprietary Dynamic Intelligent Routing facilitates communication-driven workflows that enable time-sensitive care delivery. The single platform architecture is designed to transcend geographic and organizational barriers and drive collaboration among all stakeholders across all care settings. Over 100,000 clinicians in organizations like St. Joseph Health rely on PerfectServe Synchrony to help them enhance patient experience and reduce HIPAA compliance risk.


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“Soviet Ukraine was a whole different reality, where a girl like me would never even dream to be what I am now.�


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The Road to

Inclusion From Taiwan to Kansas, Nashville to Indianapolis, Sonia Chen Arnold’s career path has been one of twists and turns that have led to her most fulfilling work yet as assistant general counsel at Eli Lilly

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By Amanda Garcia | Photos by Kristin Deitrich

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SONIA CHEN ARNOLD Assistant General Counsel for Litigation and Legal Compliance Eli Lilly

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Raised by a lawyer and a musician, Sonia Chen Arnold was taught early in life to balance art and academia and to always prioritize education. Her father had earned his master’s degree in law from the University of Missouri–Kansas City after moving his young family from Taiwan to Kansas; her mother is a pianist and holds a degree in music from Chinese Cultural University in Taiwan. Arnold herself originally pursued liberal arts over science, majoring in violin musical arts at Vanderbilt University. However, during a fiddling class taught by the award-winning musician and composer Mark O’Connor, Arnold heard something that changed her trajectory. “Anyone can be a musician,” the guest lecturer said that day. “But the only people who should be musicians are those who can’t live without it.” While she was a good student and accomplished in her craft, Arnold realized that she was too multi-passionate to dedicate her time exclusively to music. So, she took on a second major in human and organizational development and an internship at a music publishing company, where she became acquainted with the business side of music. While filing copyrights for songwriters there, she discovered her interest in the industry’s legal side and decided to go to law school to become an entertainment lawyer. Having moved to Indianapolis during elementary school, Arnold decided to attend the Indiana University School of Law in Bloomington. Arnold would then spend the first eight years of her career in private practice as a litigator. The epitome of success for a private practice attorney is to become an equity partner of a law firm. In 2011, Arnold had sacrificed the necessary blood, sweat, and tears to do so and was preparing for her vote that fall when she got a call about a rare opening at the global pharmaceutical giant Eli Lilly. AWARDS “I was so close to making partner, and I wanted to prove to myself that I In 2016, Eli Lilly was ranked number seven out of one could do it,” she says. “On top of that, hundred on the Thomson I would’ve been the first Asian AmerReuters Diversity and ican and second ethnic minority out Inclusion Index, which of more than one hundred lawyers at evaluates thousands of the firm to make it into the partnerpublicly traded companies ship from being an associate—not worldwide. to mention a woman—which made For the twenty-second year, Eli me a mentor to a lot of associates.” Lilly has earned a place among But Arnold was raised to never turn Working Mother magazine’s down an opportunity without learn“100 Best Companies” for its ing about it first, so she applied for efforts in the advancement of the job with low expectations. women, child care, and paid parental leave. She interviewed, and after meeting Eli Lilly’s general counsel

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and learning about the company, its work, and her own upward potential, Arnold was intrigued. She had been pushing so hard to make tiny strides for diversity at the law firm, but at Lilly, she saw the opportunity to make contributions to a more advanced culture of diversity and inclusion that still had room for improvement. Additionally, Arnold felt the new position would not only allow her to be more than an example for other women and minorities, but also make a difference in the careers of other young attorneys. When faced with the choice to stick with her original plan for success or explore a completely new path with great potential, she had to ask herself: will being a partner make me happier? Arnold joined Eli Lilly in May 2011 and has never looked back. Now assistant general counsel for Lilly’s Litigation & Legal Compliance Center of Expertise, Arnold uses her influence to promote Lilly’s company-wide commitment to diversity and inclusion every day, in part by helping to manage Lilly’s Preferred Outside Counsel Program. “I work with amazing law firms across the country, with highly intelligent lawyers,” she says. “When they’re working on Lilly projects, I want to see a team that includes women and minorities—associates and partners with diverse backgrounds.” In this way, Arnold is able to directly invest in both the future success of other attorneys and to better serve Lilly’s customers. “Making sure our employees are as diverse as the millions of people we serve is crucial to our success—and that includes the legal department, outside counsel, and our vendors,” she says, emphasizing that championing diversity is an important way to make meaningful contributions to business needs. “When I mentor people who are interested in law, I always tell them to not be so focused on what you ‘should’ do,” Arnold explains. “Ultimately, it’s more important to find something that you enjoy and have a passion for because if you don’t, you won’t do well.” At the same time, Arnold—who is married to a corporate attorney in

 onia Chen Arnold S was recognized as a “Rising Star” by Indiana Super Lawyers in 2008, 2009, and 2011.


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“Making sure our employees are as diverse as the millions of people who use our medicine is crucial to our success—and that includes the legal department.”

partnerships Decades of Experience Ice Miller was an early pioneer in the defense of pharmaceutical and medical device products that improve the health and well-being of patients around the globe. Ice Miller’s long standing leadership and cost-effective, creative commitment to defending these important, life changing products and the companies who make them continues today. Chicago Cleveland Columbus DuPage County, Ill. Indianapolis New York Washington, D.C.

icemiller.com

Ice on Fire

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private practice and has a nineteen-month-old daughter­—acknowledges that you can’t do everything. Professionally and personally, Arnold prefers to spend her time doing things that can make a difference. In this spirit, she has narrowed her volunteer time to the boards of three organizations. One is as a member of the Board of Visitors for the IU Lilly Family School of Philanthropy, the world’s first school dedicated solely to the study and teaching of philanthropy. Lilly Endowment, Inc. made the initial planning grants that launched the school’s predecessor, the Center on Philanthropy at Indiana University, more than twenty-five years ago and has provided substantial support throughout the school’s history. She also sits on the board of the International Violin Competition of Indianapolis. The competition brings forty of the world’s brightest musical talents from around the world to Indianapolis every four years to compete for a unique prize package that includes a cash reward, a recital at Carnegie Hall, the loan of the 1683 ex-Gingold Stradivari violin, and professional assistance in launching a violin career. Arnold is also a board member of the Asian American Alliance, an organization that exists to empower Asian Americans to lead and serve in businesses and communities as a way to engage and enhance their leadership potential. “I’m a prime example of why Asian Americans need to be empowered to actively seek leadership roles,” Arnold says. “If I hadn’t taken risks and embraced opportunities to lead, I wouldn’t be where I am today.” Arnold follows a drive for diversity and inclusion to the center of her personal success and satisfaction. She has maintained her parents’ example of balancing art and academia and, along the way, discovered that using her time and legal expertise to enhance lives, to advance careers, and to speak up for minorities is the thing she cannot live without. AHL

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Taking Charge of the Controllable

Simon Manoucherian’s journey from Iran to his current role as deputy general counsel at Grifols is a testament to the power of ethical determination and education

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By Amanda Garcia

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Soldiers patrolled the streets as the van delivered precious cargo to the airport. Martial law had been declared, but was failing to calm the upheaval in Iran in 1978. Simon Manoucherian’s PolishArmenian great-grandparents on both sides had immigrated to Iran before he was born. Almost half of the world’s ethnic Armenian population has lived outside of Armenia for generations after the genocide of Armenians by the Ottoman Empire and, subsequently, by the Turkish Republic at the turn of the twentieth century. Now, thanks to this van and the friend who drove it, they would move again to escape the radial Islamic revolution. “Sometimes things happen that are out of your control,” Manoucherian’s father said to his five-year-old son as they boarded the plane to America. Seeing his parents leave everything behind to make a better life for their family taught Manoucherian the value of determination and hard work. Watching his parents learn a new language inspired his passion for education. Paying attention to the way they kept the family together in the face of hardship taught him resilience and faith. “My parents taught me to overcome obstacles,” he says. “They taught me to keep pushing, be a good person, and never underestimate the value of education.” Manoucherian was enrolled at a private Armenian school, and in fourth grade during the weekly religion class, he memorized the Ten Commandments. The commandments inspired a budding interest in law—including common rules such as traffic lights, crosswalks, and signs that designate who is allowed to park where and when. He realized that all rules boiled down to those ten ancient commandments in one way or another. He was fascinated by whatever it was inside human beings that compelled them to obey. After school that day, he went home and told his parents he wanted to be a lawyer.

By sixth grade, Manoucherian could perfectly recite the Miranda rights, loved the concept of being innocent until proven guilty, and had developed a passion to read and learn. His fascination with law, coupled with his parents’ values and work ethic, motivated him through California Lutheran University (where he graduated magna cum laude with a bachelor’s degree in political science), Southwestern Law School (where he was associate editor for the Law Review, a member of the Moot Court Honors Program, and in the top 10 percent of his class), and the beginning of his career. Before the age of forty, Manoucherian had become an equity partner at a private firm and had reached what he believed was the pinnacle of legal practice. Meanwhile, he also met his wife. For a time, they were both content to be consumed by work, but when she became pregnant and her grandmother died in the same year, their mindset began to shift. “We had to take a few days off for the funeral, and I realized it was the first time I’d slowed down in years,” he says. “It gave me the

1978 Immigrated to the United States

1991 Gained US citizenship

SIMON MANOUCHERIAN Deputy General Counsel Grifols

1998 Graduated from Southwestern University School of Law


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THE AMIN LAW GROUP, LTD.

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opportunity to think about how I would balance work and fatherhood.” A few days later, a compelling email from on old boss arrived with an intriguing in-house opportunity. Grifols is a multinational biopharmaceutical and diagnostics company that is a leading global producer of blood plasma-based products. “When I came here, I was blown away,” Manoucherian recalls. “Thirty days later, I joined as senior counsel and director of litigation.” That was September 2008, and three months later, his twin boys were born. “This company supports work-life balance, and my whole team supported me in my work when my babies were born,” he says. Manoucherian has since been promoted to Grifols’s assistant general counsel and then to deputy general counsel in June of 2016. He also knows his work is directly helping a company that’s having such a powerful impact in healthcare. “When I give the ‘Welcome to Grifols’ talk at new employee orientation, I love to say that my team and I are the only lawyers I know who save lives,” he says. “We are part of the entire process. If we do

Our practice areas span many interrelated fields, including: Healthcare Business Corporate Governance & Transactions Finance Real Estate Intellectual Property Insurance Litigation Personal Matters

2008 Joined Grifols as senior counsel, director of compliance, litigation, and employment

2011 Promoted to Grifols’s assistant general counsel, director of litigation and employment

2016 Promoted to deputy general counsel

www.aminlawgroup.com

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2006 Became national VP of HR for FPA Medical Management, Inc.

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PROUD TO PARTNER WITH

SIMÓN

MANOUCHERIAN DEPUTY GENERAL COUNSEL TO HELP

MANAGE ITS LABOR AND EMPLOYMENT RELATIONS

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We help healthcare industry clients successfully navigate the complex landscape to manage risk and capitalize on opportunities. From efficiently operating your workforce, to managing your collective bargaining, to growing or consolidating your market position, our multidisciplinary team can meet your needs.

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“We believe we have the technology to build the foundation that a deficient immune system needs.” our jobs right, people get access to our life-saving drugs and diagnostic machines.” As head of all legal operations in North America, Manoucherian is committed to understanding all aspects of the business. Most of Grifols’s medicines are made of plasma, so he has visited several of its 162 donor centers. He is also familiar with operations at the two main US manufacturing hubs and international offices, including Grifols’s global headquarters in Barcelona. Manoucherian is dedicated to building trust with his team through collaboration and shared responsibility. “I relish this role, and I’m so proud of this company,” he says. “It’s a lot of work, and I know I couldn’t balance everything without such an amazing team.” Appreciation for others is a company trait, and pride and passion for donors, patients, and employees is ingrained in Grifols’s culture. One project that he is particularly excited about is Grifols’s Convalescent Plasma Collection Project—a system that is dedicated to fighting emerging pathogens around the world by collecting antibody-rich, hyperimmune plasma from donors who were sick and have recovered. In Liberia, for example, Grifols collected plasma from Ebola survivors. In a complex process, plasma is broken down into core units used to develop medicines to fight specific illnesses. “We believe we have the technology to build the foundation that a deficient immune system needs,” he says. “Grifols engineering, as well as manufacturing, is famous for turning concepts like these into reality.” Whether it’s developing life-changing medical resources, pursuing a career in law, learning a language (he fluently speaks four), or moving to a new country, he has become an expert at turning concepts into reality. He has always had a passion for bettering human life (which happens to be Grifols’s ultimate mission), and he knows his father’s determination, his mother’s consideration, and his integrity are the components to do just that. AHL


LIFE

Weathering the Storm CFO Shelly Hunter helped lead Mercy Hospital Joplin through a devastating natural disaster

On a Sunday afternoon in late May 2011, an EF5-rated multiple-vortex tornado struck Joplin, Missouri, with winds exceeding 200 miles per hour. At nearly one-mile-wide, it cleared a large path along the southern part of the city where, at the epicenter of the storm, St. John’s Regional Medical Center stood. It was just four days earlier when the hospital had serendipitously completed its annual “all hands on deck” earthquake drill, so the staff was prepared for the disaster. All 169 patients were evacuated within ninety minutes, and a triage center was quickly established nearby. Physicians who had been working all day stayed on to help throughout the night, many of whom worked up to thirty-six hours straight. The next day, Lynn Britton, president and chief executive officer of Mercy, made a major statement that the hospital in Joplin would be rebuilt and retain all employees. The corporate headquarters shipped computers to Joplin, so offices could be set up in a local convention center, and a MASH-type tent served as Mercy’s first temporary structure in a line of three temporary hospitals. At the same time, Mercy Joplin’s leadership team quickly set to work. The immediate plan was to design and build a state-of-the-art facility and retain its devoted staff in the years it would take to do so.

SHELLY HUNTER CFO Mercy Hospital Joplin

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Tina Smith

By Amanda Garcia

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“It would have been so easy for Mercy to walk away from us, but instead they invested in us over the four years it took to rebuild.”

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Meanwhile, chief financial officer Shelly Hunter and her finance team were taking the long view as they started planning for future growth. Mercy had lost 50 percent of its market share as a result of the disaster, but it was determined to regain it all and increase volume. These ambitious goals would have been impossible without a dedicated team and a committed ministry leadership. “The cost was $150 million after FEMA and insurance to support the losses,” Hunter explains. “It would have been so easy for Mercy to walk away from us, but instead, they invested in us over the four years it took to rebuild.” During the rebuild, Hunter managed current construction expenditures while maintaining steady ongoing operations at the temporary hospital. She worked closely with construction partners to stay within budget, while also working closely with FEMA to ensure funding and with the insurance company to negotiate claims. “We needed to set ourselves up for success in the future, which required projecting volume as accurately as possible,” she says. As financial strategist and planner, Hunter also developed strategic initiatives to drive the hospital forward to greater growth. “Balancing the current projects and future growth required a lot of focused work and a great team of brilliant, talented analysts,” she says. Corporate construction partners were highly supportive, along with the project manager, hospital leadership team, and the Joplin community itself. “It was a lot of fast-paced work for all of us,” she says. “But we pushed through knowing there was a light at the end of it all.” The planning of a building of this size and complexity typically takes a minimum of about two years, but Mercy won construction awards for breaking ground in January 2012—just eight months after the tornado struck. And in 2015, Mercy moved into its new state-of-the-art, $460-

million facility, complete with tornado-rated safety measures. “During the transition period, we coined the term ‘change fatigue,’” Hunter says. “But our folks are incredibly resilient, and we made it through together.” As a result of the phenomenal combined effort of many teams, Mercy is now the preferred provider of most service lines in Joplin. By summer 2016, the hospital had regained 5 percent of its market share, the budget was met, and volume targets had been hit and exceeded. Mercy even made a $24 million cost improvement (not considering depreciation) in fiscal year 2015 thanks to Hunter’s team of efficiency experts. Of course, maintaining the most efficient cost is worthless without also ensuring the highest quality healthcare. Achieving both also requires intensive planning in a constantly changing environment. “That’s why my work is so fun,” says Hunter, whose skill set and idealistic-thinking approach was an exceptional fit for the project. “I call it a Rubik’s Cube because all those moving parts are constantly affecting each other.” One key advantage to Hunter’s successful financial strategy is the fact that she grew up in the Joplin area and understands the population, as well as where Mercy might succeed in certain outlying areas. Her twenty years in healthcare have helped her understand how to apply national trends to the plan. Putting all those together is perhaps Hunter’s greatest strength, giving her a view of the whole picture: Mercy’s strengths, Joplin’s needs, and the growth required to break even and cover all depreciation costs within two years of opening (by June 2018). Ultimately, Mercy Hospital Joplin is a ministry with a mission to transform the health of the community it serves. “You can’t succeed here if you have a big ego,” Hunter says. “Everything has to be about caring for the patient and the greater good of the organization.” Approaching their work with that service mindset is a defining characteristic of the Mercy team, as is their relationship-oriented commitment to the community. It’s a key reason why they banded together in the face of a disaster, stuck together through the rebuilding years, and continue to stand united and grow into the future. And while planning and strategy are certainly essential, it’s Mercy’s commitment to quality, service, and each other that can weather any storm. AHL Siemens Healthineers is committed to becoming the trusted partner of healthcare providers worldwide, enabling them to improve patient outcomes while reducing costs. Driven by our long legacy of engineering excellence and our pioneering approach to developing the latest advancements, we are a global leader in medical imaging, laboratory diagnostics, clinical IT, and services. Siemens Healthineers is dedicated to helping our partners be successful—clinically, operationally, and financially—from prevention through diagnosis and treatment. To learn more about Siemens Healthineers, please visit usa.siemens.com/Healthineers.


A9111-9507-A1-4A00 | © Siemens Medical Solutions USA, Inc., 2016

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Engineers solve problems. Pioneers break new ground. Siemens Healthineers does both. As our market transforms, new challenges bring new opportunities. Introducing Siemens Healthineers—combining deep engineering know-how with a pioneering spirit that boldly embraces the future. In addition to ground-breaking technologies in medical imaging, laboratory diagnostics, and clinical IT, we offer an expanding portfolio of advanced therapies and molecular diagnostics, as well as new enterprise services. All to help healthcare providers improve patient outcomes while reducing cost.

Perhaps that’s why nine out of ten hospitals in the U.S. depend on our solutions, including all the hospitals on the U.S. News & World Report Honor Roll.1,2 Along with our new name comes a renewed commitment. We will do all we can to enable our partners’ success, because that is what partnership is all about. Learn more at usa.siemens.com/healthineers. 1 2

IMS Hospital Database and SAP Installed Base: May 2015. c2015. U.S. News & World Report: Best Hospitals 2016-17: Overview and Honor Roll [Internet]. Washington, D.C.: U.S. News & World Report; c2016.


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Forging Ahead in No Woman’s Land Janice Klostermeier reflects on her path to healthcare finance—and what its hurdles say about the uphill climb for women to the C-suite By Kelli Lawrence | Photos by Kristin Deitrich

Her grades started to slide. At age twenty-five and pregnant with her first child, Klostermeier had enough credits to graduate but a subpar GPA in accounting courses, so she tracked down a school administrator for assistance. “I was told the school didn’t need students like me who couldn’t get out on their own merit,” she recalls. “It was a horrible thing to say.” But Klostermeier bounced back, getting on the phone the next day to schedule an appointment with the university president. Not only did he say that she was free to graduate, but he also assured her that she was exactly the kind of student UTA was proud to call its own. She accepted her first opportunity in the healthcare industry that very same year. However, in the late 1980s, Klostermeier says, the field didn’t carry the same reverence that it does now—particularly with accountants. Those with the best transcripts were striving for a start with one of the “Big Eight” accounting firms at the time, including Ernst & Whinney and Coopers & Lybrand. Klostermeier, meanwhile, took an alternate route. “My job wasn’t sought after,” she says about the position at her first healthcare company, which involved internal auditing. “I just barely had my fingers on the bottom rung of the ladder.” What she soon realized, though, was that she was surrounded at this job by former public accountants that had burned out quickly with those big-name employers and came to healthcare seeking a calmer, lower-pressure work environment. This led to Klostermeier receiving “Big Eight”-style training, which in turn led to her ascent up the healthcare ladder. Four years after her UTA graduation—and not yet thirty years old—she found herself thriving as the CFO of a one hundred-bed hospital. The road between that CFO position and her current one was more a cherished scenic route than an express lane. Klostermeier was system controller in a couple of different locations before consulting independently.

JANICE KLOSTERMEIER CFO Hollywood Presbyterian Medical Center

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It happened many years ago, but Janice Klostermeier vividly recalls the conversation that kept her from her first CFO job in a major hospital. She had spent nearly two decades in the healthcare industry by then—including the past two years in senior management for a hospital. She held a master’s degree in healthcare administration; she was also a CPA and a Fellow of the American College of Healthcare Executives. “I had credentials none of [the other applicants] had,” she says. Nonetheless, the hospital’s CEO quelled the possibility with just one sentence in a face-to-face conversation: I can’t put a woman in that position. “And that went straight to my heart—this was the twenty-first century, not the Dark Ages,” Klostermeier says, incredulously. “But I immediately recovered because one of the things you do in this business as a female is recover quickly—and don’t ever become a victim. I said, ‘I appreciate your position on that. . . . What can you do for me?’” What he could do for her wasn’t nearly enough, considering that she started working—quite successfully— as an independent consultant shortly afterward. Today, Klostermeier is the CFO at the Hollywood Presbyterian Medical Center in Los Angeles. That’s not bad for someone who says she has “gone about everything the wrong way” in her career. That journey logged a lot of miles in Texas. Not only was Klostermeier born and raised there, but she had spent many years in the Lone Star State pursuing higher education—first at a junior college and then at University of Texas at Arlington (UTA). She married at nineteen and worked as a secretary and bookkeeper, a job she started just days after graduating high school. It was admittedly a lot on her plate for an extended period of time. “I’d graduated high school and junior college with honors,” she recalls. “But after slogging through seven-and-a-half years without a break, you get burned out.”

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ADVANCED MEDICAL MANAGEMENT A FULL SERVICE INDEPENDENTLY-OWNED MEDICAL MANAGEMENT SERVICES ORGANIZATION (MSO), THIRD PARTY ADMINISTRATOR (TPA) AND FISCAL INTERMEDIARY (FI) HAVING DECADES OF EXPERIENCE WITH MULTIPLE IPA, HEALTHCARE AGENCY AND HOSPITAL CLIENTS

AHL APR.MAY.JUN 2017

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5000 Airport Plaza Drive, Suite 150 Long Beach, CA 90815 562.766.2000

Meanwhile, she raised her children, divorced, and then met and married her current husband. Before coming to the West Coast, she spent several years on the East Coast as the CFO (and, eventually, chief administrative officer) of the largest privately held emergency medical group in the Northeast. When the group decided to sell and made her a generous financial offer, Klostermeier and her new husband headed west. As successful as her journey has been, one aspect still proves frustrating: the continued absence of women in the highest ranks of the healthcare industry. Klostermeier acknowledges that the majority of chief nursing officers are female, though. “The other positions—CFO, COO, CEO—are few and far between for women,” she says. “There are over 5,600 hospitals across the United States, yet it’s difficult to find many women in C-suites, especially when you get to the big systems. Even where I’m at right now . . . it’s a single hospital. Would I have this much success in a system? I don’t know.” While Klostermeier feels it may be at least partly attributable to a generational shift—e.g., women choosing to raise children later in life, putting healthcare career growth on the back burner—she believes C-suite opportunities are there if women make the effort to get noticed in their day-to-day work. “You have to risk being assertive,” she says. “Networking is a must, particularly through organizations like the American College of Healthcare Executives. You need to serve on committees and serve on boards if you can.” But more than anything, she stresses the importance of women learning all they can from those above them, regardless of gender. “I’ve had some amazing CEOs mentoring me along the way,” Klostermeier says. “There are harsh ones out there that can damage one’s self-esteem and career track, but if you find one that respects you— and I’ve found several—you’ve got it made.” AHL

ADVANCED MEDICAL MANAGEMENT—PROVEN LEADER IN HEALTHCARE MANAGEMENT—STABILITY: 1981 Founded, 1993 MSO, 2008 TPA; GEOGRAPHY: In 39 of 58 California Counties; INDUSTRY KNOWLEDGE: CAPG member since 2000, Government Programs Chair third year and CAPG/PAC for Industry Advocacy. Well known and respected healthcare firm for more than three decades.

More than 500 physicians at Hollywood Presbyterian serve the Hollywood community and surrounding areas.


We are committed to being the difference.

The difference to our patients. The difference to our community. The difference to you. At CHA Hollywood Presbyterian Medical Center, we believe that high-tech medicine works best when combined with old-fashioned personal care. That is why our comprehensive services, from leading-edge fetal medicine to neurosciences and beyond, are delivered by the area’s top physicians and staff — dedicated to quality at every level. It is this difference that helps us create a vibrant, caring, and healthy community.

1300 North Vermont Avenue Los Angeles, CA 90027 213.413.3000 | www.hollywoodpresbyterian.com


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Power Service A former nuclear technician, Jason Atkins leverages technology in a different field today, improving nurses’ decision-making, patient education, and quality of care at Emory Healthcare

AHL APR.MAY.JUN 2017

By Amanda Garcia

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Like many students, Jason Atkins didn’t have a well-formulated plan when he graduated high school. But instead of taking a year off to explore his options, Atkins decided to work with nuclear reactors. He entered the navy’s nuclear program as an electronics technician and was immersed in rigorous education for a little more than two years. By the end of his training, Atkins’s appetite for learning was insatiable and further pushed him to complete his formal education. He was accepted into a program through a navy nursing Reserve Officers’ Training Course (ROTC) scholarship and found his calling as a registered nurse in a navy critical care unit in San Diego. Even in those early experiences, Atkins was more than impressed by the impact of technology, and even more so with its untapped potential. He was inspired to discover how technology could expand and improve patient care, particularly in the realm of medical and nursing informatics, so he went on to get a master’s degree in biomedical informatics and further merge his interests in healthcare and technology. These days, Atkins’s natural ability to evaluate technology and its impact on clinical care remains a major asset in his work as chief nursing information officer at Emory Healthcare. His work naturally corresponds with Emory’s CMIO—his counterpart, who focuses on physician workflow—and they both work closely with the CIO, who is responsible for IT architecture and infrastructure. Collaboration is key between the three leaders as they work to understand the complete technology environment at Emory. “We know that one of us can’t change a single thing without a downstream impact,” Atkins says. But Atkins’s role as chief nursing information officer is unique because he is responsible for meeting the technology needs of the largest workforce in the organization: nurses. And because healthcare regulatory and legal requirements continue to expand, nurses are not

JASON ATKINS Chief Nursing Information Officer Emory Healthcare

only tasked with the responsibility of providing care to their patients, but now they also have the added burden of using technology to record and coordinate care and manage information flows. These new challenges have created endless opportunities for Atkins and his team. “One of my main focus areas is figuring out how to reduce the burden of documentation and manual transcription for nurses and improve communication between care team members,” he says. It’s a big job, but the team has made substantial strides in the nearly three years that Atkins has been in this role. They’ve automated the medical administration process to improve medication administration safety, for example, and they’re currently working on the ability to pull information from infusion pumps and automatically transcribe it to patients’ EMRs. “We’re always looking at which medical devices are creating data that needs to be transcribed into the medical record and figuring out how it can be automatically added to the EMR,” he says. The nursing informatics team that makes all of this happen at Emory is surprisingly lean and includes only three nursing informatics specialists in addition to Atkins. They work closely with the IT department to evaluate, test, and focus on the technology itself. But when Atkins joined Emory, he not only brought his skill for technology, but also his passion for education. “I’ve built an education team of nursing informatics educators,” Atkins says. “It’s made of five nurses with a variety of backgrounds and experiences, and they compliment the IT specialists by learning the technology and teaching it to other nurses.” These educators teach in classroom or web-based training settings, or occasionally as a unit-based service to increase nurses’ confidence in decision-making. Conversely, these educators also work with clinicians to identify needed changes in existing technology, which they then feed back to Atkins and the informatics specialists. This valuable information has required marketing the education team as approachable and


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“Nurses are the key to teaching individuals what healthcare should look like and how to navigate patientcentered, needs-oriented care.” accessible and making them widely visible across the organization. “They all practice clinical care directly one day a week, and the rest of the time they preach what they practice,” he says. Taking education a step further, Atkins is equally passionate about teaching patients about their own health and care options. Informing patients about the disease process, medication dosage, and appropriate times to take the next steps are crucial components of moving from service-based to value-based care. This transition has also shifted the focus to keeping patients healthy and decreasing visits to the care team, thereby moving the greatest inherent risk to that longer time between care encounters. This extended time puts more responsibility on the patients themselves and requires them to know more information. And who are the conduits of such information? The answer, of course, is nurses. “They are the key to teaching individuals what healthcare should look like and how to navigate patient-centered, needs-oriented care,” says Atkins, who looks to nurses as a necessary lubricant of integrated workflows. Not only do nurses spend the most time interacting with the patient, but they are also responsible for communicating about the patient with service providers. “Because of that, nurses will help us cross this transition of care in a safer, more holistic way,” Atkins notes. This passion for serving others has grounded him throughout his career and has manifested in a highly collaborative, team-centric leadership style. “Whether it is your country, your patients, or the job of the person taking care of the patient,” Atkins says, “service is what it’s all about.” AHL

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Prescription for Success AHL APR.MAY.JUN 2017

How several healthy doses of reality in the healthcare industry helped T.J. Griffin keep PharMerica on the fast track for growth

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By Chris Gigley


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T.J. GRIFFIN Chief Pharmacy Officer PharMerica

“I want to make sure medication therapy is not a reason patients have to stop what they’re doing.” his father-in-law fell into a coma for six weeks and passed away after one day of lucidity. Then, in 2013, Griffin lost his father to complications from throat cancer. “[My father] was in and out of nursing facilities, as well,” Griffin says. “The first one where I visited him, I looked at his chart and the IV hanging there and realized it was the wrong one. It was an underdose for my father. I was more worried about the other patient, who had double the dose he required.” Those family experiences are never too far from Griffin’s mind. Knowing how much work and pressure nursing facility staff face pushes him to ensure the utmost accuracy on every dose PharMerica pharmacies produce. “Our customers rely on us, and we want to limit medication reconciliation issues, which data links to higher costs and higher hospital re-admissions,” he says. “I want to make sure medication therapy is not a reason they have to stop what they’re doing.” PharMerica currently has ninety-three pharmacies in forty-six states and a team of about 3,000 employees, including about 200 consultant pharmacists who review all aspects of every patient’s medical chart and therapy. “Our culture is one of care, commitment, and collaboration, which means best-in-class patient care and a deep commitment to our clients’ success. On top of all the daily dispensing our pharmacies do, we’re hands-on in helping nursing homes stay regulatory compliant,” Griffin says. Monitoring compliance in forty-six different states isn’t easy, he explains. To manage it, he receives daily legislative updates through e-mail. “They’re not always about law changes, but I know what’s being talked about as a potential law or regulatory rule changes,” he says. And, in each state, a PharMerica pharmacy director serves as the point person with the state board of pharmacy, attending quarterly meetings and gathering information. The company also has its own compliance department that tracks changes in nursing home law. “We’re active in making sure we can be a voice with our nursing home partners if there’s a change in how they operate,” Griffin says. “We want to be a voice with them to

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T.J. Griffin has an especially unique level of insight into the impact of his work. He knows it makes a difference because he grew up watching it in action. The chief pharmacy officer of Louisville, Kentucky-based pharmacy services company PharMerica has seen his own family rely on acute caregivers and the medicines they provide. Not only were science and math Griffin’s two best subjects growing up, but he also dated the daughter of the pharmacist in his small Illinois hometown. “I got to know him and his business and how respected he was in the community,” Griffin recalls. “He was really a caretaker of the community. We ended up getting along better than his daughter and I did.” Griffin knew he wanted to work in healthcare at an early age, but he didn’t decide on pharmacy school until after his family went through several healthrelated hardships. The first was the paralysis of Griffin’s grandfather. Given just six months to live due to ensuing complications, he lived another six years instead. Griffin’s grandmother became the primary caregiver and a regular customer at the local pharmacy. Griffin remembers her story about two pharmacists there who essentially saved his grandfather’s life. “My grandfather was always in pain, and these pharmacists kept making him stronger medication to the point where they couldn’t make it any stronger,” Griffin says. “They knew something wasn’t right, put two and two together, and found out that the nurse was watering down the pain medicine.” That story showed him how vital pharmacists were, and after high school, he enrolled in pharmacy school at the University of Iowa. After graduating, he moved to Florida to take a job with Eckerd, the same company for which the two pharmacists had worked. “As I progressed through that company, I would tell that story of the two pharmacists to folks who worked with me,” Griffin says. “You need to go back and get to know your customers. There was a reason my grandmother needed help. There’s more to the story.” Griffin spent thirteen years at Eckerd, until another family trauma redirected his career path. Within a week of discovering his mother-in-law was seriously ill in 2003, he got a call from PharMerica. “To tell the truth, I didn’t know what a long-term care pharmacy was at the time,” he says. “I had the interview and felt like it was divine intervention to be able to bring my wife and son to be near my mother-in-law. I got a full education right away on hospice care and how caring and loving long-term and hospice care nurses are. They’re really the unsung heroes of medicine.” Griffin’s mother-in-law passed away months after he joined PharMerica, but unfortunately, he wasn’t done getting a firsthand look at long-term acute care. In 2006,

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make sure rules and regulations make sense and don’t inadvertently affect our ability to have good patient outcomes.” To manage all this work effectively, Griffin surrounds himself with a knowledgeable team that share responsibilities. PharMerica has thirteen regional pharmacy directors and three VPs of operation who oversee anywhere from five to eight pharmacies each. “There’s no way you can do a good job if you’re overseeing thirty pharmacies, filling as many prescriptions as we do,” Griffin says. “We have over one hundred separate clinical and service metrics we monitor to ensure we can provide best in class care and service.” Griffin’s latest focus is the company’s antimicrobial stewardship program, which is an effort to stop the spread of drug-resistant super viruses that are becoming alarmingly more common. “Hospitals have had these types of programs for years. Now that nursing homes are becoming more like mini-hospitals, they need these programs, too,” he says. Griffin says that he wants his team to measure the use of antimicrobials to extend their effectiveness. “You have got to select the optimal drug regimen for the right outcomes,” he notes. “You can’t just throw big-gun antibiotics at a microbe that may still not be resistant to a first-line therapy.” Soon, Griffin explains, those antibiotics won’t work anymore, allowing that microbe to spread. For the type of end-consumer PharMerica most often serves, the elderly, this outcome is particularly ominous. “Our role is to focus on diagnosis, communicating among the healthcare providers, nursing facilities, and pharmacists,” Griffin says. “Then, it’s selecting the right drug, the proper dosing, and proper duration. We create an accountability structure.” Education, either on-site or via PharMerica’s online portal, is another key aspect of the program, Griffin explains. He knows better than most that it’s better to learn that way than by experiencing problems firsthand. Griffin has been through it, and because of that, he hopes that fewer people will in the future. AHL “TJ Griffin and Pharmerica have affirmed a commitment to proactively identify and manage medication risks, which comprise over 37% of the adverse events affecting the industry. Pro-GeneX and Pharmerica are proud to work together in bringing the advantages of personalized medication risk management to entire long term care patient populations.”

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Charting a Better Course in North America After leaving Soviet Ukraine at twenty-six, Tetyana Buescher rode her momentum all the way to her current position as general counsel for CompuGroup Medical By Kathryn Silverstein

TETYANA BUESCHER General Counsel CompuGroup Medical

maintaining compliance with healthcare legislation, such as the Health Insurance Portability and Accountability Act, is roughly 40 percent of her job. She understands the need to wade carefully through regulations, which is where her experience in the financial services industry becomes so valuable. “Sometimes business needs clash with regulatory needs and create huge expenses for companies,” she says. “What has been happening in healthcare is that smaller players are being pushed out of the market or bought up by larger companies due in large part to the expense of ongoing compliance.” Buescher explains that while a small business could potentially provide a better and more nimble service or ideas, the regulatory field raises the bar to entry and

“My grandmother could not even read, and here I am, a first generation immigrant with an executive position in a global healthcare company.”

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As Tetyana Buescher reflects on her journey thus far, she admits that sometimes it’s hard to believe all the twists and turns her life has taken. “My grandmother could not even read, my parents never had a college degree, and here I am, a first generation immigrant with a JD degree and an executive position in a global healthcare company, advising on legal affairs in North America,” says the general counsel for CompuGroup Medical about her unique background. Buescher, a former in-house lawyer in the financial services industry, moved to the United States at the age of twenty-six from Ukraine, where she grew up in an average family as the daughter of a factory worker and a government clerk. “Soviet Ukraine was a whole different reality, where a girl like me would never even dream to be what I am now,” she says. In her current role, Buescher is a key member of the business team, wearing both business and legal hats. “Sometimes there are days when I don’t do anything particularly legal,” she explains. However, this arrangement makes more sense given the host of regulations that her company must comply with in order to produce cutting-edge healthcare technology solutions. “The presence of a lawyer is necessary to ensure a new product is in compliance during the design and concept phase, which can save time and effort down the road,” she says. “I know from the get-go whether or not a new idea will work from a regulatory standpoint.” This legal advice is critical in the increasingly regulated healthcare industry. Buescher estimates that

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Sherin and Lodgen joins American Healthcare Leader in congratulating

Tetyana Buescher on her outstanding accomplishments as General Counsel of CompuGroup Medical.

Sherin and Logen LLP

Complex Law. Clear Guidance

AHL APR.MAY.JUN 2017

Real Estate | Litigation | Business Law

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www.sherin.com

development in the healthcare marketplace. CompuGroup is in a unique position, being a small association with a start-up mentality backed by a larger company based in Germany. This allows CompuGroup GIVING THANKS FOR to develop and bring new products HELP ALONG THE WAY into the market in a highly reguBuescher credits strong mentors lated industry. However, this can for helping her throughout present unique challenges to the her career, starting with her small, two-person legal team that contracts professor and now Buescher heads, due to the need to dear friend Jennifer Martin, who keep costs down and also compete hired her as a research assistant during law school and coached with larger corporations. and raised her confidence as Buescher’s position is uniquely a young attorney. She also challenging as well, because she credits Liz Levy, now an attorney must proceed with a heightened at MIT, who was her mentor cultural awareness when collabothrough National Association of rating with her colleagues in other Women Lawyers and who also became a close friend. “Both countries. It’s her experience from Liz and Jennifer did so much adapting to the cultural differences for my confidence level and between her native Ukraine and professionalism,” Buescher says. the United States, though, that has been critical in helping Buescher Her list of mentors would not navigate these potentially turbube complete without mentioning Byron S. Kalogerou, a partner lent waters. “Being from a different at McDermott Will & Emery LLP culture makes it easier for me to who lent his time and expertise adapt. I learned a new culture once; in a mentoring role, as well I can learn it again,” she explains. as her current boss, Werner “Moving to a different field or Rodorff. “Werner is an amazing role, or working within a different human being,” Buescher says. “He put a lot of confidence and environment, demands adaptabiltrust in me, and I appreciate it ity. I am actually excited to learn very much.” new angles to look at things, new approaches, and new mindsets. That is a trait that has been the most important to my career.” Her perspective on healthcare business and culture is heavily informed by her understanding of its regulations. She found the same to be true when it came to understanding American culture through its legal system. “Learning procedure and Constitutional law made me see American history in a different light. It helped me figure out American culture,” Buescher says. “Coming from a country with a communist regime that fell when I was fourteen, and seeing how the system here works and how great it is, I have a greater understanding of what makes this country special. It gives me a sense of pride living my American dream.” One of her personal goals is to give back to the community that helped her find her place and lead a successful career in law. “I benefited greatly, and I want to give back,” she says. “I am humbled and grateful for the opportunity to mentor women in the professional workspace through a formal mentorship program at CompuGroup. I also want to come back to the National Association of Women Lawyers program and offer mentor services now that I’m more advanced in my career.” AHL


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A New Set of Orders Erlanger CIO David Peterson details his journey from the navy to civilian medicine

AHL APR.MAY.JUN 2017

By David Baez

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Tennessee-based Erlanger Health System—the seventh largest public healthcare system in the United States— attacks new IT projects, such as the recently underway EMR install, with an extra dose of discipline. That’s probably due to the company’s chief information officer David Peterson and his military background. For more than twenty years, Peterson served Navy Medicine as a medical service corps officer, initially as an administrator overseeing medical records and managed care. He then helmed a multimillion-dollar IT deployment project stateside, as well as in the European theater, moving on to do the same for the Marine Corps supported by Navy Medicine. Finally, he earned a spot as CIO for the National Naval Medical Center, known as “The President’s Hospital.” In 2001, he retired from the navy and embarked on a civilian career. But while Peterson won’t discount the influence that the military’s culture of discipline and regimentation had on him or deny that it migrated to his civilian work, he is quick to point out that, when it comes to medicine, there are vastly more similarities than differences in the two sectors. “Military medicine is medicine,” Peterson says. “With operational warfare, it’s a much more regimented environment. But in hospitals and clinics, it’s all about the patient’s care. You could have a navy captain physician treating an enlisted sailor in that bed, and it’s a patient-physician relationship.” Peterson approached the transition thoughtfully and carefully, making sure that the work he took on allowed for a clean transfer of skill sets. While he transitioned from being a military officer in khakis to wearing a suit and tie for the University of Maryland Medical System, Peterson says it was essentially the same job. “The only difference was getting to work at eight o’clock, whereas at the National Naval Medical Center, I was attending Admiral’s Call at six thirty,” he says. “I still had to deal with providers, patients, and their families. Actually, the hardest part of the transition was deciding which tie went with which suit.”

After working for several different health systems and running a consulting firm, Peterson joined Erlanger in September 2015 as senior VP and CIO. He calls himself a “turnaround CIO” who has expertise in stabilizing IT departments that need guidance. To that end, he maintains an open-door policy with staff and lets everyone, whether it’s a director or an analyst, know that they are involved in all decisions. This includes going to various members of the staff and asking what they think about pressing projects before presenting the idea to his leadership team. “You get the most out of people when you treat them with respect,” he says. “I was like that in the navy, too. Even though I was an officer, I never used my rank to get something done. It was always a team approach.” Peterson views IT as an intimate part of the caregiving process, rather than a detached unit. He sees the relationship between IT and clinicians as a partnership. At the end of every monthly IT staff meeting, Peterson reminds his staff that although they are not caregivers, per se, they play an important role in the patient care process. “We support the tools we give the clinicians to help patients,” he says. “In that way, we help provide care for the patients, and we can hold our heads up high. I never talk about IT in general. Everything is always in the context of overall clinical and business strategy.” Peterson and his staff have completed roughly 30 percent of an Epic EMR install. Once the project is complete, records that used to require accessing multiple systems will be streamlined into one. A doctor or a provider will be able to follow the entire continuum of a patient’s care in one record, thus giving a clearer picture of a patient and saving healthcare professionals enormous amounts of time and effort. In the end, all of this effort benefits the patient at the hospital. Peterson believes that information technology has radically transformed the patient experience overall, not only by increasing efficiency on the operational level, but also in terms of the amount of health information that is now so readily available. “It’s opened the eyes of the consumer,” he says. “The

DAVID PETERSON CIO, Senior VP Erlanger Health System


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“You get the most out of people when you treat them with respect. I was like that in the navy, too.”

AHLMAGAZINE.COM

patient has become a player in their care through access to medical records and all the information on the Internet. They come into a doctor’s office fully prepared, with different options of treatment. Providers have to be careful. A small community hospital could be competing against clinical research data downloaded from Johns Hopkins, and the patient might second-guess that physician.” Peterson is one of seven senior executives on Erlanger Health System’s senior executive team, an indication of the degree of respect IT is granted within the system. Whether it’s clinical initiatives or the acquisition of a new physician practice, the other executives always look to IT as an important player in integration, Peterson says. “If they want to go somewhere and I can’t support it technically, there will obviously be a problem getting there,” he explains. “With quality initiatives and financial goals, we have to provide them with what they need to be successful.” As he drives the organization forward, Peterson depends greatly on the lessons he learned in the military, not the least of which is that, though contexts may differ, medicine is always medicine. “The environment might change,” he says. “A civilian hospital is different than a wartime environment with jets flying off the carriers. But at the end of the day, medicine is always about the patient.” AHL

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A Patient’s Perspective CFO Bill Fenske draws on his own childhood experiences as a patient to care for Rice Memorial Hospital

AHL APR.MAY.JUN 2017

By Matt Alderton

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Growing up in southwest Minnesota, Bill Fenske spent a lot of time in and out of hospitals. So, the fact that he has worked in them for the last twenty-five years is no accident. “I was a healthcare user as a child due to a birth defect,” says Fenske, now CFO at Rice Memorial Hospital, a Level III trauma center in Willmar, Minnesota. “I had a lot of surgical procedures that were really scary and really painful. They were not pleasant experiences.” His early encounters with medical care made an impression on Fenske. When combined with a lifelong penchant for numbers and statistics that he inherited from his father, a math teacher, Fenske found himself drawn to healthcare administration as a young accountant. “I got my degree in accounting and started working for a public accounting firm that audited hospitals,” he explains. “I needed to leave public accounting in order to get my MBA, so I moved into a different part of healthcare and worked at a clinic for three years while I went to night school at the University of Minnesota. After that, I started looking at CFO jobs in hospitals.” As Fenske would soon learn, the role ended up being a perfect fit. “It wasn’t conscious, but healthcare was a part of me because of my childhood,” Fenske says. “I really believe that we all have a calling in life, and that it’s our responsibility as human beings to find that calling. I was fortunate enough to find mine early on in my career.” Although he doesn’t care for patients directly, Fenske’s job—ensuring that Rice Memorial Hospital

BILL FENSKE CFO Rice Memorial Hospital

can deliver the best possible care at the lowest possible cost—impacts them profoundly. “Finance is critically important to healthcare because at the end of the day, if you don’t have the money to pay your employees and your bills, you can’t provide the service,” Fenske says. He describes part of the CFO’s job as keeping a hospital steady in perpetually choppy waters. “One of the biggest things a CFO can do—and what I’m proud that we’ve accomplished here—is set a vision for how to enhance the financial strength and viability of the hospital by developing long-range financial plans that strengthen the organization and allow it to implement its strategy,” he says. At Rice Memorial Hospital, the largest municipally owned hospital in Minnesota, those long-range plans have focused on improving productivity, which also allows the hospital to deliver more care with fewer resources. These initiatives have also focused on leveraging assets to lower its long-term debt-to-capital ratio and increasing its cash reserves, which Fenske has grown from a thirty-day supply of operating expenses to a nearly 125-day supply. However, it’s not only financial strategies that have made Rice stronger; it’s also the way that Fenske has implemented them. “Most people in healthcare have numerous degrees, so we’re all inclined to think academically. I use an academic approach to teach people what our financial best practices are, utilizing examples to help them understand why they’re our best practices and why it is that we need to utilize them,” he explains.


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Celebrating

“I remember from when I was a child how scary the hospital was, so it’s really important to me that I empathize with patients.”

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Fenske focuses heavily on making intricate financial concepts relatable. “Something I learned many years ago is that you need to express finance in terms of what it means to individual departments by utilizing terminology and examples that are relevant to their area of focus,” he says. “That’s the biggest reason why CFOs are not successful—because they’re not able to relate to each department within the business and understand what their unique needs are.” One aspect that’s weighing especially heavily on several departments at Rice Memorial Hospital is the Affordable Care Act and the many changes it continues to bear, including revenue-cycle management, which Fenske has approached aggressively in response to healthcare reform. “Pulling out all of the legal reimbursement that we are entitled to based on the services we provide has brought a lot of strength to our balance sheet, which will help us get through these rocky times that we have in front of us,” he says. At the end of the day, however, what stays at the forefront for Fenske isn’t accounting strategies, it’s patients. “I remember from when I was a child how scary the hospital was, so it’s really important to me that I empathize with patients who are experiencing that feeling now when they come to our facility for services,” he says. “Whether that’s reassuring a patient that their services will be covered by insurance or helping them find another mechanism to pay for their care, I’m in a position to help them alleviate some of their worries so they can focus on getting well.” AHL

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“You can’t teach hungry. It’s an innate quality that lawyers either have, or they don’t.” P. 85


IMPACT


IMPACT

Laying Down the Law in Cook County Gina Knox helps protect Little Company of Mary Hospital with strong responses to litigation and extensive internal education

AHL APR.MAY.JUN 2017

By Jeff Silver | Photos by Kristin Deitrich

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When Gina Knox went to law school, she was looking to expand beyond the patient-care responsibilities of her role as a registered nurse at Evanston North Shore Hospital. The job she ultimately landed probably exceeded what she might have imagined at the time. As general counsel at Little Company of Mary Hospital (LCMH) in Evergreen Park, Illinois, much of Knox’s time is devoted to litigation strategy and risk management in the highly litigious environment of Cook County. The county, which has no tort caps, has recently experienced a significant rise in the number of claims filed and other legal actions taken, along with a similarly large spike in the amount of verdict values—as high as $53 million. It also operates with some unique statutes, such as interest that is attached to pending appeals, which adds to the cost and complexity of defending cases. In light of this, Knox and LCMH take a proactive stance in responding to legal actions and addressing risk management with a thorough review of claims and education throughout the hospital. “It can be costly

to mount a defense, but if you don’t put up a fight, you simply attract more of the same—much of which is inappropriate manipulation of the system for financial gain,” she says. Knox and her team execute risk assessments and ensure that appropriate policies are in place to guide processes and decision-making at all levels of medical, support, and administrative staff. This can involve everything from reconciling apparent conflicts between various Joint Commission and Illinois Department of Public Health regulations to determining when onpremises recordings using smartphones and even police body cams is allowed. While addressing and clarifying these issues, Knox initiates related educational programs for the appropriate staff and departments. Recent sessions have covered global standards of care and scenarios related to emancipated minors, informed consent, and appropriate procedures for DUI blood draws. Although typically driven by standard-of-care information, there have been instances when outside litigators and physicians have also been brought in to speak about issues involving risk prevention and management.


IMPACT

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GINA KNOX General Counsel Little Company of Mary Hospital

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IMPACT

STAT SHEET: LITTLE COMPANY OF MARY HOSPITAL

298

licensed beds

601

professional staff

2,109

employees

531

AHL APR.MAY.JUN 2017

nurses

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“I often ask groups to submit specific questions they have ahead of time so we can address them directly,” Knox says. “That helps avoid hypothetical situations and later having staff trying to make real-world decisions based on more general information we might have presented. We always want them to have specific details and to err on the side of caution.” Knox works tirelessly to ensure that the legal office is exceptionally accessible to everyone. Previously located on a remote floor before the hospital moved into its new building less than four years ago, the office is now in the same location as the rest of the hospital administration, which facilitates ongoing communication with key executives. She also encourages an open-door policy for anyone who may need advice. “I want staff to feel free to come see me or consult with my office and to know that we’re accessible 24-7,” she explains. “That approach helps build personal relationships and demonstrates that we’re really part of the team. It helps create an environment in which staff welcomes our input instead of dreading when they see ‘the lawyers’ coming.” To help establish sound relationships quickly, Knox is part of LCMH’s onboarding program for new physicians. She believes that meeting them “when things are good, not just when there’s a potential problem” goes a long way toward creating personal and more productive connections. Physicians who have met her through the program have, in fact, tended to be more proactive in consulting her and her office via texts and informally visiting the legal office. In the thirteen years since Knox began working at LCMH, her philosophy of “self-education” has enabled her to keep up with the many changes that have occurred in healthcare practice, policies, governance, and regula-

200,000

approximate number of babies delivered

1930

founding year of first hospital

tion. For Knox, that process has included reaching out to colleagues and teammates and being mentored by Patricia Foltz of Anderson, Rasor & Partners. It’s helped her address issues that usually aren’t taught in law school, such as how to handle a recalled product that the manufacturer wants returned, but that is still considered evidence in an ongoing lawsuit. Knox maintains an extended network that includes LISTSERVs and formal education, helping her to keep up with important legal developments and trends. It also provides her with valuable decision-making resources. “You might have all the information, but still need to talk it through with someone else to confirm that you have the answer,” she says. And when someone else needs assistance? “It’s a good thing if you can reach out to ask for help. It doesn’t bother me if you don’t know the answer. It bothers me if you don’t know how to ask.” Through all her litigation, education, and risk management efforts, Knox attests that there is no such thing as a former nurse: “I’m really very protective of the hospital and the entire team.” AHL Anderson, Rasor & Partners, LLP’s attorneys have represented Little Company of Mary and many other Chicagoland hospitals and healthcare professionals in litigation matters, preventative and healthcare legal counseling, and medical staff matters for over thirty years. We help our clients make a difference and we make a difference to our clients.


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Gina M. Knox, R.N., J.D. and her many

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Company of Mary Hospital and Health

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Neighbors Helping Neighbors Lakewood Health CEO Tim Rice uses a grassroots approach to running the healthcare system, while at the same time propelling his mission to provide quality, personalized care in rural Minnesota

AHL APR.MAY.JUN 2017

By Stephanie S. Beecher

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In the pastoral townships surrounding Staples, Minnesota, residents are known to talk. Although some may brush off this spiel as typical small-town conversation, Tim Rice is more likely to lean in and listen. As the CEO of Lakewood Health System, Rice is supremely aware of how his decisions affect his neighbors, as he uses his unique vantage to gauge the quality of healthcare in his community. Then, he looks for ways to improve it. “Being in a rural community, you really live under a microscope,” says Rice, who has worked for Lakewood Health System for more than thirty-five years. “You might make a decision and have to sit next to the person it affects the next day at the school or at church. As a leader in a small community, there are significant obligations. How do we get the right quality at the right price? We should always be pursuing the opportunity to improve the healthcare that is offered.” Founded in 1936, Lakewood Health System is an integrated health provider with a twenty-five-bed critical access hospital in Staples and five primary care clinics throughout the region. In addition, the health system offers women’s specialty services, senior services, surgical, and outreach care. With a regional population of

no more than 15,000 residents, Lakewood doesn’t exactly have all the moving pieces of the country’s metropolitan healthcare organizations. However, running a rural facility still has its unique challenges, Rice explains. “We work to provide all the services we can here,” he adds. “But it must be able to be done well. If we cannot do it well, we do not do it at all. Quality takes priority over money. Certain things can occur—like physicians leaving or major reimbursement changes—that can have a major impact on the operations and viability of an organization. One VP might run four departments. Employees and management must also multitask their work, so you learn to be flexible and adapt.” Rice doesn’t moonlight as a surgeon, of course, but it isn’t exactly a stretch to say that he’s spent some time in the operating room. In fact, after leaving his family farm for college in the 1970s, he went to work as CFO at a small county hospital, where he was exposed to a wide spectrum in the healthcare field. Rice was taken under the wing of the hospital’s CEO and chief of staff, who regularly pulled him into surgery. “The chief of staff said, ‘You’re going to learn medicine,’” Rice recalls. “He had me exposed to all kinds of procedures. He wanted me to understand the patient side of things. I had such support from him because they let me

TIM RICE President, CEO Lakewood Health System


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“If you do the right things for people, they will come to you. Word of mouth means people will select our organization.” people are using hospital and clinic services,” he says. “You may look at it as eliminating hospital stays, but if we’re effectively providing care, isn’t that what we’re supposed to be doing? An organization has to adapt and learn how doing the right thing impacts them from an operational perspective. It is so important to reduce our overall cost of care and make patients healthier. We are passionate about the triple aim and improving value whenever and wherever we can.” It’s all about the pursuit of the greater good, Rice says. This attitude is the reason that Lakewood Health System has partnered with its competitors and regional agencies to improve health throughout the region. They

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learn and got me started on the right foot. I owe a lot of gratitude to the physicians and administrators there.” His experience at the county hospital left a mark, and when Rice left for Lakewood Health in 1977, he made it his mission to make a difference. “Being independent and not in a system, it allows us to make decisions pretty quickly,” Rice says. “We do a lot of grassroots type of activities, and all of that creates buy-in. Working on improving health is one of them.” Recently, Lakewood Health invested in a new EHR and entered an agreement with an ACO, which allows Lakewood to legally obtain information on its Medicare patients. The arrangement gives Lakewood the ability to collect important data and insight into its quality of care. “We can get cost and utilization information and find out how we are doing in comparison to others,” he explains, adding that the program also links coordinators to patients to oversee their care and health. For example, a community paramedic might make a home visit to a resident who has been constantly landing in the emergency room, only to find out they are living without electricity, or that some other issue is adversely affecting their health. Once the problem is identified, the Lakewood team can find ways to help. “This approach looks at all of the elements of why

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work jointly on addressing topics such as community health collaborations, promoting healthy lifestyles, food insecurity, and maternal and infant care. “I want all of our competitors to be exceptional,” Rice says. “If my child got hurt, I don’t know where my child might be. So even though we compete, there are key things we must pursue together for the well-being of our patients and communities. I don’t want our own organization to be a barrier to that.” “If you do the right things for people, they will come to you,” he adds. “Word of mouth means people will select our organization.” Rice works to create the same congeniality among his staff, as well. He regularly meets with representatives from each division to get input on ways to enrich employee culture. And recently, he’s been working with employees on strengthening its mission statement. “If it doesn’t connect to the heart of the people who are doing the work, the vision is not as effective as it can be,” he says. “We want them to know we can really create connections and have a positive influence within the community and in the workplace. And you can really make a difference because it’s like neighbors taking care of neighbors.” AHL NXC Imaging is honored to be one of Lakewood Heath System’s trusted imaging partners. NXC Imaging proudly works hand in hand with hospitals and clinics to provide state-ofthe-art radiographic equipment. We’ve partnered with Lakewood Health System to provide innovative diagnostic tools that can handle the most advanced imaging needs. We look forward to a continued collaboration with Lakewood Health System to help provide quality healthcare to the community it serves.

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Investing in People, Not Policies Nebraska Medicine’s Frank Venuto is on a mission to make HR a strategic business partner by linking the investment made in employees to the organization’s ability to provide exceptional healthcare By Stephanie S. Beecher

Offering quality patient care combined with research and education, Nebraska Medicine has become one of the most esteemed medical centers in its region. With the clinical integration of the Nebraska Medical Center, Bellevue Medical Center, and UNMC Physicians, the organization provides access to more than 1,000 physicians and 676 licensed hospital beds, all exemplifying the promise of “Serious Medicine. Extraordinary Care.” In order to maintain this high standard, chief human capital officer Frank Venuto works to keep waste out of the formula and ensure the talented workforce feels supported and valued. Your official title is chief human capital officer. What do those words mean to you? Frank Venuto: Using the term “human capital” reflects an innovative way of thinking about your workforce. What makes any company flourish is its people and the collective genius they bring; they make an organization come alive and have either a positive or negative impact on patients. There is no replacement for high-accountable talent, and it should be treated as any other business asset. To grow as a healthcare system, you must invest in your people, just like you would for other priorities, such as infrastructure or technology. By making an investment in employees, you not only ensure that their skills are specialized, so that they can take the best possible care of patients, but you also send them an important message— that they are valued, cared about, and supported.

Dave Hynek

Venuto: Decades ago, HR fulfilled more of an administrative function. It was tactical, less solutions-oriented, and revolved more around policy rather than functioning

as the strategic business partner it has become today. I would say that Nebraska Medicine’s HR is more connected to operations now than it has been in the past. We deliver a strategic orientation to our work, assessing whether our policies, practices, and culture of today will hinder or aid in moving our organization into the future, and we course-correct accordingly. By making sure that we are delivering workforce solutions for both our colleagues and management teams, we ensure that the health system continues to deliver on our brand promise of “Serious Medicine. Extraordinary Care.” We are making great strides. One of our leaders told me that one year ago, he never would have thought about having HR at the table to discuss our business problems. Today,

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How does this perspective differ from traditional HR?

FRANK VENUTO Chief Human Capital Officer Nebraska Medicine

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he couldn’t think of why he wouldn’t. That’s the partnership we are after. You mentioned that HR professionals previously served in more administrative roles. How do you position HR as a strategic player in the organization? Venuto: The key is to demonstrate the value and return for investing in your workforce and to communicate that investment in the same business terms that organizational leaders consider for other strategy and operational decisions. But HR’s reach is more than just demonstrating your business acumen. You have to partner with your chief transformation officer and patient experience officer to build a single corporate culture and a leadership strategy to support it. For example, we are currently focused on recruitment and retention of top talent, especially as we are staffing our new Fred & Pamela Buffett Cancer Center. We are improving our entire selection process, from candidate sourcing to one-year onboarding. We are simultaneously working on reducing the cycle of our time-to-fill and improving the retention of our first-year colleagues. We expect to achieve significant savings in the cost of agency labor, premium pay, and turnover, while improving the quality of our hires. Importantly, this work bleeds into managing our colleague experience and putting effort and energy into our human capital, similar to the way we focus on our patient experience. Research shows that if great employees leave their organization, it’s because of their managers; high-accountable talent wants to work with other high-accountable talent. We are focusing on the development of our front line and management talent while creating the proper systems of accountability to maintain top talent. We have to improve ourselves as an employer and position ourselves to compete for great healthcare talent. In the healthcare industry, staffing remains a top concern—especially as aging baby boomers demand more care. How has Nebraska Medicine worked to improve its employee relations?

Also, we are being proactive in listening to our high-achieving employees through focus groups, advisory councils, forums, and roundtables with senior leadership. Because of their input, Nebraska Medicine offers career development support that did not exist twenty or thirty years ago. Nebraska Medicine has grown through a series of mergers and integrations with other healthcare organizations. One of the results of this growth was a combination of various wage programs that needed to be rationalized. The inequity was causing great dissension among our colleagues and creating distrust for our leadership. Consequently, leadership agreed to address significant compression issues and a three-year plan was developed and communicated. We recently added $60 million to our compensation program to ensure that every employee is paid in accordance with their experience, education, and performance. While the investment was significant to reach market competitive rates, the larger message was equally as important: our staff saw evidence that we listened and acted, remaining true to our word. Since this important investment, we’ve had less than a handful of nurses turn down our offer due to pay and we’ve also seen a reduction in our turnover. What keeps you motivated as a healthcare leader? Venuto: I am just like the majority of all employees—it’s not just about a paycheck. I strongly believe in the vision of Nebraska Medicine and its ability to positively impact our patients, their families, and our community. That is the same motivation that I hope to instill in our entire workforce by showing that their work is meaningful and their contributions are recognized and appreciated. If you can touch the hearts and minds of your employees and let each individual know that he or she is important to your collective success, then ultimately our patients will benefit. AHL

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Venuto: We know that the makeup of our workforce is evolving. Our employees span several generations and each generation has unique needs. Nebraska Medicine has to position itself to provide benefits and support that meet employees at their current life stages. The average age of our employees is mid-thirties, but those employees’ needs are significantly different from employees in their sixties. We are focused on individualizing our benefit offerings to cater to the priorities of our colleagues and educating them accordingly. This innovative way of thinking makes us a better employer and better place to work.

“If you can touch the hearts and minds of your employees and let each individual know that he or she is important to your collective success, then ultimately our patients will benefit.”

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IN

CARE Janet Miller leads a legal department recognized as one of the most innovative in the country to help University Hospitals serve its community By Amanda Garcia

AHL APR.MAY.JUN 2017

EVERY

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When University Hospitals began its search for a new general counsel in 2001, it called an attorney who had already become a valued legal partner during her years as outside counsel. At first, Janet Miller turned down the offer because she was concerned the job wouldn’t allow her to continue her work in the community. However, when the CEO assured her that her commitment to that work was an asset, Miller agreed to explore the option. “During the interview process, the hospital personnel kept emphasizing their organizational culture,” Miller recalls. The hospital has always been vocal about its commitment to serving the community and being culturally centered around quality, compassionate, state-of-the-art care. “I thought it all sounded nice, but when I got here and saw firsthand how they live it every day, I was convinced,” she says. That was more than fifteen years ago, and Miller has never found a job more satisfying. University Hospitals is one of the oldest organizations in Cleveland. It was started by a group of civic-minded women with the intent of providing care for those who couldn’t afford it—particularly soldiers wounded during the Civil War and workers who were injured during the Industrial Revolution. During Word War I, the original Lakeside Unit of doctors and nurses cared for soldiers in France. The next generation of the unit was stationed in Austria and cared for soldiers in World War II in the Pacific regions. The children’s hospital of University Hospital is 125 years old, and its MacDonald Women’s Hospital is the only hospital in Ohio dedicated to women’s health. “We were started and supported by people who wanted to care for their community,” Miller says. “All these years

CORNER later, our strategies remain focused on that same goal.” To support these strategies, Miller has structured her law department around practice groups that focus on the primary business areas of the organization. Attorneys work closely with executive leadership, physicians, operations, finance, human resources, and other areas to build collaborative expertise and new solutions. Lawyers learn the business, and business leaders learn applicable legal principles, empowering each to interact and work more effectively. “As a lawyer, seeing the big picture is incredibly helpful but typically only happens if you’re working in-house,” Miller says. “Recognizing that has made me a better general counsel with my outside counsel, and I am careful to keep them informed. Early on, we even invited outside counsel to sit in on our department to learn our business better.” Putting University Hospital’s values of teamwork, excellence, innovation, and compassion into action every day is one reason why InsideCounsel named the law department one of the top ten most innovative in the United States in 2013. It received the award for developing a computerized system used by personnel to report any incident at any hospital or physician office as soon as it happens. “Knowing when an incident happens allows us to address the issue immediately rather than wait months or years if and when a claim arises,” she says. “We want to address quality, safety, and care issues immediately.” The introduction of the program initially resulted in an increase in incidents at the hospital because everything was being reported, but the immediacy of the information decreased the number of claims and lawsuits and has saved the hospital more than $200 million to date in litigation costs and increased the quality of care and patient safety.


IMPACT

JANET MILLER Chief Legal Officer, Corporate Secretary University Hospitals

“We were started and supported by people who wanted to care for their community. All these years later, our strategies remain focused on that same goal.” community,” she says. “We have a hospital in an Amish community and have a member of the Amish community on that hospital board of directors.” This location also has a parking lot with a buggy rail, and its maternity ward has many midwives to accommodate traditional Amish birthing needs. “Those are the kinds of things that we take into account when we say we’re committed to serving our communities,” Miller says. University Hospitals also prioritizes diversity of staff, vendors, and service providers as one of its five core values. Miller is proud of the diversity of her legal team, but acknowledges that it can be a challenge to find qualified candidates in healthcare law who are ethnically and racially diverse. True to her nature, Miller has used this particular challenge as another opportunity to innovate. “Our interns here in Cleveland tend to be very diverse,

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Transparency was vital for the success of this and other programs, allowing personnel in each area to analyze how the process could be improved. “Every incident—even if there was no harm—went back to its respective department to be addressed in order to improve the quality of care,” she says. It is called the Lessons Learned program and hinges on the expectation that teams would not point fingers, but rather work together to solve problems. It built trust among teammates, which allowed them the freedom to focus on providing excellent quality care and finding creative solutions. “It has also bettered the legal team because people aren’t afraid to bring issues directly to us,” she explains. Another factor that makes Miller’s legal team and the entire organization better is University Hospital’s prioritization of diversity. “We serve an incredibly diverse

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Congratulations to our friend and colleague Janet Miller

on this well-deserved recognition!

AHL APR.MAY.JUN 2017

Benesch applauds Janet for her visionary leadership and unwavering dedication to University Hospitals.

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www.beneschlaw.com

and after they work with us, we have the ability to follow them in their careers,” she explains. To capitalize on this homegrown pool of potential future hires, all interns complete an intensive, two-day in-house training course (for which they often receive course credit) to prepare them for both their internship and their career. “We’re building our own talent and setting our interns up to get great jobs when they leave us,” she says. Miller is committed to helping others find creative solutions to complex problems and for investing in others—from her interns to her team to business partners, patients, and the community. Her goal is to set up her talented staff with the ability to reach their hopes and dreams, and if they are recruited away from University Hospitals, it’s Miller’s hope that they duplicate and advance those values elsewhere. She is a champion of values like innovation, excellence, compassion, and teamwork, and believes that diversity brings unity, creativity, and a better ability to solve new issues. “If I do my best to fight for values like these in my corner of the world, maybe others will, too,” she says. “And maybe soon, every corner of the world will be better together.” Fortunately, Miller has found the perfect corner of the world to start, and thanks to her colleagues at University Hospitals, it’s getting bigger all the time. AHL


IMPACT

The Keys to Forging Pertinent Partnerships General counsel Steve Burres keeps Rotech Healthcare Inc.’s legal costs down by keeping its partnerships honest By Kelli Lawrence

Expertise is a factor, he says, because in a highly regulated, specialized industry such as healthcare, the ability to keep up is always critical. Cost is another, since overcharging is prevalent among several law firms—especially larger ones, in Burres’s experience—and he doesn’t want Rotech to fall victim. “We seek explanations [for overages] and keep them in our arsenal,” he says. “We may let them complete the project assigned, but we won’t give them the rest of our business if we notice abusive time-keeping practices.” Case in point: Burres recalls a law firm that not only rewrote a legal brief twice—billing fifty hours for each writing—but also billed for having its paralegal check over the same document. “If you’re paying for the lawyer to write it, you’re paying for the research, fact-checking . . . you’re paying for it all,” he notes. “I’m not paying someone to check someone else’s work. That’s what we felt was abusive. And we eventually fired them.” Integrity is the third key, and as a somewhat more straightforward concept than trust, it has to do with respecting the way a business operates. “Trust is harder to weed out than integrity,” Burres explains. “Trust you can mask. Integrity comes out in the bill.” Of course, solid answers to questions—that is, “an answer we need, and one that’s not drawn out”—are a good indicator of a firm with which Burres enjoys working. Reciprocated appreciation and respect go a long way, as well. “We always like firms that want our business,” he says. “You can’t teach hungry. It’s an innate quality that lawyers either have, or they don’t.” While he ideally has all three keys at all times, Burres acknowledges that it’s easier said than done in certain situations. Medicare is one example, while litigation for car accidents and workers’ compensation is another. “When a Medicare expert is needed, it comes at a cost,”

STEVE BURRES General Counsel Rotech Healthcare Inc.

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Long before he joined forces with Rotech Healthcare Inc. in January 2014, Steve Burres had a fondness for the medical industry. He previously worked with large hospital systems while in private legal practice, and he also knew from past experience that he had a knack for efficiency and a solid sense of how long certain practices and procedures take. These experiences helped Burres develop a keen eye for cost discrepancies, one that would eventually benefit all of Rotech—once Burres moved into more of a leadership position there, at least. So he paid close attention, and he waited. “When I did get in a position where I could question the bills, I used my past experience as a guide and finally said, ‘Enough is enough; this abuse has been going on too long,’” he says. Rotech is a leading industry provider of CPAP machines, home oxygen therapy, and other medical equipment and services. As such, Burres has a wide range of responsibilities: in addition to overseeing the legal department, he is the secretary for the entire company and handles matters dealing with the board of directors. On top of all this, he also manages all active claims— litigation and workers’ compensation—leads equipment repossession projects, negotiates with insurers, drafts contracts, and negotiates leases for all of Rotech’s 400 locations nationwide. While other companies may have a team of lawyers, Burres is the only lawyer at Rotech, making his handling of the legal department all the more impressive. He cites hard work and well-honed time management skills, but Burres also relies on three factors to successfully navigate murky waters and come away with the best partnerships: expertise, cost, and integrity.

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Young Conaway joins American Healthcare Leader in congratulating Rotech Healthcare’s

Steve Burres

on his outstanding accomplishments.

Shumaker, Loop & Kendrick, LLP recognizes Steven B. Burres, Associate General Counsel, for his outstanding work and leadership at Rotech Healthcare Inc.

Jason A. Collier

AHL APR.MAY.JUN 2017

Attorney at Law 941.364.2791

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slk-law.com CHARLOTTE | COLUMBUS S A R A S O TA | TA M PA | T O L E D O

he explains. “There’s not much you can do about that. If you don’t want to pay the high billable rates, you will likely not get a lawyer with the necessary expertise you need to handle the issue.” These are the instances, he says, when he must be sure to manage time as well as money. “If it’s a small issue, I tell the law firms [in advance] that I don’t want a certain action to go over five hours,” Burres says. “And if it has to go over, they need to call me and tell me why. In all honesty, when they know you’re looking at the bill, they work more efficiently.” Across-the-board efficiency has certainly worked in Burres’s favor thus far, considering Rotech’s legal department has come in at about 20 percent under budget annually since he’s taken leadership. And that’s with his in-house staff comprised of only three people: himself, one paralegal, and a risk manager. With that kind of success, it’s easy to see why Burres feels no need to hire additional staff. That is, unless Rotech itself were to upgrade in size—an idea he finds quite appealing. “I know my peers have departments with around eleven or twelve lawyers, and I’m just one,” he says. “But if we continue to grow and expand in the marketplace, I can see an argument being made to successfully grow my department.” For the time being, though, Burres is pleased with what he and his team are able to accomplish on a daily basis. “I think everybody’s always looking to trim costs, and when it happens, I think it shows your added value,” he says. “There has to be a mutual respect for one another to get things done, and I think we have that in the Rotech legal department.” AHL

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Sustainable Thought UnityPoint Health’s CFO ingrains an all-encompassing philosophy of sustainability into the company’s culture By Keith Loria

MARK JOHNSON Senior VP, CFO UnityPoint Health

sustainability, but also helps eliminate variation and improve the patient experience and outcome.” An additional initiative in this realm is in payment reform, in accordance with the position that the underlining fee-for-service structure is not sustainable in the long run. “It doesn’t align incentives—it rewards quantity versus quality—so we’ve been very active over the course of the last five to six years in moving to more value-based payments,” Johnson says. “We’re committed to that journey and think it’s the right thing to do.” UnityPoint’s fee-for-value movement started small, with one of its smaller regions, Fort Dodge, becoming active in the Pioneer Program through Medicare. Several other regions later joined managed security service providers (MSSPs), learning how to manage populations. Then, it jumped into some commercial contracts with larger payers in the region. Today, UnityPoint has advanced to participating in NextGen solutions. “We really thought we had to get into these to understand how they worked. If we just waited until we felt we had all the capabilities developed, we would have probably never done it,” Johnson says. “In addition to the payment transformation, we’ve also done more on the clinical side of the house, working on how we can better provide care for patients.” It’s what UnityPoint refers to as “care coordination.” “Moving from a primary care office to a specialist office to potentially needing hospitalization, we are really trying to figure out how to better do those transitions in care,” he adds. “We also realized not all of our patients need the same thing, and we are launching several different programmatic ways to meet the needs of patients

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“Foundational competency” is a phrase to live by for Mark Johnson. “It’s something that we know we have to do, and have to do it well,” Johnson, senior VP and CFO for UnityPoint Health, says. “Sustainability is one of those core competencies. Employee engagement is another; physician engagement another, along with patient experience. We know it’s all important to be successful.” Sustainability overlaps with all facets of the operation at UnityPoint Health, an integrated health system providing care throughout Iowa, western Illinois, and southern Wisconsin through more than 280 physician clinics, thirty-three hospitals in metropolitan and rural communities, and home-care services throughout its nine regions. “It resonates in everything we do,” Johnson says. “We really worked hard to marry our system-wide planning process with our budgeting process, so as we have new initiatives, having more rigor around our business planning and getting it in the budget has become an important step for us.” All sustainability initiatives at UnityPoint entail biannual reports to the board of directors on their progress, and Johnson works with different regions, clinics, and hospitals to make sure they’re financially on track. When it comes to UnityPoint’s long-term financial sustainability, Johnson focuses on several points. “One is we feel we need healthy and cost-effective operations, and we have had a formal sustainability program since 2011,” he says. “Really, our focus is on how we eliminate waste, how we become more efficient, and how we implement best performance that not only drives financial

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Thank you for your continued support Mark Johnson

“Really, our focus is on how we eliminate waste, how we become more efficient, and how we implement best performance.”

AHL APR.MAY.JUN 2017

that meet a broad spectrum, so we’re providing the right care, at the right time.” Take, for example, a healthy twenty-five-year-old who wants quick, convenient options such as virtual care, telehealth, and the ability to communicate with a doctor electronically—or a senior patient who needs help managing multiple chronic conditions. Part of Johnson’s responsibility is to help drive what the best practices and procedures are for the company, and then to populate them across its entire system. “If you look at our history, we came together from independent, free-standing facilities, and when we first started, our mantra was—and we still feel—that healthcare is local and left a lot of autonomy to the regions,” he says. “As we matured as a system, there are certain things that are best practices, and although there may be a local nuance, we strive to do them in a consistent way.” To that end, UnityPoint recently put together a Clinical Leadership Group, where representatives from all regions and parts of the care continuum meet to determine best practices and performers, validate that their conclusions are evidence-based, and then apply them to the appropriate groups. “We also started having quarterly meetings between our regional leadership and system leadership, and what we do is look at high-level KPIs, or key performance indicators. For those that are successful, we ask them what they’re doing and point them out to their peers,” he says. Though he majored in finance in college, Johnson wasn’t interested in pursuing a job in the banking industry and looked for a way to apply his skill to an industry that helps people. He considers today to be one of the healthcare industry’s most exciting eras. “Healthcare is an industry where you have constant technology changes, which is always exciting and can be an enabler to the strategies we are working on,” he says. “The transformational nature of the industry is what sets it apart from other industries right now.” AHL

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Welcome to the Future of Pharmacy Gary Johnson has helped revolutionize University of Kentucky HealthCare’s operations and patient care through innovative ambulatory pharmacy services By Jeff Silver

Gary Johnson stepped into his position at chief pharmacy officer with a mandate to focus on inpatient care at University of Kentucky HealthCare (UKH). But he also brought a vision for developing a much broader approach to how ambulatory pharmacy services could make significant contributions to the well-being of the 900-bed hospital’s finances and patients. An agreement was reached that as long as he met the inpatient objectives, he was free to develop an ambulatory pharmacy model. Since then, ambulatory pharmacy services have become the single largest contributor to UKH’s bottom line.

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How large of an increase have you made in UKH’s pharmacy services in the last five years?

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Gary Johnson: When I arrived, there were only two retail pharmacies. Now, we have six retail pharmacies providing prescriptions for many patient types, including discharge, same-day surgery, emergency department, clinic, contract pharmacy, specialty, and employee prescriptions. These combined activities have resulted in an annual ambulatory pharmacy net income growing from $12 million to $86 million.

Was there internal resistance to your plans? Johnson: Health systems typically don’t think of prescriptions as a source of value, but they are why big retail chains put stores around hospitals. UKH actually wanted to close one of its two original retail pharmacies to eliminate the operational costs. We had to educate stakeholders on the benefits of an aggressive ambulatory pharmacy program, which included expanding the federal 340B program that facilitates large medication discounts for hospitals with indigent patient populations that exceed 11.5 percent—as well as our work with program vendor partners Verity and ScriptPro. Our rate for Medicaid and uninsured patients is around 30 percent, so that presented tremendous possibilities. We had to help senior leadership understand the opportunities this kind of program could provide. Aside from the financial advantages, describe some of the other benefits you’ve been able to provide. Johnson: Rather than lose prescription processing to commercial chains, we’ve tried to drape an iron curtain around the entire health system. That allows us to integrate the full continuum of care. We share information


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with physicians about whether patients are complying with their medication regimens. We have merged inpatient and ambulatory care so that when a patient is admitted we reconcile their current medications with what they need while inpatient. Then, when they’re discharged, we explain the new prescriptions, how to take them, which of the old ones to discontinue, and offer to fill the new ones. We even deliver their discharge prescriptions directly to their rooms through a concierge service we call Meds-to-Beds that is in conjunction with ScriptPro. When it first started, we were providing discharge prescriptions for about 15 percent of patients. Now it’s up to 60 percent, and we’ve seen a corresponding 15 percent decrease in the number of patients coming back through the emergency department. We’re also able to provide specialty medications within twenty-four hours instead of patients having to wait up to two weeks to get them through the mail. Can you explain more about the specialty pharmacy services? Johnson: New biologic drugs are being derived from human plasma and other organic proteins that are highly effective at curing, not just treating, conditions like hepatitis C. Within three months, these new drugs can remove the hepatitis C virus from the body, but it’s very expensive—up to $100,000. We work with our laboratory genomics department to determine the patient profile and the appropriate duration of treatment. To comply with manufacturers’ protocols and insurers’ requirements for dispensing, we also established a call center that contacts patients to monitor compliance and is available to answer their questions around the clock. All of these services and capabilities have also been developed with ScriptPro and have succeeded in creating a specialty pharmacy program that contributes 40 percent of UKH’s monthly income from operations—and that’s from a total of 2,000 prescriptions compared to 35,000 that make up the remaining 60 percent.

Johnson: We introduced a lot of automation. We use five high-density storage carousels provided by Talyst that hold $5 million worth of medications. Each

“Health systems typically don’t think of prescriptions as a source of value, but they are why big retail chains put stores around hospitals.” AHLMAGAZINE.COM

As you’ve expanded pharmacy services so extensively, how have you also managed to improve efficiency?

GARY JOHNSON Chief Pharmacy Officer University of Kentucky HealthCare

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carousel responds to prescriptions that originate from patients’ EMRs and delivers them to the pharmacist. They’ve reduced medication errors by 76 percent. We’ve integrated the software controlling carousel delivery with the hospital’s electronic records so clinicians can all access real-time information regarding the status of medications being delivered to the floor. The inventory automation also tracks everything that we dispense on a daily basis and automatically suggests orders to maintain a five-day par level for every drug. That has helped reduce overall inventory by 35 percent. In addition, we use a robotic arm to prepare IV medications. It’s sealed, so contamination is nonexistent and we can mass-produce drugs with long expiration dates, which isn’t possible when preparation is done manually. With lots of drug shortages, we can compound drugs—such as nicardipine—that manufacturers stop making and then often reintroduce with tremendous price increases. What are your future plans at UKH? Johnson: I want to continue expanding the ambulatory pharmacy infrastructure, so we can service an even broader array of patients. AHL

AHL APR.MAY.JUN 2017

UK leads the way in end-to-end systems integration. ScriptPro salutes Gary Johnson and University of Kentucky for creative, intelligent, inspiring leadership. UK’s pharmacy program is a model for ambulatory patient care and health system financial success. Together, University of Kentucky and ScriptPro are advancing healthcare.

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Dr. Gary Johnson’s idea to outsource day-to-day management of his hospitals 340B program to the experts at Verity Solutions has been an unqualified success with an increase in 340B savings. Internal compliance and auditing efforts are also much stronger. ROI exceeded expectations without counting labor savings and redeployed labor.

Talyst is proud to partner with UK HealthCare in their mission to deliver

unparalleled pharmacy services.


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If She Builds It, They Will Come How Megan McKinnon is thinking beyond salary to create the ideal workplace at Piedmont Healthcare By Chris Gigley

The survey is part of a parallel initiative McKinnon has led to upgrade technology and analytics processes in the human resources department. This included the creation of an HR dashboard in 2015 that gave the department streamlined access to a variety of data, from flu shot compliance to average response times at call centers. McKinnon also rolled out a cloud-based system that links a number of different processes that had previously been fragmented. “Now we have a one-stop shop for technology where we can track succession planning, do talent reviews and surveys, and implement merit increases,” she explains. “Before, it was all in different systems with different logins. Transparency is vastly improved because employees have access to information they didn’t have before.” Meanwhile, McKinnon and her team have implemented the Promise 360 employee recognition program in 2015. According to an employee survey, it’s been a success. “The results showed that employees being recognized for the work they do was our top strength,” she says. Promise 360 allows patients, peers, and managers to nominate employees who exemplify one or more of Piedmont Health’s core values. Each of its six hospitals award one employee monthly, but the company also goes to the next level, honoring one exceptional employee annually at a special dinner. “That whole program will be a prominent part of our employee value proposition,” McKinnon says. Outstanding leadership will also be a key component, and McKinnon understands that she must serve as a

MEGAN MCKINNON Executive Director of Compensation and Rewards Piedmont Healthcare

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Megan McKinnon is on a mission to make Piedmont Healthcare a top workplace destination by 2026. And while she has focused on compensation for much of her career, she understands it’s not always about money. “It can be, and we pay competitively,” the executive director of compensation and rewards says. “But it’s driven me to figure out other ways to build a connection with employees so they don’t leave for an extra few dollars.” McKinnon is already well on her way to hitting several key milestones toward her goal, including a turnover rate of less than 10 percent and placing the company in the 75th percentile in employee engagement. She and her team recently launched an awards optimization tool born out of results from a company-wide survey that gave Piedmont Health employees a say in the process. McKinnon explains that survey questions weren’t just designed to show whether employees preferred, for instance, lower health insurance premiums over a gym membership, or richer retirement plans rather than larger bonuses. It also touched on work-life balance issues, such as the importance of flexible hours. “The bottom line is to find out what we can do to be a top workplace for employees at every distinct part of their career journey,” McKinnon says. Although she joined Piedmont Healthcare in January 2012, McKinnon thinks there is always more to learn as the company grows and changes. “We want to know what makes employees feel valued so we can deliver that to them.”

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good example for other managers. Not only is she quick to recognize her staffers, but she also ensures they know nearly everything she does. “My whole leadership goal is to create an environment where, if I were to walk out the door today, there wouldn’t be any impact because the team is so strong that they can pick up and go with it,” she says. McKinnon also gets her employees face time with senior leaders at the company whenever possible. She invites them to meetings they otherwise would never be part of, and if she can match an employee’s passion with a project in another department, she will recommend him or her for it. McKinnon understands the value of a strong internal network, having built a strong one for herself over the years. “You figure out who can help you achieve different components of different projects, and if they need something from me, I try to deliver,” she says. “I think having integrity and delivering on what you say you will deliver on is key to building that strong internal network.” So is backing everything with data. “I tend to be able to position information to them in a way that makes sense,” she says. “It’s just listening and learning what their concerns are and how you can best address those. I learn something every day about how I can contribute better.” McKinnon considers herself a hands-on manager. She does all the work her team does so she understands their challenges. At the end of the day, they all feel fully supported by her. “If they make a mistake, they know I have their backs,” she says. “I always assume good intent. If you treat employees well in terms of the flexibility you give them, they’ll really work hard for you and won’t want to disappoint you.” Piedmont Healthcare has given McKinnon the same kind of flexibility in her career. The least she could do, she says, is make the company one of the best workplaces in the country: “I really have a passion for the employee experience because I love Piedmont and I want every employee to feel connected like I do.” AHL

Megan McKinnon (right) and Piedmont Healthcare executive director, communications and public relations, Elisabeth Wang, attended the inaugural Piedmont President’s Award recognition event.

Scott Wang

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“The bottom line is to find out what we can do to be a top workplace for employees at every distinct part of their career journey. We want to know what makes them feel valued so we can deliver that to them.”


Congratulations to Megan Mckinnon Executive Director of Compensation and Rewards at Piedmont Healthcare Megan, we salute you for leading Piedmont Healthcare to realize its vision of becoming a top workplace in the health care industry. We look forward to partnering with you and Piedmont Healthcare for years to come. Together, we unlock potential.

willistowerswatson.com


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Acclimation by Immersion General counsel Jerard Jensen sheds light on shifting from CEO to in-house counsel, his role today with Marshfield Clinic

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By David Baez

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Even when he was in private practice and serving as outside counsel for the medical practice management firm MGMA, Jerard Jensen, general counsel for Marshfield Clinic, felt at home in the C-suite—and the board felt good about him being there as well. So much so, in fact, that when MGMA’s CEO took another position, the company asked a surprised Jensen if he would be interested in serving as interim CEO while they conducted the search for a permanent replacement. “I had a close role with the board and senior management, so I was already functioning in a C-suite manner, but I wasn’t expecting to be offered the position,” Jensen says. “I recall sitting in an airport when the question was put to me, and the next thing I knew, I was talking about how it was going to work. A lot of things happened very quickly.” Jensen was interim CEO at MGMA from the fall of 2014 until the spring of 2015, when the company found a permanent CEO. He stepped back and resumed his former role with the company briefly, but at that point he had already decided he was going to take a job as general counsel with Marshfield. His experience in the C-suite heavily influenced the decision to go in-house. “I really enjoyed the CEO role,” he says. “I think that’s a big part of why I moved into an inside general counsel position. You are an inside C-suite executive and as much a businessperson as a lawyer. Your legal skills are used in that context from a business perspective, rather than the pure lawyering skills you use when you’re representing a

client. I like looking at business and organization results as opposed to simply legal results.” Taking the helm of legal for the vast delivery system, which has been prominent in Wisconsin since the early twentieth century, was a head-spinning experience at the outset, something Jensen characterizes as “immersion acclimation.” He took the seat of the interim general counsel and promptly got to work in a culture he knew little about. “The organization has an iconic reputation, and I knew about that, but I didn’t know much about how things worked internally,” he says. “Those first weeks were very long days with a lot of meetings. I had to meet my own staff for starters, and then I had to spread out and get to know dozens of senior leaders. I had to immerse myself in things structurally and organizationally at first and then begin to understand the culture. Learning on the run is challenging, but it was also exhilarating.” In spite of his C-level position, Jensen recognized that he was also the new kid in town and made sure not to interfere with preexisting dynamics in the organization, which had been working quite well; there was no need to fix what wasn’t broken. His staff is small, with only six direct reports: one is devoted to professional liability issues, a second handles physician/clinical issues and regulations, a third deals with facilities contracts, and a fourth works with IT and intellectual property matters. As the hospital begins the push to expand its scope by acquiring St. Joseph’s hospital and bringing acute care to its Eau Claire facility, the plan is to grow the team. In

JERARD JENSEN General Counsel Marshfield Clinic


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Orrick’s health care finance practice encompasses financings for publicly owned hospitals and health care providers, private nonprofit hospitals and health care providers and proprietary organizations. We work with a wide range of issuers, including state authorities, cities, counties, hospital districts, local authorities, joint powers authorities, and nonprofit corporations. From 2011-2015, Orrick was ranked by Thomson Reuters (based on dollar volume) as the #1 bond counsel for publicly offered health care financings.

Orrick is a San Francisco, California based firm with offices in 25 markets across the United States and worldwide.

orrick.com

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the meantime, they use outside counsel for advice on antitrust law, employment issues, and a host of other areas that fall outside the scope of the team’s expertise. “As general counsel, I have the obligation to decide how the legal discipline is applied to secure our business objectives, but I can’t even begin to think about doing all that’s necessary to accomplish those ends,” he says. “I need to rely on other inside counsel here, as well as outside counsel. I expect my outside counsels to have a clear idea of what my organizational strategies and needs are. I don’t want detached opinions; I want somebody to understand my business and to facilitate a business end for me using the legal skill set.” Jensen says that the major challenges he sees facing Marshfield—and any healthcare organization for that matter— are regulatory issues and industry consolidation. He believes that changes in internal business processes due to regulatory changes will be more difficult than the changes with how organizations interact with government. In addition to handling all that compliance, legal will be at the forefront of the vertical integration of care delivery, getting there from the old system of fragmentation. As he deals with these external forces, Jensen says he isn’t done learning about the organization he joined a year-and-a-half ago. “For the first week or so, my head was spinning, but then things settled down and I formed a perspective,” he says. “Over the next month or so, I felt pretty much at home. But I was always open to learning more, and I still am today. I know enough now to function effectively in my role, but I don’t know, with an organization like this, that I’ll ever know everything.” “As long as you continue to remain willing to learn more, you’re in a position where you can continue to improve your performance.” AHL

ORRICK’S NATIONAL HEALTH CARE FINANCE PRACTICE

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Finding the Right Fit Michael Lynch explains how HealthCare Partners finds the perfect physicians to improve patient care

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By David Baez | Photo by Kristin Deitrich

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Many professions are vulnerable to hits when the economy plunges, yet unemployment among physicians generally stands at less than 1 percent— irrespective of economic conditions. As a result, this makes recruitment in the industry distinct from other professions, according to Michael Lynch, HealthCare Partners’ senior vice president of clinician recruitment and retention. “Unlike with lawyers or IT, where there is an ebb and flow of demand for those services, in healthcare, the demand hasn’t gone down,” Lynch explains. “It shifts, but it stays in the general sphere. The way people access their healthcare may be different, but the demand is always there.” Physicians who are looking for a change also tend to be passive job seekers; if they openly pursue a new position, it could have repercussions in their current role. This presents a major challenge to HealthCare Partners in its recent recruitment initiative, but Lynch is at the helm of finding solutions. As the industry began to shift its focus from volume to value with new healthcare laws in 2012, HealthCare Partners’ executives concentrated on not only finding high-quality physicians, but also ones whose approach harmonized with the company. The culture at HealthCare Partners is singular, which Lynch says is “one of the most unique I’ve seen in healthcare.” The company has been studied by leading business schools examining how culture effects dedication among employees. Indeed, Healthcare Partners’ language reflects its emphasis on community: the CEO is referred to as the company’s “mayor,” and employees are “teammates of the village.” The company’s core pillars

are also expressed in its trilogy of care: caring for our patients, each other, and the world. HealthCare Partners is not shy about its ambitions in this space, having declared a mission of becoming what Lynch calls “the greatest healthcare community the world has ever seen.” To reach this lofty place, it is essential to increase patient access to care and have just the right physicians in place. In searching for physicians, Lynch and HealthCare Partners look at a doctor’s philosophy of practice, as well as the quality of their work. He notes that most physicians chose this line of work not only to treat those who are ill, but also to keep them healthy overall, which is in line with HealthCare Partners’ focus. In their recruitment campaign, HealthCare Partners shows them that this model of medicine—as opposed to the volume-based assembly line model—exists, and that doctors don’t have to be in a small physician group with all its attendant difficulties to practice it. But how does one get this information to physicians when many are veiled in their present jobs? To get around this obstacle, HealthCare Partners has begun a grassroots campaign to get face-to-face with as many physicians as possible. For the past two years, the company has been active with the American College of Physicians and other professional associations, putting HealthCare representatives in the company of more doctors. Every year, it hosts the opening reception at the AAFP’s annual Family Medicine Experience conference. The company also goes to medical schools and speaks of its trilogy of care, planting the seed with students on the cusp of becoming physicians. “Things like e-mails and direct postcards won’t cut it,” Lynch explains. “We try to be face-to-face and


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MICHAEL LYNCH Senior VP of Clinician Recruitment, Retention HealthCare Partners

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“The way people access their healthcare may be different, but the demand is always there.” Experience is always in demand. And we have the supply. For more than 20 years, we’ve helped large healthcare networks gain access to better doctors, ensuring a higher quality of care and increased patient satisfaction.

CONTACT Cindy Slagle at 954.837.2369.

AHL APR.MAY.JUN 2017

weatherbyhealthcare.com

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actually use the old-school method of calling physicians in a certain practice area and talking to them, asking for five minutes of their time, and telling them who we are and what we’re about. We tell them, ‘If you practice with us, you can do it the way you always wanted to.’” Once they get face-to-face with physicians, or prospective physicians, they talk about focusing on patient satisfaction along with balancing cost for procedures. HealthCare Partners gives patients more time with physicians than the ten-minute visit model allows, so the doctor can get to know all of the patients’ needs. The company strives for better coordination across the spectrum of the patients’ care and eliminates redundant procedures and testing. When patients are in the hospital for a procedure, all the information is immediately transferred to the primary care provider. HealthCare Partners hopes to find eager ears when passing along this philosophy at conferences and medical schools. And, Lynch says, it’s been working. “We’ve been able to increase the quality of our physicians from a clinical standpoint, as well as the alignment of mission values and philosophy,” he explains. “It’s also allowed us to take top-grade physicians within the organization and free them up to take up leadership positions. In 2016, we’ve already met our hiring goal before going into the fourth quarter for most markets. Over the past twelve to eighteen months, it’s been a godsend.” As the recruitment efforts continue and more physicians align with HealthCare Partners’ mission, the company’s culture is amplified and the lofty goal of being the greatest healthcare community becomes more attainable. “We don’t think being the most profitable or the biggest makes us the greatest,” he says. “It’s the trilogy of care and our philosophy of patient care, and my drive is to push that culture to our patients and physicians and have everyone feel that.” AHL According to a 2013 benchmarking survey from Association of Staff Physician Recruiters* (ASPR), it takes between 131 and 184 days for a hospital’s in-house recruitment team to fill an open position, depending on the specialty. In many cases, this long hiring process results in significant revenue loss for the facility. As a result, locum tenens physicians are often called upon to work temporary assignments in these facilities. Not only does it take less time to get a locum into a position (usually about sixty days, and sometimes sooner), but using locum tenens ensures that patients can still be seen, hospitals can earn revenue, and that the existing staff doesn’t burn out. With access to more physicians through Weatherby Healthcare’s extensive network of quality providers, facilities can help maintain their ability to provide care while reducing the amount of time it takes to fill a position.

Experts at placing experts.

*2013 ASPR In-House Physician Recruitment Benchmarking Survey Executive Summary


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Implementation from the Ground Level There’s never a dull moment overseeing the CareFirst legal team, and Randy Sergent faces all of the unknowns with the same commitment to thoroughness By Joe Dyton

RANDY SERGENT VP, Deputy General Counsel CareFirst BlueCross BlueShield

as CareFirst’s Patient-Centered Medical Home (PCMH) program, among other programs designed to better integrate patient data, to provide better resources for primary care, and to improve and streamline care for the sickest members. The CareFirst legal team has played a vital role in ensuring that such programs are developed and implemented in compliance with a broad array of federal and state laws, as well as regulations. Sergent and his team must also help guide each initiative through issues such as conflicting state and federal privacy laws, insurance laws, federal tax laws, laws governing the provision of medical care, marketing laws, and more. “For all of those programs that can have a direct impact on member care, it’s important that my team is able to get in at the ground level and help design the program in a way that it works for the business within the existing regulatory framework,” Sergent says. When he’s not handling complex projects, Sergent’s days are spent handling the challenges that come with being a legal professional in the medical industry. One such challenge is the sheer volume of new laws his team encounters. The Affordable Care Act and its regulations stand out, but other examples include changing privacy regulations, state insurance laws, and antikickback and antifraud requirements. Sergent and his team must also rapidly digest new and changing laws as they emerge in order to enable CareFirst to adjust its operations as needed. “The key is that we have to be proactive as a department. We can’t wait for someone to bring problems to us,” he says. “We have to understand deeply what the business needs are, where it’s going, and what it wants to do so we can identify the legal problems before they become business problems.” Sergent is in an interesting position, as he doesn’t just

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At any given moment, Randy Sergent has a lot on his plate working for CareFirst BlueCross BlueShield, but it’s a scenario that he’s been preparing for his entire career. Sergent, who is the vice president, deputy general counsel, and assistant secretary for CareFirst, manages the Baltimore legal office, which is roughly half of the company’s legal department. He leads his team of attorneys in providing advice on the corporate and regulatory issues for the company, while also managing a team that prepares and obtains approval of member benefit contracts, policy forms, and similar documents. Before taking on this role, though, it was his career path itself that made him more than ready to take on this type of leadership position. Prior to joining CareFirst, Sergent was a partner with Venable LLP, where he was involved in insurance regulatory matters and litigation. He also served as deputy counsel to the Maryland Insurance Commissioner and as an assistant attorney general within the civil litigation division of the office of the Maryland Attorney General. “In a heavily regulated industry like health insurance, it’s important to have a broad perspective,” Sergent explains. “For what we do day to day in-house, we quickly need to recognize which are the important issues and which are not, and how the business project is going to be shaped by the regulatory environment. It often requires a lot of nuance and understanding, and a broad background and deep business understanding really is necessary to bring your full abilities to bear on what you’re doing.” Sergent is constantly working on numerous projects, but one of his team’s most important ongoing initiatives is the provision of advice-to-patient care initiatives, such

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Wiley Rein LLP congratulates

Randy Sergent for his well-deserved recognition and profile in American Healthcare Leader

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We are honored to continue our relationship with Randy and CareFirst BlueCross BlueShield

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“If there was one thing I would tell a young lawyer on how to become successful in this field, it would be to learn not just the law, but learn your client’s business thoroughly.” manage other lawyers, but he also gets into the mix when needed. He will often take a lead role, particularly on high profile, sensitive projects. He also has to find time for the third leg of his managerial role: overseeing and supporting the contracting team that prepares and obtains approval of policy forms, contracts with employers, and similar documents. While it’s not strictly a legal function, it is an important role for the company that is highly deadline-oriented and involves making sure approvals are obtained and forms are loaded into the company’s system for the entire spectrum of the company’s products. “I think you balance [different roles] by paying close attention to all of them and giving them the time that they need,” he says. “I’m not sure I have a magic formula to it, but the variety keeps you on your toes. It certainly makes me a better lawyer to have a business unit with non-legal concerns as part of my responsibility. The real key, though, is to have an excellent team on whom you can rely. Our legal and contracting teams are highly skilled and motivated, and often, I am supporting them as much as or more than directing them.” The general counsel isn’t shy about admitting his job is challenging, but he also believes it’s a good time to be an in-house counsel. One main reason is because he gets to be part of a team pursuing a company mission rather than just serving as an outside consultant and because in-house legal work is becoming increasingly sophisticated. As in-house counsel, he gets an opportunity to learn about a variety of different subjects, and he believes it’s important to know how the business operates nearly as well as his clients. “For example, if I need to advise finance on something, I’m going to also need to understand the non-legal constraints that finance is functioning under to give legal advice that makes sense and is workable,” he says. “If there was one thing I would tell a young lawyer on how to become successful in this field, it would be to learn not just the law, but learn your client’s business thoroughly. Your solutions will make sense only when you understand the problems that your clients face.” AHL


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No Small Wonder Milford Regional Medical Center may have a smaller IT division than many other organizations, but that hasn’t stopped Nicole Heim and her team from producing big results By Joe Dyton

NICOLE HEIM CIO, VP Milford Regional Medical Center

Heim admits the role is a tough tightrope to walk between satisfying users’ requests to make information systems more usable and keeping their information secure. “Sometimes those requests introduce additional security risks,” Heim explains. “I’m weighing security and usability, and it goes either way depending on different scenarios. Often, the security requirements we need to put into place add a layer of frustration to users, so I think it’s really important to have communication so staff are aware why we have to put these measures in place.” Two security options Milford Regional may add to its portfolio are secure texting and data loss protection (DLP). Secure texting was identified as a need last year, especially for physician-nurse communications. Currently, Milford Regional is in the middle of its investigation for a secure texting solution and hopes to have one during fiscal year 2017. DLP is a different story. Heim admits her team has been looking at it for some time, but the high costs are an issue. For the time being, the IT division is looking at a proof of concept to see how big the risk is. “We have policies and procedures in place of course to protect our data, but DLP just makes it easier for us so we can set in policies and enforce it automatically versus just educating the staff on what they shouldn’t be doing,” she says.

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At Milford Regional Medical Center, phrases such as “not enough resources” or “not enough people” don’t serve as excuses for not getting the job done. Instead, they are used as fuel to push even harder to achieve success. The nonprofit, acute care hospital based in Milford, Massachusetts, houses 145 beds and serves a region of more than twenty towns. It resides under the Milford Regional Health System umbrella, along with TriCounty Medical Associates and the Milford Regional Healthcare Foundation. The IT division, led by chief information officer and vice president Nicole Heim, comprises just fifty people, but provides support to all physicians, nurses, and other employees of the medical center. Heim’s responsibilities include overseeing all applications, interoperability, informatics, networking, system administration, technical specialists, help desk, switchboard operation, telecommunications, and clinical engineering. Since Milford Regional is a small community hospital, many senior leaders have to wear multiple hats. One of Heim’s hats is Health Insurance Portability and Accountability Act security officer, a key position, as protecting patients’ medical files is at the top of the security team’s priority list.

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Along with keeping its patients’ information secure, Milford Regional has also accomplished a lot over the past few years, despite being a lean operation, personnel-wise. In 2011, the first year of the program, it achieved Meaningful Use Stage 1 and reached Stage 2 just three years later. This past year, Milford Regional was recognized by the Healthcare Information and Management Systems Society as a Stage 6 hospital and is currently looking at the requirements to hit Stage 7, which will include going completely paperless. “It was a rush to implement a fair number of projects to achieve those meaningful use milestones, and we received more than $2 million in incentive payments from the government,” Heim says. “We could use that money to invest back in technology and the hospital in general.” As a whole, Milford Regional also has its sights set on reducing patient readmissions. It received a grant in 2013 from MeHi and used the funds to pilot sending post-discharge continuity of care documents to a visiting nurse association and a skilled nurses facility, a program which proved successful. Milford also received two more grants through the Health Policy Commission to focus on reducing readmissions, which it used to reach out to other organizations to encourage them to connect to the Massachusetts Health Information Highway (also known as the HIway). Unfortunately, a lack of personnel or resources prevented other organizations from moving forward with the connection. Milford Regional was able to offer some of the grant funding to help these other organizations pay the initial cost to connect to the HIway, but even with the added support, it turned out that they weren’t able to connect to the project long-term. “It was rather frustrating for our staff because it wasn’t through any lack of effort on our part,” she says. “Those facilities are just not in a position yet to connect electronically. They must still rely on paper.” Milford Regional also looked at technology to assist case managers as a way to help reduce readmissions. However, it was determined the most impactful intervention in the chart grant initiative was its people. Milford Regional has a staff who works with patients while they’re at the hospital and then postcharge to make

“We in IT don’t obviously provide direct patient care, but we definitely have a huge part in assisting the clinicians that do.” sure they have their medications and appointments, and sometimes help with transportation to and from those appointments. “We definitely look for technology to help us, but in the end, I think the most impactful intervention again is the people resources we dedicated to this project,” Heim says. When she’s not running the IT division and helping to keep patients’ information safe, Heim gives national talks to fellow industry professionals. One of the messages she hopes to get across is the need to leverage technology to assist hospital business operations and help the clinical staff improve their workflow so they can focus on providing high-quality care. “We in IT don’t obviously provide direct patient care, but we definitely have a huge part in assisting the clinicians that do,” she says. “We’re an important part of the team and add value to the whole process. We can impact the patient care without providing it directly.” With limited funds and personnel, Milford Regional’s IT division has managed to secure multiple grants, help its clinicians provide great patient care, and play a key role in the organization to reach Stage 6 recognition. That would be quite an accomplishment for a fully funded and staffed organization, but Milford has proven limited resources don’t have to mean limited success. “I think you have to look at what you have available to you and just try to achieve what you set out to do,” she says. “We have a talented, dedicated team, and we leveraged our investments that we already had in place to make our systems workable for our clinical staff and secure for our patients, and to show that we can really use technology in a meaningful way.” AHL


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Strategy’s

Playground Pediatric care and IT unite to tackle population health at Children’s Hospital of Orange County

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By Amanda Garcia

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Bill Feaster was studying computer science at the University of California–San Diego when the Vietnam War began to escalate. His low number in the draft lottery inspired his realization that he’d much rather fix people than fight them, so he decided on a new career and switched his major to premed biology. It wasn’t until after completing medical school, two residences, and two fellowships, though, that he circled back to IT as he entered private practice in pediatric anesthesia and critical care at Children’s Hospital Oakland. In that first job out of residency, Feaster couldn’t help but notice the hospital’s lack of information systems. He turned his attention to the issue, and within four years, Oakland had installed its first system. A few years later, Feaster shifted gears again to earn his MBA. He then moved to Sutter Health and spent six years practicing pediatric and obstetric anesthesia while directing its center for women and children services. His business knowledge was put to good use when he accepted a position at Community Medical Centers as senior vice president and chief medical officer, but after three-and-a-half years in full-time administration, Feaster was ready to get back to his patients.

BILL FEASTER CMIO Children's Hospital of Orange County

Feaster accepted a position as a clinical professor of anesthesia and pediatrics at Stanford University School of Medicine, where his time was balanced between faculty practice and hospital administration. That complementary role gave him the opportunity to implement information systems and surgical IT support at the hospital, once again combining his love of technology and medicine. After ten successful years at Stanford, Feaster moved once more to accept a full-time IT position as CMIO at Children’s Hospital of Orange County (CHOC) in 2012. CHOC’s mission is to nurture, advance, and protect the health and well-being of children, and its vision is to be the leading destination for children’s health by providing exceptional and innovative care. “We can’t provide exceptional care without the resources to do it, and that includes information technology,” Feaster says. By providing state-of-the-art IT, Feaster and his team support both the mission and vision of the organization, enabling the hospital to achieve its goals. As CMIO, Feaster is responsible for assuring that clinical care is supported by IT through clinical information systems such as EMRs and analytics. He also spends a few clinical hours each week on his longtime specialty of pediatric anesthesia.


IMPACT

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Feaster oversees a team of thirty-eight people—twenty-nine of whom focus on informatics, analysis, and clinical records, and ten who focus on analytics and interfacing with outside systems. But these days, Feaster is most excited about the team’s work around population health technologies. One significant goal of CHOC’s current strategic plan is to provide a full continuum of care for children not only inside the hospital, but outside of it as well. This involves a pediatric care system including components such as financing, affiliated medical groups, and extended care management, in the community. The breadth of a system such as this is, in fact, the very definition of population health, and Feaster and his team have been working with partners and innovators to deliver it, including their creation of pediatric applications for Cerner’s HealtheIntent data platform. “If you don’t know where you’re going, it’s sure hard to get there,” Feaster says. To that end, he has honed his skills in formulating and communicating strategy throughout his career. He and his team are responsible for the population health strategy at CHOC, and they all work together to stay focused on strategic goals. “But strategy doesn’t come out of a vacuum,” he continues. “It’s a team sport, created in a participatory process with input from many.” Broad input casts a vision of what the future could be, cultivates major buy-in, and drives the team toward that future by developing multiple, smaller strategies along the way. Imagining the possibilities of future care for children was the beginning of CHOC’s journey to population health, and much of those possibilities were based on new technology. “It’s important for technology to not drive strategy or operations, but support them,” he says. “Everything we do aims toward a shared vision.” Strategy is what guides Feaster’s team as they walk to the future; it makes sense of all their steps along the way. Ultimately, Feaster’s personal goal is to combine his passions for medicine and technology and provide care for thousands of patients at a time by creating the most value in crucial areas such as population health. As an organization, CHOC is working hard to maintain the health of its community’s youngest population—keeping the healthy well, keeping the sick as healthy as possible, and doing its best to ensure that patients don’t need hospitalization again (though CHOC will be there with open arms if they do). “I can see that we’re making an impact on this area of medicine, and it’s exciting,” he says. “It’s what I’ve discovered is my calling, and I’m pretty happy about that.” AHL

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Going CFO Laura Zehm is doubling down on the population health movement to help Montage Health provide exceptional care at a cost its community can afford

All

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By Stephanie S. Beecher

For some healthcare organizations, keeping people out of the hospital may seem counterintuitive. But at Montage Health, promoting health outside of its hospital walls is part of its philosophy. It wasn’t always that way, though, for the nonprofit healthcare provider based in Monterey, California. Similar to other legacy healthcare organizations, Montage turned its focus to internal interests—number of patients treated, patient revenue, operating costs, etc.—until around 2008, when community leaders approached the hospital and urged the team to do something about the cost of healthcare. That’s when Laura Zehm, CFO for Montage Health, knew that it was time to steer major change. “We realized we were just kind of throwing patients over the wall,” Zehm recalls. “We started talking about changing direction to where we felt like we needed to go, which was toward population health. We needed to do a better job of serving the community, whether they were in our house or not.” This demand for change was growing evident in-house, as well. Zehm says that over the years, she watched as the cost of her own employees’ health plans rose at steeper rates. She sought to find a solution to alleviate their burden. After canvassing the country in search of an innovative business model that could align with Montage’s service mission, executive leaders landed in Asheville, North Carolina, where a population health program was successfully underway.

LAURA ZEHM CFO Montage Health


IMPACT

“We needed to do a better job of serving the community, whether they were in our house or not.”

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“We looked for people that were ahead of us,” she says. “The Asheville Project was a disease management program based upon individual coaching and interventions. We added a wellness program to this effort. These two efforts overlap, and, when deployed together, resulted in a five-year flattening of our own health plan cost curve. We definitely saw some success.” Once Montage knew that population management could work with its employees, Zehm worked with her fellow executives to build a business model and presented it to the board. In 2012, the board approved measures to bring the concept to the community. Montage’s population health initiative centers on key partnerships with primary care physicians, specialists, and case managers that provide individualized care. “We have a population management company, where the case managers are engaged with specialists, and they are really good at calling on people and getting them engaged in their own healthcare,” she says. One of the questions that emerged included how to best align Montage’s community health goals in a way that was financially sustainable for local healthcare providers. The health system needed to find a way to get closer to the premium dollar so it was incentivized to keep people out of the hospital, as opposed to inside. The answer? “We ended up building an insurance company,” Zehm explains. “We wanted to partner since we did not know anything about running an insurance company, but all of the insurance providers were dealing with healthcare exchange issues. We also felt that we could not wait. So, if our goal is to keep people out of the hospital, then we needed to find a financial model sustainable enough for our own system.” As a result, Aspire Medicare Advantage Insurance launched in 2014. It was an unusual brainchild for a healthcare system, and something that wasn’t always an easy sell for Zehm, who took the reins as CEO at the insurance subsidiary. “When we first sold the idea to the board, they said, ‘Let me get this straight; I started on the board of a hospital, and now I’m on the board of an insurance company,’” Zehm says. “They were asking why we were doing it and how. With the rapid rate of change, we need to continue to inform, communicate, and educate.” Zehm says she stressed that if Montage didn’t take control, someone else would—and they probably wouldn’t favor the end result. “I went through this litany of what would happen if we didn’t do it,” she says. “We could be commoditized. Then we’re fighting and scrapping, and maybe getting worse and worse deals, and then

Willis Towers Watson is proud to congratulate

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the community would blame us for it. It was scarier to think about the future without doing something like this. That’s why I have so much passion for it.” It’s a passion that has endured for more than thirty years, when Zehm first came aboard at Community Hospital of the Monterey Peninsula as a reimbursement specialist. Zehm says the health system has offered her growth and the opportunity to be innovative. Switching Montage’s focus to population health was admittedly a risky transformation. But still, Zehm says the organization is “going all in” on its population health plan. She points to the success stories that have emerged from case managers, which prove they are heading in the right direction. Today, Montage Health is the nonprofit parent of a family of companies, including Community Hospital of the Monterey Peninsula, Community Health Innovation, Peninsula Primary Care, and Aspire Medicare Advantage Insurance. “We hope to change the way that healthcare is delivered in Monterey County,” she says. “The healthcare system is designed to address healthcare in a holistic way, meeting people where they are in their health status and helping them to stay healthy, manage their disease, and to help them manage the healthcare system.” AHL

Willis Towers Watson is at the forefront of helping healthcare organizations adapt to a rapidly changing landscape. As a global advisory, broking, and solutions leader, we help clients turn risk into a path for growth. We work with more than 430 of the largest US hospitals and healthcare systems to design and deliver solutions that manage risk, optimize benefits, and cultivate talent. willistowerswatson.com

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“It has been our great pleasure and privilege to support Laura in leading innovation and transformation of healthcare in Monterey County.” – Leslie Margolin and Joanna Horsfall co-founders of The Margolin Group

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IMPACT

Positive Energy for Compassionate Care CFO Michael Hedrick’s work for Rogers Behavioral Health System is sparking critical growth and spreading access to mental health services

MICHAEL HEDRICK CFO Rogers Behavioral Health System

When Rogers Memorial Hospital first opened its doors in 1907 as the Oconomowoc Health Resort, understanding of mental health and how it should be treated was fairly basic. Even so, the health center based in Oconomowoc, Wisconsin, did its best to provide patients with the era’s most innovative mental healthcare treatments. More than a century later, Rogers Memorial Hospital is the anchor of the Rogers Behavioral Health System, a fast-growing nonprofit behavioral healthcare provider that, at its core, provides services for children, teens, and adults suffering from disorders such as obsessivecompulsive disorder, anxiety, depression, addiction, and eating disorders. To say that the health system has come a long way from its early days of offering hydrotherapy is an understatement: today, Rogers is one of the largest behavioral-specific health systems in the Midwest and the largest in Wisconsin, serving about 17,000 patients every year. One of the key players pushing Rogers forward is CFO Michael Hedrick. Since joining Rogers Behavioral Health System in 2013, Hedrick has helped lead the charge in executing a growth and development plan, in addition to guiding financial strategy, capital formation, and IT infrastructure. Hedrick uses his extensive experience in advising growth firms to bring mental health services to more people. He believes that there are three major obstacles that individuals with behavioral health issues face: societal stigma, funding shortfalls in the field of behavioral health, and denial by those affected that they have a treatable condition. “My role here has been to facilitate a growth and development team, and to implement and support the vision they have and the services the organization provides. I can’t run the units or do therapy, but I can certainly help,” Hedrick says. “Blessed is the word. It’s a perfect fit. Here, I get to contribute to something that has meaning.”

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Sara Stathas

By Sarah Kollmorgen

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Even in the past three years, Rogers has benefited from Hedrick’s expertise as it underwent rapid growth, increasing days of patient care by 67 percent to in excess of about 200,000 annually. One of the projects Hedrick is most excited about is the spread of Rogers Behavioral Health clinics throughout the country. Although based in Wisconsin, Rogers has recently opened clinics in Chicago, Minneapolis, Tampa, Florida, and Nashville, Tennessee. Rogers is also considering expanding to markets on both the East and West Coasts in the future. For the 2016 fiscal year, Rogers recorded more than 17,000 admissions across its fifteen locations. Although Rogers’s expansion may seem rapid, Hedrick sees growth as beneficial not only to the growing number of people the organization is able to treat, but also to Rogers’s employees themselves. “If your organization isn’t growing and pushing in new directions, then your staff becomes stagnant,” he says. Pushing growth and improvement ensures that employees are engaged and see a future with Rogers. “Having positive energy in the workplace also helps our staff maintain the emotional resiliency to be at their best with our patients and give them compassionate care.” Compassionate care is crucial at Rogers, which is why the company has focused on the quality of its growth, as well as its geographical spread. Hedrick says one of Rogers’s biggest initiatives recently has been building up its IT infrastructure. In other words, Rogers has gone digital. In July 2016, Rogers became the first standalone acute psychiatric hospital to achieve HIMSS Stage 6 with an EHR system. “We are probably going to end up with one of the most advanced IT systems in behavioral health,” he says. Rogers essentially revamped its information systems from the ground up, replacing each piece of equipment in the health system, as well as wiring in nine new locations to ensure the entire system is connected through a highspeed bandwidth. Hedrick’s team was also able to implement an electronic financial system, thereby effectively pulling billing out of the paper age. Not only are 94 percent of bills now electronic clean claims, Hedrick says, but Rogers can now also compare financial data to other electronically collected data. For example, Rogers can compare billing data to cost information to create financial statements for each individual program at Rogers, meaning that the

In addition to his CFO duties, Hedrick has played a major hand in the IT infrastructure at Rogers Behavioral Health System.

hospital can analyze how an eight-person Sunday night anxiety group is doing from both a financial and census standpoint. “Coming from outside the healthcare industry, I found that the whole revenue cycle is an amazingly complex piece of work,” he says. “A misstep anywhere in the process has a ripple effect that can really create problems. You have to make sure from the moment you start talking to someone about how you can help them that everything is done right. Prior to joining Rogers, I had no idea how much effort and technology went into getting that part right.” Patients and employees at Rogers Behavioral Health, however, can rest assured that Hedrick will get it right. Although the CFO is quick to commend members of his team for their vision and hard work, Hedrick’s own passion for working at Rogers and supporting its mission comes across clearly. “When I look back at what we’ve done in the past three years, it far surpasses what I’ve done in the prior twenty,” he says. “It’s good to be on the side of the angels.” AHL

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IMPACT

Building Special Asembia CEO Lawrence Irene expands on the specialty pharmacy company’s evolution and its annual summit, the largest US event of its industry By Adam Kivel

AHL APR.MAY.JUN 2017

Connections 114

From the start, Asembia was an organization with family in mind. Founded as Armada Health Care in 2004 by brothers Robert and Lawrence Irene and their father, Sandy, Asembia’s focus is in the specialty pharmacy segment and offers comprehensive hub services, pharmacy network management, group-purchasing services, innovative technology platforms, and more. This is to say, Asembia brings strategic solutions and leading-edge products and services while maintaining a high-touch sensibility. Asembia’s work in the pharmacy industry optimizes patient care and outcomes, while always considering the person behind the technology and medicine. This can be difficult considering the complex specialty therapies in which it works, but the Irene family’s dedication, empathy, and professionalism are paramount in assuring the comfort and health of the patients Asembia can affect. Its patient support and hub services ensure that the optimal patient and prescriber journey is achieved and therapy goals are met. This also includes its specialty pharmacy network, which spans specialty, retail, and health system pharmacies across the country, as well as their full-service group purchasing organization. Throughout its diverse work, Asembia remains passionate in providing opportunities for the professional


IMPACT

LAWRENCE IRENE CEO Asembia

growth and advancement of its own employees and other medical professionals. One example of this dedication is the 2017 Specialty Pharmacy Summit, which will be held from April 30 to May 3 in Las Vegas. The annual event is the largest US healthcare conference focused on specialty pharmacy and will feature thousands of attendees, ranging from payers and drug wholesalers to pharma/ biotech manufacturers and pharmacy providers. AHL spoke with Asembia CEO Lawrence Irene about the evolution of Asembia, its goals for the future, and the effect that the Specialty Pharmacy Summit can have. What were some of your major goals for the organization at its foundation as Armada in 2004?

How have those goals evolved over the years? Irene: All these years later, the goals remain the same. The company continues to focus on supporting our pharmaceutical manufacturer and pharmacy partners and their efforts to help patients fulfill their specialty

What are the most interesting changes that the organization has undergone in its twelve years? Irene: The industry has changed and so have we, including our brand. This year we rebranded our organization as Asembia. The timing was right, and we wanted our brand to reflect the technology-centric company that we have become. We are still anchored by our pharmaceutical relationships as a group purchasing organization, which has helped us grow our pharmacy network to more than 30,000 retail, specialty, and health-system pharmacies nationally. Over the last few years, the necessity to manage patients taking specialty medications has given birth to the high-touch patient services model (HUB) we provide as well. We have invested in these HUB services as a way to improve patient care through adherence and compliance. We employ pharmacists, nurses, and certified technicians to ensure that patients receive the highest level of care available. Behind all of our services is the backbone of Asembia: the technology.

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Lawrence Irene: The main goal was to create efficiencies between pharmaceutical manufacturers and a group of specialized pharmacies and their patients. This was the basis for the creation of the trade class known as specialty pharmacy today.

medication needs. The solutions, however, are now rooted in technology and trying to solve for efficiency, cost effectiveness, timely delivery, and recording all applicable data points in this high-touch prescription delivery and patient services environment.

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The Asembia1 Specialty Pharmacy Workflow Platform is what connects all specialty entities together. From the manufacturer, the pharmacy, the prescriber, and the patient, Asembia1 is the premier technology solution for pharmacies to provide visibility into the life cycle of a prescription and the standard for capturing all patient interaction. Showcased at the 2015 Specialty Pharmacy Summit, Asembia1 has quickly become the industry standard and is the specialty technology powering pharmacies across the country. What is Asembia’s place in the specialty pharmacy industry? Irene: We consider Asembia to be at the center of the specialty pharmacy industry, working with all pharmaceutical entities to advance the level of care for patients in need of these complex therapies. That was true at our founding, on a smaller scale, but within the middle of the industry nonetheless. The industry was in its infancy stages, and we were determined to positively impact the marketplace through our unique services and solutions. Tell me about the conference Asembia launched, which is now known as the Specialty Pharmacy Summit. What need does it meet in the industry? Irene: What started as a small meeting of fewer than ten pharmacies in 2004 has become the premier specialty conference and expo event annually. With more than 5,000 attendees and representation by virtually all specialty stakeholders, the summit drives collaboration, education, industry trends, and innovation.

AHL APR.MAY.JUN 2017

How has the conference positioned both you and your company as leading voices in the industry?

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Irene: We have always felt that the Summit acts as an incredible catalyst for industry growth, collaboration, and shared voice. It is hosted by Asembia for the betterment of the industry and the advancement and improvement of specialty care that all stakeholders provide.

“We consider Asembia to be at the center of the specialty pharmacy industry, working with all pharmaceutical entities to advance the level of care for patients in need.� Could you give me a rundown of the immediate and long-term future plans for the company? Irene: We continue to expand our contracting programs and services here at Asembia, and we are also continually investing in and launching enhancements to our Asembia1 technology platform and patient services/ support capabilities. The specialty pharmacy industry is constantly evolving, and we too are evolving to keep pace with the incredible innovation this segment of healthcare has been experiencing. We continue to hire talented individuals that have immediate impact here at Asembia and expand our incredible patient support services staff to support new programs and expanded partnerships that positively impact the patient journey. With new specialty drugs coming to market at a tremendous pace, we understand the importance of providing white-glove service along with end-to-end solutions that will positively impact outcomes for patients. We feel we are strongly positioned to continue to play a critical role in the care continuum in this regard. We look forward to continually building upon our strong partnerships while also developing new ones with leading pharmacies, pharmaceutical and biotech manufacturers, payers, and other industry stakeholders to support patients who require complex therapies. AHL


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“As I was lying in the cath lab having an angioplasty, I thought, ‘You know, I’m awfully glad I helped build this place.’” P. 167


PROGNOSIS


PROGNOSIS

The Cancer Moonshot has Attorneys Mariam Koohdary helps AstraZeneca usher its pipeline of lifesaving pharmaceuticals through FDA approvals and beyond

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By Russ Klettke

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PROGNOSIS

makes her sound less like a lawyer and more like a scientist. In fact, she is the daughter of now-retired medical professionals (her mother was a nurse and her father a physician), and she has a natural affinity for biology and chemistry. Koohdary even combined a political science major with premed studies in college, but her father encouraged her to choose law over medicine. After graduating from law school at Temple University, Koohdary clerked for a federal judge at a time when the dockets happened to be filled with patent disputes that were coming to trial. She was intrigued not only by the legal nuances, but also by the novel scientific concepts that gave rise to disputes in the first place. “I saw the importance of science in advocacy,” she says. “And I loved the combination.” At AstraZeneca, Koohdary supports teams across the three main phases of the pharmaceutical life cycle: the research and development, launch, and the postlaunch periods. Each has its own challenges, its own set of problems to solve, occasional disappointments, and some true success stories. Generally, the legal team first engages with investigational products when they reach the human clinical trial phase. For example, the rules around informed consent for patients who participate in trials are stringent, so management of the legal-regulatory requirements must be similarly tight. When those trials prove a new compound to be safe and efficacious, a genuine excitement builds among Koohdary’s legal team as much as with

MARIAM KOOHDARY Deputy General Counsel, Product and Portfolio AstraZeneca

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Medical breakthroughs that were once thought of as impossible are becoming realities every day. At the same time, these breakthroughs are fundamentally changing the way professionals treat some of the world’s most devastating diseases. For Mariam Koohdary, deputy general counsel at global pharmaceutical company AstraZeneca, this is a major aspect of what motivates her work­—not to mention the work of about 3,000 AstraZeneca researchers who work with a $1 billion annual budget, individuals whose work Koohdary and her legal team help support. The company’s work focuses on respiratory and cardiovascular-metabolic conditions, as well as oncology, but AstraZeneca’s approach to fighting cancer also includes applications of immunotherapy. This falls under one of the ten recommendations to come out of former President Barack Obama’s Cancer Moonshot project (managed by the National Cancer Advisory Board, a federal agency in the Department of Health and Human Services). “We are finding ways to use our own immune systems to attack cancer cells,” Koohdary says. Other approaches the company takes include developing therapies that target specific mutations to attack cancer cells, which block tumor cells’ DNA-encoded ability to reproduce, and using antibody-drug conjugates that direct cancer-killing agents to target specific tumors. To hear Koohdary describe what the company is doing

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ASTRAZENECA PRESENTS BREAKTHROUGHS IN CANCER MEDICATIONS This past fall, AstraZeneca—along with its global biologics research-and-development arm, MedImmune— showcased the potential of a variety of cancer medicines through forty-six scientific presentations at the European Society for Medical Oncology (ESMO) 2016 Congress in Copenhagen, Denmark. AstraZeneca also reported progress in advanced breast cancer research and is addressing the need for treatment advances in this area. According to the biopharmaceutical and pharmaceutical company, about 30 percent of women with early breast cancer go on to develop advanced/ metastatic disease, with median overall survival of two to three years. Although advanced breast cancer (Stage III/IV) is generally incurable, it is still treatable, and the goal is to improve both the length and quality of life for patients, according to AstraZeneca’s news release.

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scientists. “This is when we get more involved with our business teams Faslodex—also known as fulvestrant, a recommended and regulatory agencies medicine for the three-quarters of women with advanced around the world who ask breast cancer whose tumor carries the estrogen receptor questions about our data, (ER)—is the only hormone therapy for advanced/ which ultimately leads metastatic breast cancer that slows tumor growth by to the approved label in binding to and degrading the ER, according to the news release. “Faslodex has over ten years of clinical evidence each respective country,” to support its use, and we are continuing to evaluate she says. As the medicaits full potential in advanced breast cancer, where we tion gets closer to launch, believe patient need is currently the greatest,” said Sean Koohdary’s team goes to Bohen, executive VP, global medicines development and work with the marketchief medical officer, in an interview with BusinessWire. ing and communications "AstraZeneca has a long, rich heritage in breast cancer research. We remain committed to investigating teams at AstraZeneca innovative potential medicines for the treatment of to ensure messaging to women with all types of advanced disease." medical professionals and patients is in keeping with the regulatory directives and the scientific characteristics of the medication. The bulk of the third phase of her work, post-launch, is managing the company’s litigation, which can include product liability lawsuits. Koohdary had the sizable legal task of managing a large class action suit a few years ago. She says there were hundreds of lawyers, scientists, and other experts involved. More than 20,000 individual patients joined the mass tort, and aside from the huge financial exposure in the case, she had to make strategic decisions that sometimes overrode counsel that had more seniority than she did. “From day one, I was often the youngest person in the room,” she recalls. The matter progressed over several years, a time in which she had to manage both the litigation itself and help educate internal stakeholders on how to navigate the business environment while it was pending. She says the litigation helped hone her leadership skills. “I have always preferred to be considered just one member of a broader team, and that litigation helped me learn a lot about the importance of having diverse views on issues, but ultimately to make a decision and stand by it,” Koohdary says. “While those decisions were


Williams & Connolly congratulates our friend and client Mariam Koohdary for her extraordinary contribution to AstraZeneca and the legal profession. We proudly join with American Healthcare Leader in recognizing her tremendous success as a healthcare attorney.

Am Law 2015 "A-List” Firm Named to prestigious list of 20 “best in show” firms in the nation, The American Lawyer, 2015 Rated #1 litigation firm in Washington, D.C. Chambers USA: America's Leading Lawyers for Business (2016, 2015, 2014) Ranked Among Top 50 Elite Trial Law Firms Nationally The National Law Journal, 2015

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“Taking the time to say ‘thank youʼ for hard work and effort is something that not enough leaders prioritize.”

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ultimately mine, getting there together was important to me. I also learned the value of true collaboration. Fundamentally, all teams want to feel that they are part of something bigger than themselves and that every member is important and has something valuable to contribute.” While Koohdary also respected and valued what she heard from outside counsel, she says that she frequently held different views. She explains that in-house lawyers generally have a better perspective of a company’s ultimate strategy as a whole and will come to different conclusions and decisions as a result. The case ultimately went to trial and AstraZeneca prevailed. Koohdary is quick to credit her legal staff, some of whom work out of the United Kingdom, Sweden, and various other countries. Leading such a large and diverse team requires building trust. “Keeping my word is important to me, and taking the time to say ‘thank you’ for hard work and effort is something that not enough leaders prioritize,” she says. “Finally, being honest is critical, which includes providing real and meaningful feedback, both positive and constructive. Almost everyone wants to improve their skills, but most people don’t naturally take the time to seek feedback.”


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She also tells young lawyers interested in healthcare and pharmaceutical law that this is as good as it gets. “There are different, challenging legal issues in this industry. It’s highly regulated, with different rules everywhere in the world. But I feel like I am part of an important mission, one that constantly offers different puzzles to solve,” Koohdary says. “What I love most is being surrounded by incredibly smart people who challenge me and help make me a better lawyer and leader.” Koohdary might be working with a lot of smart lawyers and PhDs, but ultimately, her task is about patients and advancing science. “I can’t wait to see what the future holds for both our approved medicines and those in our pipeline,” she says. “After all, it's not really about the law, it's about the science and the patient.” AHL

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Ice Miller LLP is proud to bring its dedicated and committed lawyers to work with Mariam Koohdary and the entire AstraZeneca legal team. Ice Miller shares Mariam’s dedication to vigorously defend AstraZeneca’s products in a cost-efficient and creative manner so that AstraZeneca may focus its resources on the science-led innovation which is transforming the lives of patients around the world.

McCarter & English, LLP congratulates Mariam Koohdary for being recognized as a leader in the healthcare and pharmaceutical industry. We appreciate the opportunity to work with such a talented attorney and leader, and we look forward to continuing our longstanding relationship and working together to help AstraZeneca achieve its goals.

We salute Mariam Koohdary and proudly join American Healthcare Leader in honoring her leadership at AstraZeneca and her outstanding career. Chicago Cleveland Columbus DuPage County, Ill. Indianapolis New York Washington, D.C.

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Ice on Fire

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Williams & Connolly is proud to have worked with Mariam Koohdary for many years and congratulates Mariam for her accomplishments and success as a healthcare attorney. As head of the US legal team overseeing its litigation, Mariam brings extensive experience, exceptional judgment, and tremendous common sense to her work.  We applaud Mariam for her extraordinary contribution to AstraZeneca during a period of constant change in the healthcare industry.  We proudly join in celebrating Mariam’s career and look forward to her continued success.

Congratulations to Mariam Koohdary of AstraZeneca

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A Whole New Area of Expertise James Brady and David Young of Kaiser Permanente shed light on the function of the company’s unique but crucial area information officers By Amanda Garcia

he entities of Kaiser Permanente (KP)—a multifaceted organization made up of the Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and Permanente Medical Groups—are spread out across seven different regions. One of these is Southern California, which itself is split into smaller groups, referred to as service areas. As area information officers (AIO), David Young and James Brady oversee two of these areas in a one-of-a-kind position at KP; Young is responsible for San Bernardino County, Brady for Orange County, and both have their hands full with technology, strategy, business leadership, workplace development, and supporting Kaiser Permanente's vision.

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You both have the unique title of area information officer. What was the impetus behind the creation of that role?

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James Brady: There are about 6,000 people in the IT organization at Kaiser Permanente, and there are three tiers of information officer roles: the enterprise CIO, eight regional CIOs, and twenty-one local medical center/service AIOs. As AIOs, we service the local areas, and each AIO has a large span of responsibility—often greater than that of a traditional CIO.

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David Young: For example, my team in San Bernardino supports 15,000 computers, 1,000 physicians, and about 8,000 employees. I have two hospitals and sixteen offsite clinics, and Jim has two hospitals, twenty-three clinics, and one building in process in Orange County. The position was created in 2009 by our regional VP, Jim Crawford, with the intent that AIOs would serve as local CIOs and as integral members of business leadership at that level.


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What makes the AIO role unique to a traditional CIO position? Brady: Traditionally, the CIO has oversight over all technology resources and staffing and full control of technology strategy. But at KP, we have a national entity and regional technology entities that are delivering applications and support. Our role is to act as peers and technology partners with all local medical center leadership teams—physicians, nurses, and administration—and be their single point of contact to help develop strategy at the business level for their particular medical center. Between 60 and 70 percent of our time is spent providing insight, translating technology needs, and providing value to the business. We then interface back with the various KP technology enterprises and regional teams to make their vision a reality.

JAMES BRADY Area Information Officer Kaiser Permanente

Young: Because we serve as business leaders, we take on more than only technology. For example, I have a passion for workplace development, and Jim is really involved with innovation. The AIO role allows us to expand those passions as business leaders. How does your AIO role support the priorities and overall mission of Kaiser? Brady: Our mission at Kaiser Permanente is to provide quality healthcare so all members can live happy and healthy lives. As AIOs, our goal is to partner with the local business to develop their strategy and vision and then enable them to achieve it. All of our roles are truly integrated—doctors, nurses, administrators, technicians, etc. And we’re all in the room together, collaborating and problem solving, so it’s very relationship-based. Nobody can reach our goals alone, so we contribute by bringing our voices to the table. How is your workflow structured?

“The next generation CIO— which is what our AIO role is becoming—is a leader that is connected to the business leaders theyʼre partnering with.” JAMES BRADY

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Young: It’s a tremendous amount of performance. Right now, we have 120 projects in my area going at once. There are the usual incidents and work orders within our respective areas, but we also get a lot of projects from outside, so it comes down to maintaining a master project list and providing resources to finish our technology road map. And, as to Jim’s point about integration, some of our staff are dotted line reports and some are direct reports, so there is a lot of overlap and coordinating. I have seven direct reports, but the total support team that I’m responsible for is sixty-five. We’re a highly matrixed organization.

DAVID YOUNG Area Information Officer Kaiser Permanente

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TEAM WORKS.

It sounds organizationally complex. Brady: Yes, but that’s another thing that makes KP unique: in every area of the organization, the direct reports may be small in number, but there’s so much emphasis on the partnerships and greater support group that the teams are actually quite large. In IT, for example, we have groups for electronic medical records, imaging and radiology, facilities, pharmacy, lab, and more, and they all have IT components that all roll up to the AIO. We also have an indirect relationship with directors in hospitals and department administrators in medical groups, and we collaborate with them at the VP level. What makes your similar jobs unique to each other? Young: We have different member and patient demographic needs, though both areas are growing strong. I’m personally involved in a lot of workforce strategy initiatives and community benefit opportunities. Jim mentioned taking on initiatives at regional and national level based on expertise, and for me, that initiative is VOIP—voice over Internet protocol.

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Working together, our doctors don’t just see you. They see the big picture of your overall health. By collaborating and seamlessly sharing your records, your care team stays on the same page, so your health always takes center stage. Visit kp.org today because together we thrive.

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Brady: And I’ve focused on strategy in our local medical center technology road map development by identifying locally deployed applications where we should have regional ones. I was also recently asked to take over a project in the Hawaii region where we’re acquiring three hospitals and moving them to the KP system. That’s another good example of participating in shared regional and national initiatives: it’s about finding areas where we can add value, and there are always niches that need contributions. What are some leadership characteristics that are essential in your role? Brady: It’s so important to understand that the next generation CIO—which is what our AIO role is becoming—is a leader that is connected to the business leaders they’re partnering with and supporting. We’re so relationships-based, so to be successful here you have to build them. We live in a collaborative world, where information is available to everyone and partnership is required to get anything done. Understanding others and being able to forge together the strengths we all bring to the table is the key to furthering the vision of the organization. To be part of providing that high-quality care is exciting. Looking to the future, what do you see on the horizon for Kaiser Permanente? Young: Lots of my work outside of technology is based on leadership development and workforce strategy. I’m passionate about this continued growth and development of managers and emerging leaders and helping them grow into their roles. I love seeing people move up just like I did over the past twenty years, and I believe that investing in those up-and-coming leaders is what will keep us strong for years to come. AHL


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Keeping an Eye on the Horizon As the executive VP and CIO for Merck, Clark Golestani uses partnerships and the “three-horizons model” to increase productivity, drive business, and leverage disruptive technology By Urmila Ramakrishnan

Clark Golestani says his job has three main focuses: operations, helping to drive the business, and leveraging disruptive technology. For these, the executive VP and CIO for Merck uses a technique called the “three-horizons model,” which helps him manage his cost structure, partner with other companies to support business objectives, and drive innovation. Golestani spoke with AHL on this strategy and what it means for Merck, a global healthcare leader. Can you explain what the three-horizons model is and how it has benefited Merck?

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CLARK GOLESTANI Executive VP, CIO Merck & Co., Inc.

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Clark Golestani: The three-horizons model is a McKinsey business model that we adapted and applied to IT. We used the three-horizons model with a couple of extensions that help us manage our risk, as well as drive the business-operations function across the entire corporation for IT. There are some really interesting debates out there about whether a CIO is really a chief technology officer, and where their primary focus should be— whether they should focus all their energy on being the partner to the business and drive business results, shift the productivity equation, or drive innovation across the organization. My argument is that a CIO needs to do all three. You can’t just do one or the other, and that’s the reason we structured IT around the three-horizons model. It allows us to get that accomplished.


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“Technology innovation is never a static thing. It’s never a point in time. It never ends. I believe that the question is just: what’s around the corner next?”

MERCK EXPLORES OPTIONS FOR BLOCKCHAIN WITHIN HEALTHCARE When it comes to innovation in healthcare, something like blockchain could be used in making advances within vaccine registries or transactional histories for patients, as well as being paired with a patient’s current EMR to provide a new level of data integrity. It’s also one avenue of technology that has more than intrigued Merck CIO Clark Golestani and his team. Last summer, during the MedCity News CONVERGE conference in Philadelphia, Nishan Kulatilaka, associate director of product management and applied technology at Merck, explained that the blockchain is a distributed system, where every node has a ledger of everything that happens. “You get a new level of transparency where you can verify what happened,” he said. A blockchain is a type of distributed ledger comprised of unchangeable, digitally recorded data in packages called blocks. These digitally recorded “blocks” of data are stored in a linear chain, and each block in the chain contains data (e.g., bitcoin transaction). These blocks of hashed data draw upon the previous block in the chain, ensuring that all data in the overall “blockchain” has not been tampered with and remains unchanged. “There’s something really cool about having your record follow you wherever you go without needing that data on you at all times," Kulatilaka said. "You’re no longer bound to your hospital system.” Merck’s applied technology group is now exploring potential applications for the blockchain approach within the healthcare field. After the financial services sector, Kulatilaka explained, healthcare could potentially be the second-biggest industry to adopt this blockchain technology.

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While the healthcare industry may not be making moves to blockchain technology in the immediate future, MedCity News reports that the technology will be implemented more widely over the next five years.

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You will hear a lot about money and investment for innovation. Some CIOs say that they can’t innovate unless they get more money. My perspective is that the CIO should have the mindset of a CEO of technology. If you think like that, the first thing you’re going to do is not ask for more money; you’re going to figure out how to drive optimization to accomplish all the goals. And that’s what we did at Merck. We structured the IT organization completely along those three horizons when it comes to cost structure. When you do, for example, you end up with a part of the organization that wakes up every day focused on driving service levels up and cost down. They operate at scale— that’s their purpose. They innovate, just like the rest of the organization, but the innovation they apply is really to drive the productivity of the IT operations function, if you will. That’s not just cost infrastructure, but really operating of all IT assets. That frees up some money, and the focus of the rest of the organization is to partner with all the business areas and drive productivity. This is how we take costs out while driving performance up, support colleagues through partnership, and leverage disruptive technology. When you look at our ability to invest and drive productivity innovation, we exceed many of our peer companies. What’s your approach when it comes to partnering with technology companies, particularly smaller ones? Golestani: It’s like growing a plant from a seed. You really need to give it a lot of tender, caring love and make sure you don’t crush it. Big companies have a way of crushing start-ups and small companies early because they always have big problems that they want solved at scale. The reality is that in order to let innovation grow, you really have to protect it. That takes a very different mindset. Big companies have the opportunity to partner with a start-up—if they’re careful of the perspective and the strategy of scaling. If you can take innovation and apply it at a scale, you’re going to get great results from it. One example of that is our partnership with Enigma IO,


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which is a small but fast-growing start-up out of New York City. They do data mining and data management on public data sets. They were a very, very small firm when we started working with them. Like any large company, we could have given them a hundred problems to start with. Instead, we focused on one problem, and they did great. Then, we expanded to two problems, and three problems, and we continued that expansion, being careful not to crush that company. We learned this early on when I was working with some start-ups early in my career. We actually gave another company too much of the problem set and demanded too much. We learned there how to really drive a successful partnership, and it’s not easy by any means. The reality is that when you’re driving innovation, you may have to solve your problem through other means until that innovation can really grow up. But if you do that, more often than not you get a far greater value proposition at the end. For Merck, these are true partnerships to solve business problems, not supplier relationships like other large companies. Quite often, you are coaching that start-up, directing them and educating. That’s very different than, “You show me what you’re selling, and I’ll tell you whether or not that fits with the solution I’m trying to achieve.” I think it’s also important to recognize that innovation is not just in the start-ups. There are start-ups in large corporations also. It’s important not to forget about the major tech players because there’s opportunity to really partner with them and drive new levels of innovation.

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13 of 16

First in Class Drugs*

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Developed by

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* Drugs approved by FDA in 2015

“My perspective is that the CIO should have the mindset of a CEO of technology.” How do you define technology’s influence on Merck’s digital health innovation? Golestani: Today, there’s really a crossover and blending of information in data sciences with health sciences, so there is an underpinning of technology capability that really fits with any of the innovation capabilities that come to market. That certainly influences where we invest and where we don’t. Merck has a health-related venture fund that is aligned to our strategic core direction of the company. It also has a Healthcare Services and Solutions subsidiary that allows us to take advantage of some of these new technologies while leveraging some of the corporate resources. It is important to remember, though, that technology innovation is never a static thing. It’s never a point in time. It never ends. I believe that the question is just: what’s around the corner next? The one area that gets me most excited for what’s around the corner next is blockchain technologies. There are opportunities to really streamline costs across the healthcare ecosystem and ways of protecting privacy that are hard to realize with other technologies. I believe there are ways of liberating patient data while also giving patients even greater control over their data to really drive and fuel research. In the end, patients can have better solutions and better therapies to many things that afflict so many people. AHL

Cognizant congratulates Clark Golestani on being recognized as an industry leader. At Cognizant, we partner with our clients to create new business models and build the infrastructure, processes, and platforms necessary to power digital success. We are honored to advise and support Merck on its journey to  become the industry’s  premier, research-intensive biopharmaceutical company, and to make a difference in the lives of people globally through its innovative medicines, vaccines, and animal health products. We wish Clark Golestani and Merck continued success and look forward to continuing our partnership. Driving Data Intelligence and Powering Cures Intelligent data insights power the cures that improve health and save lives. These insights are the result of clinical drug trials supported by the kind of advanced, cloud-based, clinical trial solutions offered by Oracle Health Sciences. These solutions enable pharmaceutical, biotechnology, CROs, and medical device organizations to maximize capabilities, go beyond incremental gains, and drive research innovation. Oracle is the only company that provides sophisticated, pipeline-to-patient solutions for clinical trial setup, big data analysis and warehousing, genetic biomarker inclusion, pharmacovigilance, and real-world data aggregation for analysis. Partnering with top life sciences leaders—like Merck—Oracle empowers them with advanced data solutions that can identify more effective drug therapies, deliver more actionable insights, improve patient outcomes, and enhance population health.


In the life sciences industry, we’re seeing new technologies make healthcare more personal with new, patient-centric, digital innovations; from self-monitoring devices that can interpret personal data and enable targeted care, to cloud platforms that invite providers to collaborate with the patients they serve. At Cognizant, our domain experts, technologists, digital and data specialists, clinicians and scientists are transforming the way clinical research sites collaborate with pharmaceutical companies, and enhancing patient engagement with innovative platforms and solutions.

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Our population’s growing healthcare needs present growing opportunities for our clients: to advance the future of medicine with digital, and improve the quality of lives.


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From Vital Signs

As a former ob-gyn specialist, Sheryl Bushman brings a clinician’s perspective to medical informatics By Jeff Silver

heryl Bushman knew she was going to be a physician when she was just five years old. Her mother had given birth to a younger sister, but the infant’s lungs had not formed properly, making it impossible for her to breathe. Bushman decided then that she would go into medicine so she could save lives and help parents avoid the grieving she saw her mother go through after the loss of her newborn sister. Bushman followed through on that promise, ultimately going into obstetrics and gynecology. What she did not anticipate, however, was the turn that her caree r took as a result of digital technology’s impact on healthcare. Today, she’s the CMIO at the full-service healthcare consulting firm Optimum Healthcare IT, based in Jacksonville, Florida. While practicing at a rural hospital affiliated with the St. Louis-based Sisters of Mercy, Bushman learned the EHR system that the nursing staff was using. Recognizing its value, she convinced the IT staff to create templates she could use for her labor and delivery notes. Soon after, they began to consolidate the two different IT platforms that the ten Sisters of Mercy Hospitals were using (including different versions of the software

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SHERYL BUSHMAN CMIO Optimum Healthcare IT

at various locations), and clinicians were invited to provide input on capabilities and features that the new system should provide. Bushman’s suggestions were so helpful and insightful that the IT group offered her a job. Although she resisted at first, she agreed to part-time involvement, which grew into a full-time commitment alongside her medical practice. “I knew I had to choose between the medical and informatics focus and realized I could impact many more people if I helped implement the IT solution,” Bushman says. “I could make the system easier to use for all specialties, more transparent, and safer for patients—everything that an integrated, well-organized health record can provide.” With no formal IT training, Bushman became medical director of clinical transformation and received seven different certifications in the system’s software. She brought to it a clinician’s eye: reviewing the “symptoms” of a given issue, analyzing the environment in which they occurred, and then developing appropriate solutions. Bushman soon realized the importance of maintaining appropriate priorities when addressing informatics issues, the most important being to stay focused on the patient and the larger clinical picture. “Physicians have


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to Vital Infrastructure “I knew I had to choose between the medical and informatics focus and realized I could impact many more people if I helped implement the IT solution.” bility to provide specific wording required to activate CMS observation status, but displayed only for Medicare patients. In another, functionality was implemented to support monitoring and maintaining physician compliance with an Oklahoma requirement to update a public record of prescriptions for scheduled medications. For the best solutions, Bushman recommends not just adding capabilities that users ask for, but instead asking what they are trying to accomplish. “Fully understanding the goal enables a good informaticist to provide several options to achieve what users need and avoid unintended consequences somewhere else in the system,” Bushman says. “Solving those kinds of problems is the fun part of the job.” Once users become more familiar with a new EHR system, it’s completely normal for unexpected issues to arise. Bushman finds that the most successful responses can be developed when the IT organizational structure includes physicians and other key operational representatives. In the face of ongoing upgrades, maintenance, and customizing to specific workflow requirements, this is the kind of engagement, Bushman contends, that is necessary to ensuring that EHRs contribute to patient and organizational health. AHL

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to remember that an EHR system has to be usable by all providers and specialties,” she explains. “That means understanding the overall clinical workload, the downstream impact of any changes we make, and keeping the data accessible to patients who want information about their own care.” After leaving Sisters of Mercy, Bushman served as CMIO at NYU Langone Medical Center, and then joined Optimum Health in 2014. Throughout these various venues, she has seen that a broad range of decisions must be made at the outset of any project in order for an EHR system to be successful. These might include determining who is responsible for completing transfer-orders reconciliation or the percentage target for physician-entered orders in the system. “There are a million policy decisions that affect care quality and compliance issues,” she says. “If you don’t make them up front and decide who’s responsible for a given factor at any given moment, then no one’s responsible.” According to Bushman, EHRs are not necessarily time-savers, contrary to common misconceptions—especially during transitional periods such as implementations and upgrades. Their key benefits are in providing transparency, so that routine questions only have to be asked once, and allowing all different specialties and departments to have access to the same information on a single platform. Everything from updated problem and medication lists to automated reminders for labs or exams are all available through a few online clicks. Bushman also refutes the idea that older practitioners typically push back against newer technology. “Adoption has nothing to do with age,” she says. “I’ve seen users of all ages who are resistant at first or have trouble getting acclimated, but once they understand the value the technology provides and their role in facilitating it, they all adapt very quickly.” Diagnosing issues and coming up with innovative solutions are Bushman’s favorite aspects of her job. In one instance, she led the team that developed the capa-

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A Healthy Pairing David Lubarsky’s experience and expertise are playing a big part in making the University of Miami Health System an efficient, cohesive unit

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By Joe Dyton

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Dr. David Lubarsky, a practicing anesthesiologist by trade, is living proof that sometimes a role outside of one's specialty or expertise can still be a perfect fit. For the last four-plus years, Lubarsky has doubled as the leader of integration efforts for the University of Miami Health System (UHealth). In his chief medical and systems integration role, Lubarsky has helped tie together numerous campuses across the South Florida tri-county region. Since taking the role, he has helped create a centralized scheduling system for the hospitals and practice, improving the efficiency of supporting infrastructure and working with critical project management at the hospitals in order to improve performance. On the surface, it appears to be a lot for one person to take on—especially when they already have another job running one of the largest departments in the country. For Lubarsky, however, the end result makes it all worthwhile. “Anesthesiologists are really integrators to start with,” Lubarsky explains. “When you look around, many are serving as chief medical officers and other health system integration roles naturally because they are used to working with a variety of different specialists and bringing people together in terms of operational efficiency and optimizing the delivery of care. Plus, I happen to love problem-solving on behalf of a good cause.”


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DAVID LUBARSKY Chief Medical, System Integration Officer University of Miami Health System

“Being committed to local change isn’t always enough; we often need an expanded view of what’s possible around the country and that can keep us all moving in the right direction.” AHLMAGAZINE.COM

The need for a role such as Lubarsky’s came as UHealth evolved from a smaller, single-facility-focused group to one that was constantly expanding across the Miami-Dade and South Florida tri-county area in many different hospitals and new outpatient facilities. As the system continued to grow, there was no real plan in place for how all of these sites should work together in order to create a unified UHealth way of providing care. “Whether it was managing care or scheduling patients, internalizing policies or management procedures, we were a group of siloed entities,” he says. “When a new administration came in 2006, we began to realize we really needed to work better together.” That was the problem. But the solution came when Lubarsky and his team decided to unify people across UHealth who were more or less performing the same tasks at a part-time level, rather than have a subject matter expert put their full attention to a particular role. The move paid off, as efficiency increased and operating results improved without losing manpower or adding additional expense. “Nobody is really an expert, and everybody is spending a lot of time and effort trying to do the best job they can do,” Lubarsky says. “It was a matter of corralling the same resources. You’re saying, ‘Hey, you’re now in charge of this part of a portfolio across the system.’ This creates a level of expertise that is a true resource and is much better than having three people who are doing a job parttime that doesn’t get their entire focus.” Lubarsky also conceptualized and developed an integration project for the University of Miami’s retail health strategy. For him, the big takeaway and key to making this project a success was understanding how committed partners can develop a joint effort toward better health coming at that care from different angles. “When you put all the various opportunities together and think outside the box a little, you realize that a partnership health strategy is not just a combination of what you are doing, but building a platform to leverage each other’s expertise and each other’s touchpoints for patients,” he explains. “There’s a lot that each partner brings to the deal that enhances the care both organizations can deliver inside and outside the walls of their respective facilities.” In other words, if the University of Miami was sending its patients to a particular pharmacy, that pharmacy would naturally do better. If that pharmacy is handling a majority of the University of Miami’s patients, its health

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GROWING THE COMMUNITY OF CARE

AHL APR.MAY.JUN 2017

In a move to grow the number of people that the system can positively impact, UHealth and partner Jackson Health System opened a new urgent care center in Country Walk in southwest Miami-Dade in September. The center is the first of an eventual six UHealth Jackson Urgent Care centers planned to open throughout the Miami-Dade County. “UHealth is proud and committed to working with Jackson to bring our excellence in healthcare to more people in our community,” UHealth chief clinical officer and chief operating officer Thinh Tran said at the facility's opening.

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system can use those designated pharmacies to augment population health initiatives around susceptible populations, whether they are lower income, less educated, or a population with chronic disease. “When patients stay on their medication regimens and check in with knowledgeable professionals about issues, their health is improved, society spends less money overall, pharmacies make a greater impact on patient lives and increase profits, and health systems have a greater chance of succeeding in the population health initiatives, which is key to succeeding in a risk assumption world,” he says. “Everyone wins with a dedicated and organized effort.” Lubarsky adds that there’s a tremendous amount that can be done in building a retail health strategy with the right partner. “It doesn’t have to be a unique or exclusive partner,” he notes. “You can have multiple arrangements. In Miami, we’ve reached out to many different potential partners in that pool.” The initiative that Lubarsky may be most passionate about, though, is moving toward value-based health. When someone takes their car to a repair shop, they have the expectation that they’ll pay an assessed fee and the car will get repaired and stay fixed; Lubarsky feels going to the hospital should be no different. “If you come in for service—whether that’s a hip replacement, congestive heart failure admission, or pneumonia—we should fix it and we should make sure when we send you out with your fixed heart it shouldn’t break again,” he says. “The core value base is about readmissions and bundled pricing. I believe that is likely to be a continued focus, and that type of initiative is a great way to get started on the volume-to-value road. It certainly isn’t new; all service-oriented industries operate this way. These initiatives associated with the often maligned Affordable Care Act are actually moving us all in the right direction.” Even if value-based health becomes the rule more than the exception, there will always be caveats, Lubarsky explains. Upfront pricing, for example, should be taken as an estimate depending on the patient’s circumstances. Academic systems such as the University of Miami have

Alberto Jacir, assistant professor of family medicine at the University of Miami Miller School of Medicine, oversees the medical direction of the six Jackson Urgent Care centers. The plan was devised in order to offer patients an option between traditional doctor appointments and emergency room care, and the locations for these facilities were chosen for their relation to areas that were previously underserved by urgent care facilities or overburdened with a high population. “UHealth and Jackson have demonstrated a commitment to bringing academic medical care further into the community,” Jacir said in a recent press release. “These urgent care centers will be uniquely positioned in the neighborhoods where they’re needed most. Our strategy has its roots in providing access to the two most influential healthcare systems in the region under a consumer-based model, focusing on convenience, service, and medical excellence.” The remaining five locations are scheduled to open before the end of the year, and will be open seven days a week, serving patients with illnesses such as the flu, fever, vomiting, earaches, simple bone fractures, rashes, and minor allergic reactions, as well as offering sports physicals and flu vaccines. The facility will also be able to perform echocardiograms and digital x-rays, while staff can conduct lab tests such as blood glucose, urinalysis, and strep throat cultures.

a tougher time with pricing because, even when they take good care of patients, what happens after they’re discharged is out of the hospital’s hands. Sometimes patients go home to environments that aren’t supportive of good care, whether it’s because of a lack of resources, knowledge, or just the inability to access additional care. The buzzword now is social determinants of health, and it is important. “Posttreatment care has to be taken into account when the bundled pricing is being considered,” Lubarsky explains. “There are poor people who may actually need a higher estimated price to reflect their true cost of doing business for things that are out of their control.” Putting Lubarsky in this role has helped improve UHealth in a number of ways, including a more efficient workforce and more cohesion between its hospitals, which has led to better care for patients. However, Lubarsky is happy to admit that this role has been just as good to him as well. The challenges that he encounters make coming to work every day fulfilling, and he’s been tapped along the way to fill a number of roles specifically


We salute the entire UHealth team for their health system integration efforts and their strides in advancing value-based healthcare in the Miami community.

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At Eyman Associates, we are committed to our clients’ work in transforming the nation’s health care system and making its benefits accessible to all. With the sophistication of a top tier health care practice, yet the flexibility of a boutique firm, we provide a mix of legal, strategic, and policy advice to health industry leaders.

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created for him to be a “fixer.” He has been a senior associate dean for safety quality and risk when a malpractice crisis was disabling the system; the first CEO of the 1,100-physician practice when it was facing an annual loss of about $100 million a year; and the initial system chief medical officer of the university’s $2-billion health system as it began to address the value-based world and meaningful use of its Epic EMR, as just a few examples. “I’ve been very lucky. Every step of the way it’s been great because I have been able to address what I think are incredibly important initiatives that make it possible to deliver better care, every day, to every patient,” he says. And almost uniquely, he is publicly fond of working with consultants, who are not always fully appreciated at times by the health system rank and file. “When you are constantly trying to invent something from scratch, having some advice about how other aspirational organizations organized their efforts is a critical part of defining your own path,” he says. “People always say that consultants simply tell you what you already know, but that is because they aren’t asking the right questions. You may know that you need a centralized safety and quality organization, but figuring out exactly how many FTEs to start with, what is a reasonable timeline to deliver results, and starting with matrixed central/local organizational charts that have been successful elsewhere provide the substance with which to engage all your internal stakeholders. Being committed to local change isn’t always enough; we often need an expanded view of what’s possible around the country, and that can keep us all moving in the right direction.” AHL Ballard Partners’ health practice managing partner, Jan Gorrie, is proud to work with David Lubarsky, chief medical and system integration officer, and the University of Miami’s Miller School of Medicine. Over the past decades, it has been exciting to be a part of the UM faculty practice evolution as a leader in innovation and care delivery as it pursues its tri-fold mission of research, teaching, and superb clinical care. Ballard Partners salutes Dr. Lubarsky for his many contributions to the U!

Eyman Associates is pleased to join American Healthcare Leader in recognizing the inspiring leadership of Dr. Lubarsky. We are proud to partner with the University of Miami and providers nationwide to improve the health-care system available to all. To find out more about our legal and policy expertise, visit www.eymanlaw.com.

PwC recognizes the vision and impact that Dr. David Lubarsky has achieved in his role as chief medical and system integration officer at University of Miami Health System. PwC was a solutions provider in supporting his efforts to drive towards value-based care by building foundational and transformational elements of a population health and value management care delivery model—addressing patient needs across the continuum of care. Dr. Lubarsky has provided the opportunity to create and deliver innovative solutions that combine strategy, clinical operations, and clinical analytics to create better outcomes. His efforts to improving quality and clinical outcomes while managing the total cost of care clearly established his commitment to measuring and managing value for patients and the health care delivery system. PwC looks forward to watching their journey towards value-based care as it evolves in the near and long-term future.


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HE AL The Patents That We expect our pharmaceuticals to cure us, and we’re thankful to the people of science who bring them to the market. But it’s lawyers like Dana Hubbard who are indispensable for turning ideas into medicine. By Russ Klettke

DANA HUBBARD Head of Life Science Patents MilliporeSigma

But IP attorneys such as Hubbard do a lot more for their employers than litigating patent infringement. With a broad understanding of what already exists in the marketplace or in the approval pipeline, they advise senior management on where product gaps exist. And in the case of Hubbard, he is so involved in the development of products that his name goes on the patent. Hubbard is a named inventor on eight patents to date, with another dozen or so inventions in the patent-review process. US patent law requires inventors to actually conceive of the invention, not simply contribute to or refine it. Hubbard’s degree of involvement meets these requirements, and he is named on the patents in the short list of inventors. “This is not common, but it’s not unusual,” he says. “We have brainstorming sessions on the conception of the invention. Because I have a broad exposure to the many technologies in the industry, I advise the other inventors on what else is being developed.” The knowledge required to be a named inventor of highly technical methods—e.g., “methods for cleaning a Protein A chromatography column employing a media comprising a Protein A ligand derived from the C domain of Staphylococcus aureus”—comes from Hubbard’s background in science. As with all attorneys admitted to the patent law bar, he holds a science degree, a bachelor of science in biology from the University of Massachusetts.

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An important part of the sometimes-contentious discussion on international trade agreements is the matter of international respect for patent protections. For healthcare professionals, this is not just a business matter, to ensure the innovators are given their just due in revenue flow—it’s also about patient safety. Dana Hubbard, an intellectual property (IP) attorney who is head of patents for MilliporeSigma—the life science business of Merck KGaA operating in the United States and Canada—knows a great deal about the subject. The global manufacturer of life science tools for the pharmaceutical industry is not only a supplier to the critical research, development, and manufacturing functions at major pharmaceutical companies, (including its corporate parent, German-based Merck), but it also invests heavily in research and development itself. The “do no harm” part of the Hippocratic oath is a first priority for the company. “We serve the largest companies in the pharmaceutical industry,” Hubbard says. “They, and we, have to be very careful about the supply chain.” Fortunately, the entire industry is getting more methodical about product cleanliness, he notes. For example, Chinese firms are bowing to legal and public pressure to honor other companies’ patents and ensure safer products overall.

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WE CONGRATULATE

Dana Hubbard AND PROUDLY CELEBRATE OUR LONG-STANDING RELATIONSHIP WITH

MERCK & CIE n

n

n

ALSTON & BIRD PROVIDES LEGAL COUNSEL AND SERVICES GLOBALLY TO DOMESTIC AND MULTINATIONAL CLIENTS ACROSS A BROAD RANGE OF INDUSTRIES.

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WWW.ALSTON.COM

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ATLANTA • BEIJING • BRUSSELS • CHARLOTTE • DALLAS LOS ANGELES • NEW YORK • RESEARCH TRIANGLE SILICON VALLEY • WASHINGTON, D.C.

A researcher uses a chromatography column containing chromatography resin (left) and a control skid (right), used to separate and purify proteins like monoclonal antibodies made and sold by MilliporeSigma customers.

Hubbard started his career with the company, which at the time was known as Millipore Corporation, in 1997. Since then, Millipore was acquired by Merck KGaA (Darmstadt, Germany) and has made five acquisitions of its own. Its product line has grown from about 60,000 filtration-based products for pharmaceutical product development and manufacturing (and microelectronics, which led to a spin-off in 2001) to today, when it offers roughly 300,000 products and services including lab water instruments, consumables and services, cell lines, antibodies, microbiology and biomonitoring, test assays, analytical reagents, and flow-cytometry kits and instruments. The clients for these have evolved over time as the pharmaceutical industry has globalized and rationalized. “The biopharma model has changed in recent years,” Hubbard says. “It used to be that R&D was conducted in-house. Now this is done by smaller start-ups, universities, and spin-offs from universities.” This contributes to faster innovation because entrepreneurial ventures that are fundamentally about R&D—for example, companies like Juno Therapeutics, MyoKardia, Spark Therapeutics, Apexigen, and Audentes Therapeutics—are not distracted by externalities more typically characteristic of larger corporations. Bigger firms still do some of their own R&D, but quite often, they’ll outsource the function. Hubbard knew he wanted to combine his love of science with the law from a relatively young age. “With


PROGNOSIS

DANA HUBBARD, LAWYER AND INVENTOR Already named on seven patents, Hubbard has about a dozen more awaiting approval by the US Patent Office:

Conductive masking laminate

Relates to a conductive masking tape for electromagnetic-interference-sensitive equipment

Congratulations!

Disposable mixing system

Relates to disposable mixers using cyclably inflated air bladders to create a wave mixing motion in the liquid

Bag support system

Relates to a rigid support housing for single use bags formed by applying a vacuum to media trapped in an intermediate chamber of the walls

Filter with memory, communication, and pressure sensor

Relates to a radiofrequency-identification (RFID) pressure sensor to determine integrity of individual filters in a multi-filter device

Filter with memory, communication, and pressure sensor 2 Uses RFID pressure sensors to control a tangential flow filtration process

Methods for purifying a target protein from one or more impurities in a sample

Hamilton Brook Smith Reynolds congratulates EMD Millipore Corporation’s J. Dana Hubbard on his outstanding leadership as head of patents. We are privileged to partner with Dana and the EMD Millipore legal team

Relates to a method of purifying proteins such as monoclonal antibodies

in protecting the company’s

Sampling system

advanced innovations, and

Uses RFID tags to identify the location and other data relating to a sample being taken

we look forward to

Sampling system 2

continuing to protect and

Uses RFID tags to track a sample through the laboratory taking and analysis system

defend EMD Millipore’s

intellectual property.

www.hbsr.com

AHLMAGAZINE.COM

science you have very black and white facts,” he says. “I liked that. But with the law there are a lot more gray areas. I struggled with that at first.” That struggle ultimately led him to where he is today: working with eleven staff attorneys across the globe. Hubbard is also one of about sixty patent attorneys working for the various businesses of Merck KGaA. He encourages anyone interested in the law as well as science to consider a career in IP. “The old joke was that an IP attorney was an engineer who went to law school at night,” he says. “Now, it’s PhDs from great schools who went to law school, and the characteristics of good IP lawyers include flexibility. Patent law means every day you’re learning new things.” AHL

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DAVID BERRY General Partner Flagship Ventures

Flagship Ventures’ unique business model has created nearly thirty promising companies working on medical and environmental technological breakthroughs By Peter Fabris

U

thinking, a “crude characterization and a giant extrapolation of conclusions.” Even so, there was enough meat on the bone to warrant further investigation. This is how many of Flagship’s investments get started: with a basic premise that the idea factory investigates and turns into a marketable concept. The process starts with a series of “explorations,” a term used to describe how the firm examines the existing science of a promising concept. During this stage, VentureLabs researchers look at the concept dispassionately from an outsider’s perspective and look at the topic from multiple angles. With no one on the team banking on a future in a narrow specialty, no Flagship personnel are beholden to existing scientific orthodoxy. Therefore, the firm can ask questions from unusual perspectives without preexisting biases. “We have a willingness to be naive,” Berry says. The first avenue of exploration of the human biome, diagnostics to measure which bacteria were associated with which diseases, didn’t pan out because no strong correlations could be found. “We realized that we couldn’t make good diagnostics, so we killed that one,” Berry says. Another realization revolved around the

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ntil recently, the human microbiome, composed of the bacteria and other organisms that live on and within us, has been misunderstood and underappreciated by medical science. The past decade or so has seen more interest in the field, as links between the microscopic creatures living in our gut and human health have been found. It is a field that intrigues Flagship Ventures general partner David Berry, as well as those working in the firm’s “idea factory.” Flagship, a venture capital firm that creates most of the companies in which it invests from scratch, has a unique business model. The Cambridge, Massachusetts, firm has a remarkable knack for spinning out promising start-ups focused on healthcare and sustainability. Its systematic approach to research and development is one that any enterprise could learn from to foster a culture of innovation. A few years ago, Berry and Flagship’s VentureLabs unit, the idea factory, delved into research that suggested a link between certain gut bacteria and obesity. The findings of the existing research were, to his

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PATENT PENDING Flagship Ventures has spun off forty-five companies to date, including these four.

Indigo Agriculture

Derived from research on microbiomes that led to the founding of Seres Therapeutics, the company launched in 2013 and is focused on the microbiomes of plants. Its mission is to develop plants that can better withstand disease and drought.

Joule

Joule, which launched in 2007, has pioneered a platform that applies engineered catalysts and photosynthesis to convert waste CO2 into renewable fuels, such as ethanol or hydrocarbons used in diesel, jet fuel, and gasoline. The company currently operates a small-scale pilot plant and is exploring ways to rapidly scale up the process.

Moderna Therapeutics

Founded in 2010, Moderna is pioneering messenger RNA therapeutics, a new in vivo drug technology that produces human proteins, antibodies, and novel protein constructs inside patient cells, which are in turn secreted or active intracellularly. This breakthrough platform offers a superior alternative to existing drug modalities for a wide range of disease conditions, the company says.

Evelo Biosciences

Founded in 2015, this company is dedicated to transforming cancer therapy through a deep understanding of the cancer microbiome. Evelo is discovering and developing novel treatments designed to attack cancer by disrupting the microbial environment that supports tumors and protects them from the body’s immune system.

premise that if the bacteria were impacting people, they were probably secreting things. Most of this research took place using mice, but the firm’s researchers found that the microbiome of mice was much different than that of humans, so that path turned out to be another dead end. Flagship didn’t give up on finding potential in the human microbiome, though. It began to study the biology of fecal transplants—where the microbiology of a healthy person is transmitted to one with a disease, most typically those suffering from recurrent Clostridium difficile infection. Such treatments were producing remarkable recovery rates, Berry says. It wasn’t practical to turn feces into drugs, but the research led to another realization: the gut microbiome actually functioned as a system similar to an organ. Studies of 250 people with healthy microbiomes showed consistent functionality despite significant variations in the organisms. This research led to the development of a proto-company—a kind of test project for a new company—and then the founding of Seres Therapeutics in 2010, based on what was known about the holistic functionality of the microbiome. “We developed consortia at the core of the microbiome’s function that allowed for other microorganisms to be attracted around them that would allow for a shift in function from a disease state to a healthy state,” Berry explains. Further, Flagship discovered a way to isolate the active “ingredient” in fecal transplants and thus had the basis for spinning out Seres Therapeutics as its own company. In 2013, Seres began clinical trials for a treatment for recurrent Clostridium difficile infection, which has been designated as a breakthrough therapy by the FDA. Seres’s approach also holds promise for ulcerative colitis, graft-versus-host disease, and a range of other diseases. Seres is just one of forty-five companies that originated in Flagship’s VentureLabs unit, and the list is growing. “Every year, we produce about five companies out of about ten proto-companies,” he says. One of the keys to Flagship’s venture-generating process is having no fear about canceling development of an idea or a prototype company when serious doubts are raised about its viability. Even the exploration phase of an idea, a

AHL APR.MAY.JUN 2017

“Insurgent companies tend to do well in areas where there are no major players.”

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x=

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GETTING STARTUPS

STARTED Bring regulatory clarity. disciplined process starting with a research question, has a four- to six-week deadline. If researchers can’t generate a promising concept for a new company, the exploration ceases or is redirected. Too often in contrast, Berry says, leaders of start-ups keep their organizations afloat even when the business case for the enterprise doesn’t hold up. Flagship Ventures’ creations are paradigm-shifters, companies developing breakthrough technologies. They generally do not have to compete with large, established players. “Insurgent companies tend to do well in areas where there are no major players,” Berry notes. For Flagship, when a proto-company doesn’t appear likely to succeed, killing it off is not considered a failure because it’s just part of the creative process. And there are always other promising ideas in the VentureLabs pipeline to explore. Another key to Flagship’s success is that its researchers, unlike most others, do not specialize in specific fields of study. They do not depend on getting published in scientific journals to boost their professional prestige. This frees them from asking oddball questions and allows them to believe in ideas that many experts might consider far-fetched. “We can go in and out of fields as we like,” Berry emphasizes. The result is intellectual freedom that is critical to Flagship’s business model. There’s also a good chance that it will lead to numerous medical breakthroughs. AHL

Actualize your game plan.

OUR STRENGTHS BECOME YOURS.

hallorancg.com

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Halloran Consulting Group is proud to partner with David Berry and Flagship Ventures to help small companies act with the expertise and efficiency of larger organizations. Our strengths become yours, bringing decades of industry knowledge in clinical and regulatory strategy, investment due diligence, quality management systems, and more. We understand that no two problems can be solved with a cookie-cutter approach, so we lend you the best people to actualize your goals and help bring your product to market.

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Born to Boot Up Adam Goldâ&#x20AC;&#x2122;s lifelong interest in computers continues to pay dividends as UC Irvine Health implements new technology systems

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By Joe Dyton

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W

“Being able to say you’ve been there and you’ve done that really does help a lot in this industry.”

ADAM GOLD Director of Infrastructure Technology UC Irvine Health

initiatives, user adoption, or just general support. Being able to say you’ve been there and you’ve done that really does help a lot in this industry.” Credibility will be a key quality in Gold’s arsenal as he’s helping UC Irvine Health’s conversion to the Epic EMR system. UC Irvine Health had implemented the Allscripts EMR system seven years previously, but leadership decided to make the switch. After a period of due diligence, UC Irvine Health decided to partner with UC San Diego Health via a community-connect model. “On the San Diego side, they have been running Epic for upwards of ten years now,” he says. “They are very well-versed in Epic, and they’ve gone through upgrades. Now, we’re going through this transformation, moving to Epic, and collaborating with UC San Diego to not reinvent the wheel, but as an opportunity that if anything needed to change within the environment, now is a good time to do it.” Going forward, the hope is that the implementation of Epic at UC Irvine Health will help streamline processes. Between Irvine and San Diego campuses, there are currently just fewer than 3,000 servers (physical and virtual), and thousands of databases and applications with different vendors that all have various requirements of operating systems and network connectivity needs. To combat this fragmentation, Gold believes UC Irvine Health will end up going with a hybrid approach. The organization will have a local presence at the Irvine and San Diego data centers for the systems that require it, and it will also have a second, virtual-hosted model where the organization would shift its workloads to the cloud and out of the data center. “You’re looking at, basically, a multitiered approach depending on the needs of the system and the needs of the user, the requirements of the application, etc.,” he says. “Our goal is to get out of the data center business. There is a lot of overhead. It’s a lot of time and support invested. With all the other initiatives we’re working on, data centers are one thing we just do not want to have to worry about.” AHL

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hile his childhood classmates were improving their athletic skills during summer vacation, Adam Gold was at computer camp. His interest in computers developed at an early age, and that passion steered him toward his career path before many of his peers. “During the summer, I would basically sit in a trailer and learn how to program on an Apple IIe in Logo, which was kind of visual basic at the time,” Gold says. “My parents were at a level where we weren’t rich, but were able to afford a computer every few years. So, I had my Timex Sinclair and IBM PCjr and really just got hooked.” Gold’s decision to bypass sports camp and learn about computers paid off for him in the long run. He is now the director of infrastructure technology at University of California (UC) Irvine Health and is the interim chief technology officer of UC San Diego Health. He oversees the technology side of the house: server infrastructure, telecommunications, desktop engineering, storage, networks, and some out-of-the box development. He started as a contractor at UC Irvine to work on the university’s Y2K project, replacing and upgrading PCs and installing new software. Then, he received a permanent position as an entry-level desktop technician before he accepted the CIO's invitation to join him at Micro General, where Gold picked up valuable exposure to web-based programs like ASP and SQL. “Because I was tinkering with it, I also got thrown into this pseudo-server admin role, where I was being asked to manage servers used for production and development that were based out of Chicago,” Gold says. A few years later, he had the opportunity to work with First American Title in the command center, managing and overseeing nearly 800 servers. This was during the big escrow boom, which elevated the necessity of the platform. Gold helped build this command center, and that experience came in handy when he returned to UC Irvine Health in 2003 to manage its server team. Since then, Gold has also expanded his focus to client services along with emerging technologies to implement in the organization and hospital. His responsibilities for the server and desktop teams, clients, and a variety of other projects—combined with changes within the organization during the last few years—led to Gold eventually overseeing the technology side of the house. “The experience is invaluable,” Gold says. “There are some leaders you work with where you can tell they’ve never been in the role they are speaking to. For me, I can confidently say I understand what it takes most of the time when we’re talking about implementations,

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The Service Advantage Reengineered specialty pharmacy BioPlus cuts through the red tape for vulnerable patients and finds cost savings for insurers By Peter Fabris

R

leader in niche healthcare organizations for two decades, and he says he is most proud of instituting policies and processes that have made a real difference in the lives of patients. This consistent execution of high-quality service is the key to success, he says—particularly for niche players in the healthcare industry. For BioPlus, the cornerstone of its service model was laid out with a complete reengineering of order and tracking processes that included a year-long development of a proprietary patient tracking system. The impetus from this effort came from a meeting between the company’s CEO, Stephen Vogt, and a nurse with a healthcare provider. Vogt proudly pointed out to the clinician that BioPlus initiated orders twice as fast as its competitors. The nurse appreciated the observation, but countered that if patients were diagnosed with cancer, they would want to have medication approved and start treatment as soon as possible. “The most important role for a specialty pharmacy is connecting with the patient to quickly start them on the right drug at the lowest cost,” Gay explains. “Research shows that the quicker you start the patient on the

RUSSELL GAY Chief Strategic Officer BioPlus Specialty Pharmacy

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eceiving news from a doctor that you’ve been stricken with a debilitating disease—such as multiple sclerosis, Crohn’s disease, cancer, HIV, or hepatitis C—is quite the shock. The last thing you need afterward is a struggle to get medicine to treat said condition. Unfortunately, that can be the case when a physician prescribes a specialty drug. These medications are not available at a local pharmacy and cost substantially more than most other medicines. They may be new to the market, and you might have to fight with your insurance company to get one. Even if all goes smoothly, it may take weeks to get your prescription filled. That is, unless your specialty drug provider is BioPlus Specialty Pharmacy. BioPlus has been able to outperform its competition by reducing the wait time to fill that first prescription to just a few days. This devotion to customer service has helped the twenty-year-old company grow at an enviable pace in the past few years. Annual revenue has soared from about $60 million in 2011 to about $850 million in 2015. Russell Gay, BioPlus’s chief strategic officer, has been a

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medication, the more likely they are to continue taking it.” Patient compliance being of the utmost importance, BioPlus took the nurse’s critique to heart and brainstormed on how to speed up its processes. A top to bottom assessment of systems and processes showed there were too many steps and too many people with a hand in moving orders along. BioPlus set out to streamline the steps and reduce the number of employees handling each case. The company also set an ambitious goal of contacting patients within two hours of receiving a prescription. No software on the market could accommodate this aim, so the company had to develop its own platform. Part of this challenge had to do with receiving orders. BioPlus is not electronically linked to healthcare providers’ EMR systems. In fact, some physicians’ offices still submit orders via fax. Complicating the matter further, each insurer has its own form to process specialty drug claims, some of which can be lengthy and complex. “All the information has to go out correctly, or the claim will be denied,” Gay says. It took about a year for the company to develop a system that could handle that level of complexity. A key feature is the ability for managers to monitor the progress of individual orders in real time. BioPlus’s clinical team watches electronic monitors that display progress through a traffic signal scheme. Green indicates the order is progressing on time, yellow means time is beginning to run short, and red shows that the order is getting close to missing that two-hour window to contact the patient. That initial phone call informs the patient that the prior authorization process is underway. “We wanted a goal and a penalty to hold ourselves accountable,” Gay says. If the company misses the twohour window, it then makes a contribution to a charity such as the American Cancer Society or the Chronic Disease Fund.

“It’s all about understanding what you are good at. The real magic is in the execution.”

The strategy has worked; BioPlus consistently meets the time limit 98 percent of the time, with an average response time of seventy minutes. “Some patients are still driving home from their first doctor’s visit when we contact them,” he says. While patients are still emotionally processing the diagnosis, the rapid response from the pharmacy offers at least a small source of comfort, with BioPlus providing assurance that someone is taking charge of the complex pre-authorization process. It’s no secret that patients can be intimidated by all the hoops they need to jump through to receive their medication, particularly in a vulnerable state after a diagnosis. “They need someone to navigate the abyss,” Gay says. In a sense, BioPlus’s primary customers are the insurance providers and, by extension, the employers who pay the premiums. These players appreciate the company’s stellar patient services, but they also want to see some economic efficiencies. In fact, some don’t fully understand how specialty pharmacies provide value, Gay explains. This is where the company’s electronic records system provides an advantage. Using this system, BioPlus analyzes the spectrum of data it has compiled about


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patients receiving treatment for specific diseases and found ways to achieve notable savings, Gay points out. For example, the company found that the cure rate for hepatitis C patients who took medication for sixty days was identical (98 percent) to those who took medication for ninety days. Reducing the amount of medication for these patients from a ninety-day dose to a sixty-day dose while still achieving the same outcome created annual savings of $15 million in 2015, Gay says. Further analysis of the company’s patient data in specialized niches will continue to show areas for savings, he says. This is especially important in an era where healthcare is increasingly focused on using resources more efficiently, according to patient outcomes. Indeed, by continuing to provide best-in-class patient service and finding savings for insurance providers and their customers, BioPlus is poised to continue its rapid growth as it expands services in areas in specialties such as oncology. “It’s all about understanding what you are good at,” he says. “The real magic is in the execution.” AHL

work that BioPlus Specialty Pharmacy does to ensure optimal patient care. Robert Irene, President

proven collaborative solutions AHLMAGAZINE.COM

For more than a decade, Asembia has been working with specialty pharmacies,  manufacturers, prescribers, payers, and other industry stakeholders to develop solutions for the high-touch specialty pharmaceutical service model. Through collaborative programs, contracting initiatives, patient support hub services, and innovative technology platforms, Asembia is committed to positively impacting the patient journey. For more information visit www.asembia.com.

and the incredible

We applaud Russell

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On Both Sides Now Diane Duvall strengthens the ethics compliance program at Catalent Pharma Solutions by leveraging her cross-departmental expertise

AHL APR.MAY.JUN 2017

By Jeff Silver

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hile the role of a legal leader involves regular interaction with many corporate functions, Diane Duvall has developed a high-performance relationship with human resources at Catalent Pharma Solutions. In fact, she even temporarily assumed a dual role as both VP of human resources for corporate functions and VP of legal, ethics, and compliance several years ago. As a former law firm litigation partner, Duvall represented various types of employers, including hospitals and pharmaceutical companies. She worked with their HR functions before moving in-house at Sanofi (formerly Aventis), where she supported its HR team on employment-related investigations and litigation matters. Now at Catalent, Duvall serves as a member of the legal and HR leadership teams as the VP and deputy general counsel, where she is providing oversight management to the ethical compliance program.

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What makes the combination of human resources and ethics compliance such an important and effective combination? Diane Duvall: Companies with cultures that emphasize integrity have more engaged employees and consistently outperform those that do not. Both human resources and compliance have a keen interest in ensuring that employees understand a company’s standards of behavior, corporate mission, and values. Those who understand and embrace those elements succeed, while those who do not are given appropriate feedback and, if needed, appropriate discipline. Both human resources and compliance also serve as common sources of advice for employees. That can be to seek clarification or to express concerns, both of which are key aspects to an effective compliance program. As such, working together helps avoid duplication of efforts and provides a better understanding of what’s working, what’s not, where expectations might need to be clarified, or where additional training may be needed.

Duvall: We do have some unique and complex regulations to comply with. But what’s critical is that our employees are clear about the compliance obligations

that apply to their respective roles and that they understand why compliance matters. In practical terms, that means ensuring that everyone in every department understands how every decision and action we take impacts our success in supplying more products and better treatments to our customers and in creating a culture of quality and compliance. When it comes to our partnership, the US Sentencing Commission’s guidelines for organizations and other applicable regulatory compliance guidelines have recognized human resources’ role in establishing organizational cultures and in helping to prevent, detect, and deter unethical conduct. Human resources, more than any other function, regularly interacts with employees, from recruitment and onboarding to ongoing employee training and performance feedback—even through to exit interviews at termination. All of these activities provide opportunities to align our mission and values with ethical leadership development and to gain insight about where there may be opportunities for improvement.

DIANE DUVALL VP, Deputy General Counsel Catalent Pharma Solutions

What advantages can you offer through your combined experience in legal, human resources, and compliance fields? Duvall: Because I have practical experience in all three areas, I have a better understanding of the challenges each one presents, and that helps me propose practical, realistic solutions. In my current role, I often pull human resources and other corporate functional subject-matter experts together to conduct investigations. My background helps ensure we stay on track to meet legal requirements and determine what is right for the company and for our corporate culture. For example,

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Because the pharmaceutical industry is highly regulated, that interdepartmental relationship must be an incredibly important one to maintain.

“Companies with cultures that emphasize integrity have more engaged employees and consistently outperform those that do not.”

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LEG UP. When faced with the complex, multi-jurisdictional legal challenges that can arise today, it’s helpful to know you have an edge. Clients who work with a law firm of our scale can tap into extensive global resources and connections – not to mention lawyers in more than 30 countries who practice in hundreds of areas of local and international business law. We salute Diane Duvall for her myriad professional accomplishments.

when we deal with bribery or harassment allegations, we might find nothing illegal, but discover there was a conflict of interest that should have been disclosed. Or there might have been rude behavior that occurred that violates our values and still needs to be addressed. My HR experience and work as a trial attorney also helps me envision how things might appear to a jury, who often care more about what seems “fair” than the letter of the law. And, quite honestly, my various experiences in these different areas also provide me with good stories to share in compliance training sessions. Do you bring any unique perspectives to your legal work as a result of your experience as an HR executive? Duvall: Things that may seem like common sense to an employment or compliance counsel may still be foreign to an employee in another function. Until you sit in the other person’s seat, it’s easy to forget that giving advice is often easier than taking it or actually acting on it. So having been on both sides, I hope I have learned to be more patient and understanding. Are you involved in any specific initiatives related to protecting or developing the corporate culture?

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Duvall: We’re working on reinforcing our speak-up culture. We want to create an environment where people feel comfortable coming forward with questions or concerns, particularly when it comes to safety and the well-being of those who rely on the products and services we provide. We are always looking for new ways to engage employees that help avoid compliance fatigue that often comes with all the different rules, regulations, and responsibilities that apply to our business. And, finally, we are formalizing our patient-first culture, which will raise awareness about the impact that all of our business decisions and actions can have on patients using our products. AHL


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Healthcare In Her Blood Bhavi Shah began as a litigator, but found her calling as a healthcare attorney. She now uses that passion to help Blood Systems, Inc. succeed within the evolving transfusion industry.

Over the last several years, US healthcare has been experiencing what may be the greatest restructuring and reorganization since the implementation of Medicare and Medicaid in the 1960s. It impacts every level and type of care, including companies in the transfusion medicine industry, which already faces unique issues that make successfully navigating the ongoing evolution even more challenging. This is true even for large companies such as Blood Systems, Inc., a nonprofit organization based in Scottsdale, Arizona, that delivers blood products in twenty-four states and provides about 12 percent of the country’s blood supply. It also distributes specialty plasma-derived pharmaceutical products in forty-eight states through its BioCARE operations and, through its joint venture, Creative Testing Solutions, tests roughly 35 percent of the country’s blood supply. Similar to other sectors of healthcare, blood service providers deal with the ramifications of reduced reimbursement and customers’ increased focus on cost of services. But there is also pressure to shift away from its

BHAVI SHAH Executive VP, General Counsel Blood Systems, Inc.

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Michael Paulson

By Jeff Silver

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traditional local community focus to meet the requirements of hospitals that are joining systems that cover larger geographic areas. At the same time, the overall blood donor base has eroded as baby boomers age and travel restrictions prevent donations from individuals returning from areas where diseases such as the Zika virus and mad cow disease are present. According to Bhavi Shah, Blood Systems’ executive VP and general counsel, these circumstances compound the differences in legal and regulatory compliance issues that blood service providers face compared to other healthcare organizations. “Blood products are different from pharmaceuticals or medical devices, and there isn’t a lot of established case law. So, we work closely with federal regulators and constantly review applicable law and regulations to figure out how they apply to our industry,” Shah explains. Blood Systems has addressed the shrinking donor population and changing demands of clinical customers through a combination of improved operations and a focus on mergers and acquisitions to help bolster capacity, its geographic footprint, and economies of scale. Its Supply Chain Optimization for Performance Excellence (SCOPE) program, for example, has helped streamline ongoing business activities. Donations collected at nearly one hundred locations are processed and manufactured at centralized facilities, and final products are returned to individual centers for local delivery. This approach optimizes production, maximizes capacity, and enables Blood Systems to meet the needs of large regional and national healthcare delivery networks.

Blood Systems operates community blood centers that serve more than 700 hospitals in twenty-four states.

Mergers and acquisitions activity also helps broaden company bandwidth, but produces additional challenges for Shah and her legal department. In 2014, when Shah joined the company as a department of one, she closed two new affiliations, one joint venture, and one asset purchase. At the start of the third quarter of 2016, Blood Systems had closed three mergers and had four more transactions scheduled by year-end. Annual revenue was projected to be about $1.1 billion, a 35 percent increase since Shah joined the company. Her team has also grown to include a second attorney and a paralegal. With each transaction—such as a stool bank (fecal microbiota transplant for the treatment of C. diff), source plasma, and an umbilical cord storage program—Shah is responsible for assimilating new lines of business and their corresponding compliance requirements. But she also has to maintain system and administrative consistency. “Along with the level of activity that goes with mergers and acquisitions, the legal department also has to integrate systems and update and create templates that can be used across all our different business units,” she points out.

Michael Paulson

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“Blood products are different from pharmaceuticals or medical devices, and there isn’t a lot of established case law. So, we work closely with federal regulators and constantly review applicable law and regulations to figure out how they apply to our industry.”


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Shah began her career as a litigator, focusing on pharmaceutical and medical device product liability and medical malpractice. However, she was interested in becoming more of a corporate generalist. Shah took a position with Cold Stone Creamery, which was acquired by Kahala Corp. This move gave her experience with a national food franchisor, an interesting new challenge. However, she discovered that she missed healthcare and eventually moved to become assistant general counsel at Phoenix Children’s Hospital. Before being considered for her current position, Shah had been unaware of Blood Systems' extensive range of products and services, even though the company was a local community provider to Phoenix Children’s Hospital. “I discovered that I could bring my litigation and corporate experience to the company’s focus on diversification and expansion. And the opportunity allowed me to stay in nonprofit healthcare and be part of a mission-driven organization,” Shah recalls. As she assesses the challenges that lie ahead, Shah says the company will have to decide whether to preserve local community brands (some of which have existed for seventy-five years), cobrand, or rebrand nationally. It will also need to focus on recruiting the next generation of blood donors and building internal legal and governance infrastructures to keep pace with company growth. Shah sees herself as looking out for Blood Systems’ best interests in every domain. “I’m the eyes and ears of the organization when we’re assessing new opportunities, accomplishing strategic business objectives, and mitigating risks,” she says. Shah notes that she did not have extensive M&A or governance experience when she joined the company. However, her network of outside resources and trusted mentors enabled her to develop essential expertise in these areas and to become a highly effective “protector” and problem-solver in the midst of the always changing healthcare landscape. AHL

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The New Face of Analytics New generations of technologies have made informatics professionals integral players in Horizon Blue Cross Blue Shield’s business strategies

AHL APR.MAY.JUN 2017

By Jeff Silver

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With more than twenty years of experience in analytics and informatics, Jason Cooper, VP and chief analytics officer at Horizon Blue Cross Blue Shield of New Jersey, has been part of an evolution that has exponentially changed how analytics is implemented in numerous industries. Perhaps none is more significant than its role in the transformation of US healthcare and health insurance from fee-for-service to fee-for-value. Cooper points out that the maturation of technology has fueled the recognition of data and analytics as both strategic assets and competitive differentiators. This has dramatically shifted the role of technologists in the workplace. “Beyond programming, math, and statistics, we now have to more deeply understand the business verticals we serve,” Cooper says. “If we work on clinical analytics, for example, we have to understand that language and be able to probe deeper to ask the right questions to put the underlying nuances, objectives, or business context into sharper focus.” To accomplish this, his team has to focus on improving business acumen and relationship management, as well as acting as consultants. This places “analytics geeks” (a term Cooper uses with pride and affection) in new territory. As a result, they have learned how to prioritize analytics projects so that the most important information is summarized and placed in a longitudinal

business context with other key performance indicators and benchmarks. “Providing a spreadsheet with 300 different numbers is confusing. It’s important to present concise insights that can be understood quickly to help business leaders make fast, informed decisions,” Cooper explains. The new role can also involve what Cooper refers to as “challenging conversations” to clarify which of many potential projects internal customers need to prioritize in order to produce the most value. “It can be difficult for business leaders to realize that we can only deliver on a portion of what they’re asking for, but it leads to higher value and very collaborative exchanges,” he says. As roles change, Cooper also sees that chief analytics and chief data officers need to be able to provide guidance on topics that are often considered to be outside their core areas of expertise. They must translate critical information among the worlds of data assets, IT, analytics, and business utility. A prime example is Horizon’s OMNIA Health Alliance. The statewide partnership of five large, integrated delivery systems and a large multispecialty group provides a fee-for-value environment to many of Horizon’s members. The platform is supported by new bidirectional data-sharing capabilities, decision support systems via advanced visualizations, and high availability for disaster recovery and business continuity with an ever-present focus on privacy and security.

JASON COOPER VP, Chief Analytics Officer Horizon Blue Cross Blue Shield of New Jersey


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“The more information we have about a member’s circumstances, the better able we are to connect them to the care and services they need.”

Empowering healthcare to achieve high-impact business outcomes through data and analytics

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Teradata and the Teradata logo are registered trademarks of Teradata Corporation and/or its affiliates in the U.S. and worldwide.

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A key differentiator is clinically intuitive knowledge gained through the exchange of information between EHRs and certain administrative claims data. To facilitate these components, Horizon’s IT group and Cooper’s teams had to dive into data latency, the cloud platform, and providers’ workflows to optimize insights that improve care quality, lower overall costs, and improve the member experience. “We had to understand facets on the technical, clinical, and administrative sides in order to identify the right analytics protocols and support tools needed to serve the operational and clinical needs of all stakeholders,” he explains. Initiatives like OMNIA will continue to make Cooper’s job and the responsibilities of the analytics department more complex. Previously, analytics data, such as drug and diagnosis codes, was typically highly structured. But new technical capabilities enable the analysis of unstructured data, such as clinical case notes or recorded customer service calls. Cooper explains that these new technical capabilities and the ability to further integrate data have opened tremendous new possibilities for advancing healthcare. For example, having an address and knowing that a member has transportation challenges can help coordination with his or her healthcare professional or community resources to increase access to care. “The more information we have about a member’s circumstances, the better able we are to connect them to the care and services they need,” he says. As the templates for care delivery and reimbursement evolve, so too has Horizon’s business model. Its technology teams have been heavily involved in the redesign of the company’s website, mobile app, and other digital assets to be more consumer-driven. “We’re thinking less like an insurer and more like a consumer-centered company,” Cooper says. “That means letting customers drive the interactions and needing to connect with them in different ways and on different platforms.” As analytics continues to transition into fulfilling its new and much more strategic role, Cooper predicts that it will shed its reputation as a cost center. “If you spend millions on analytics, you should be able to show three, five, or even seven times that amount coming back annually to the organization and its stakeholders,” he says. “That’s just table stakes. Analytics is evolving into being a value center.” AHL

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From Reactive Healthcare to

AHL APR.MAY.JUN 2017

JEFF TERRILL President EXOS

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Proactive Health Jeff Terrill knows from personal experience that his company can make employees healthier, and he has the numbers to show it saves his clients money, too By Russ Klettke

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movement, an essential for improving performance that focuses on moving your body better; and recovery, which allows the mind and body to re-energize and prepare for the next day’s demands. By design, each of the four pillars is integral and essential to the others. Terrill explains how mindset, for example, is fundamentally important because it drills down to individuals’ core motivations. “This is where we break ambivalence, where we get to what their ‘it’ is,” he says. “For example, a participant might say, ‘My back pain is so bad I can’t play with my kids.’” When an EXOS coach helps that person to develop a stronger, pain-free body, the individual is inclined to stay in the program to achieve other goals as well. EXOS currently services 150 companies, which includes 25 percent of the Fortune 100. A comprehensive institutional review board clinical study of the EXOS program at one of those Fortune 100 companies found that they achieved superior health outcomes compared to a wellness study group. An independent actuarial study at Cancer Treatment Centers of America found that for every dollar spent, a return on investment of $2.96 was achieved in lower healthcare costs and lower absenteeism. Terrill’s journey to lead EXOS—itself a division of a broader enterprise that provides similarly structured performance solutions to student and professional athletes and elite military—started from the other side of health, that of a reactive mode. He formerly served in executive roles responsible for health plans, managed care operations, medical groups, and health insurance,

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mployers are increasingly embracing the benefits of healthy workplaces with some version of company-sponsored wellness programs. But there have also been mixed reviews on whether these programs yield a financial return to the businesses that sponsor them. The RAND Corporation published a study in 2013 that found many programs in the $6-billion workplace wellness industry do not yield a convincing return on investment. However, even a single healthier employee might be considered a victory. At least one company can objectively claim success in providing proactive health solutions that have a positive return on investment: EXOS. “The elegance is in the simplicity,” Jeff Terrill, EXOS president, says. “Seventy-five percent of all chronic disease is caused by four factors: food choices and portion size, physical inactivity, stress, and tobacco use. These factors are also responsible for 81 percent of all hospital admissions, and these factors are controllable.” EXOS’s proprietary methodology provides pathways to improved health and performance that are broadly applicable to the full employee population. Based in solid science, the company’s methodology achieves a high level of participation—including for the employees who need it most. The company’s methodology includes what they call the four pillars of human performance: mindset, or dedicating oneself toward a goal with a full understanding of what it requires to accomplish it; nutrition, or the foundational support to fuel mind and body performance;

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“We provide companies with flexibility to calibrate our performance solutions across a continuum of location types.”

EXOS is the proven leader in proactive health and performance, trusted by elite athletes, the military, community centers, colleges and universities, and innovative companies worldwide. We provide the knowledge and skills people need to identify and overcome obstacles, creating personal breakthroughs. That's why leaders around the world are employing our individualized game plans to transform their workforce and help them live healthier,

AHL APR.MAY.JUN 2017

happier, and more productive lives.

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To learn more about who we are, what we do, and our industry expertise, visit teamexos.com.

including industry leaders such as Cigna and Aetna. In these positions, he was dealing with the disease side of healthcare, helping people live with illness—a stark contrast to proactive health, which focuses on disease avoidance or elimination. “When the recruiter called me for this position, I initially thought it was an odd fit, because I thought EXOS served only elite performers,” Terrill says. “But I appreciated EXOS’s different approach and learned how diverse the served population was.” Terrill reflects on how, in the thirty years prior to this position, he witnessed the prevalence of disease explode. For example, the rate of diabetes increased from one in fifty people to one in ten, and obesity rose from 10 percent of the US population to what now approaches about 40 percent. “I asked, ‘What’s wrong with our healthcare system?’” he recalls. He experienced, in granular detail, the costs of taking care of diseases. Proactive health, he notes, is far more effective and less expensive. “EXOS had the answers,” Terrill says. So he took the position and went to work. Being physically active himself and an avid runner in relatively good shape, he was surprised to find through the company’s assessment measurements that his performance was suboptimal, that he needed to hydrate more, get better sleep, work on strength training, and train for movement quality. The changes are palpable, he says, “a testimony of my own performance improvement as a result of behavior upgrades,” as he describes it. His personal benefits include eliminating knee pain and optimized biometrics, which all occurred without prescriptions. “Food and fitness are medicine,” he says. The changing nature of work and workplaces requires EXOS to evolve and adapt with them. “This means we provide companies with flexibility to calibrate our performance solutions across a continuum of location types,” he says. For example, a gym isn’t necessary for the program to work, as many off-site work locations are too small to justify the costs of an on-site fitness facility. EXOS can utilize spaces such as conference rooms to draw in participants who might be intimidated by weights, machines, and mirrors for “no sweat” movement sessions. EXOS’s digital technology capabilities allow its programming to reach an employer’s entire population, even those who work at home. Proof is there that there are as many ways to become healthy as there are to get sick. For Terrill, who has worked on both sides of the equation, proactive health is more than obvious. AHL


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The Conductor’s Mentality

Bob Hudson has needed to make some tough calls at the Henry Mayo Newhall Hospital, but it’s his ability to assess the greatest needs that has made the clinic a prominent healthcare destination By Michael Hernandez

William Innes

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When Hudson came to Henry Mayo, the hospital certainly had its share of problems. Chief among them, the Santa Clarita Valley’s only hospital had felt the effects of a 1994 earthquake for years, taking on millions in debt to cover the repairs. By 2000, the hospital was reported to be more than $38 million in debt. After joining the hospital in 2001, Hudson took the hospital into bankruptcy a year later. It eventually emerged in 2003 with a four-year reorganization plan and agreement to completely pay all of its creditors. So how did a hospital so deep in debt manage not only to stay open, but dramatically increase capacity and even open a brand new health and fitness center? As Hudson learned, the key is learning to grow in a controlled manner. Sometimes, this means saying no to certain kinds of growth in order to focus on others. “It’s hard. Sometimes you say no because it’s just not the right time or financially it doesn’t make sense,” Hudson explains. “A certain type of service may need to be at a tertiary level facility or a specialty hospital because we’d never have enough volume to be able to keep the skill sets of our nurses, therapists, technicians, and doctors. So, even though everyone wants it, you have

BOB HUDSON Senior VP, CFO Henry Mayo Newhall Hospital

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s the CFO of Henry Mayo Newhall Hospital, Bob Hudson is spearheading a major expansion of services available to the Santa Clarita Valley community in California. Already home to an advanced primary stroke center, a vital community cancer program, and an acclaimed breast imaging center, Henry Mayo is constructing a six-story patient tower that will expand capacity by 140 beds. But an expansion such as this doesn’t happen overnight. Hudson is overseeing the financing of the project as the completion of a fifteen-year master plan that’s been in the works since he joined Henry Mayo in 2001. In the years prior, though, Hudson gained some surprising experiences that proved useful for hospital expansion in ways one wouldn’t expect. For instance, Hudson, as a CFO, once had to shut down two hospitals out of a group of three in order to build up the remaining hospital. “The business wind-down was quite an experience,” Hudson says. “I think having gone through that helped prepare me for this turnaround I was able to participate in here because I saw some of their problems. I hope I was able to avoid some of those.”

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“As I was lying in the cath lab having an angioplasty, I was talking to the staff and the doctors, and I thought, ‘You know, I’m awfully glad I helped build this place.’”

POWERING FINANCIAL AND PATIENT HEALTH

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takes a trusted partnership

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to say no because it’s not the right thing to do for the community.” Hudson hasn’t just been on the hospital administrator’s side of this kind of situation. He once attempted to start his own business, researching and developing alternative therapies for chronically ill patients. Hudson and his business partner aimed to simultaneously reduce chronic pain, reduce the cost of chronic illness, and improve patients’ quality of life. Although pain control, meditation, and journaling have since become common in palliative care, Hudson found that his efforts were about thirty years early. While the experience was educational, the answer at that time had to be no. But his most important job, Hudson says, is trying to figure out a way to say yes to difficult, yet important factors. The Henry Mayo CFO can point to a long list of items he’s been able to say yes to in his time at the hospital, including a neonatal intensive care unit, open heart surgery, a cardiac catheterization laboratory, and significant expansions to the hospital’s emergency room, operating rooms, and intensive care unit. The clinic even opened a nationally recognized breast imaging, surgery, and treatment center. However, even after one manages to say yes, there are still stressors and obstacles before accomplishing growth. There are financials, external relations, audit committees, and frequently changing Medicare and


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state healthcare regulations to keep up with, for example. Compliance presents a major task, but Hudson finds that keeping up is a matter of hiring, educating, supporting, and leading his employees. His main advice to people who want to lead is to not micromanage employees. “Often, the boss syndrome wants people to be the boss. I’m more of a conductor,” he says. “I don’t like to boss anybody. You hire good people, give them opportunity, and let them do their job.” While the challenges of the job can take a toll, Hudson has found the results of his work worthwhile. He aims to have the new patient tower completed by 2019 and is working on increasing the hospital’s bond rating. Keeping up with regulation, while a challenge, has certainly paid off, as Hudson has experienced it firsthand. After a minor stress-related heart attack, he found himself being treated at Henry Mayo. “As I was lying in the cath lab having an angioplasty, I was talking to the staff and the doctors, and I thought, ‘You know, I’m awfully glad I helped build this place, ’” he says. AHL

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The Results Are In Harvey Guindi and Health Network Laboratories leverage IT to drive efficiency and become more consumer facing

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By David Baez

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Wisdom has it that at least threequarters of all healthcare decisions are driven by data that comes from testing laboratories such as Pennsylvania-based Health Network Laboratories (HNL). Harvey Guindi, chief of information systems (IS) for HNL, believes that improvements in the laboratory testing process similar to the ones his company is implementing can have an impact far beyond the laboratories’ bottom line and in the world of healthcare at large. Guindi also believes that IS has been put in a position to have a central role in these initiatives. “As we’re moving in the industry from focusing on results to focusing on answers, information systems can help with dealing with risk,” he says. “If you can get someone to deal with their problem sooner rather than later and not end up in an emergency room, that is going to benefit the system.” Guindi positions IS as a leader in the company’s evolution. The department touches everything from medical devices to revenue delivery and collections. Guindi is in fact a member of the executive team, granted equal importance and say in company decisions just the same as finance, sales, or lab operations. “The importance of intelligent leadership by the CEO in creating the environment that embraces innovation and evolution allows each executive team member to contribute beyond their core responsibility, benefit our organization, and our customers,” he says. “The thing about our executive team

is that while we each have our own domain, we’re all charged with the growth and strategy of the company, not just the effective management of our own area.” The latest example of IS playing a key role in growth and innovation at HNL has been the initiative to reduce customer wait times at the laboratories’ fifty-plus patient service centers. The executive team agreed on a goal of maintaining its fifteen-minute-or-less patient waiting time, an industry-leading standard, in the face of increasing demand, patient volumes, and growing network of patient access points. Once it was in place, Guindi pushed to use tech to leverage the advancement, promotions, and advertisements. Soon on the company’s website, customers will be able to see average wait times at any patient service center location. If they were basically equidistant between two locations, customers could select a destination based on the shortest wait. “That was an area of debate and conversation,” Guindi recalls. “Maybe somebody could have to wait longer than they expected, so there was a lot of discussion about what it meant to provide this level of transparency, what the pros and cons were. That’s the kind of engagement we have; the willingness to challenge each other in terms of what we can do and what we should do to create the greatest value for our customers.” When Guindi came on board in 2013, he put together a bold, three-year strategy that is now in its final year. There were four aspects: increase access to and for


PROGNOSIS

inspired by potential

Providers

Services, Solutions and Accelerators

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tion ula Popalth ment He nage Ma

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Well Man ness agem en

Benefits Administration

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P In atie Sy form nt st a em tio s n

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HARVEY GUINDI Chief of Information Systems Health Network Laboratories

Pharma and Life Sciences

Creating VALUE through Technology, Data and Services

rl Pape Labs

About ValueLabs • Over 19 years of experience | Over 5,500 employees | Over 1,500 healthcare domain experts • Strong transformation services group | Innovative process improvement services and IPs • High-end consulting professionals assisting in business process, technology consolidation • Lean SIGMA processes and tools applied in all areas of Paperless Lab(s) • Developing capability in leading LIMS, ELN, CDS, SDMS and interfacing middleware • Over 50 strong point solutions and accelerators • Best-in-class industry frameworks leveraged for testing, validation services • Flexible, resource-ready and innovative approach for pricing models

Business benefits Time to market

Operational efficiency

Cost optimizatiion

Quality improvement

Efficient process automation

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patients, grow and retain existing business, improve bad debt and revenue cycle management, and increase operational efficiencies. In terms of improving consumer access, Guindi says he looked at it from a retail perspective, with a goal of making the company’s service available when and where customers wanted it. This meant extending hours, swapping appointments for walk-ins, and meeting the fifteenminutes-or-less goal. “We did this knowing that it drives greater loyalty and more volume when people get their needs taken care of,” he says. The second initiative—to grow and retain existing business—centralized on integration of systems. What used to be done on paper moved to electronic interfaces, and Guindi’s team made sure that providers didn’t have to jump through many hoops when dealing with the company. A group was dedicated to improve EMR systems integration with the laboratories themselves. When Guindi came to the industry, he was taken back by the notion that providers were expected to do the highest quality of work with the greatest integrity, but didn’t always get paid for it. Revenue cycle management at HNL needed an overhaul. “It was a formula that was going to bury us,” he says. “I said, ‘We have to look at this from more of a retail perspective and put solutions in place that improve our collections and ensure that the reimbursement model doesn’t hurt us.’” IS also used software to build more efficiency into the collections system and saved an abundance of administrative overhead that had been eating at the company’s profit margin—the fourth aspect of the three-year strategy. As the plan reached its conclusion in 2016, Guindi says that the biggest challenge to healthcare providers right now is still how to handle the industry’s shifting of risk. “Whereas all these things used to be managed by insurance companies, they’ve gotten out of the risk model but are still the payers. Now hospitals, physicians, and labs have to manage that risk,” he says. “The biggest issue I see we’re faced with is how an industry not wellversed in managing risk now deals with that.” It’s a challenge, but as Guindi has proved at HNL, IS can play a key role in overcoming it. AHL

Health Information Systems

HL S Exc Info r Ma hang matio nag e n em ent

“The biggest issue I see we’re faced with is how does an industry not well-versed in managing risk now deal with that.”

Payers

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PROGNOSIS

Cyber Solutions for the Long Term Long-term care organizations are employing increasing degrees of technology to improve seniors' lives. Paul Nigro shares how that’s being implemented at Brookdale Senior Living.

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By Russ Klettke

172

Americans and most populations of the developed world are aging, with post-World War II boomers leading the way into retirement and managing the issues related to aging that eventually come. The long-term care (LTC) industry—independent living, assisted living, memory care, skilled nursing, and other services—is already serving more than 13 million people in the United States. And that number is projected to double by 2050, a year when 20 percent of the country will be over the age of 65, according to the Stanford Center on Longevity. The resources needed to serve this huge need will be great. The companies involved in LTC are devising several means of doing this, such as aging-in-place services (home care) and building more facilities for assisted living and memory care communities. They are also finding that technologies offer exciting possibilities to enrich the lives of residents and improve caregiving. For example, look no further than Brookdale Senior Living, Inc., a leading provider that operates more than 1,100 senior living communities in forty-seven states. The company is an innovator and early adopter, due in part to its growth through a number of mergers and acquisitions during the last decade. Its growth-by-acquisition strategy has been challenging in an IT capacity, as the communities it has purchased have legacy systems and data that need to be kept intact to satisfy regulators. “We look at their excellence,” Paul Nigro, senior VP of integration for the company, explains. He refers to the characteristics of quality enterprises that made them attractive acquisitions in the first place. “With single location facilities, we can bring them into our system within twenty-four hours of the closing and train their staff on operational use in under thirty days,” he adds. Multilocation acquisitions, he notes, take longer. The investment in wireless technologies in communities serves an important purpose. Nurses and other caregivers now keep records on tablets, replacing what was formerly done on paper charts. Nigro details how indi-

PAUL NIGRO Senior VP Brookdale Senior Living

vidual patient care plans and medication schedules are on a single platform, which improves staff efficiency and caregiving itself. Devices are attached to carts, making the digital tool an intrinsic part of daily nursing tasks. But the digitization of the operation of Brookdale communities fosters something else, Nigro says. “We work to disconnect administrators and other leaders from their desks to get them into the community, engaging with our residents and families,” he says. “Not only do these tools ease the workflow, but the less time they spend in front of a screen means more time touching lives.” Another workflow benefit is where Brookdale employs technologies in the home health services portion of their business. Where mobile caregivers formerly needed to physically access files for patients, electronic delivery and applications on mobile devices have revolutionized that process and made it more efficient.


PROGNOSIS

“It’s a much more efficient documentation process in home health services,” Nigro says. “The caregiver can take notes and electronically share information with the next caregiver. That reduces a lot of time spent retrieving paper notes.” Efficiencies and improved caregiving quality are just two benefits of the increased use of technology in longterm care environments. According to a 2014 article in healthcare technology publication HITConsultant.net, automation can reduce labor, reduce human error and fatigue, reduce paper waste, provide greater predictability in patient outcomes, identify when patients fail to adhere to a therapeutic schedule, and deliver datadriven insights on program efficacy and improvements. Nigro notes that technology has a growing role in helping the company achieve its mission of enriching lives. “Over the past several years, we’ve invested heavily in the technology necessary to provide wireless communications to our residents,” he says. “This promotes resident and family engagement through iPads and smartphones. They can connect via FaceTime.”

“We work to disconnect administrators and other leaders from their desks to get them into the community.” Such connectivity, more typically associated with the grandchildren of most LTC residents, makes sense from a clinical health standpoint. According to a “Rewiring Aging” study that Brookdale conducted (guided by the Stanford Center on Longevity), a third of respondents would like to be able to text or video chat with family and friends, more than a quarter would be interested in taking group classes to learn how, and only 5 percent say they are completely opposed to new technology. And, more to the point, those that did start connecting with others through technology showed powerful emotional benefits. “Connectivity, particularly between distant family members and our residents, is a big part of the future,” Nigro says. “What runs through everything is finding the best ways to serve our seniors.” AHL

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Comview is proud to provide Brookdale Senior Living with substantial savings, productivity increases, and control over fixed and mobile telecommunications expenses, inventory, and related processes since 2012. Comview simplifies enterprise telecom management throughout the communications lifecycle—from procurement to bill payment and points in between­— so staff can focus on higher-value activities while gaining transparency and sustainable ROI. Comview offers a flexible, customized, cloud-based platform and friendly expert managed services with savings guarantees. www.comviewcorp.com

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PEOPLE INDEX

The Vitals NADEEM BRIDI, P. 29 Chief Intellectual Property Counsel Acelity L.P. Inc. With more than fifteen years of experience licensing and acquisition of intellectual property rights, Nadeem Bridi has been at Acelity since 2001. LAWRENCE IRENE, P. 114 CEO Asembia Holding a degree in pharmacy from St. John’s University School of Pharmacy, Lawrence Irene has twenty-five years of experience in healthcare and has helped found multiple successful companies, including Asembia. MARIAM KOOHDARY, P. 120 Deputy General Counsel AstraZeneca Since 2005, Mariam Koohdary has been a part of the AstraZeneca team. Today, she serves on the pharmaceutical company’s US Leadership Team and the Legal Senior Management Team. RUSSELL GAY, P. 153 Chief Strategic Officer BioPlus Specialty Pharmacy Russell Gay helps develop plans for one of the leading specialty pharmacies in the United States, BioPlus. He also founded his own consulting firm and is the executive director for the Independent Specialty Pharmacy Coalition, an industry advocacy organization. BHAVI SHAH, P. 159 Executive VP & General Counsel Blood Systems, Inc. Aside from overseeing all aspects of legal compliance and counsel for Blood Systems, Inc., Bhavi Shah belongs to American Health Lawyers Association, the Association of Corporate Counsel, and the Arizona Association of Corporate Counsel. PAUL NIGRO, P. 172 Senior VP of Integration Brookdale Senior Living

AHL APR.MAY.JUN 2017

Paul Nigro is a certified public accountant and holds a bachelor’s degree in accountancy from the University of Illinois at UrbanaChampaign. He’s been with Brookdale Senior Living since 1997.

174

RANDY SERGENT, P. 101 VP, Deputy General Counsel, & Assistant Secretary CareFirst BlueCross BlueShield Randy Sergent’s legal expertise isn’t confined just to CareFirst’s Baltimore office. He serves as a commissioner on the Maryland Health Care Commission, which is responsible for issuing certificates of need for hospitals and other

institutions and addressing other state health policy issues. He has served as the chair of the Maryland State Bar Association’s Health Law Section, and next year will serve as chair of the Maryland State Bar Association’s Standing Ethics Committee. He is also a member of the Board of the Howard County Conservancy, a local land trust and nature center that provides nature education to school children in Howard County Maryland. DIANE DUVALL, P. 156 VP, Deputy General Counsel Catalent Pharma Solutions With a degree from Rutgers Law School, Diane Duvall has served as an in-house counsel in the pharmaceuticals industry for more than fifteen years. BILL FEASTER, P. 106 Chief Medical Information Officer Children’s Hospital of Orange County Specializing in pediatrics and anesthesiology, Bill Feaster earned his MD from the University of Rochester School of Medicine. He currently belongs to the American Academy of Pediatrics, California Society of Anesthesiologists, and Lasallian Education Fund. TETYANA BUESCHER, P. 63 General Counsel CompuGroup Medical In addition to her role as CompuGroup’s general counsel, Tetyana Buescher is trilingual and she is on the marketing committee for the General Counsel Institute at National Association of Women Lawyers and a mediator at Association of Corporate Counsel. SONIA CHEN ARNOLD, P. 42 Assistant General Counsel for Litigation & Legal Compliance Eli Lilly Sonia Chen Arnold has won a host of accolades including being recognized as a Rising Star by Indiana Super Lawyers in 2009, 2010 and 2011; being selected to participate in Class XXXIII of the SKL Leadership Series; being a finalist for Young Professionals of Central Indiana’s Young Professional of the Year Award in 2008; and serving as the Taiwanese American Heritage Week Master of Ceremonies in 2006.

DAVID PETERSON, P. 66 CIO Erlanger Health System After more than a decade with the navy, where he cut his IT teeth, David Peterson ran a gamut of jobs that would ultimately prepare him for his role with Erlanger, including the University of Maryland Medical System, Catholic Health Initiatives, Boston Medical Center, and Dimensions Health System. JEFF TERRILL, P. 164 President EXOS Jeff Terrill has been in healthcare for more than twenty years. Before assuming the role of president at EXOS in 2013, he worked in Cigna’s Emerging Markets segment and as president and CEO of Scottsdale PHO, Inc. DAVID BERRY, P. 146 General Partner Flagship Ventures David Berry holds an MD from Harvard Medical School and a PhD from the Massachusetts Institute of Technology. He was selected as a 2014 Young Global Leader by the World Economic Forum. In 2007, he was named Innovator of the Year by the MIT Technology Review, and one of the top thirty-five innovators in the world under the age of thirty-five. He speaks globally on topics such as innovation and entrepreneurship. BRENNAN TORREGROSSA, P. 12 VP and Associate General Counsel GlaxoSmithKline In December 1972, Brennan Torregrossa’s mother, Ann, was nine months pregnant with him when she and her lawyer husband Joe won a voting rights case before the US Supreme Court. Only the fifth woman to earn a law degree from Villanova University, Ann was nervous, and the baby started kicking during oral arguments. Justice William Brennan worried she might go into labor and helped deflect another justice’s tough questions. He later wrote the unanimous opinion in the case, became a family friend, and in tribute, Ann named her son after him.

JASON ATKINS, P. 58 Chief Nursing Information Officer Emory Healthcare

SIMON MANOUCHERIAN, P. 48 Deputy General Counsel Grifols

Starting out as the interventional radiology nurse manager at Balboa Naval Medical Center, Jason Atkins has been active in the healthcare industry since 2003, assuming various roles in health informatics.

Simon Manoucherian immigrated to the United States when he was five years old, and in fourth grade decided to become a lawyer. After law school, he specialized in litigation and made partner at Meserve, Mumper & Hughes. Now, as deputy general counsel of Grifols, Manoucherian oversees the company’s entire legal function in North America.


PEOPLE INDEX

HARVEY GUINDI, P. 170 Chief of Information Systems Health Network Laboratories With a passion for mobile technology and healthcare, Harvey Guindi belong to the Drug Information Association, New York Academy of Sciences, and Institute of Electrical and Electronics Engineers. MICHAEL LYNCH, P. 98 Senior VP of Clinician Recruitment, Retention Healthcare Partners During his time working for the air force, Michael Lynch earned the John Levitow Award. Today, he leads Healthcare Partners in enterprise efforts and strategy in clinician recruitment and retention in addition to academic partnerships and affiliations. BOB HUDSON, P. 167 CFO Henry Mayo Newhall Hospital

He holds a PhD in information systems with a concentration in information security. DAVID YOUNG, P. 126 Area Information Officer Kaiser Permanente David Young’s first exposure to computer technology was during his six years in the air force. Following the military, he was hired at Kaiser Permanente, which allowed him enough stability to finish his college education and earn his MBA. Over the past twenty-one years, he has held seven different positions at Kaiser Permanente, each with increasing responsibility and scope, and is currently area information officer for San Bernardino. LINDA WELLER-FERRIS, P. 27 VP Lahey Health Cancer Institute

Bob Hudson has been with Henry Mayo Newhall hospital for more than fifteen years. He is also a board member of the California Hospitals Association.

With a PhD from the University of Michigan, Linda Weller-Ferris has more than eighteen years of experience in senior oncology leadership and multiple service lines, including neurosciences, cardiovascular health, women’s and children’s health, and robotic surgery programs.

JANICE KLOSTERMEIER, P. 54 VP, CFO Hollywood Presbyterian Medical Center

TIM RICE, P. 76 President & CEO Lakewood Health System

Raised on a “gentleman’s farm” near Ft. Worth, Texas, Janice Klostermeier found she had a proclivity for bookkeeping and accounting in high school. In fact, she won numerous speed contests for shorthand and typing along the path that ultimately led her to the C-suite of the healthcare industry.

Having previously served as the president and CEO for the Renville County Hospital in Olivia, Minnesota, Tim Rice has been the president and CEO at Lakewood Health for more than thirty-five years. He is active in the community of Staples, Minnesota, as the chair of LEAP Staples Area Business Group, a member of the Staples Lions, and a member of the Staples Area Men’s Chorus. In 2006, he received the Staples Motley Citizen of the Year from the Staples Motley Area Community Foundation.

JASON COOPER, P. 162 VP, Chief Analytics Officer Horizon Blue Cross Blue Shield of New Jersey Jason Cooper has more than twenty years of experience in analytics and informatics in the for-profit, nonprofit, and government sectors, including leading teams at Horizon Blue Cross Blue Shield, Cigna, and CVS Health. He also belongs to the International Institute for Analytics and the American Medical Informatics Association, and is an editorial board member at the American Journal of Pharmacy Benefits. JAMES BRADY, P. 126 Area Information Officer Kaiser Permanente

Having begun her career as an RN, Gina Knox brings a “practitioner’s perspective” to her role as general counsel for Little Company of Mary Hospital. An avid athlete and sports fan, she “balances heart, mind, and soul” by training regularly with long runs or weight training before heading to work. JERARD JENSEN, P. 96 General Counsel Marshfield Clinic A member of the Wisconsin State Bar, Jerard Jensen is a Milwaukee native with more than twenty-five years experience in healthcare law.

A leader in healthcare strategy, John O’Hearn was awarded the Leadership Fellowship from the Texas Hospital Association in 2015, followed by a Health Care Transformation Fellowship from American Hospital Association in 2016. CLARK GOLESTANI, P. 130 Executive VP and CIO Merck & Co., Inc. Clark Golestani started his career in consulting before getting exposed to biomedical pharmaceuticals. He’s been with Merck since 1994 and holds a bachelor’s from MIT. SHELLY HUNTER, P. 51 CFO Mercy Hospital Joplin Named one of the top leaders to know by Becker’s Hospital Review in 2015, Shelly Hunter is not only a healthcare leader, but she’s also involved in her community. Currently, she is on the board of the Joplin Family Y and Bright Futures USA, a member of the Joplin Rotary, and a volunteer ally for the Circles organization. NICOLE HEIM, P. 103 CIO & VP Milford Regional Medical Center Nicole Heim has nearly twenty years of experience in planning, supporting, managing, and implementing healthcare information systems. DANA HUBBARD, P. 143 Head of Patents MilliporeSigma Aside from her role at EMD MilliporeSigma, Dana Hubbard belongs to the American Intellectual Property Law Association, Licensing Executives Society, and Association of Former Clerks and Technical Advisors to the US Court of Appeals for the Federal Circuit, and the Association of Corporate Patent Counsel. LAURA ZEHM, P. 108 CFO Montage Health When Laura Zehm isn’t advancing Monterey’s community health, she enjoys soaring the skies in her Piper Archer plane. “I don’t actually care where I am going,” she says. “The destination is just a reason to get in the air.” FRANK VENUTO, P. 79 Chief Human Capital Officer Nebraska Medicine It seems Frank Venuto was destined to work in healthcare. Growing up in Rockville, Maryland, he first spent time in a hospital as a young

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James Brady spent two years in the navy before he entered the nonprofit sector. He worked his way from information technology to healthcare and up to a CIO role before a friend suggested he apply for an area information officer position at Kaiser Permanente. Brady was hired as area information officer for Orange County in 2013.

GINA KNOX, P. 72 General Counsel Little Company of Mary Hospital

JOHN O’HEARN, P. 24 VP of Strategy, Development Medical Center Health System

175


PEOPLE INDEX

The Vitals continued patient, and later worked as a lab aide during high school. Though choosing healthcare administration as his college major felt like a natural transition, it wasn’t until he broke from the industry to work for Marriott Corporation that he developed his HR philosophy. While he enjoyed his time in hospitality, Venuto says he was soon drawn to healthcare once again. “It was a combination of understanding the mission of a hospital, which is to help people, and the business side,” he says. “Being a part of Nebraska Medicine is doing something better than getting return on a stock.” SHERYL BUSHMAN, P. 136 CMIO Optimum Healthcare IT Dr. Sheryl Bushman’s clinical background gives her a unique perspective on medical informatics. By implementing EHR systems, she has helped transform healthcare delivery in fifteen hospitals and hundreds of ambulatory practices in six states. She lives on a working farm outside of Kansas City, Missouri, raising row crops, cattle, pigs, and chickens. T.J. GRIFFIN, P. 60 Chief Pharmacy Officer PharMerica

Bill Fenske has been in healthcare since he joined Columbia Park Medical Group in 1989. Today, he is the CFO at Rice Memorial Hospital and serves as an adjunct professor at St. Mary’s University and South Central College, where he teaches in the accounting department.

Mark Johnson has essentially been with the UnityPoint Health team since graduating from Hillsdale College in 1987. His first job—one that lasted twenty-four years—was for St. Luke’s Regional Medical Center, an independent hospital in Sioux City, Iowa, which affiliated with UnityPoint. When not at work, Johnson is a hockey aficionado who has been actively involved in youth hockey for eighteen years, serving on boards, coaching, and watching his three sons play throughout the United States and Canada.

MICHAEL HEDRICK, P. 111 CFO Rogers Behavioral Health System Before Rogers, Michael Hedrick advised on growth and development strategy for banks and large corporations; he has a successful record of more than $13 billion in capital transactions with more than thirty-five corporations. However, Hedrick feels his three years of work for Rogers is more significant than the entirety of the previous twenty. STEVE BURRES, P. 85 General Counsel Rotech Healthcare, Inc.

T.J. Griffin has more than twenty years of experience in pharmacy automation, and he holds a bachelor of science from the University of Iowa. MEGAN MCKINNON, P. 93 Executive Director Compensation, Rewards Piedmont Healthcare

DR. JACK COX, P. 36 Senior VP & Chief Medical Officer St. Joseph Health

Piedmont Healthcare’s Megan McKinnon has at least one extraordinary childhood anecdote: at age ten, she appeared in a scene with the late Johnny Cash in the six-part television miniseries The North and the South. She remembers a long day of shooting, and that Cash, who played the abolitionist John Brown, had trouble with this lines.

Dr. Jack Cox first began to dream of a career in medicine as a high school football player. His mother, a nurse and his own family physician, helped to inspire his interest in the medical field, and his travels have taken him all over the world.

Kent Hoyos has been at the Pomona Valley Hospital Medical Center for more than twenty years. Today, he is directly responsible for IT functions across the all departments. DAVID SCHLAPPY, P. 22 VP & Chief Quality Officer Reading Health System AHL APR.MAY.JUN 2017

MARK JOHNSON, P. 87 Senior VP & CFO UnityPoint Health

Having previously worked at a private law firm, Steve Burres joined the medical world in 2014 as a member of the Rotech Healthcare team. With both a bachelor’s degree and a law degree from the University of Florida, Burres is also a board member of Association of Corporate Counsel.

KENT HOYOS, P. 34 CIO Pomona Valley Hospital Medical Center

176

BILL FENSKE, P. 68 CFO Rice Memorial Hospital

David Schlappy received his bachelor’s degree in statistical science from BYU and a master’s in biostatistics from UNC Chapel Hill. He worked as a statistician for Intermountain Healthcare and in the quality departments of four other hospitals before joining Reading in 2014. He is a certified Six Sigma Black Belt and speaks Korean.

TRENT TAHER, P. 18 Director of Health, Nutrition Taher, Inc. Trent Taher earned a degree in economics from the University of Montana before he joined the Taher, Inc. team in 2007. The company was founded by Taher’s father, Bruce Taher, in 1981. ADAM GOLD, P. 150 Director of Infrastructure Technology UC Irvine Health In 2013, Adam Gold won the Information Services Blue Vase Award from UC Irvine, where he has worked since 2008. Outside of work, he is an active contributor to the American Society for the Prevention of Cruelty to Animals.

JANET MILLER, P. 82 Chief Legal Officer & Corporate Secretary University Hospitals Janet Miller earned her bachelor’s degree from the University of Michigan and her law degree from the University of Notre Dame School of Law. She has been with University Hospitals for more than fifteen years while she has also served on board of directors and governance committee at the YWCA’s Cleveland Chapter. GARY JOHNSON, P. 90 Chief Pharmacy Officer University of Kentucky HealthCare Gary Johnson’s interest in science initially prompted him to consider becoming a physician, but the desire for a routine schedule that would leave room for raising a family led him to pharmacy. As a former high school and college basketball player, Johnson still plays point guard in his local pick-up league. He joined University of Kentucky HealthCare in 2011 after starting his career in pharmacy in 1997. CAROL STELTENKAMP, P. 32 CMIO University of Kentucky HealthCare Carol Steltenkamp has been in the healthcare industry for more than fifteen years. She holds an MBA from the University of Kentucky and an MD from University of Cincinnati College of Medicine. DAVID LUBARSKY, P. 138 Chief Medical, System Integration Officer University of Miami Health System David Lubarsky has been with the University of Miami in one way or another for more than fifteen years. Outside of his function of chief medical, system integration officer, he teaches in the schools of nursing, medicine, and business. He is an active member of the American Board of Anesthesiology and the American Academy of Pain Management.


INDEX

People & Companies A

H

P

Acelity L.P. Inc., p. 29 Arnold, Sonia Chen, p. 42 Asembia, p. 114 AstraZeneca, p. 120 Atkins, Jason, p. 58

Health Network Laboratories, p. 170 Healthcare Partners, p. 98 Hedrick, Michael, p. 111 Heim, Nicole, p. 103 Henry Mayo Newhall Hospital, p. 167 Hollywood Presbyterian Medical Center, p. 54 Horizon Blue Cross Blue Shield of New Jersey, p. 162 Hoyos, Kent, p. 34 Hubbard, Dana, p. 143 Hudson, Bob, p. 167 Hunter, Shelly, p. 51

Peterson, David, p. 66 PharMerica, p. 60 Piedmont Healthcare, p. 93 Pomona Valley Hospital Medical Center, p. 34

B Berry, David, p. 146 BioPlus Specialty Pharmacy, p. 153 Blood Systems, Inc., p. 159 Brady, James, p. 126 Bridi, Nadeem, p. 29 Brookdale Senior Living, p. 172 Buescher, Tetyana, p. 63 Burres, Steve, p. 85 Bushman, Sheryl, p. 136

C CareFirst BlueCross BlueShield, p. 101 Catalent Pharma Solutions, p. 156 Children’s Hospital of Orange County, p. 106 CompuGroup Medical, p. 63 Cooper, Jason, p. 162 Cox, Jack, p. 36

D

I Irene, Lawrence, p. 114

J Jensen, Jerard, p. 96 Johnson, Mark, p. 87 Johnson, Gary, p. 90

K Kaiser Permanente, p. 126 Klostermeier, Janice, p. 54 Knox, Gina, p. 72 Koohdary, Mariam, p. 120

Duvall, Diane, p. 156

L

E

Lahey Health Cancer Institute, p. 27 Lakewood Health System, p. 76 Little Company of Mary Hospital, p. 72 Lubarsky, David, p. 138 Lynch, Michael, p. 98

Eli Lilly, p. 42 Emory Healthcare, p. 58 Erlanger Health System, p. 66 EXOS, p. 164

F Feaster, Bill, p. 106 Fenske, Bill, p. 68 Flagship Ventures, p. 146

G Gay, Russell, p. 153 GlaxoSmithKline, p. 12 Gold, Adam, p. 150 Golestani, Clark, p. 130 Griffin, T.J., p. 60 Grifols, p. 48 Guindi, Harvey, p. 170

M Manoucherian, Simon, p. 48 Marshfield Clinic, p. 96 McKinnon, Megan, p. 93 Medical Center Health System, p. 24 Merck & Co., Inc., p. 130 Mercy Hospital Joplin, p. 51 Milford Regional Medical Center, p. 103 MilliporeSigma, p. 143 Miller, Janet, p. 82 Montage Health, p. 108

R Reading Health System, p. 22 Rice, Tim, p. 76 Rice Memorial Hospital, p. 68 Rogers Behavioral Health System, p. 111 Rotech Healthcare, Inc., p. 85

S Schlappy, David, p. 22 Sergent, Randy, p. 101 Shah, Bhavi, p. 159 Steltenkamp, Carol, p. 32 St. Joseph Health, p. 36

T Taher, Trent, p. 18 Taher, Inc., p. 18 Terrill, Jeff, p. 164 Torregrossa, Brennan, p. 12

U UC Irvine Health, p. 150 UnityPoint Health, p. 87 University Hospitals, p. 82 University of Kentucky HealthCare, p. 32, 90 University of Miami Health System, p. 138

V Venuto, Frank, p. 79

W Weller-Ferris, Linda, p. 27

Y Young, David, p. 126

N

Z

Nebraska Medicine, p. 79 Nigro, Paul, p. 172

Zehm, Laura, p. 108

O’Hearn, John, p. 24 Optimum Healthcare IT, p. 136

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O

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Stat Sheet

26M

81% Eighty-one percent of lawyers believe that non-hourly billing for outside counsel has become a permanent trend. However, the overall amount of work done on a non-hourly basis has remained steady for the past several years at 9 percent. GLAXOSMITHKLINE, P.12

12% AHL APR.MAY.JUN 2017

Blood Systems, Inc. delivers blood products in twenty-four states and provides about 12 percent of the country’s blood supply. Through its joint venture, Creative Testing Solutions, it also tests roughly 35 percent of the country’s blood supply.

178

BLOOD SYSTEMS, INC., P. 159

The long-term care industry serves more than 13 million people in the United States—a number that is projected to double by 2050, a year when 20 percent of the country will be older than 65. BROOKDALE SENIOR LIVING, P.172

125 University Hospitals is one of the oldest organizations in Cleveland, started by a group of women to provide care for those who couldn’t afford it—particularly soldiers wounded in the Civil War and workers injured during the Industrial Revolution. Its children’s hospital is 125 years old, and its MacDonald Women’s Hospital is the only hospital in Ohio dedicated to women’s health. UNIVERSITY HOSPITALS, P. 82

1 In July 2016, Rogers Behavioral Health became the first stand-alone acute psychiatric hospital to achieve HIMSS Stage 6 with an EHR system. ROGERS BEHAVIORAL HEALTH, P. 111


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Partners in the business of healthcare and advocates for the pharmaceutical industry. Nelson Mullins attorneys provide multidisciplinar y experience to our healthcare and pharmaceutical and medical device clients. Not only do we have insight into business and government developments that drive healthcare trends, we also routinely convert that knowledge into tangible benefits. We also work with our clients to identify and manage risks in advance of litigation and offer dedicated discover y practice attorneys to manage eDiscover y needs. We are trial ready, but settlement savvy.

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Nelson Mullins Riley & Scarborough LLP Attorneys & Counselors at Law Atlantic Station | Suite 1700 201 17th Street NW | Atlanta, GA 30363 www.nelsonmullins.com | 404.322.6000 Stephen M. Brooks, Partner

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American Healthcare Leader unites the visionaries and experts for whom healthcare is more than just a business. It’s your source for innovation and advocacy from those who are shaping what’s next. We’re with you every step of the way.

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American Healthcare Leader #6  
American Healthcare Leader #6