American Healthcare Leader #13

Treating a Community

In this issue, discover how leaders are deploying population health tactics to improve health outcomes for the employees and consumers they serve

Jessica Larsen-Gallup p.48

Jamie Mauer p.60

Penny Mills p.77

Yusuf Rashid p.92

Alexandra MacDonald p.134

Jill Fragoso p.144

Cover:

Gillian Fry

The Path

12. From his very first job onward, Michael Parini has been motivated by his passion to help others

22. Candy Lindsay shares four tips on recruiting for the hospice industry

26. Bob Bacon reflects on his three decades-long career in compliance at Penn Medicine

36. Moses Vargas dishes on how he made it to executive leadership by the age of forty-three

The Reason

70. At Boston Scientific, Elizabeth Hendler crafts workplace policies that address changing cultural norms

82. Greg Jackson understands firsthand how his work at medical device company NuVasive can impact lives

77. A look at Penny Mills’s efforts to increase access to critical medications for those living with addiction

86. Tracy Ting discusses how she revamped Avanir Pharmaceuticals’ mission, vision, and values

40. Cathlynn Nigh and her team guide their clients step by step through HITRUST certification

52. Michael Einodshofer wants to make it easier for consumers to navigate the pharmacy

45. Sean Lowder provides insight into what healthcare organizations should be doing to secure their data

64. QIAGEN is helping to usher in a new era of genomicsguided precision medicine

The Issues

Caley Newberry (Amedisys), Gillian Fry (Beyond LLC), Cass Davis (Avanir Pharmaceuticals)

The Impact

134. Finity Inc. is motivating its users to take control of their health and well-being

141. David Henley strives to make compliance a partner to every department at Passport Health Plan

138. Alan Sefcik ensures L’Oréal’s wellness programs take a holistic view of health

150. Verizon’s bringing a new level of connectivity to healthcare through its Intelligent Edge network

The Business

98. Find out how Leah Klinke standardized WVU Medicine’s billing process without cutting jobs

118. Emma Yamada leads her team at Holy Name Medical Center down the data hole

107. Medline Industries improves its clients supply chains with a new approach to inventory management

125. Kathi Barton delivered a hybrid benefits package to employees after The Kraft Heinz Company merger

48. Jessica Larsen-Gallup spearheaded Avera Health’s critical 340(b) pharmacy discount program

92. Yusuf Rashid is creating an integrated model of care at Community Health Plan of Washington

60. Jamie Mauer juggles the needs of Bemis Company’s multigenerational workforce

144. Jill Fragoso’s employee wellness efforts are improving health as well as business outcomes at Texas Children’s Hospital

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A New Outlook on Well-Being

For a long time, my understanding of what it meant to be healthy was quite limited. I thought that the only thing influencing someone’s health were physical symptoms such as coughing, sneezing, muscle aches, and other common signs that someone isn’t feeling well.

However, working with our guest editor, Dr. Sandra Guerra of Humana Military, on the population health issue of American Healthcare Leader helped open my eyes to just how many factors—internal and environmental—can affect an individual’s health and well-being. These factors, what Guerra and other population health specialists often refer to as the social determinants of health, include issues such as access to food, a stable housing environment, transportation, social isolation, and more, and can have a profound impact on a person’s overall health and wellness.

It was eye-opening to work with so many population health leaders for this issue, and it was equally impressive to discover how they are improving the health and well-being of the communities they serve. For instance, Penny Mills, executive vice president and CEO of the American Society of Addiction Medicine, is collaborating with legislators to increase access to prescription drugs that are critical to treating individuals with substance use disorder (p. 77). And Jessica Larsen-Gallup spearheaded the implementation of Avera Health’s 340(b) program, a critical discount program that helps patients who require financial assistance afford their prescription drugs (p. 48).

After hearing about how these executives have made an impact through their population health initiatives, I started to realize just how influential the social determinants of health have been on my life and the lives of my friends and family.

Whether it’s my grandparents who live on a fixed income while their healthcare costs rise while they deal with aging-related health issues, or friends who meticulously analyze their budgets to determine whether they can afford the cost of a doctor’s visit, working with Dr. Guerra on the population health issue has made me

realize how many factors play into a person’s ability to remain healthy.

At the same time, though, it’s been inspiring to see how leaders throughout this issue have been addressing the healthcare needs of the people they care for, tailored in a way that makes the most sense for their communities. I’m looking forward to seeing how this holistic approach to care will continue to impact health outcomes nationally and help us all live healthier lives.

Joe Dixon Editor

From the Guest Editor

Cass Davis

My Patient Is the Population

When I first considered a career in preventive medicine and population health, my peers responded with skepticism. They said things like, “You will miss seeing patients every day,” and “What kind of job do you get with that specialty?”

But the reality is far from what my professional peers understood. My desire to work as an executive physician, overseeing the health of millions of deserving families across the country, has been incredibly rewarding. Instead of impacting the lives of twenty people a day in a clinical setting, I am ensuring the health of six million lives daily as the chief medical officer TRICARE at Humana Military.

Before my tenure at Humana, I had a successful and enlightening career in public health in Texas. During this time, my passion for population health was grounded in improving and protecting the health of people in fundamental ways, such as providing immunizations, dental care, family planning, communicable disease treatment and prevention, disaster response, and policy development. I recognized and respected the importance of being a physician leader where my voice was not only an advocate for disenfranchised populations but one of reassurance and education to the population entrusted to me.

For me, population health is understanding the health needs of a group of people and taking

all available resources, innovation, technology, data, and policies to help them achieve their best health over a lifetime.

I am thrilled to see how many leaders in this issue of American Healthcare Leader are also engaging with population health in their environments. For instance, Jamie Mauer of Bemis Company (p. 60) is tailoring employee benefits to address the needs of both millennial and baby boomer employees throughout the organization. This is just one example of how important it is to offer health solutions in a manner that will work most effectively for a certain population.

Population health is finally at the forefront of the conversation to improve the health of people in the United States. The fundamental components of population health include: recognizing the desire to reach the best health, value in the cost of health services, quality healthcare every time for every person, actionable, accurate data, and respect of the professionals who are the trusted agents of the health system facing patients.

My peers no longer wonder what my specialty does. My “patient” is the population, not an individual. The healthcare industry is beginning to align with the critical role population health physicians and leaders have in moving us all to our ideal health for our lifetime.

Sandra Guerra, MD, MPH

The Path

Every step an executive takes on their career journey is pivotal to achieving their current successes. Along the way, individuals accumulate technical skills, foster relationships, and develop the leadership acumen that have turned them into pioneers of the industry.

12. Michael Parini draws inspiration from his college summer job as a mover in his executive role at Vertex Pharmaceuticals

18. Jim Stansel blends his love of law and policy-making at PhRMA

22. Candy Lindsay lays out her recruiting strategy for the home health and hospice industry

30. Paul Leslie draws from meaningful mentorship experiences early in his career as a legal leader

33. Annette Walker is passionate about giving back to the community in which she has lived for more than four decades

By Lior Phillips

Moved to Make a Difference

From his first job as a mover to his role at Vertex Pharmaceuticals, Michael Parini has been driven by a desire to help others and to work with integrity

Michael Parini EVP & Chief Legal and Administrative Officer

While many college students take summer jobs as movers, few see the work as much more than lugging other people’s furniture on and off trucks. Even fewer look back to the time as informative to their current work. But Michael Parini learned early that every job has the potential to make a serious impact on people’s lives. And if you go about it the right way, any role can make a big difference in solving problems for others—a value he focuses on in his current work at Vertex Pharmaceuticals, no matter the function, department, or task.

“Moving is a seemingly straightforward task, but I learned that work also involves people and emotion,” Parini says. “There’s usually some life change that is attached to a move. Maybe somebody needs more space because of a new baby. Maybe they need to move cities for a new job. Maybe they need to leave a beloved home after a tragedy. I learned how important it is to understand the people you’re working with, and not just as clients,” Parini says.

In between moving jobs, Parini earned his bachelor’s and master’s degrees from Georgetown. After a stint as an associate at Akin Gump Strauss Hauer & Feld LLP, Parini took on a corporate counsel position at Pfizer—a role that reinforced his focus on problem-solving and compassion.

He joined the Fortune 100 company at a young age, moving up the corporate ladder to eventually become its senior vice president and chief litigation counsel. Although he was often one of the youngest people in the room and lacked the long tenure others had, Parini’s passion for learning from others and embracing their strengths helped overcome most potential problems. “Convincing the experienced, high-quality team that I could add value to them as a collective and as individuals was a problem to solve, but I asked a lot of questions and connected a lot of dots,” he says. Moreover, he helped change the department’s mind-set on litigation as a whole. “We embraced opportunities to treat litigation more like a business problem than a legal problem,” he says.

“I learned how important it is to understand the people you’re working with, and not just as clients.”

Parini’s time as a mover isn’t the only experience from his youth that continues to have an effect on his business mind-set. A self-described small child and the third of four boys, Parini grew up with a strong “justice bone,” constantly driving toward solving problems in a thoughtful, fair way. Whether in his relationships with coworkers and clients or in his personal work ethic, Parini continued to embody that quest for solving problems with integrity. “I quickly fell in love with the idea of becoming a lawyer, especially working in life sciences and medicine,” he says.

When Parini joined Vertex Pharmaceuticals in 2016, it was because he had found a company that shares his passion for justice and helping others, as well as a role that allowed him to exercise that problem-solving skill set across the organization rather than merely the legal function. In fact, in his current role as executive vice president and chief legal and administrative officer, Parini’s impact in legal, HR, quality, communications, and compliance is only the beginning.

A common thread among his responsibilities is taking in outside stimuli, anticipating potential issues, and communicating how the organization and its mission responds—both to internal and external stakeholders. “On any given day, I’m putting together statements on the company’s positions, ensuring we’ve got the right people and right resources, and working with the CEO and other senior leaders on big strategic questions,”

Parini says. “In all this work, I am representing Vertex and sharing our vision for the kind of company we are and the kind of company we want to be.”

Parini’s adept communication hasn’t gone unnoticed from those whom he works with on a regular basis.

“Michael has mastered the art of productive and respectful straight talk. He uses his open and engaged style to set high expectations for his teams,” says Joshua Levy, litigation & enforcement practice cochair at Ropes & Gray LLP.

That ability to connect with individuals throughout the organization was particularly helpful when he first joined the organization. Parini describes that time as tumultuous, as the legal and compliance team had gone through a lot of changes and a long search for a leader prior to his arrival. In fact, the department had seen 34 percent attrition in the preceding years. “If you’re turning over a third of your team year after year, that’s a hard way to have a functioning culture that can add value to the organization,” Parini says. This was the first true test of his problem-solving skills at Vertex.

“It was a lot about setting the vision, setting the right expectations, and then walking the talk,” he says. That meant getting a strong leadership team in place, making difficult decisions about talent, and ensuring the people were aligned on the right strategy. And now, three years later, the attrition rate for the department has dropped from 34 percent to only 4 percent. “You see a lot more engagement, a lot more investment, and it’s paying off in better outcomes for the individuals and the company,” he says.

Since that time, Parini has taken that approach to leadership of five different departments, as well as spreading his influence even further. A big part of that influence comes from the fact that he helps show that Vertex leadership wants to contribute across the entire function, to get people to stop thinking of themselves as contributors to a department and rather as contributors to a single, united Vertex. “I want to encourage people to think about why an issue is important and to think about a company objective, not to just rush into a

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CHANNEL YOUR INNER GENIUS

Trial & triumph

problem,” he says. “Once you have clarity around that, the tasks and deliverables slot in nicely underneath.”

Adding structure and creating shared accountabilities in this way has helped everyone at Vertex think more crossfunctionally. It has also given Parini a lot of insight on the many employees of Vertex, to see how they each fulfill the mission and integrity that he has found fuels him as well. Much like his time as a mover, he knows that every person comes into work with their own story, their own emotions and their own reasons; but he has focused on bringing them all together under a common mission.

“Mission is critically important and something that has drawn me to every place I’ve been, and that’s especially true here at Vertex,” Parini says. “An old boss of mine used to say that you can answer most of your problems by determining what a caring company would do in this situation. People need to see the vision in you, but you also need to understand them as complete human beings. Helping individuals solve their own personal problems as well as work toward big-picture company problems is something that I’ve always cared about.” AHL

Global healthcare companies face many challenges: intellectual property disputes, changing regulation, and trade challenges, to name a few. Opportunities for growth exist in acquisitions, joint ventures, licensing, distribution, supply agreements, and international trade. Global law firm White & Case works with companies to navigate challenges and seize opportunities.

By Joseph Kay

For many legal professionals, the law is a kind of family tradition.

But Jim Stansel didn’t come from a family of lawyers, and he doesn’t point to fictional television lawyers as his early inspirations. Instead, he remembers hearing, at six years old, discussions and debates about the 1976 presidential election, Gerald Ford vs. Jimmy Carter.

“I grew up in Southern California, the least political place in the world and about as far from DC as you can get, but I remembered people talking about the issues, and that grabbed my attention,” Stansel says.

He developed a passion for discussing the biggest political and policy stories of his youth and followed it all the way to Yale Law School. The program was another early step in a career that combines policy-making with legal practice.

That intersection has continued to drive his career, from the classroom to the courts to his most recent position at the Pharmaceutical Research and Manufacturers of America (PhRMA).

PhRMA is a DC-based trade association. Its mission is to advocate for public policies that foster effective, innovative medical research across the industry. As executive vice president and general counsel, Stansel builds the legal team and crafts its strategy.

It was just after Yale, clerking at the United States Court of Appeals for the Tenth Circuit, that he came upon a case that made him seriously consider pursuing healthcare law.

“It was a kickback statute case,” Stansel recalls. “It involved a hospital that was alleged to have paid bribes to doctors to refer patients. The seedy financial side—combined with the potential impact on patients—is really what piqued my interest.”

Starting his private-sector career at law firm Sidley Austin, he connected with other lawyers working on healthcare law issues. The firm helped enable associates to develop their own career interests; Stansel’s perseverance eventually got him partnership at Sidley and then landed him a position with the US Department of Health and Human Services (HHS).

After leaving HHS and spending seven more years at Sidley Austin where he cochaired its global life sciences team,

Jim Stansel EVP & General Counsel PhRMA

Stansel arrived at PhRMA. He joined the organization in 2016 and quickly recognized the unique, mission-oriented culture at work.

“Law firms tend to be more siloed— at least, that’s my base of experience,” Stansel says. “PhRMA is completely the opposite; it has a collaborative and open feel to it. The mission focus—paving the way for medications to help patients— really permeates this place, and it’s an exciting thing to be a part of.”

He credits his time with HHS for teaching him how to navigate bureaucracy, manage in all directions, and build consensus. When he joined the department he was thirty-five years old, and the bureaucratic conditions of federal work surprised him.

“Learning to work with people, learning to have the meeting-before-the-meeting to actually drive consensus, understanding how the personalities and potential biases of people impact the way that they see an issue: all of those were things I had to learn when I got there,” Stansel says. “It was certainly a learning curve, but it was worth the investment.”

That has informed his approach at PhRMA, which is to position the legal team as a creative, collaborative partner to the business. At this organization, lawyers should be contributing ideas and proposing innovative solutions— not just standing by to respond to problems. This approach has garnered him recognition from outside firms with which Stansel works.

“We’ve been focused on trying to break down those barriers. We’ve been able to bring consensus-driven solutions to the challenges that face our industry. As a legal department, we can make a difference.”

“Jim is an effective team leader and talented at marshaling consensus on complex legal issues that intersect with science and policy,” says Krista Carver, a partner at Covington & Burling LLP. “As outside counsel to PhRMA, we admire Jim’s thoughtfulness, strategic vision, and collaborative spirit.”

Crafting that collaborative unit is a question of recruitment, retention, and culture. It’s been a time of growth at PhRMA, and Stansel has had the opportunity to build up the team from twelve to sixteen. The new hires are sourced across trusted networks and selected to build up expertise across the organization’s many concerns.

“It’s a great opportunity to shed some things and create a new culture,” he says. “We really focus on being proactive: how can we make sure our colleagues across the building want to bring us in and value us as partners? I think we’ve done that pretty successfully.”

As a leader, Stansel aims to teach individuals how to do things correctly, but let his people govern themselves. Everyone on this team is an expert in some area, so no one person can effectively dictate the specifics. Honest listening, missionoriented conversations, and transparent decision-making are crucial, he says.

He describes this as a uniquely exciting time to work in the medical research industry. With sci-fi-esque solutions emerging across the field, his team looks

for ways to keep policy evolving. The future of treatment is more individualized than ever; this will bear out new types of expenditures, he says, for which public agencies will need to prepare.

For example, CAR-T therapy uses a patient’s own cells (modified by viruses, and replicated in a lab) to attack cancer in the body. Such individualized treatments are novel and promising, but require a vast amount of resources.

One policy response to this evolution is a value-based arrangement for treatment. This is a commercial arrangement to price and bill drugs based on their performance, and one of the solutions Stansel is excited about. If a treatment works, insurers and patients pay the full value of it; but if it’s ineffective, or less effective than promised, the cost is reduced. The industry shoulders more risk in exchange for greater patient access.

“It’s a good way to align incentives correctly and get the right medicines to the right patients, but there are legal constraints that make it difficult to do,” Stansel says.

And that’s precisely the kind of opportunity PhRMA and the legal office are looking for, he adds.

“We’ve been focused on trying to break down those barriers. We’ve been able to bring consensus-driven solutions to the challenges that face our industry. As a legal department, we can make a difference.” AHL

In an increasingly regulated world, we have an exceptional ability to help biopharmaceutical clients navigate their most complex business problems, deals, and disputes.

Covington lawyers, including several alumni of the FDA and other key regulatory bodies, advise the world’s leading biopharmaceutical manufacturers, emerging companies, and the principal industry trade associations, including PhRMA, on all aspects of human pharmaceutical and biologics regulation—from research and development to commercialization and lifecycle planning.

By Joseph Kay

In the Home, Across the Country

Candy Lindsay leads a top-flight recruiting team to staff hospice & home care company Amedisys

Candy Lindsay VP of Talent Acquisition Amedisys

The day Candy Lindsay first helped others discover their careers, she realized she had discovered her own.

After completing graduate studies in social work, Lindsay was a child abuse case worker and, eventually, a police sergeant. She was tabling for the department at a college recruiting event, and discovered that she loved helping people realize fulfilling careers.

“I was always attracted to individuals who were ‘lost,’ taking opportunities that were handed to them with no real end game in mind,” she recalls. “I use my education and experience to guide these individuals to opportunities that they find compelling and rewarding, with a clear path for the future.”

Lindsay knows she’s lucky—she’s never felt adrift in her own career. But for anyone who’s let themselves become too comfortable, or stayed in a position till long after it became unfit, her mission is to help them reconnect.

Lindsay has spent more than twenty years in healthcare. In 2016, she arrived at Amedisys, one of the nation’s largest providers of home health and hospice care. As vice president of talent acquisition, her task is to maintain an all-star recruiting team that can staff demanding, specific positions across the United States. To do that, she applies four strategies from throughout her experience:

Have a Vision

Lindsay arrived at Amedisys in 2016. In the past year, the organization has hired more than six thousand people; building a recruiting team capable of such a task has required discipline, patience, and an incremental approach to development. They built up a foundation by streamlining processes, conducting strategy sessions with hiring managers, learning to more effectively source passive candidates, and providing targeted screenings of candidates. Now, there’s a stronger, more targeted pipeline of talent across the country.

“This year was our operational excellence year, and next year will be our best practice year,” she explains. “It’s been a journey. I feel good about the progress we’ve made thus far, and the proof will be in the results that we deliver.”

Deploy Specialists

One of Lindsay’s first projects at Amedisys was to select a team of highly skilled recruiters, whom she can deploy to work on crises as they arise. Borrowing an acronym

from her police career, Lindsay calls them her SWAT team: a handpicked crew of agile, mobile, and exceptionally effective operators that she can deploy to solve urgent, unique dilemmas. It’s been one of the most effective tools throughout her recruiting career, and it’s serving Amedisys as well.

“As a leader, you often hear that there’s a fire somewhere,” she says. “I’ll get a call saying, ‘It’s critical, we have to have these seven positions filled right now or our patients won’t get the care that they need.”

“Using a small team of skillful, agile, highly motivated recruiters to supplement the work of the larger team can be very effective,” she adds. “Assigning them fewer, critical requisitions that they will fill as quickly as possible can be just the thing that a difficult market needs.”

Give

Everyone a Voice

As a business service, recruitment has to be versatile

Caley Newberry

and highly responsive, and that means communication channels need to be as clear as possible. Regular meetings are key, but leadership has implemented structural changes to ensure that there are opportunities for learning and growth.

“We host a monthly meeting with all the field recruiters and let them decide what needs to be on the agenda,” she says. “Their team leaders facilitate the calls, so questions get answered and everyone gets the opportunity to hear a consistent message. They have some ownership in the outcomes of these monthly calls.”

Amedisys also hosts an annual summit for the entire talent acquisition team for training, team-building, and sessions with leadership. The highlight of the event is an evening awards dinner, where CEO Paul Kusserow is a regular attendee. Lindsay notes that the event builds unity and purpose across the organization and allows the hardworking team a chance to be recognized.

Stay Aligned

“Once greatness is achieved it can become difficult to maintain, so it is important to continually recalibrate and monitor results,” Lindsay says. “I ask, ‘Are we really following our best practices?’ Do I hear complaints coming in, or are we all following the same process that we know works?”

If she hears complaints, she’s ready to call for a retraining.

In an early strategic meeting, recruiting leadership crafted a set of questions for recruiters to ask hiring managers. Over time, those questions have been honed and updated. Retraining sessions, including role play, have kept the team intentional and aligned.

“If we aren’t aligned, we won’t get the quality talent that we so desperately need,” she says.

As a hospice and home health provider, Amedisys requires the most committed, resilient, and experienced professionals. It’s not posturing; an imperfect fit could quickly develop into burnout, dissatisfaction, or inadequate care. With patient health and safety at stake, excellent staffing is crucial.

“Amedisys is a company of caregivers,” Lindsay says. “Every one of our employees lends a hand in providing compassionate care for our patients. That’s why we’re committed to finding the most passionate, best-qualified employees who understand the higher calling of this opportunity.” AHL

Wheless Partners is 1 of only 40 firms selected & sanctioned in ACHE’s National Executive Search Firm Exchange Wheless Partners Executive Search & Leadership Consulting is honored to partner with exceptional leaders such as Candy Lindsay. We applaud Candy’s strategic ability and steadfastness in advancing organizational initiatives and securing key intellectual capital.

By Jenny Draper

The New Generation of Compliance

Penn Medicine’s Bob Bacon reveals how compliance trends have reshaped the world in which the world-renowned research and clinical care organization operates

Bob Bacon returned to his office in University City, the academic heart of Philadelphia, after a week in Washington, DC, as a guest speaker at the Compliance Officers’ Forum held by the Association of American Medical Colleges. Bacon is particularly insightful on the subject—not only as the organization’s cofounder and first chair, but also as the leader who has witnessed the evolution of compliance firsthand at Penn Medicine, where he has served for more than thirty years at the highest rated academic medical center in region.

“Compliance as a career path did not exist,” says Bacon, vice president and billing compliance officer. “Now it’s inconceivable that any large healthcare organization today would not have a compliance program. But the question is, how effective is it? Is it right-sized, properly funded, hitting the core issues, and possibly revamped? Because the market keeps changing.”

Ranked in the top ten hospitals in the United States by the US News & World Report , the University of Pennsylvania Health System (UPHS), also known as Penn Medicine, unites physicians, nurses, researchers, and teachers to provide patients with the highest level of care, and Bacon knows that the billing process is a crucial part of that ongoing commitment to service. As healthcare environments change, so too must the administrative function adapt.

“Medicine has transitioned,” Bacon says. “You didn’t see patients going home on infusion pumps a few short years ago, but now that is common. Our world has really changed, what we deliver has changed, and the auditors have gotten substantially savvier.” With the increasing prevalence of telemedicine and home health services, he says the field of billing and compliance

must evolve its systems to anticipate an uptick in external audits and government data mining.

That mission of care began more than two centuries ago with the founding of the first hospital in the United States, Pennsylvania Hospital, as well as the nation’s first school of medicine and teaching hospital—all part of the Penn Medicine history. Its legacy of firsts continued with the development of the first general vaccine against pneumonia and the discovery of the Philadelphia chromosome in cancer research. The private network of three hospitals, two regional medical centers, and numerous clinical care providers emerged in 1993.

“I'm very fortunate to be able to serve people like Dr. Carl June, who is at the forefront of cellular therapy,” Bacon says. “To me, the job is how can I make their lives a little easier, and it’s thrilling to be a part of that. I deal with the money, but they’re dealing with life and death.”

Since his arrival on campus in 1996, Bacon has fortified that Ivy League legacy by championing the compliance program at all stages, from communication and education to auditing and monitoring. He also has defended the clinical practices of the University of Pennsylvania and the Penn Presbyterian Medical Center to representatives from the Office of the Inspector General throughout the years of the corporate integrity agreement.

Bacon VP & Billing Compliance Officer

Bob

Penn Medicine

“Compliance as a career path did not exist. Now it’s inconceivable that any large healthcare organization today would not have a compliance program.”

In 2001, he published the article, “Lessons Learned from Corporate Integrity Agreements,” and the following year he coauthored the article, “Practical Considerations for Conducting Effective Billing Audits,” which was published in the Healthcare Financial Management Association’s national journal.

Today, Bacon continues to advocate the evolution of best practices. For example, Penn Medicine produces and utilizes innovations—such as telemedicine—yet barriers emerge when documentation requirements adhere to outdated systems, according to Bacon, and billing obstacles restrict use and access under geographical and credential constraints. He adds that an extended time frame for the development of new codes is needed to create room for such technological advances.

“There is no question that real fraud exists in Medicare billing, but there's something wrong when our caregivers are spending more time documenting than they are with patients,” Bacon says. “And whether for clinical reasons or physical exhaustion of working twelve, fourteen-hour days, error of omission is not an intent to defraud the government.”

Bacon explains that the expansion of audit scope and intensity required by federal and state False Claims Acts also may pose a risk of overdocumentation that unjustly increases the risk of fraud. He advocates for a greater balance between common sense documentation and the fieldwork to ensure the patient’s medical record contains the important signatures and notes for patient encounters and in-person visits, as well as treatments and plans of care.

“The Hippocratic Oath says do no harm to your patient and that medicine is the practice of the healing arts,” Bacon says. “You can’t quantify art. I see no advantage in coding cops, but I see plenty of advantages in serving our providers and illustrating ways to do it right and, to the extent you can, efficiently.”

His advocacy for change, such as documentation templates as well as reimbursement and regulatory reform, stems from his experience, which spans reimbursement, managed care, professional liability programs, and accounting. He cites his task-oriented approach as a Vietnam-era veteran and the ability to actively listen as his leadership philosophy. He says it equips him to chair both the Charge Description Master Committee and the Recovery Auditor Contractor committee. And with a master’s degree in healthcare administration from Saint Joseph’s University, he pays it forward at his alma mater as an instructor in the Graduate Health Administration program.

As the billing leader at Penn Medicine and a national lecturer, Bacon wields his decades-long career to usher in a new era of compliance—one that offers a more efficient experience for both doctors and patients within and beyond the prestigious academic medical center. In doing so, he’s earned the moniker he affectionately answers to as “the grandfather of compliance.”

“Today's patient is far more likely to research providers and be willing to travel to get to the best care,” Bacon says. “And the informed consumer makes a different world.” AHL

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By Jenny Draper

Positioned for Impact

Paul Leslie champions diversity to help Parkland Health & Hospital System best care for its communities

More than one million patients visit the Parkland Health & Hospital System each year in Dallas, where Paul Leslie continues its century-long tradition of excellence in patient safety and care. And his award-winning legal team is on the front line of progress as the academic medical center and healthcare operation serves an increasingly diverse population.

“It’s not very often that a lawyer can say, ‘I’m doing God’s work,’” says Leslie, chuckling. “We’re providing state-of-the-art care for Dallas County. The people at Parkland, and in our legal department, consider it a calling.”

As one of the largest public hospital systems in the United States, Parkland includes thirty-four clinics in the surrounding community, a brand new state-ofthe-art 870 licensed bed acute care hospital, a Level I Trauma Center, a Level III Neonatal Intensive Care Unit, the second largest civilian burn center in the country, a community health plan, and an independent center for clinical innovation. It also houses the primary teaching hospital for the University of Texas Southwestern Medical Center. “It does not get any more complex and challenging than managing the legal affairs

of a large academic medical center that serves as the region’s safety net hospital,” Leslie says.

Leslie, executive vice president and general counsel, is a linchpin within all those moving parts. His legal team—comprising nine attorneys and nineteen support professionals—ensures the system stays within the guardrails of what’s legal and appropriate from a regulatory standpoint amid the complex regulations that fill up a library at its headquarters.

“Lawyers are strategically important to effective healthcare operations,” Leslie says. “You can’t have any sophisticated healthcare practice in the United States today without having legal expertise at the table to help guide the decision-making in just about everything.”

Leslie considers that proximity a primary motivator behind his decision to go in-house in the healthcare space. He joined Parkland in 2010 as interim general counsel before former Parkland CEO Ron Anderson requested he come aboard officially a year later. Prior to Parkland, Leslie shaped his thirty-one year legal career as Tenet Healthcare’s associate general counsel and as a partner at Dallas-based law firms Taber Estes Thorne & Carr and Gardere & Wynne.

The general counsel leads his department based on the values he gleaned from the mentorship he received earlier in his career. He describes one of these influential mentors, former trial lawyer Webber Beall, as a true Southern gentleman with impeccable ethics and a great moral compass.

“Sometimes young lawyers get tempted to cut ethical corners or to do something fast and loose,” Leslie says. “Beall demonstrated that doing what’s right even when it might cause you or your client discomfort was always the right course of action.”

Leslie also credits another early career experience as the foundation for his leadership mind-set. He clerked for Texas Supreme Court Justice James A. Baker at the Dallas Court of Appeals after law school—he earned a juris doctor from St. Mary’s University after a bachelor’s degree in financial management from Texas Christian University.

“I was surrounded by folks that exude integrity,” Leslie says. “You have to do what you say you will do, or be fully transparent as to why circumstances change. Associate with people that create a culture that walks the talk. Lots of people get caught up chasing money, but they should chase enthusiasm. Pursue the opportunities that truly excite you each step of the way and you will have a marvelous and rewarding career.”

Leslie chased his enthusiasm to Parkland, where he now he leads an award-winning legal team. Last year, the Texas General Counsel Forum presented Parkland’s legal affairs department with the 2017 Magna Stella award for Excellence in Diversity. Leslie also received the Forum’s 2016 Magna Stella award as the outstanding General Counsel in the

Paul Leslie EVP & General Counsel

Health & Hospital System

Parkland

Our First 10 Years Have Stacked Up Nicely

“Lots of people get caught up chasing money, but they should chase enthusiasm. Pursue the opportunities that truly excite you each step of the way, and you will have a marvelous and rewarding career.”

Non-Profit and Government Agency category. The Forum comprises general counsel and senior managing counsel from more than half of the Texas-based Fortune 500 companies.

His team created a database to track eligible minority- and women-owned business enterprises (MWBEs) and hosts “Let’s Talk Business” workshops with Parkland’s supply chain team to diversify the company’s workforce and vendor network. In 2016, nearly 18 percent of the outside legal spend went to MWBEcertified law firms. In 2017, that number increased to nearly 23 percent. Although his entire department worked hard and values diversity, Leslie credits his deputy general counsel, Nneka Egbuniwe, and senior associate general counsel, Jay Balfour, as being particularly strong forces behind the department’s success. “Achieving success in our diversity initiatives was only possible with all members of the team being fully engaged and supportive of their importance.”

Parkland’s organic progression on the diversity front mirrors the national trajectory, according to the general counsel. As population demographics shift, he explains, companies across industries are recognizing the growing need to serve diverse customers through the cultural competencies of a diverse workforce.

“You really are at a disadvantage if you do not understand that you have to engage and show that you value your patients in a way that they culturally understand and appreciate. There is no way that can be effectively done without a diverse workforce and supportive leadership structure.” Parkland’s chief executive officer, Frederick P Cerise, MD., is a particularly strong champion of diversity, Leslie noted. “We could not have been as successful without Fred’s genuine engagement and support,” he says.

Currently, Parkland’s legal team is 76 percent female and 24 percent male; 48 percent white; 40 percent AfricanAmerican; 8 percent Hispanic; and 4 percent Asian. And for Leslie, diversity applies beyond gender and race to backgrounds and personalities as well. The team balances an equal number of extroverts and introverts within the department.

“When you understand the ways people are wired differently, you understand what they need to be successful,” Leslie says. “That training has helped the department become cohesive and work extremely well together. The success of the department is not any one person’s— it’s the whole team’s success.” AHL

At time of publication, Paul Leslie was no longer with Parkland Hospital.

By Charlene Oldham

Delivering Care Close to Home

Annette Walker relishes the opportunity to give back to the community in which she has lived for more than forty years

Despite her busy personal and professional life , Annette Walker has remained focused on improving the quality of life for other people. It’s a passion she has pursued no matter how full her plate, she says.

Walker was recently appointed president of City of Hope Orange County, in Irvine, California, where she will drive the development of a $200 million cancer center and the expansion of prevention programs throughout the region. For her, this role is an opportunity to take a firm stand against cancer in the community where she has lived for more than forty years.

“Cancer is the true competitor,” says Walker. “I look forward to aligning our community’s resources to meet the needs of the 3.2 million people in Orange County, of whom one in three is likely to receive a cancer diagnosis sometime in their lives.”

Before assuming her job at City of Hope, Walker was president of strategy for Providence St. Joseph Health (PSJH), the country’s third-largest health system, which operates 50 hospitals, 829 clinics, and a range of services across 7 states in the western US. Serving the organization for thirteen years, she established herself as an innovator and as someone who promoted health and all-around wellness.

“As leaders, it’s our responsibility to use our influence to help make peoples’ lives better,” says Walker, who was named by Modern Healthcare magazine as one of the Top 25 Women in Healthcare in 2017. “It’s been a commitment of mine to especially help families and make it possible for people to be good parents—among our employees and throughout the communities I am helping to serve.”

While at PSJH, Walker made focusing on the community an all-encompassing endeavor, which was consistent with the health system’s core values. Founded by the Sisters of St. Joseph of Orange and the Sisters of Providence, the organization embraces a mission to serve all, especially the economically disadvantaged and most vulnerable.

“The mission is to be God’s presence in the world and to make sure people know that they are loved,” Walker says. “The health system does this by tending to their physical, spiritual, and emotional health. This perspective helps make people whole—body, mind, and spirit. It also honors the dignity of each human being as more than simply a physical body to help heal.”

Inspired by the PSJH mission, Walker led the development of the system’s strategic plan called, Health for a Better World. The foresighted road map takes the organization beyond traditional hospital settings, reaching deep into the community and working with

like-minded partners. This new direction includes a focus on virtual health, as well as the social determinants of a healthy population, including schools, housing programs, community clinics, and more.

“Communities still need hospitals available 24/7, and we know we need more ambulatory centers where people can easily access care. That’s not changing,” Walker says. “What is changing is the breadth of a health system’s vision and the kinds of things it sees itself involved in. PSJH has a goal to lead the way in improving our nation’s mental and emotional well-being, to transform care and improve outcomes for all populations, especially those covered by Medicaid. These are big goals, but they are where healthcare leaders must focus.”

Along with treating physical illness and injury, focusing on the nation’s mental health crisis is a major PSJH initiative. Recognizing that more than 40 million adults have a mental health condition, and more than half of them go untreated, the health system is addressing stigma, gaps in care, and the lack of social support that impacts people who are suffering.

The new PSJH model of care integrates mental health treatment into care settings, creating partnerships to reach more people and helping individuals before they’re in crisis. This effort entails screening for problems in the primary care setting when they can be spotted and treated early. Additionally, there is a special focus on populations most at risk, including mothers suffering from postpartum depression and children ages eight to fifteen whose mental health issues often go undiagnosed and untreated.

Annette Walker President City of Hope Orange County

Ana Watts

“Communities still need hospitals available 24/7, and we know we need more ambulatory centers where people can easily access care. That’s not changing.”

To ensure the health system remained aligned with local needs, Walker spent considerable time talking with employees, leaders, and members of governance. In developing the organization’s plan, she and her colleagues engaged more than 1,200 people in their discussions. “We met with people, really trying to understand the current state, comprehend what the concerns were in their communities and, then, what the vulnerabilities and threats were and how we should come together to transform our future.”

For Walker, the philosophy of listening and involving many people in decision-making is essential. “We can’t control all the things that are going on in healthcare, but there are some elements we can control, including how we listen and respond. We can raise the bar on cooperation for the good of the community. We can hold ourselves accountable to act justly and treat all people with love and compassion.” AHL

Deloitte is proud to celebrate Annette Walker for all her accomplishments with Providence St. Joseph Health and wish her well in her new role as President, City of Hope, Orange County. Congratulations on your continued success.

By Will Grant

At forty-three, Moses Vargas has already achieved what many would consider a full career’s worth.

As vice president and general counsel for Connecticut Children’s Medical Center, Vargas admits he’s in danger of being relegated to the kids table at biannual meetings of fellow children’s hospital executives.

“I

know I’m one of the youngest but, more importantly, I’m surrounded by tons of bright and intelligent people who can teach me so much,” Vargas says.

Vargas’s continued dedication to evolving in his role is evident not only in his approach, but by the continual expansion of his responsibilities. While overseeing legal and compliance, in-depth roles such as clinical risk management and providing business and administrative guidance to leadership have challenged Vargas to successfully balance his legal foundations with complex operational stakeholders.

Since joining Connecticut Children’s in 2011, Vargas’s rise has been fast, but not unexplainable. His commitment, not just to the “what” of providing legal guidance, but the “how” can be imperative to how seriously his colleagues heed his advice. “What differentiates a good lawyer from a great in-house lawyer is one who can take legal advice and relay it to his peers in a way that allows them to understand the issue,” Vargas says. “I

have to understand the business implications and can hopefully provide advice that is able to accomplish the needs of both.”

Vargas admits it’s not only possible, but that it makes it even more imperative for him to understand the members of the executive team and senior leadership.

“If I know people well, I can tailor the delivery of my advice in a way that isn’t necessarily challenging or presumptive,” Vargas says. “I find success when I’m able to successfully engage with my executive team and senior leadership and help them accomplish their jobs.”

The general counsel’s success may also lie in his ability to manage the requirements of several often disparate stakeholders. Along with his more traditional legal obligations, he also oversees internal audit, which is responsible for auditing most of the organization’s

Moses Vargas

VP & General Counsel

Connecticut Children’s Medical Center

“As healthcare providers, our ability to render care is equally as important as a patient’s right to have their information be treated as confidential.”

departments. It’s a delicate balancing act of ensuring accuracy and compliance but not seeming like a threat to the rest of the organization. “Compliance and internal audit can be seen as invaders who are there to find problems,” Vargas says. “That’s not my philosophy. I always want to be collegial and collaborative and show people we’re here to help. We might find issues, but that’s OK.” Vargas says that working with this mind-set and in collaboration with department heads has earned compliance a trusted reputation that he aims to continue.

Vargas says taking the hospital’s business interests under his purview has required widening his scope from a strictly legal perspective. “As a vice president, I have to think about business decisions that take risk on, because we can’t be a risk-averse organization,” Vargas says. “It’s important to recognize when I have to take my legal hat off.” Vargas says that can sometimes mean moving ahead with a business decision that wouldn’t always be his first move from a risk-adverse legal position. Vargas reiterates the importance of working closely with the executive team and understanding that everyone involved is working for the betterment of Connecticut Children’s.

While business goals are always a priority, the organization also has a renewed focus on workplace safety. Vargas says he’s impressed with Connecticut Children’s commitment to issues highlighted by the #MeToo movement. “It is our responsibility to ensure that we are providing a safe environment for our employees so they feel comfortable and are able to work in a setting

where they have no fear of harassment or retaliation,” Vargas says. Connecticut Children’s continues to evolve its workplace training, but Vargas believes it’s imperative for leadership to take ownership of these issues and ensure that they are seen as an absolute priority for the organization.

Workplace safety of a different sort also remains an essential priority for Vargas and the information security team at Connecticut Children’s. “As healthcare providers, our ability to render care is equally as important as a patient’s right to have their information be treated as confidential.” Connecticut Children’s is constantly assessing its vulnerabilities when it comes to data security, recently focusing on data phishing scams. Vargas says the information security team’s ever-evolving infrastructure to ensure privacy isn’t just done to comply with federal and state standards, but is due to their commitment to ensure patient information remains secure. “Our efforts are rooted in the knowledge that we are safeguards of patients’ information,” Vargas says. “We owe it to our patients to ensure that if they come to us, we’ll do everything we can to protect their data.”

As Vargas’s responsibilities widen, he says that learning to examine issues from a clinical operations lens will further aid his evolution. “We have various initiatives to ensure that we’re providing top-quality care to keep patients safe and maintaining a strong clinical operation. These are all areas of a world I’m looking forward to getting to know better.” AHL

The Issues

National, and even global, forces have an unmistakable impact on an executive’s work.

Whether it’s a legislative change or an industry-disrupting technological breakthrough, executives must constantly adapt their business strategies to keep their company thriving.

40. Cathlynn Nigh discusses how BEYOND LLC guides its clients through HITRUST certification and more

45. Sean Lowder dishes on cybersecurity best practices in the healthcare industry

48. Jessica LarsenGallup discusses the complexities of running Avera Health’s 340(b) discount program

52. Michael Einodshofer is on a mission to reduce waste and improve patients’ access to critical prescription drugs

56. Amid the rapidly changing healthcare industry, ConnectiCare’s Robert Kosior’s focus stays local

Cathlynn Nigh CEO

BEYOND LLC

Going Above and BEYOND

Cathlynn Nigh and her team provide more than HITRUST certification consulting to their clients

By Jeff Silver | Portraits by Gillian Fry

When Cathlynn Nigh worked in compliance and internal audit at TransUnion, she probably didn’t realize she was on a path that would lead directly to founding BEYOND LLC, a HITRUST CSF assessor organization that also provides readiness, validation, and remediation services. While on that path, she worked for Blue Cross Blue Shield, where she was on the internal control and evaluation team that handled HITRUST prep as well as testing work for the organization to obtain HITRUST certification. That was when she recognized an untapped business niche.

“I realized that my background provided the perfect skills for working with small- to medium-sized companies that didn’t have the resources of much larger organizations to build their information security programs, identify security risks, or obtain HITRUST certification,” Nigh says. “I could create a company to provide the kind of one-to-one counseling and compliance consulting that no one else was offering.”

Within a year and a half, BEYOND opened offices in Chicago, New York City, Cincinnati, and Orlando, Florida and has grown to a staff of twelve highly seasoned IT, security, and other specialists. Ironically, its depth of expertise has also enabled the company to land one of the largest payer organizations and one of the top national hospitals as clients, both of which are outside the niche Nigh had envisioned.

“Even with as fast as we’ve grown, we’re still very much a boutique firm,” she says. “But that has much more to do with the unique capabilities we offer than it does with our size.”

The team includes chief information security officer Ray Biondo, a former HITRUST board member and former chief information security officer at a large healthcare payer organization; director of information security and HITRUST services Craig George; vice president of operations Suzanne Dennison, a former brand manager at Sprint; compliance analyst Sean Brennan; and Lynn Elliott, senior technical writer and a former Random House editor.

With that bench strength, BEYOND is different from many competitors in that every team member is accessible to clients to answer questions and address ongoing issues.

“Even with as fast as we’ve grown, we’re still very much a boutique firm. But that has much more to do with the unique capabilities we offer than it does with our size.”

“You get the A-team right off the bat,” Nigh says. “That ensures that we directly deal with clients’ priorities and are accountable for focusing on what’s important to them.”

She stresses the importance of companies finding a consultancy with advisors who are the right fit for their organizations. That is because the HITRUST validation process is extremely rigorous and time consuming, with all the required processes and testing executed at the same time that IT departments are maintaining normal day-to-day operations. Preparing for a successful certification can easily take more than a year, so a match of personalities and cultures between the client and the consulting firm is critical.

BEYOND takes a multiphase approach to achieving HITRUST certification. The team first assists with a self-assessment process that compares a client’s existing information security program to the requirements for HITRUST CSF certification. Next, BEYOND makes recommendations on how to strengthen security and prepare for the HITRUST validation process itself. After reviews, testing, validation, and certification is obtained, the team is available to work with the client to maintain, mature, and align their program with HITRUST requirements.

“HITRUST is an ongoing framework, not just a point in time,” Nigh explains. “We can work with clients on a continual basis or step in to help them address any issues that may be identified during interim year reviews.”

Because of its boutique environment, BEYOND frequently identifies additional services that can greatly enhance clients’ information security programs. While working towards HITRUST certification, the team discovered that its first client also needed internal control documentation. They were able to immediately pull the writing team together to address the issue.

In many cases, the company also works with external partners to address specific client needs. BEYOND has become an Armor Channel Partner to offer managed services for monitoring threats and vulnerabilities, and also works with CPA firm IS Partners when accounting services and SOC2 reporting is required.

“Clients come to us when they want to obtain HITRUST certification, but we have the foresight, agility, and existing relationships to recognize and successfully address other areas that impact the integrity of their security operations,” Nigh says.

In addition to enjoying the collaboration that occurs between the company and its clients and partners, Nigh feels a sense of satisfaction as she witnesses changes within the IT community.

“We’re all dealing with the unfortunate reality of data breaches and new forms of risk,” she says, “But those challenges have spurred an evolution as information security takes on a more prominent role within many organizations and overall security awareness increases.”

Cathlynn Nigh and Ray Biondo help lead BEYOND LLC’s consulting efforts.

New technologies have also created opportunities for the company. In one instance, a client became one of the first cloud-based healthcare organizations to obtain HITRUST certification. BEYOND worked with HITRUST to appropriately adjust the processes involved and succeeded in making its client one of the first to be certified for cloud-hosted operations.

For all of BEYOND’s technical skills and accumulated knowledge, Nigh maintains that another reason for its success is the passion of the team. For them, protecting health information goes beyond technical infrastructure and certification requirements. It’s personal.

“There are established methods and protocols to successfully increase security and deal with data breaches,” she says. “But when health information is involved, it means critical devices can malfunction or a patient might be given the wrong medicine. Our work isn’t just about proprietary information—it’s about protecting lives.” AHL

“But when health information is involved, it means critical devices can malfunction or a patient might be given the wrong medicine. Our work isn’t just about proprietary information—it’s about protecting lives.”

By Jeff Silver

A Holistic Approach to Data Security

In the days of mainframe computers, data was safe unless someone physically broke in to where it was stored. But now, data is everywhere, which is both a blessing and a curse. Information is available at users’ fingertips, often in real time, and can be used for countless business functions, as well as to provide solutions for better patient care. But greater access also means increased vulnerability.

Sean Lowder, an information security specialist with more than twenty years of experience, and former chief information security officer at Blue Cross Blue Shield of Louisiana (BCBSLA), points out that the greatest challenge for healthcare companies and security professionals is balancing the desire for speed and streamlined operations with the security required to protect them.

“People want things quickly, so security sometimes takes a back seat,” Lowder says. “The main concern used to be focusing on proper data processing and accuracy, but the new challenge is how to manage and protect massive amounts of data.”

In any system, Lowder says, vulnerabilities exist simply by having that system up and running. Once identified, many can be dealt with by simply rolling out a patch, while others can’t be adequately addressed without shutting down the entire system and, instead, usually require constant monitoring.

Between those two extremes, Lowder stresses the importance of taking a holistic perspective that positions cybersecurity as part of an overall business model, not just an isolated specialty. This is the approach he took at BCBSLA. He first identified where the most critical security gaps and vulnerabilities existed, and then developed a short-term strategy that included funding plans and extensive communication with all stakeholders. This enabled the most critical items to be remedied as quickly as possible. His long-term plan added a broader range of processes and technologies that were designed to build on the initial improvements. This second phase required several additional years to complete.

“It’s essential to include as much of the business staff as possible in security improvement planning and to explain why changes are being made in language they understand,” Lowder says. “Ultimately, they should be able to explain and defend the reasons for such an initiative as well as you can.”

Sean Lowder offers insights on how to identify vulnerabilities and the most effective strategies to address them

Doing that successfully requires building strong personal relationships. Those relationships enable technology leaders to understand the concerns and priorities of other departments, how they do their jobs, and to get to know hot-button issues that might create resistance to proposed changes.

Sean Lowder

Information Security Specialist

“Sometimes it’s less about technology and more about retreating from your position a bit to drink a lot of coffee, go to lunches, and ask a lot of questions,” Lowder admits. “Talking about what happened at another company or about online safety issues connected to someone else’s kids can be what brings them around to your point of view.”

The biggest mistake many companies make is trying to do too much too fast as they try to address security issues, Lowder says. In addition to causing problems by ignoring their staff’s natural resistance to change, hastily implemented solutions can also inadvertently interfere with normal business operations and processes. At one of Lowder’s former consulting clients, problems arose in the formulas for products the company manufactured, but implementing strict control measures the company wanted would have drastically interrupted operations. Instead, Lowder instituted passwords to acclimate staff to the new routine. The passwords then facilitated an examination of who had access to the formulas and, finally, led to developing more appropriate and effective controls.

Several ongoing developments are also providing added tools to protect organizations’ critical healthcare data. Artificial intelligence offers new capabilities for sifting through immense amounts of information to detect unusual patterns of human, as well as system- and, potentially, bot-initiated behavior. Threat intelligence analyst is a relatively new security position in which specialists scour the corners of the dark web to find sensitive information before criminals and scammers do. And the implementation of data center microsegmentation applies stringent permission restrictions so that users have access only to data required for approved functions related to their job responsibilities.

David Le

“People want things quickly, so security sometimes takes a back seat. The main concern used to be focusing on proper data processing and accuracy, but the new challenge is how to manage and protect massive amounts of data.”

Lowder also participates in extensive threat sharing networks, such as the National Health Information Sharing and Analysis Center and HITRUST’s Cyber Threat Xchange. Security data used to be closely guarded by individual companies, but, in the interest of transparency, they now share information to head off new and developing threats as quickly as possible.

“Shared threat networks help keep us a step ahead of the bad guys,” Lowder says. “In some instances, information about a newly detected threat can be fed directly into a company’s security infrastructure for automatic adjustments and immediate added protection.”

With so many advancements, the greatest cybersecurity vulnerability remains human users of data and IT systems. For that reason, Lowder highly recommends maintaining an ongoing awareness initiative that constantly reminds staff of best practices and good data hygiene.

An important element of any awareness program is keeping audiences engaged with fresh presentations and information. To help keep things lively and interesting, in the past, Lowder has created live presentations with outside experts. For example, FBI agents have explained how to keep children safe online, which ties into the importance of routinely updating passwords and other desired security behaviors.

“There’s always some new threat or vulnerability, or some new breed of attack,” he says. “Because security issues change daily, we have to be in constant communication with leaders and end users. It’s never a one-and-done solution.”

AHL

FireEye has created a unique learning system. Our real-time knowledge of the threat landscape ensures that our o erings provide the best means to protect our customers. We are constantly guided by our frontline expertise as we build our products, deliver threat intelligence and arm our services team to prepare for, respond to and prevent breaches.

By Jeff Silver

Quality Care Close to Home

Thanks to the 340(b) pharmaceutical discount program and Jessica Larsen-Gallup’s expertise, Avera Health provides healthcare to some of the Upper Midwest’s most vulnerable patients

Jessica Larsen-Gallup began her career

as a clinical research specialist focused on oncology for a pharmaceutical manufacturer. She had been inspired in her career path by Clarice Starling, Jodie Foster’s character in Silence of the Lambs, a dogged investigator who ultimately puts seemingly unrelated puzzle pieces together to crack the case.

Then, as a clinical research coordinator, Larsen-Gallup handled a similar role at Avera Health until 2009, when Avera McKennan Hospital & University Center became eligible for the Public Health Service Act’s 340(b) program. It requires drug manufacturers to provide medications at a reduced price for outpatient drugs for qualifying hospitals. Because the program is intended to benefit organizations that serve the nation’s most vulnerable patients, Larsen-Gallup knew she had found a new venue for her project management, collaboration, education, and problem-solving skills.

“Since Avera is a network of safety net hospitals, the 340(b) program helps stretch our federal resources further,” LarsenGallup says. “The opportunity to help implement it meant that I could play a role in enabling more of our patients to receive healthcare care close to home. It was very exciting to contribute to the effort.”

The Avera network serves nearly one million patients through thirty-three different clinical facilities in one hundred communities throughout South Dakota and parts of Iowa, Minnesota, Nebraska, and North Dakota. A significant portion of those patients who are economically insecure qualify for discounted services at Avera facilities. That’s because most charitable care providers serve individuals who earn up to 150 percent of federal poverty guidelines. However, Avera allows up to 400 percent of the guidelines and also includes other expenses and debt load as part of its charity care qualifying calculations.

Care for the Neediest

The Public Health Service Act’s 340(b) program accounts for 5 percent of all medicines purchased in the United States each year. In 2016, that amounted to approximately $16.2 billion. Covered healthcare facilities can provide discounted medicines to all qualified patients, whether they are uninsured, covered by Medicaid, or by private insurance.

Jessica Larsen-Gallup

| Director, Pharmacy Business & Analytics |

Avera Health

Dr. Guerra’s Perspective

When I was in residency at a Catholic hospital run by business-savvy nurses, I was told, “No money, no mission.” In reading about Jessica Larsen-Gallup’s work, I am reminded how true that saying is when taking care of those in need. At Avera Health, the mission is clearly to serve the population they have been entrusted with as close to home as possible. Through Jessica’s leadership, leveraging a federal program has enabled Avera to fulfill that mission.

It is also apparent federal programs come with some hefty complexity and requirements to keep funds flowing. Developing systems to manage the grants is often a challenge nonprofit healthcare providers have, and I applaud the foresight of the team to tackle the problem head-on, even recognizing how, many times, standardization is needed to move forward.

Another way to look at standardization is to think of it as the implementation of best practices. When systems are strapped financially, change is difficult. Yet, when the bar is raised for everyone, often the health system recognizes the change to be in the best interest of the patient. And that is everyone’s mission.

Guest Editor

The three-year learning curve to set up 340(b) to become fully operational took Larsen-Gallup somewhat by surprise.

“Even working with Dr. Steve Petersen, vice president of pharmacy services, who has more than thirty years of experience, the process was overwhelming,” she admits. “I see my new hires go through the same experience and tell them it’s all part of the process. With so much complexity, they have to accept the idea that they won’t be experts for a while.”

Her process included identifying and interviewing appropriate subject matter experts, learning a vast array of new and highly nuanced terminology, attending conferences, and researching details with various consulting organizations.

Aside from the complexity of qualifying for and staying in compliance with the program, Larsen-Gallup also discovered the extent to which 340(b) has an impact throughout the healthcare system. “Everyone thinks of it as a pharmacy program, but it goes well beyond that,” she says. “It has an impact—and requires input from—everyone from billing and cost reporting to clinical and information technology staff.”

In 2010, the Affordable Care Act expanded the reach of 340(b). In addition to disproportionate share facilities like Avera McKennan, critical access and community hospitals could also qualify. Because of their experience, Petersen and Larsen-Gallup were tasked with identifying which of the remaining thirty-two Avera locations qualified, and then bringing them into the program.

Even though her expertise had increased exponentially, the new assignment carried even more challenges than the original McKennan initiative because, in addition to subtle operational differences at each facility, they also used different drug wholesalers, automated medication dispensing machines, as well as discrete health information systems.

“The lack of standardization made things difficult,” Larsen-Gallup says. “We

couldn’t take boilerplate files from one site and move them to another. Each set and each system had to be rebuilt, retested, and reintegrated.”

By tackling the facilities in groups of five or six at a time, the process was completed within three years. It resulted in a total of twenty-two Avera facilities qualifying for and coming into compliance with 340(b) requirements.

Using the same approach, LarsenGallup has helped lead a standardization initiative across the Avera network. This includes a single vendor that provides software to manage all 340(b) compliance information. In addition, all locations will be using a single formulary and an enterprise-wide upgraded version of Meditech, both of which are expected to be completed in 2020.

“Standardization will help tremendously with managing 340(b),” Larsen-Gallup says. “Instead of having to replicate processes, we’ll be able to manage activities like drug mapping once and then push them out to all the covered facilities.”

From a much less technical perspective, Larsen-Gallup is constantly aware of the mission that guides the execution of all her responsibilities. Avera is a healing ministry owned by the Benedictine Sisters and Presentation Sisters, and even though 340(b) is a behind-the-scenes activity, she focuses on the impact it has just as if she was involved in caring for patients face-to-face.

“The work my team does and the cost savings we help create translates into keeping local hospitals financially viable and making it possible for a grandmother having a heart attack to be treated locally instead of having to drive one hundred miles for treatment,” she says. “Because of our mission, there’s a grace and a humility in the human condition that we are asked to experience, and I think it makes a difference that our patients can feel.” AHL

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ONGOING TECHNICAL SUPPORT

We collaborate with our clients and become an extension of the covered entity’s 340B leadership to help ensure goals and objectives are met

By Lior Phillips

For the Greater Good

Throughout his career in healthcare, Michael Einodshofer has been guided by his desire to make a difference in the lives of as many people as possible

Many young pharmacists begin their careers in retail pharmacy, but Michael Einodshofer was not just there for a paycheck. He realized quickly just how important pharmacists and the medications they dispense are in the patient’s health journey. “It’s the last mile of healthcare—where diagnosis ends and treatment begins,” he says. “Everything I do now comes back to that experience at the pharmacy counter.”

However, Einodshofer’s days of filling prescriptions and counseling patients are long behind him. Instead, he’s taken steps in his career to see where he can make a greater impact in the industry. “Having the best drugs in the world doesn't matter if patients can’t afford them. This industry needs to find ways to drive waste out of healthcare and enable patients to make better decisions financially and clinically,” he says.

Einodshofer graduated from the University of Pittsburgh with his bachelor’s of science in pharmacy in 1997 and he began his work as a retail pharmacist immediately after. An MBA followed not long after, and Einodshofer transitioned from retail to the hospital and health plan side of pharmacy. After nearly ten years in leadership roles such as director of pharmacy operations at the UPMC Health Plan, he joined the Walgreens Boots Alliance, specializing in projects focused on specialty cost containment, new drug forecasting, and clinical care. He also brought a new focus on data-driven solutions for clients, advanced analytics, and established other forward-thinking strategies.

After advancing into senior director roles, pharmacy benefit management company Maxor National Pharmacy Services offered him an opportunity to find new avenues for improving the health of millions. Einodshofer became the company’s chief innovation officer in 2016, a position that allows him to look across business teams and think creatively. His direct team is responsible for helping each business unit within Maxor adopt new technologies and approaches to their

business via analytics and new clinical intervention programs that improve overall healthcare quality and client experience.

The healthcare world appealed to Einodshofer because it is, in a sense, a massive sandbox—at once anything is possible but also because so much still needs to be determined.

“It’s so complex and interconnected that it’s hard to change things quickly, but we're making great progress,” he says. Across the industry, web-based self-service tools have become standard in the past decade, empowering patients and members with access to information, but there remains health literacy barriers that limit adoption of these tools.

One way that Einodshofer and Maxor have worked to change that has been a shift from expecting a patient to know what questions to ask to developing solutions that find a patient who didn’t know they had a question.

“Instead of expecting the consumer to find the content, we have the content and find the consumer,” he says. The company recently launched myMaxorLink, for example. This product allows the data analytics team to find patients that might benefit from a lower cost alternative drug, gap in care, or another issue. They then deliver information through a HIPAA-compliant myMaxorLink mobile messaging platform so it can be actionable in a timely, clear manner. “Alerting a patient to a lower cost alternative can save thousands of dollars a year, yet these options likely would have gone unnoticed if we expected the patient to find such opportunity on their own,” he says.

“Relay Network is proud to provide the technology behind myMaxorLink, a first-of-its-kind mobile

Michael Einodshofer Chief Innovation Officer

Maxor National Pharmacy Services

“We are setting out to change the narrative around the affordability of drugs.”

engagement solution in the PBM industry that connects patients to individualized solutions right in their moments of need,” says Matt Gillin, CEO of Relay Network.

But across all projects, one of Einodshofer’s biggest priorities is to remove waste, both for the benefit of Maxor and downstream for patients and plan sponsors. “Maxor gives me a lot of hands-on opportunities to interact with patients to deliver cost-effective care,” he says. “My analytics team is sharing things the clinician might not have noticed in their standard interactions with a patient. But we can see patterns in data beyond what a patient is telling them at the point of sale.”

Within Maxor’s Specialty Pharmacy business unit, Maxor has done a lot of important work in cystic fibrosis (CF), priding itself at excelling in the disease space. “We work closely with all manufacturers in the CF space and are one of a just a few pharmacies in the country that can provide every CF medication to patients. We also selectively look from other manufacturer partners outside of CF that might have an interest in working with a specialty pharmacy dedicated to patient and provider services,” Einodshofer says. But to get all of the various teams to work together toward those goals, Einodshofer needs to build a culture

of success. “I’ve seen a variety of leadership styles in my career, and it’s most effective when a leader wants their people to succeed and enables it,” he says. If you hire the right people in the first place, Einodshofer suggests, then trusting them to take ownership, act responsibly, and work productively should come naturally. “I’ve learned how important it is to respect the champion’s creed—always do the most productive thing in any given moment,” he says.

The value of every minute couldn’t be clearer than when discussing the company’s ability to help patients live longer, healthier lives. And, too often, patients aren’t able to do so because they either can’t afford the necessary drugs, or they don’t understand how different delivery channels can improve affordability. “We are setting out to change the narrative around the affordability of drugs,” Einodshofer says. “There is a significant amount of waste on drugs that don't deliver healthcare value, yet are actively promoted for the manufacturers’ economic gain. Our mission is pull the curtain back for our plan sponsors, call out where money is being wasted, change benefit design accordingly, and launch intervention programs that maintain affordability and maximize quality outcomes within the pharmacy benefit.” AHL

A Community of Care

Robert Kosior of ConnectiCare explains how the company tailors its healthcare plans and services to the local market

By Randall Colburn

Robert Kosior SVP & Chief Operating Officer ConnectiCare

Just as many other industries have gone through the transformation from small, locally owned businesses to large, national corporations, healthcare is moving in a similar direction. These changes bring many benefits, including capital investments, infrastructure, and knowledge. Despite these changes, however, healthcare is still local, and its businesses must respond to the unique needs of the communities they serve.

Take Connecticut, for example. Although Connecticut is considered a wealthy state, with an average population of healthy, financially well-off residents, averages can be deceiving. The state’s largest cities are among the poorest in the country. Many of these poorer residents make up healthcare provider ConnectiCare’s core membership. This fact is not lost on Robert Kosior, senior vice president and chief operating officer for the Farmington, Connecticut-based company, or on most of its employees. Although many health insurers across the country have stopped participating in the individual health exchanges created by the ACA, ConnectiCare is one of two insurers offering coverage to individuals through Access Health CT, Connecticut’s health insurance exchange.

In addition to the individual market, ConnectiCare’s business primarily includes small businesses, cities, towns, local municipalities, and retirees enrolled in Medicare Advantage. “Our members are among those that carry the highest burden due to rising healthcare costs, and they take on the overwhelming task of navigating through an increasingly complex system while tackling health literacy,” Kosior says. “Our mission is to create healthier futures for our customers and communities. To do this, we must continue to work toward making healthcare more affordable and ensuring that our members can easily get the care they need.”

Here’s a look at how the company succeeds.

Ambrose

Brian

Keeping It Local

ConnectiCare’s local presence is a key advantage. Its employees are part of the communities it serves. “I’m a lifelong Connecticut resident,” Kosior says. “I spent fifteen years of my career commuting over the border to Massachusetts, and I am grateful for the opportunity to positively impact healthcare in my own community. We know our providers, understand the individual needs of our members, and can connect them to local resources. That said, we keep the local market top of mind when identifying and executing our products, processes, and strategies.”

ConnectiCare’s member call center is also located at its company headquarters in Farmington, Connecticut. The company has also opened a number of retail locations across the state to further engage with its members. “Our retail centers provide a unique faceto-face experience,” Kosior says. “Members come in to get answers to benefit questions, find the right provider, understand and pay bills, and attend educational programs and health and wellness classes.”

In addition, ConnectiCare recently invested in community resource coordinators, who help members access additional resources within their community to help with their broader needs. “As an industry, we have just started to acknowledge the impact that socioeconomic issues have on people’s health,” Kosior says. “How can we expect someone with diabetes to control their blood sugar when they are worried about putting food on the table, a place to sleep, or a safe environment?”

ConnectiCare’s local focus also influences its relationships with hospitals, physicians, and other healthcare providers. “Our goal is to be more engaged, responsive, and accessible with our provider network.”

Kosior acknowledges that this is becoming more difficult, given the continued consolidation of healthcare, which means that decisions that were once made locally are increasingly being made out of state. “The sphere of influence has now expanded beyond our state borders, which we have adjusted to, but the delivery of care is still

ConnectiCare’s team combines its local presence with a progressive approach to care.

“Information is key. We are a data-driven organization; we use this for informed decisionmaking and to help our providers understand their patients’ needs, drive better outcomes, and improve quality—while at the same time managing costs.”

local, and these relationships are more important than ever,” Kosior says.

This is because improving cost and quality requires a higher level of engagement with the provider network. ConnectiCare has a dozen provider collaborations across the state, where it partners with primary care and multispecialty groups, integrated delivery systems, and other organized provider groups to manage the healthcare needs of its members. “We aim to use these partnerships to drive improvements in cost and quality,” Kosior says. “Our role is to support our provider network in the efficient delivery of healthcare services through data-driven insights on our members.”

A Data-driven Response

Healthcare data analytics is an area that has received tremendous attention and is key to making progress when it comes to cost and quality. The space is changing rapidly, and the risk is that smaller health plans can be left behind. So far, that has not been the case for ConnectiCare.

“We have made significant investments in this area and are fortunate to have a staff of highly skilled and dedicated individuals with expertise in programming, data analysis, actuarial, statistics, and healthcare management,” Kosior says. “Information is key. We are a data-driven organization; we use this for informed decision-making and

to help our providers understand their patients’ needs, drive better outcomes, and improve quality—while at the same time managing costs.”

Kosior notes that Care Management Solutions, Inc., an affiliate of ConnectiCare, helps do just that. “Data-based programs, like the offerings through Care Management Solutions, are based on clinical evidence, claims data, and behaviors of each individual to help activate members to engage in preventive measures and chronic disease management,” Kosior says. “It’s proven effective. Using data to help employers keep their workforce healthy and productive is crucial to running successful businesses.”

A Look Ahead

Through its provider collaborations, ConnectiCare has seen emergency room visits and acute bed stays drop by 9 percent and 16 percent, respectively. Additionally, primary care visits have increased by 30 percent.

Though results have been positive, Kosior acknowledges that much more needs to be done. “I’ve yet to hear that enough has been done to improve healthcare,” he says. “Until then, we will continue to make changes. The path we have chosen is to work with our providers and not in conflict with them. This approach is far more effective, rewarding, and keeps the member or patient at the center of the conversation.” AHL

CHRONIC DISEASE MANAGEMENT, COUNSELING & TRACKING

ONLINE PARTICIPANT PORTAL

PARTICIPANT SUPPORT CALL CENTER

ONGOING ANALYTICS & REPORTING WELLNESS PROGRAMS THAT WORK

People drive results. Our data-powered, human-driven approach to wellness can improve the health of your employees and your company’s bottom line. Find out how an integrated wellness strategy can change the landscape of your company. Learn more at: CareManagementSolutions.com Follow us on PREVENTIVE CARE EDUCATION & TRACKING

By Jeff Silver

The Right Benefits at the Right Time

Today’s workforce hinges on multiple generations working together more than ever before. To facilitate that, Jamie Mauer has adapted Bemis Company’s total rewards package to reflect a broad range of needs.

American-based companies

are facing two significant issues that are changing how they approach recruitment, retention, and benefits management: baby boomers are transitioning into retirement and millennial employees are becoming the predominant workforce demographic group at the same time as healthcare, health insurance, and associated benefits continue to undergo change.

In an effort to address both waves at once, Jamie Mauer, senior director of total rewards at Bemis Company, helped lead a comprehensive review of the company’s overall total rewards and benefits strategy in the United States that began in early 2016. The initiative closely examined specific challenges that leaders across the company were facing and dived into detailed demographic data analysis to effectively redesign Bemis’s benefits strategy and offerings.

“In 2015, baby boomers made up more than 40 percent of our workforce, but as they retire, we find many of our hires are millennials,” Mauer says. “Baby boomers and millennials have very different needs and preferences. We wanted to ensure that our total rewards package appropriately addresses them both.”

The assessment was guided by three basic principles: ensure employees perceive compensation and benefits as competitive with the rest of the market, support a high-performance culture by fostering ownership and aligning rewards to performance, and manage cost through efficient processes and experiences that are viewed positively by employees.

After comparing to industry benchmarks, Mauer and her team made several changes. The most significant was switching health insurance carriers and providing employees with two different health plan options. Beginning in 2017,

employees could choose either a highdeductible plan or a PPO plan, which had previously been the only option.

One of the main reasons behind the change was that many millennials felt the PPO plans were too expensive and offered more coverage than they needed. The current plans are offered through United Healthcare for Wisconsin residents and through Anthem Blue Cross Blue Shield for all other states.

Bemis is also working with CVS Health and its pharmacy benefits plan. With the change to CVS Health, Bemis implemented mandatory mail-order prescriptions for maintenance medications, adopted a strategic approach to formulary management that contains certain exclusions, and incorporated programs that focus on generic medications.

“Our carrier selection process focused on providing employees with a top-level provider network that offers great quality with the best possible pricing,” Mauer says. “Better reporting and analytics will also enable us to strategically customize the plans over the long-term.”

Source:

US Workforce By the Numbers

Jamie

Dr. Guerra’s

Perspective

The evolution of the workforce feels like it happened overnight, but the reality is our focus on employee health changed more quickly than the needs of the population. Employees want to achieve their best health, and employers are seeing themselves as part of the solution. Jamie Mauer and Bemis Company’s leadership are out front of this shift, ensuring they are changing with the times.

True health is multifaceted. The work environment, where employees spend at least forty hours a week, is a place where health activity is now necessary, compared to previous years when hours sitting in a chair or standing in a manufacturing line was common.

Many companies like Bemis are incorporating flexible scheduling into their rewards packages to allow employees to work from home or make other accommodations. That change may have not been available before, but today, it not only improves retention and job satisfaction, it also has been shown to improve the health of the employee by enabling healthy eating and healthy activity that might not be readily available in the office setting.

I applaud Jamie in leading the organization to value the health data of their employees, which allows them to make informed decisions about how health is impacted by the work environment. When data becomes a tool to know more about a population’s health, the solutions become apparent.

Guest Editor

Many different forms of communication and tools were provided to employees to help them make the most appropriate choices when the new healthcare package became available. Benefit counselors were trained to provide one-on-one sessions to explain the options. Postcards were sent to employees’ homes to direct them to a web-based application that compares the plan options. In addition, benefits booklets, videos, and printed worksheets were provided to employees who preferred a more traditional, less technology-based process.

The results have been very successful. The number of employees who migrated to high-deductible plans has been within the range that Mauer’s team projected and premiums did not increase for the 2018 plan year.

Moving forward, analytics will play an important role in how the company’s benefits develop. Mauer expects to use aggregate claims data to help identify opportunities for improvement and for carriers to offer clinical programs that will help address them. For example, as is common in manufacturing, a key medical cost driver for the Bemis workforce is spine and back issues. The company is looking into how to prevent and mitigate those types of injuries.

Mauer is also conducting a wellbeing analysis as part of a plan to expand the company’s wellness offerings. In addition to the existing focus on physical wellness, she believes behavioral health and financial education represent important elements of a more holistic approach.

“Baby

boomers and millennials have very different needs and preferences. We wanted to ensure that our total rewards package appropriately addresses them both.”

She expects debt management, budgeting tools, strategies for increasing both emergency and retirement savings, and other topics will all be part of what will become a multiyear road map for expansion.

As they work to accommodate both older and younger generations in Bemis’s workforce, the total rewards team has introduced changes to programs impacting retirement and employees’ work/life balance. For example, Bemis can now rehire retirees on a short-term basis to pass on knowledge to existing workers. The team has also been educating leaders on how to implement a variety of flexible work schedules—compressed work weeks, telecommuting, and core hours, to name just a few—that are customized to the unique demands of each department.

“Not all leaders are comfortable with flexible schedules,” Mauer points out. “But as more of their peers introduce it and increasing numbers of employees

want it as an option, we’re seeing more accommodations made for things such as appointments, adjusted schedules, and working from home.”

Successful implementation of changes to Bemis’s benefits packages can be attributed, in part, to the several different roles Mauer has held during her fifteen years with the company. Her experiences cover a broad range of HR specialty areas, including benefits, compensation, payroll, HR systems, and HR shared services. As a result, she has gained tremendous insight into the downstream work that’s required to execute any given project or strategy.

“When we switched our healthcare carriers, we started getting everyone aligned six months before the change happened,” she says. “My previous roles helped me understand who all the stakeholders were and what each of them needed to know and when.” AHL

In honor of strategic leadership.

We celebrate Jamie Mauer of Bemis Company for her comprehensive and innovative approach to workplace wellness.

By Joe Dixon

Healthcare has long been on the cusp of massive change.

From data and analytics to patient empowerment, recent advancements might indicate the industry is finally about to reach its most pivotal moment yet. A new era of personalized medicine—known as precision medicine—has arrived, and it’s opening a host of new possibilities for care providers that were unimaginable only a few years ago. Precision medicine takes into consideration every gene throughout a person’s genetic profile and uses that data to design a treatment for a patient. Precision medicine is accelerating at a rapid pace, thanks in part to Sean P. Scott and QIAGEN.

QIAGEN is global provider of molecular solutions that enable customers to gain valuable molecular insights from samples containing DNA. QIAGEN delivers sample-to-insight solutions that provide the tools a laboratory needs for a complete end-to-end next-generation sequencing (NGS). From sample collection tubes, to sample preparation, instrumentation, and software that analyzes, interprets, and reports NGS test results, QIAGEN supports each step of the workflow, enabling any lab around the world to achieve actionable insights in NGS. As the number of genomes sequenced each day continues to skyrocket and healthcare professionals increasingly rely on genetic information to enhance patient care, QIAGEN has made it critical to drive advancements in genomics-guided precision medicine.

These advancements could have big implications for treating cancer, which is a genetic disease—that is, cancer is caused by certain changes to genes and has been associated with genetic risk factors of other complex population diseases such as cardiovascular disease,

Sean P. Scott SVP, Chief Business Officer & VP, Clinical Market Development

QIAGEN Genomics and Bioinformatics

neurodegenerative disease, and diabetes. Genomicsguided precision medicine also has the potential to revolutionize disease diagnosis, treatment, and prevention that will lead to better patient care and outcomes, says Scott. This is why QIAGEN is committed to making significant investments in the commercialization and democratization of these important technologies and capabilities. While other companies tend to focus on the workflow instrumentation and ability to generate data, QIAGEN focuses more on creating actionable insights from the data. Therefore, QIAGEN does not just enable laboratories but works alongside ordering physicians to identify opportunities for timely and actionable clinical decision support—which the company believes is the last mile in the race for genomics-guided precision medicine.

“There’s no question that there is great promise for genomics-guided precision medicine, but to date, there is limited evidence of the clinical benefits,” Scott says. According to him, the current industry trends that are driving genomics-guided precision medicine include the shift from disease treatment to prevention, the need

“No matter the size of the lab, we’re focused on helping them understand how to develop a more insightful and actionable report for the ordering physician. This enables the physicians and the laboratories they serve to make better decisions for improved patient care and outcomes.”

for less invasive biopsy methods and more personalized targeted therapies, and the departure from traditional anatomical descriptions of cancer to genomic stratifications, such as referring to a patient with breast cancer as HER2 positive. Although harnessing the power of new genomic technologies and NGS still presents some significant production and bioinformatics challenges, there is growing evidence that improved standards, guidelines, and practices will help genomics-guided precision medicine become one of the most effective ways to care for patients, Scott says.

In his role, Scott is primarily responsible for helping clinical molecular diagnostic and molecular pathology labs develop their dry lab capabilities to support and expand their current or planned NGS-based test services. Whether the labs are large reference labs, commercial

speciality labs, or small labs within hospital systems, Scott and QIAGEN take a holistic approach to their consultations, considering the entire sample-to-insight workflow, collaborating with professional associations on the development of standards and guidelines, and democratizing the best practices of other QIAGEN customers for the benefit of everyone.

“No matter the size of the lab, we’re focused on helping them understand how to develop a more insightful and actionable report for the ordering physician. This enables the physicians and the laboratories they serve to make better decisions for improved patient care and outcomes,” Scott says.

Although Scott has been working on the cutting edge of genomics-guided precision medicine for more than a decade, the field is still a relatively new concept

within the healthcare industry, he says. Therefore, leaders like Scott are critical to the successful and responsible implementation of NGS-based tests within today’s clinical setting. The healthcare industry is undergoing a dynamic shift away from DNA-based diagnostic testing toward theranostics and prognostics, and physicians are seeking supplemental information on treatment and trial options for their patients, Scott says. That means it’s imperative that healthcare providers embrace the full potential of genomic data and standardize NGS testing according to professional association guidelines and institutional best practices.

“When you talk to the ordering physicians who are trying to draw insights or make treatment decisions based on genetic test results, there’s still a large chasm between complete and accurate reports and reports that are insightful, actionable, or influential over the clinical decision-making process,” Scott says.

Genomics-guided precision medicine promises to transform healthcare, but for this potential to be fully realized, providers, payers, regulators, and industry insiders must work collaboratively to ensure the seamless integration of this new technology across the clinical setting, Scott says. The building blocks for such a system are already forming, and healthcare providers need to develop capabilities for genomic integration, molecular profiling, and to apply clincial outcomes data at the point of care to accelerate the adoption of precision medicine.

“You will not see true genomics-guided precision medicine capabilities within provider networks until they can figure out how to best integrate genomics data with clinical outcomes data. I think that’s the real challenge right now,” Scott says. AHL

We’ve got your reporting covered

Designed for standardized clinical interpretation and reporting, QIAGEN Clinical Insight (QCI™) Interpret supports your decision making from genetic analysis to clinical action.

Compatible with any next-generation sequencing platform

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For more information, visit www.qiagenbioinformatics.com/QCI

The Reason

Some executives feel the importance of their work because they have experienced its impact

Shaped by their

others

or

firsthand.

mission to help

by their personal experiences

with healthcare, many executives are drawn to the industry from a sense of empathy and a desire to make a difference for others.

70. Elizabeth Hendler is tackling issues such as the gender wage gap and the #MeToo movement head-on at Boston Scientific

77. The American Society of Addiction Medicine is advocating for increased patient access to life-saving addiction treatment medications

82. Greg Jackson draws motivation for his work at NuVasive from his father’s spine issues

86. Tracy Ting used her grit and resilience to help reshape Avanir Pharmaceuticals’ mission, vision, and values

92. Yusuf Rashid is designing an integrated model of care at Community Health Plan of Washington

The Guardian of Integrity

Elizabeth Hendler discusses how her team at Boston Scientific continues to implement leading-edge workplace policies in an era of changing societal norms

By Jenny Draper | Portraits by Gillian Fry

Considering her childhood,

it’s no surprise

Elizabeth Hendler champions legislative efforts to combat sexual harassment and reduce pay gaps.

The vice president of legal operations and chief employment counsel at Boston Scientific grew up in Parkway Village, an apartment complex constructed to house United Nations employees during the 1960s in Queens, New York. “It was an era and a place where the way you effected social change was through law,” she recalls.

There, her friends came from Japan, Guyana, and Norway, and her neighbors included feminist icon Betty Friedan and NAACP head Roy Wilkins. Her father, a lawyer, was on the board of the New York Civil Liberties Union, and she often joined him at desegregation meetings.

“Living in a microcosm of different races and cultures—where everyone wore different clothes, ate different foods, spoke different languages—was unusual and formative,” Hendler says. “A lot of people talk about the Civil Rights movement, but if you’re living in an all-white area it may not resonate. I watched the laws that protected my friends develop in front of my eyes.”

In her high school yearbook, Hendler envisioned her own future as a lawyer and, as it turned out, she now leads a global employment law team that is helping to take corporate responsibility to a new level about three hours north of Parkway Village in Marlborough, Massachusetts.

The $9 billion public company has invented about thirteen thousand life-changing products, such as pacemakers and defibrillators, to help more than twenty-five million patients live longer, healthier lives each year around the world.

“What attracted me to Boston Scientific, in addition to its can-do people and mission, was that I’m an adoptive parent,” Hendler says. “When I was contemplating adoption, I found out Boston Scientific offered paid adoption leave, which was then, and still is, extraordinarily rare.”

Boston Scientific also provided domestic partner benefits before many other companies, Hendler adds, and that inclusive approach continues to differentiate it in the eyes of its workforce. The company displays a rainbow flag at nearly all of its facilities during LGBTQ Pride Month and offers gender-neutral bathrooms for transgender employees. And it also holds a number of veterans flag-raising ceremonies during national holidays.

“For many years, most companies shied away from taking any kind of stance,” Hendler says. “They didn't see it as their place to comment on what was going on politically and socially outside the core business. But that expectation has changed.”

Hendler is part of the resurgence of inclusion that’s now entering corporate offices, and she’s marked the uptick in companies creating corporate social responsibility departments to manage the newest form of corporate risk: the convergence of politics, societal issues, and social media in the shifting business landscape. “We are in the perfect storm,” she says.

Now employees want to see not only the company’s values but also its stance on today’s headlines, whether the company responds via external or internal

Elizabeth Hendler VP, Legal Operations & Chief Employment Counsel

Boston Scientific

“People thought companies had sexual harassment under control. The problem didn’t go away. The problem went underground.”

communication, according to Hendler. “Employees want to know what their leadership is thinking about it and more importantly what they are doing about it,” she says.

Hendler’s legal team is on a mission to ensure that Boston Scientific is ahead of that perfect storm. Their focus spans harassment and discrimination investigations, disability leaves and accommodations, compensation practices and pay equity, and restructuring and reductions for more than 29,000 employees in 125 countries across 6 continents.

To tackle these issues, establishing global connectivity is top of mind for Hendler. Last year, her team of lawyers built a global training program that unified localized policies. Her team continues to add scenarios in the global code of conduct set to roll out early this year.

Hendler also oversees legal operations, which optimizes legal spend and systems for greater visibility among the global legal department. For example, her operations team created a legal onboarding program to announce what legal stands for in an orientation video to set the tone. “We wanted our lawyers to know that we expect them to be the guardians of integrity,” she says.

Evidence of their labors is clear. Glassdoor recently named Boston Scientific on its list of “Awesome Companies With No Gender Pay Gap Hiring Now.” It reported 99 to

100 percent pay equity among men and women of all races. It also earned a score of one hundred on the Human Rights Campaign Corporate Equality Index.

“You have to compare apples to apples and look at the jobs people are doing,” says Hendler, a member of the steering committee for pay equity at Boston Scientific. “That enables you to see if you are truly paying comparable wages for comparable work.”

Her team hired an outside statistician to review pay equity by position, level, and function. They conducted surveys and wrote an open letter to employees, while also creating a social media communications plan for Facebook, Twitter, and LinkedIn.

Hendler also held a Global Pay Equity Summit last March to assemble teams from legal, talent acquisition, and communications in a task force to monitor the ever-changing reporting requirements all over the world.

For example, some US states won’t allow employers to ask about salary history. And the government of Great Britain required companies to publish their pay data on their websites. To further support its commitment to pay equity, Boston Scientific changed its hiring practices to prohibit the request of salary history from US candidates and is considering similar practices in other countries in accordance with local laws.

But pay equity isn’t the only issue Hendler and her team are leading the charge on. Social media, the catalyst for the #MeToo movement, also provoked a corporate renaissance around workplace sexual harassment— the fervid end of hush money settlements dubbed “the Harvey Weinstein effect” by USA Today

“People thought companies had sexual harassment under control,” Hendler says. “The problem didn’t go away. The problem went underground. Social media fuels that anger, but I'm seeing more companies proactively using social media to share their commitment to zero tolerance on a massive scale.”

Although most companies have had sexual harassment policies and training for years, Hendler adds, the recent spotlight on sexual harassment expanded corporate attention to arbitration clauses and confidentiality agreements.

Even though Boston Scientific doesn’t use arbitration and implemented a robust sexual harassment policy more than twenty years ago, the company is renewing its zero tolerance stance. Hendler and her team are also working on expanding its harassment training into one, cohesive global program that will be required of all employees and managers.

Looking ahead, Hendler’s team anticipates other changing societal norms. Her team is reassessing its historical drug-test policies based on the legalization of medical marijuana and recreational marijuana in the United States.

“We must remain legally compliant but not rule out a portion of the population we might want to hire,” Hendler says. “We must establish a rationale to answer why or why we’re not drug testing in areas where pot is legal.”

The top-down approach applies to addressing these societal changes, but to be an employer of choice, Boston Scientific develops its internal benefits from the bottom up. “We ask what our employees need to bring their whole selves to work,” Hendler says.

The result: the menu-style Benefits to Fit Your Life program, which offers Boston Scientific employees far more than standard health insurance. It provides pet insurance; the Milk Stork program for breastfeeding mothers on the go; financial assistance education for student loans; sabbatical options every seven years; and childcare subsidies.

Teaching Others to Give Back

While Elizabeth Hendler expands Boston Scientific’s impact around the world, the legal leader also focuses on improving her own community outside of the office. She volunteers at The Foundation for MetroWest’s Youth in Philanthropy (YIP) program, which has granted more than $1 million to youth-serving nonprofits, from animal shelters to food pantries.

“We give youth teams some money and they decide which community program gets it and why,” says Hendler, a panelist who evaluates the youth presentations. “It teaches them the concept of giving back and making tough decisions.”

More than 1,250 middle school and high school students have completed the experiential leadership development program since its launch in 1997. Hendler also cites the YIP sponsorship of after-school programs, such as an initiative for students to play basketball and do homework together and a nature society for inner-city children.

“These kids are unbelievable and the program is so creative,” Hendler says. “It’s the future of philanthropy.”

Baker McKenzie congratulates Liz Hendler on her leadership and contributions to Boston Scientific and the healthcare industry.

Ogletree Deakins salutes our partner

Elizabeth Hendler

of Boston Scientific

Baker McKenzie’s unique culture inspires collaboration as trusted colleagues and friends, exemplified through the strong global partnership with Boston Scientific.

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“I like to hear what people are saying, which then helps us to draft policies and programs. You can’t expect other people to be engaged if you are not excited. Part of leading is jumping in.”

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Hendler also supports employee resource groups at Boston Scientific. She has served as a mentor in the Women’s Network Program and as a member of the company’s Corporate Citizenship Council, and is currently the sponsor for the East Asian Pacific Employees in Leadership group.

“I get out there and talk to different people who I might not ordinarily see in the course of my day job,” she says.

“I like to hear what people are saying, which then helps us to draft policies and programs. You can’t expect other people to be engaged if you are not excited. Part of leading is jumping in.”

As a trusted global healthcare legal provider, Baker McKenzie ’s strong partnership with Boston Scientific of over twenty-five years shares a vision of helping to make a meaningful impact on lives around the globe through innovation, solving complex problems, and collaborating to navigate a constantly changing and challenging world.

Widening the Access Point

Addiction is a massive problem in the United States, but not everyone has the same access to treatment. Through legislative and regulatory changes, The American Society of Addiction Medicine is helping to increase access to evidence-based treatment for all.

By Galen

Beebe

For

individuals with substance use disorder,

access to evidence-based treatment is a major issue. Addiction treatment medications are highly regulated, the workforce is inadequate and unevenly distributed, and treatment programs lack quality standards. But the American Society of Addiction Medicine (ASAM) is changing that.

ASAM advocates for legislative and regulatory changes that will increase patient access to the three medications clinicians use to treat opioid use disorder. Two of the medications, buprenorphine and methadone, are themselves opioids. “Because they’re opioids, this has created stigma around them, and they are subject to far more regulation than opioids that are prescribed for pain,” says Penny Mills, executive vice president and CEO of ASAM. “From ASAM’s perspective, we believe that patients and clinicians should have access to all of the available medications, because you don’t know what’s going to work with each patient.”

In 2016, ASAM advocated for passage of legislation that granted nurse practitioners and physician assistants the ability to prescribe buprenorphine. Before 2016, it was the sole medication in the United States that only physicians could prescribe, and this new legislation significantly expands treatment options in underserved areas. “The opioid epidemic particularly has hit rural areas,” Mills says. “There are a lot of rural areas where there are no physicians, but there may be a nurse practitioner or a physician assistant who could care for the patient.”

However, physician assistants’ and nurse practitioners’ ability to prescribe is

“From ASAM’s perspective, we believe that patients and clinicians should have access to all of the available medications.”

Penny Mills |

their curriculum. Medical students who complete this curriculum content would be eligible for a waiver to prescribe buprenorphine upon graduation.

The criteria are now used by more than thirty states and many private payers to make medically necessary determinations for what level of care a

Dr. Guerra’s Perspective

The role of organized medicine is to actively represent the needs of patients and those professionals who care for them. The American Society of Addiction Medicine (ASAM) is a successful example of this function through its advocacy across the country for increased access to the three medications needed to treat substance addiction by increasing prescribing rights of all provider types.

And though this seems easy enough, anyone who has tried to unify stakeholders on issues in behavioral health within the traditional house of medicine understands how daunting this task can be. I applaud ASAM’s ability to leverage its proven track record of improving primary care in rural areas to help get more trained providers in opioid use disorder into these hard to reach areas.

The steps Penny Mills and ASAM have taken to gain consensus on clinical practice guidelines, form needed coalitions, and develop curriculum and certification programs has been essential to address the current population health crisis.

Guest Editor

patient needs. “It has been validated and researched that if you send the patient to the right level of care, you get a better outcome,” Mills says. “If you either send someone to too low a level of care or even too high a level of care, you don’t have as good an outcome.”

In 2018, ASAM will launch a certification program, which will certify that programs deliver the stated services for their level of care, as well as advocating that all patients receive a standardized assessment to match them to the appropriate level of care. Currently, a program might state that they are a residential program without clarifying whether they are a level 3.7 residential program, which has on-site physicians and nurses, or a level 3.1 residential program, which does not.

These long-term solutions, from legislative changes to standardizing care, are central to addressing substance use disorder in the United States. “This problem has been in the making for more than twenty years, and you’re not going to turn it around with $4 billion in the 2018 budget,” she says. “It’s going to take long-term changes and long-term investment.” AHL

By Will Grant

Legal’s Strong Backbone

How NuVasive’s Greg Jackson helps the company’s legal team support innovation

San Diego-based NuVasive, a company that specializes in spine, spine medical device, and minimally invasive spinal surgery technology is powered by innovation. When it comes to matters of the spine, NuVasive’s technological breakthroughs include a patented Lateral Single Position Surgery that enables surgeons to treat more patients in the lateral decubitus position. They’ve also invested heavily in state-of-the-art technology to help combat early-onset scoliosis and adolescent idiopathic scoliosis. The NuVasive TLIF Portfolio provides the requisite tools surgeons need to plan surgery, access affected levels, restore disc height and alignment, provide optimal fixation, and deliver graft material. The company seems intent on being an innovator and not merely an adopter.

For NuVasive’s senior director of legal affairs and litigation, Greg Jackson, innovation is where the company needs to spend the majority of its efforts, and it’s his job to make sure NuVasive is able to swing for the fences in this arena. “As we continue to evolve the technology, legal is there to support that process,” Jackson says. “Legal is here to protect the organization and make sure it remains compliant and effective so the focus for the business can be innovation and developing the type of technologies that continue to help patients.”

Jackson came to NuVasive in 2016 after accumulating law firm experience at Bowman & Brooke and DLA Piper, among others. “I had fantastic mentors very early in my career right out of law school who harped on the value of being a true advocate for your client, being responsive, and putting yourself in the shoes of your client,” Jackson says. He believes his law firm days offer him empathy for working with NuVasive’s outside counsel as well as reminding him that not all outside counsel knows the different and often more diverse role that an in-house position entails.

“As we continue to evolve the technology, legal is there to support that process.”

Finding meaning in his work is not difficult for Jackson. In fact, he says he wishes the company would have been around long before its 1997 founding. Jackson’s father, a retired Marine Corp colonel, underwent an extensive spine surgery whose aftereffects make innovation at NuVasive even more personal to Jackson. “It fundamentally changed his life in a negative way because he didn’t have a good experience,” Jackson says. “The technology just wasn’t there yet. Had NuVasive been around at that time, it could have been much different.”

The surgery was extensive and quite invasive, and Jackson says his father’s back was essentially filleted open during the operation. “His activity level and ability to do things were severely impacted.” Jackson says. It was the first time he’d ever seen his father wince in

The Leadership Benefits of Lacrosse

While attending Penn State University, Greg Jackson was team captain of the varsity lacrosse team. Jackson admits that although short-lived, the experience helped shape him and his approach to leadership. “In hindsight, the most valuable takeaway is that I look at the relationships I’ve made and incredible bonds I made with my teammates,” Jackson says. “It taught me that you’re only together for a short period of time, but you go through a lot and get to know each other.”

That experience has been replicated at NuVasive, in part, because Jackson says it’s so apparent that everyone is committed to the same goals. “When I think about the team we have, there’s a really strong bond that bleeds over outside of work with the people here,” Jackson says. “We’re there for one another and make sure that we support each other. If you can build that kind of atmosphere, it’s amazing.”

pain, and that image still sticks in his head and keeps him focused on the company’s mission. “I’ve seen how it can change someone’s life. I get why it’s important,” Jackson says. “One of NuVasive’s primary focuses is in innovation concerning minimally invasive approaches to get to to the spine.” Although those methods may not be able to help his father at present, Jackson says it gives him a personal connection to those whom NuVasive is able to help.

It’s a different kind of personal connection, though, that brought Jackson to NuVasive. After serving as outside counsel for a number of years for the company, Jackson says he jumped at the chance to come to NuVasive to take on an in-house position. “I was always impressed with the people and the technology here,” Jackson says. “Where the company is going and what it wants to accomplish was something I really wanted to be a part of.”

Jackson says that going in-house has provided him a more rewarding and individual connection to his work. “What I really like here is that you learn about the business in a much more meaningful way and then you work with the different business interests to drive results,” he says.

The variety of responsibility means that Jackson doesn’t often get to go too far in the weeds, but this has also allowed him to learn when his involvement is necessary and when a task can be delegated. “There are times when you need to take a hard line and times when you need to be creative with your solutions to help the business meet its needs,” Jackson says.

Jackson says that the culture on his own team owes a large debt to the culture he’s seen at the company at large. “Everyone here knows the company and they believe in it,” Jackson says. “There’s a lot of institutional knowledge, so it’s been easy to work with everybody.”

The legal team isn’t without challenges, however. Data privacy, big data, and working toward more value-based

“What I

really like here is that you learn about the business in a much more meaningful way and then you work with the different business interests to drive results.”

Bradley congratulates Greg Jackson on his recognition in American Healthcare Leader.

healthcare solutions are top of mind for the legal department right now. “You also have to be strategic in how you position yourself in the market,” Jackson adds. “This is a cool role because you’re looking at the whole industry and what you, as a company, can do to try and move the ball forward.”

Jackson says that legal’s goal isn’t to get bigger, just to get better, and that everyone on his team understands the goal. “I enjoy the challenge and look forward to growing with the organization,” Jackson says. “I hope to be part of something special as we continue to roll out new technology.” AHL

It is a privilege to work with Greg and his legal team at NuVasive

On a Mission to Innovate

Tracy Ting helps Avanir Pharmaceuticals promote its message of commitment to patients

By David Levine | Portraits by Cass Davis

Tracy Ting VP & Chief People Officer

Avanir Pharmaceuticals

Grit and resilience. Those two words define the worldview of Tracy Ting. As vice president and chief people officer at Avanir Pharmaceuticals, headquartered in Aliso Viejo, California, Ting has been helping the company transform its messaging, including its mission, vision, and values, to better reflect the work it does and the people who do it. That grit and resilience, she says, come directly from her father.

Ting and her family moved from Hong Kong to the United States in 1983 when she was eleven. As a young man, her father, a native of mainland China, had been directed toward a career in farming by the government. “But he was scholarly and wanted to go to school, so he took his mom and moved to Hong Kong as a teenager,” Ting says. There, her father finished high school and began to work as a sales representative for a semiconductor company. “Back then, my dad was one of very few non-Westerners in his Hong Kong office who would walk around with a Wall Street Journal . He thought outside the box by using publications like the Wall Street Journal and TIME magazine to learn and refine his English,” she says. “My dad is a great example of grit and resilience, and that has transferred over to who I am today as a fighter who believes that everything is possible. The inner strength and ambition that my dad possesses continues to inspire how I approach my own career.”

Her own life followed an unlikely path as well, beginning at UCLA where she studied communications. “I wanted to go into broadcast journalism and be the next Connie Chung,” she says. But after college she got a job with the public accounting firm Coopers and Lybrand LLP, now PricewaterhouseCoopers (PwC). “In the early 1990s, it had a unique program where it was looking for liberal arts people with no financial or accounting

“My dad is a great example of grit and resilience, and that has transferred over to who I am today as a fighter who believes that everything is possible.”

background from targeted schools to join their audit practice,” she says. She was one of only thirty in all of US, and the only UCLA graduate, chosen for the program that year.

After PwC, she then went to work at Varian Medical Systems, a global medical device company, in 2000. While there, she decided to leave finance to take a human resources role. “I had no HR experience either,” she says. “The company encouraged me to expand beyond my finance functional expertise and created a role for me in HR. I have been very lucky throughout my career. When I raise my hand to take on something new, the company was always supportive of me and let me do it.”

She left Varian in 2014 to become the senior vice president and chief human resources officer at Affymetrix, a global biotechnology company specializing in genomic tools. When it was acquired by

The Courage to Do Differently

Do Different, Differently. That’s the working title for a book Tracy Ting would like to write. “It stems from the idea that, if I could go back to my younger self and give her advice, here is what would I tell her,” she says.

• Embrace your innovative spirit.

• Be courageous and take calculated risks.

• Surround yourself with great people.

• Gain meaning in what you do.

• Be authentic, use good judgment, and trust your instincts.

• Then, put on your wings and fly.

Avanir’s New Mission, Vision, and Values

Mission statement: Delivering innovative central nervous system solutions to improve the lives of patients and their care communities.

Vision statement: We’ve got nerve! When there’s a patient, caretaker, or provider in need—we’ll protect. When there’s a call for innovative treatment solutions—we’ll answer. When there’s a central nervous system case that seems unsolvable—we’ll challenge. It’s who we are. We’re fighters. It’s why we’re here. We are Avanir.”

Values of CARE:

C: Commit to serving together: Show compassion, get involved and advocate for patients, caregivers, communities, each other, and our company.

A: Achieve with integrity: Be transparent, honest, and accountable for yourself and others.

R: Rise to the challenge: Be curious, explore beyond your comfort zone, and drive innovation. Show grit; be tough, tenacious, and resilient.

E: Energize each other: Engage with enthusiasm, celebrate and contribute to each other’s successes, collaborate and harness our collective power.

Thermo Fisher Scientific in 2016, all the C-suite roles, including hers, were eliminated. So, her family moved from Silicon Valley to San Diego, and she took the next eighteen months off to spend time with her husband and two daughters. “I am so thankful for that time,” she says. When she was ready to return to work, she wanted to make sure she worked for a company she believed in. “I wanted to join a company with an exciting story to tell, a transformational story,” she says. “I love transformations, driving culture change, building engagement, and branding the company as it embarks on a new journey.” That company ended up being Avanir Pharmaceuticals, a biopharmaceutical company focused on bringing innovative medicines to patients with central nervous system (CNS) disorders, where there remains a high unmet medical need.

She joined Avanir in December 2017, charged with leading the HR and corporate communications functions, including setting a strategic direction for its people and the overall company culture toward innovation and growth. She was part of a new executive management team, which decided it was time to share the new Avanir with the world, she says. “To do that, we needed an anchor. To me, a mission, vision, and values statement is the perfect anchor to start that journey to represent who we are, what we believe in, and what we are here to do.” She wanted the new mission, vision, and values to represent the voices of Avanir’s people and she cosponsored a passionate team of employees who created the company’s new value statement. She asked that the new vision statement be gritty and edgy, perhaps even make the readers feel slightly uncomfortable, because the greatest growth and transformation comes from

being uncomfortable, she says. “We don’t want to be like every other pharma company, because we are not like the others,” she explains. “Let’s think outside the box. So, we did.”

Launched in May 2018, the new mission, vision, and values will be incorporated into training sessions, rewards programs, competencies, company processes, and procedures. “For this to live forever, and not just be a nice poster or wallet card, you want people to live it every day,” she says.

Grit and resilience, that fighting spirit, is now written into the company’s DNA—just like it is in Ting and her father. “Every job I had, I didn’t have training for. I was fortunate enough to be in supportive environments and was encouraged to try things I had never done before. In a sink-orswim situation, I will always learn to swim.” AHL

“Every job I had, I didn’t have training for. I was fortunate enough to be in supportive environments and was encouraged to try things I had never done before. In a sink-orswim situation, I will always learn to swim.”

By

Building an Integrated Model of Care

How Yusuf Rashid is partnering with care providers to deliver a system of care that works for Community Health Plan of Washington’s members and payers

When he was growing up in Canada,

Yusuf Rashid saw a trend among the Canadian celebrities he admired. Neil Young, Michael J. Fox, Wayne Gretzky— they all moved to the United States to realize their potential contribution. Rashid didn’t want to pursue a career in Hollywood or sports, but he did see opportunities south of the border in his chosen field of healthcare.

What he saw was a hybrid healthcare system bursting with potential. “You have private systems and for-profit systems that coexist with national andor regional government and not-for-profit models,” Rashid says. “There’s no better environment that you’re going to find out there for innovation and to bring about potential for revolutionary change.”

However, he also saw that these systems incentivized insurance companies, care teams, and patients to pursue different outcomes, leading to fragmented and uncoordinated care. He envisioned a different system in which the pillars of healthcare focused on a single goal. “I believe the best healthcare system is when you have a delivery system where the care teams and the health plan are aligned with the patient’s goal of staying well,” he says.

This vision brought him to Community Health Plan of Washington (CHPW), a not-for-profit managed care plan that was founded by Washington State’s community health centers, where he now serves as vice president of pharmacy and vendor relationship management. Rashid’s role encompasses both prescription drug and medical benefits, giving him a holistic view of the health plan and positioning him to create solutions to more effectively integrate with the community health centers.

Yusif Rashid | VP of Pharmacy & Vendor Relationship Management

|

Community Health Plan of Washington

He began by addressing challenges within his own department. When he joined CHPW in 2014, the pharmacy department was not achieving target cost or quality outcomes. Instead of focusing on cutting costs alone, they refocused their attention on value—delivering the highest quality care at the lowest price. “By focusing on a model that’s built around value, we were able to improve measurable outcomes for adherence as well as dramatically reducing the amount of high-risk medications that were prescribed,” he explains.

To increase the quality of care, they redefined CHPW’s relationships with the community health centers, developing clinical partnerships, sharing data and resources, and launching pilot programs to empower physicians and pharmacists. “What really forged our partnership was designing around the needs of the patient in a collaborative manner,” he says. “Not judging based on bad outcomes, not preaching or patronizing our provider partners, but problem-solving together with the goal of taking the best care of the patient as possible.”

“Guiding the healthcare system to do the right thing for the patient is a core component of our corporate vision at MCG Health,” says Jon Shreve, president and CEO of MCG Health. “MCG is proud to be a component of the informed care strategy that Yusuf has implemented at CHPW. Yusuf’s success shows that putting the patient at the center of care can not only improve patient outcomes but also create efficiencies in the healthcare system as a whole.”

CHPW’s members, and their needs, are diverse, so they tailored their approach to serve each community’s needs. No single approach would work across the entire system. “Depending on which community we’re looking at in the state, we need to be aware of how we can reach

“We’ve developed accurate, but also timely reporting to identify patients that are newly diagnosed and engage them with support in the first couple of weeks of their first prescription fill to give.”

the patient with care that resonates with them, and that recognizes their point of view, as well as their risks and their vulnerabilities,” Rashid says.

One way CHPW is addressing this challenge is by sharing accurate and timely data with community health centers to better target patient engagement efforts, both for individual patients and population health. The twenty community health center partners use six different EHR systems, so CHPW partnered with Arcadia Healthcare Solutions, a health technology company, to aggregate physician and pharmacyclinical-provider data and health-plan claims data between the providers and health plan. “For our community health centers and primary care providers, having visibility to the clinical data that’s in their EHR as well as our pharmacy claims data from the pharmacy world all pulled into the Arcadia system helps us get a more complete picture of the individual patient. It also allows us to see trends in different regions, different

clinics, and different communities using the software,” Rashid says.

In certain Hispanic populations, for example, the data shows that a disproportionate number of patients don’t take antidepressant medication as prescribed. Patients that CHPW care providers engage with immediately after they begin taking medication have better adherence rates in the long run, so Rashid and his team developed a pilot program to better support newly diagnosed patients in these populations with more timely interventions.

“Patients taking antidepressant medications are at highest risk of stopping their medications early on in treatment,” he explains. “We’ve developed accurate, but also timely reporting to identify patients that are newly diagnosed and engage them with support in the first couple of weeks of their first prescription fill to give. This gives them the support to hopefully improve their chance of taking the medication properly in that critical first three months.”

Evidence-based Guidelines and Software Focused on

Improving Patient Outcomes

MCG care guidelines and software are used by 8 of the largest U.S. health plans and over 1,700 hospitals to ensure patients receive appropriate care in the proper setting. Our solutions integrate with virtually every EMR, Utilization Management, and Population Health platform to place the power of vetted, clinical evidence directly in your workflow.

Dr. Guerra’s

Perspective

Integrated healthcare means different things to many different people. This article focuses on the core principles most can agree on. Firstly, we all agree the goal should be to be to achieve one’s best health. Secondly, we agree health should be achieved in a valuable and high quality way; we recognize there are no shortcuts to health. Thirdly, we must respect all those who want to help a person achieve their health as a team of healthcare professionals, coaches and partners. And finally, we are building solutions on actionable data and compassion.

Yusuf Rashid and Community Health Plan of Washington demonstrate the need for data to be made widely available so communities can rally behind a plan of action. It is with this foundation that health may be improved with medication compliance, improving access, or providing education. This concept is fundamental to both for-profits and nonprofits alike.

Guest Editor

Another pilot program empowers pharmacy partners to meet with diabetic patients to reinforce the physician’s initial diagnosis and aid in medication management. CHPW recognizes their community health center pharmacy partners as care providers and reimburses them as such, further integrating the responsibilities of the traditionally separate healthcare providers. “That has resulted in improved engagement from the patient, empowering the patient to understand the importance of their medication treatment, and to improve their follow-up by taking medications as prescribed and getting their diabetes better under control,” Rashid says.

This system-wide integration mirrors the way that CHPW approaches individual patients. On the institutional level, integration means viewing all parts of the healthcare system as interrelated parts of a cohesive care model. On the patient level, CHPW views behavioral, mental, and physical health as interrelated parts of a holistic person. Effectively addressing the patients’ needs requires reenvisioning the care delivery system. “The need is so great, but unless you have an integrated, holistic approach to patient care, it’s going to be very difficult to actually improve outcomes for members,” he says.

When he came to the US at the beginning of his career, Rashid saw an opportunity to revolutionize a system through an integrated model and, in particular, through using managed Medicaid to serve the most vulnerable patients in the healthcare system. “When I look at the problems with healthcare in the US, I can’t think of a challenge that’s closer to the problem we’re trying to solve than managed Medicaid,” he says. “If we can solve the challenges in managed Medicaid, I think the rest of it is going to be easy.” AHL

The Business

Healthcare is a constantly evolving industry that demands executives to plan ahead. Often, this means business leaders need to address departmental- or company-wide issues to remain focused on driving innovation and devising strategies to maintain a high level of care.

98. Leah Klinke details how she led a revenue cycle revolution at WVU Medicine by implementing Epic for billing system-wide

101. Jamie Harkins discusses how standardizing processes throughout OSF HealthCare led to improved business results

110. Brian Zuck explains how the shift to category management has improved the performance of Essentia Health’s supply chain

118. Emma Yamada dives down the data hole to help Holy Name Medical Center stay on the leading edge of healthcare

122. Communication is the cornerstone to Heather Obora’s successful supply chain strategy at Inova Health System

By Randall Colburn

An Epic Transformation

When Leah Klinke executed WVU Medicine’s decision to switch the hospital’s billing functions over to Epic, she worked to ensure no jobs would be lost in the transition

In her early career as a business consultant, Leah Klinke once joked that she would never work in a hospital’s billing office. “They just looked like they were always working so hard,” she says. “Constantly running around, working so hard for every penny. It just looked like a really stressful job.”

As chance would have it, Klinke soon found herself knee-deep in billing when she took the position of director of patient financial services at WVU Medicine. In 2016, she was promoted to the assistant vice president of hospital revenue cycle.

Klinke says she loves the work and is doing her part to make the billing environment less hectic by standardizing key processes across WVU Medicine’s eight different billing sites, which are scattered throughout rural West Virginia.

Previously, the locations didn’t operate as a united, streamlined system, Klinke says. “Everybody was

doing something different,” she says, noting their use of systems such as McKesson, Allscripts, and Meditech. In August, however, WVU Medicine kicked off an initiative to convert each hospital to Epic, a top-of-the-line software suite that provides a host of benefits in the realm of billing, not to mention numerous other healthcare functions.

Epic has no shortage of benefits for the organization. Klinke says the system allows her to develop strategies and set goals for her team and it also provides simple solutions. For example, if there was an error in choosing one’s coverage in the previous systems, the error would snowball to such a degree as it traveled throughout the system so that efforts to correct it required a great deal of manual intervention on the back end. Epic has the ability to auto-select coverage based on eligibility, which not only saves time but allows for fewer errors downstream.

Leah Klinke

Assistant VP, Hospital

Revenue Cycle

WVU Medicine

WVU Medicine’s flagship hospital, J.W. Ruby Memorial Hospital, has been using Epic since 2008, and one of Klinke’s first projects when she started in 2012 was bringing the company’s two Eastern Panhandle hospitals onto Epic. In that process, however, the billing functions of those offices were brought to the Morgantown billing office as part of an initiative decided before she began her tenure. As a result, Klinke says they were able to only retain a handful of employees, meaning WVU Medicine lost a great deal of billing expertise and, due to an influx of new employees, needed to “start from scratch from a training perspective.” This is an outcome she hoped to avoid with WVU Medicine’s Epic conversion efforts.

“One of our goals through the transition was not to do what I think a lot of systems have done, which is to close down billing offices in these rural areas of West Virginia and move all the jobs to Morgantown,” she says, citing the common practice of a company corralling all of its billing staff into one large service center.

The problem is that, in doing this, a company is often taking away jobs from communities that desperately need them. “Being in a rural state like West Virginia, where there aren’t a lot of good jobs in these communities, we don't want to be that large employer that consolidates jobs in areas where there aren't jobs.”

She continues, “One of our objectives is to figure out how we can optimize operations and deliver a high-quality product while retaining the expertise and the jobs in the local market.”

It helps having a system such as Epic, which makes it easy for the billers at WVU Medicine’s myriad locations to communicate. “With this system, we can’t operate independently. Everything that we do is now interconnected,” Klinke says.

Greg Ellis

Previously, it was easy for each office to operate in a silo. Now, Klinke says that WVU Medicine leaders who don’t often get the chance to circulate to different sites have a renewed sense of alignment and connection with staffers throughout the state.

“We really understand what's going on in their system, and we have regular connections with each of the sites to talk through their challenges and everything,” she says. “We’re also building relationships among the leaders by having them use each other as resources. Communication has gotten much better, as has the transparency into what’s happening in each office. All you need to do it just pull up the Epic dashboard to see what's going on.”

Still, even this staff-centric approach comes with its own unique challenges. Epic will have a major impact on the dayto-day functions of these billing offices, and Klinke notes that this changing of responsibilities among leadership can be “perceived as a narrowing of scope.” What Klinke and her team are trying to convey is that, although a director’s or manager’s responsibilities might be evolving, the actual scope has broadened considerably.

“Trying to communicate that in a way that employees receive positively is certainly a challenge,” says Klinke.

The key for Klinke is in conveying to staff and executive leadership at each hospital that the Epic rollout and staff retention initiatives she’s pursuing will result in greater efficiencies and better results from billing functions that come with little additional cost. Over time, however, those results are bound to reveal themselves organically, with Epic’s functions working hand in hand with Klinke’s leadership to ensure a smooth transition.

It’s essential that healthcare embrace efficiency and technological innovation, but, as Klinke demonstrates, sustaining the communities at the heart of an organization is just as important.

By Charlene Oldham

Simplified & Standardized

Jamie Harkins began her college career as an engineering major. Although she eventually left that behind in favor of a career with more personal interactions, she has been building a lot of bridges lately, at least in the metaphorical sense—first in her role as vice president of risk management for OSF HealthCare and now in her current position as vice president of quality, safety, and risk management.

OSF is a faith-based health system that currently includes thirteen hospitals and other facilities serving people in multiple states. But, until 2017, each had separate systems for tracking data on events such as falls in the facilities and patient complaints. As part of its efforts to standardize and streamline practices, OSF purchased a raft of software and services under the Midas Health Analytics Solutions care performance platform that it rolled out to all its facilities in the summer of 2017.

“I think we were previously failing to leverage our power as a system by looking at our performance system-wide, and that's really what this offered us,” Harkins says.

But the implementation process proved a bit more challenging than expected, in part because OSF’s diverse holdings include hospitals, a large multispecialty group, an expansive home health care practice, and more. Project planners first had to find a way to implement the same processes across a diverse array of settings before it was even practical to use the same performance platform to collect and analyze clinical quality data.

“For example, each facility had event reporting and had a totally different way of doing it, and everybody had strong opinions about the right way of doing it,” Harkins says. “There had to be a recognition that we had to find one way of doing things and, if it didn’t advance patient safety, it wasn’t worth doing.”

OSF’s senior leadership team saw the value behind standardization and played an integral role in establishing guiding principles and prioritizing the project, she says. The resulting platform has elements that don’t apply in every care setting in order to offer what each facility type needs. It’s also more laser-focused on using clinical data analytics to improve patient safety and the reliability of care rather than collecting data with a focus on report writing, trends, and record keeping.

Jamie Harkins spearheaded the effort to unify processes across OSF HealthCare, resulting in improved performance system-wide

Along with the implementation of a new event reporting system came a new philosophy from leadership. “We’re really trying to steer away from just counting events reported and using that as any kind of assurance of our level of safety, because it’s not a reliable measure,” Harkins says. “Just because fewer falls were reported doesn't mean fewer falls actually happened. We are now

looking beyond the events themselves and rather trying to understand what caused it to happen in an attempt to learn how to prevent harm.”

Coordinating clinical data and analyzing it at the system level allows the information to be examined by everyone from clinicians in hospital settings and other facilities within the OSF network, to leaders, quality and safety experts, and risk management specialists in OSF’s headquarters in Peoria, Illinois. Sharing system-wide information allows every facility to better identify opportunities for improvement. It also makes it easier for the management team to devote dollars and other resources to the areas where they will have the biggest impact on improving patient care and reducing the likelihood of adverse events, says Harkins.

“If the same thing causes more than one event, then we failed to learn from the first one. It’s not just about counting. Now, the whole system can learn from one hospital, whereas that was more difficult in the past,” she says.

As part of its overarching strategy to leverage its strengths as a larger system, OSF is also moving to standardize its peer review process, which is being rebranded as professional practitioner evaluation. Peer review is a long-standing practice in the healthcare industry and was already part of the culture in OSF’s medical group and at the hospitals OSF acquired, Harkins says, but there wasn’t a system-wide way of doing it.

“If there is a performance problem at one hospital, we'd like to be able to implement any intervention or corrective action at all our hospitals,” she says. “And, if there is a practitioner having difficulties in a particular area, we want to support them in improving performance early and proactively. To accomplish this, we needed similar processes, language, and a shared philosophy.”

Details of the system-wide evaluation process are being finalized now in a process that Harkins has found surprisingly smooth.

“I thought there would be more resistance to the change because physicians and medical staff are notoriously autonomous,” she says. “But, at the same time, if you present them with something that makes sense and isn't overly laborious, they really will get on board, because they have a lot of ownership into their own performance and quality of care and they believe in the review process.”

Jamie Harkins VP, Quality, Safety, & Risk Management OSF HealthCare

“If the same thing causes more than one event, then we failed to learn from the first one. It’s not just about counting. Now, the whole system can learn from one hospital, whereas that was more difficult in the past.”

Tomorrow’s results require commitment today

On behalf of 52,000 colleagues worldwide, we salute our friend and client Jamie Harkins for her commitment to process improvement to empower results for OSF HealthCare.

Aon is a leading provider of risk, retirement, reinsurance and health solutions to the health care industry.

Just as with clinical data, all the evaluation information will eventually be housed within a single system, simplifying and supporting processes including physician recredentialling. Data on everything from clinical events, claims information, and patient complaints to physician performance will be easily accessible across the entire OSF network, it will allow leaders to more thoroughly assess the reliability of systems impacting the organization.

Considering so much information will be collected in a single database, it makes sense that Harkins’s official job title has recently expanded to include quality and safety. Although she’s supported activities in each area for a while, OSF HealthCare’s increasingly data-driven approach to improving patient care will make it easier to coordinate functions across the risk management and quality and safety teams. And the two already experience a lot of crossover when it comes to factors such as patient safety event investigation and risk assessments, Harkins says. In her newly branded job, she will be working closely with both teams and continuing to hone OSF’s focus on operating as one coordinated system. Beyond that, she tries not to get too caught up in titles and formal job descriptions.

“I’ll just do what’s best for the organization— whatever I can do to help the organization provide the best care to patients and fulfill its mission. I figure I can’t go wrong there.” AHL

For more information visit aon.com or contact: Scott Saunders Senior Vice President 412.594.7583 scott.n.saunders@aon.com

By Jeff Silver

The Perfect Balance

Trisha Gillum reveals the secrets behind optimizing cost, quality, and outcomes at Kettering Health Network

As director of supply chain management and purchasing for Kettering Health Network, Trisha Gillum is responsible for sourcing everything from toilet paper to orthopedic implants across 8 hospitals and 175 physician practices. In every case, she and her team act as consultants that address the network’s many different challenges.

“A particular change might increase spend on supplies, but if it reduces false positives on contaminated blood cultures, for example, it improves quality and the patient care experience,” Gillum says. “As we assess organizational needs against what vendors offer to address them, we constantly strive for the right balance of cost, quality, and outcomes with a focus on the patient.”

One of her tactics in achieving the right balance is decreasing variability across Kettering’s clinically integrated network. By standardizing what is kept in inventory, she is able to contribute to results that are more consistent, of higher quality, and at lower costs.

“Many customers we speak to are trying to crack the standardization code,” says Rick Hammerly, Medline’s division vice president of sales. “By serving all care settings, we provide full transparency to supply chain teams about pricing and process to drive improved outcomes and savings.”

Gillum’s most important strategies in reaching those goals are leveraging data and transparency, and building relationships with executives, physicians, and clinicians. Once she and her team have identified the appropriate data, which is culled from databases provided by Kettering’s financial decision support department, Gillum and her team use the information to explain the reasons for making changes to all stakeholders. The team identifies a physician champion who can follow up with peer-to-peer conversations to help build clinical support while the supply chain team educates executives on reasons for altering the status quo.

The most useful data, Gillum says, often focuses on best practices or the research that drives them. That might raise questions such as, “Why spend five times more than is necessary to reach a particular goal?”

“By serving all care settings, we provide full transparency to supply chain teams about pricing and process to drive improved outcomes and savings.”

Transparency contributes to making changes by letting the data speak for itself. In one instance, four cardiac stents with a $500 variation in price were categorized as green, yellow, or red to represent cost—red indicating most expensive—and overall value. Monthly reports published their frequency of use, who used them, and when the applications were clinically appropriate.

“We raised awareness by specifying which product was better for specific patients and outcomes,” Gillum says. “We didn’t take away choice but helped highlight the best uses based on value and appropriate clinical practice, and no physician wanted to be seen as having the most red ratings.”

The monthly reports resulted in such a dramatic change—physicians stopped using the red-rated stent—that the vendor renegotiated its price in order to reposition it with a green rating.

The supply chain team manages a list of up to one hundred different projects at any given time. The team is split into smaller specialized groups, such as analytics, systems, and sourcing. This enables each to act as primary points of contact for different service lines and to build key relationships within specialties. It also creates narrower bandwidth on which each specialized group can focus.

“By serving all care settings, we provide full transparency to supply chain teams about pricing and process to drive improved outcomes and savings.”

The project queue itself is prioritized by what Gillum calls pain-gain assessments often made in relation to white elephants—products or services that have a high degree of passion and emotion around them. This might be displayed, for example, as a physician group that threatens not to perform a particular type of procedure at Kettering if a specific change is made.

“We can take a year to work on a very challenging project that will save $500,000, but that also generates lots of pushback requiring tremendous manpower to respond to, carries high implementation cost, and forces us to spend excessive political capital,” she explains. “Or, we can tackle five $100,000 projects that will be easier to implement. It all boils down to creating the most overall value.”

Because of her background and experience, Gillum is well positioned for tackling all the challenges faced by a modern supply chain leader. She has worked extensively in healthcare finance and decision support, which gives her insight into Kettering’s business side. But she also worked in the operating room environment where she gained firsthand knowledge of clinical and operational procedures. This combination of expertise enables her to speak effectively whether she is presenting a business case to CFOs and other executives or explaining the medical reasons for making a change to clinical teams.

“If I’m speaking with a financial group, I can help them understand the clinical concerns doctors may have regarding a proposal we’re considering,” she says. “Otherwise, they might think the physicians are just saying no for no good reason.”

That was the case when Kettering was examining the possibility of prohibiting sales representatives from the

operating room during orthopedic surgeries. In that case, Gillum pointed out that the representatives actually provide value by ensuring that surgical implants are ready for use and being able to provide immediate answers if questions arise about the devices.

Gillum’s standardization efforts also extend to Kettering’s pharmacy practice. She has helped develop network-wide product committees that evaluate and compare the clinical impact of various medicines. She also helped launch the Medication Assistance Program. The program matches specific patients and their treatment needs to drug manufacturers’ programs that provide financial assistance or free products. After six years, the program has generated $10 million in savings.

Gillum and her team are part of an ongoing evolution in healthcare supply chain management. She describes the traditional approach as buying products, moving them from point A to point B, and showing the resulting costs. In addition, supply chains must now assess data from multiple sources, understand how products are being used, and provide solutions to address a variety of needs and challenges. Those include offsetting reductions in Medicare and Medicaid reimbursements, supporting services delivered via telemedicine and outpatient care, as well as increased focus on overall patient well-being.

“We need a holistic understanding of how products are being used in specific cases to ensure the best financial and clinical value,” Gillum says. “We accomplish that by being transparent and answering questions, listening to our partners, and building relationships so that we work collaboratively. We never want to dictate changes that make their jobs more difficult.” AHL

By David Levine

The (Supply) Chain of Command

Healthcare has no shortage of acronyms and abbreviations, from A1C to ZULU (that’s Greenwich Mean Time, according to the Centers for Medicare and Medicaid Services). Here’s a new one you may not know: PIR. That, as coined by Medline Industries, stands for perioperative inventory rationalization. The PIR team consists of clinical and logistical experts, and it is Medline’s way of helping hospitals gain better control over operating room supplies. A more organized storage area means clinicians can collect supplies faster and easier per procedure, increasing both their productivity and satisfaction. It also means a reduction in inventory costs since the least-used and expired products will be removed from the perioperative storage area entirely. Hospitals, after all, are big businesses faced with growing expenses. On average, 70 percent of a hospital’s supply budget is dedicated to the operating room. Managing and controlling that supply chain is critical to ensure patients receive the appropriate supplies exactly when they need them and also to ensure hospitals are operating at their maximum efficiency levels. Medline’s PIR program is an example of a healthcare company not only distributing medical supplies, but going the extra mile with additional consultative services to address customers’ key pain points.

Medline, based in Northfield, Illinois, is the nation’s largest held manufacturer and distributor of medical supplies, distributing more than eighty thousand of its own med-surg and lab products, and distributing more than 550,000 Medline-brand and national brand products to US customers. Its capabilities lie in providing products, education, and services across the continuum of care with offices in twenty countries. In 2017, Medline exceeded $10 billion in overall company sales.

Medline Industries is rolling out a new program to help hospitals manage and control their inventory of surgical supplies

PIR has been in development for two to three years, with several programs implemented across the country. “Operating room supply management is a critical pain point we hear about from customers,” says Ron Evans, Medline’s market director, sterile procedure trays (SPT) perioperative projects. “Demand for our PIR program grows year over year as more customers are finding there is a lot to gain by attacking the inventory management process, which has historically taken a back seat, relatively speaking, to negotiating with vendors on product unit price. The purchase price of a product continues to be critical; however, customers are realizing there are also significant savings to be achieved when proper focus is placed on the supply management process.”

For example, when a customer needs a new perioperative pack program or wants to revise its current

Ron Evans

Market Director, Sterile Procedure Trays & Perioperative Projects

Medline Industries

“Some customers believe the answer is fewer packs. We peel the onion back and show them how that can also lead to wasted components and a less efficient case pick process.”

–Ron Evans

program, Medline will request a surgical procedure report that reflects the type and volume of surgical procedures performed over a twelve-month period. It analyzes the entire spectrum of perioperative products, including reports on purchase order history and the most recent inventory count. “Through that data, we can uncover products usage, not to mention products that are no longer active, move slowly, or are stored in multiple locations without a consolidated approach to inventory management,” Evans says. Medline’s blend of analytics based on usage, logistical suggestions to improve efficiency, and re-engineered packs is a “threeway combination that makes a major impact on the daily supply chain process,” he says.

“We give our customer, once the new specs are devised, a list of components and the associated volume, so they can lower the volume of inventory they carry. There is still need for some backup, but we can radically reduce shelf stock,” Evans says.

In addition, the surgical procedure data is transformed into a procedural matrix that groups procedures together that require similar product usage. And Medline sends a clinical nurse to the client to dig deeper and find other areas to cut waste and improve product control. “We sometimes find inappropriate use of certain custom packs. We find very often they pick additional components and, depending on the specialty, they are wasting other components,” Evans says. If the client has sufficient volume, Medline builds a program for that specific category to be more efficient.

“Some customers believe the answer is fewer packs,” he says. “We peel the onion back and show them how that can also lead to wasted components and a less efficient case pick process. It impedes their ability to set up and turn over operating room suites, which is a key measure of operating room productivity these days.”

Although the impact of a PIR program is directly related to the customer’s current situation, Medline’s team has seen a reduction in the on-hand inventory investment of 250,000 to 500,000. Improved inventory turns and the elimination of dead stock and duplicate inventory in turn improves space utilization. From an operating room efficiency perspective, it has shown to

Tim Carlson

lower case pick time and improve overall efficiency by 30–40 percent, including operating room suite setup.

And this is not just a problem in the operating room. Many healthcare facilities already run lean. Many supply chain department team members are focused on day-to-day operations, which means they have limited bandwidth for special projects to streamline operations. Robert Jones, Medline’s director of supply chain services, says that the company has a team dedicated to supply chain optimization. His team consults with health systems to develop a tailored approach that accelerates customers’ supply chain strategies, and Medline offers programs to support health systems’ biggest needs, whether its related to managing people, streamlining processes, or utilizing technology to improve transparency and automation in a health system’s supply chain. “Medline can supplement with labor for special projects as needed so health systems’ internal talent can remain focused on smooth day-to-day operations,” Jones says.

“For example, we have multiple inventory management technology solutions to support the chain of custody of any product for better visibility into where the product is at all times from a hospital loading dock to the patient,” Jones says. “This gives visibility into what patient it went to and automates the billing process. That way the hospital appropriately tags each product to the right patient for proper billing.”

Medline has invested in PIR and other supply chain program initiatives as part of its overall effort to change how it interacts with its customers.

“The company made a conscious decision to move our customer relationships to a more solutions-based approach,” Evans says. “That is more beneficial to our customers, and we feel that it is the appropriate response to the pressures our customers face in the marketplace. We can identify cost savings early to make sure it is worth its weight in financial gains. There is a pain point there, and the reception has frankly been more positive than we anticipated. By addressing pain points, we become not just a product provider but their distribution partner.” We want to be their supply chain partner.” AHL

“Medline can supplement with labor for special projects as needed so health systems’ internal talent can remain focused on smooth day-to-day operations.”

–Robert Jones

Robert Jones Director, Supply Chain Services

Medline Industries

By Randall Colburn

A Unified Team

Dynamic partnerships help Brian Zuck leverage category management to drive profitability at Essentia Health

When Brian Zuck joined Essentia Health, the company was in the process of standardizing its supply chain operations. That meant aligning processes and procedures across seventy clinics and fifteen hospitals throughout Minnesota, North Dakota, Wisconsin, and Idaho. The challenge for Zuck, Essentia’s administrator for supply chain management, was that while his team was mandated to drive the change, other departments were at differing stages of readiness and willingness to change their decision-making models for supplies and services.

“Supply chain was an early adopter in a newly centralizing organization,” Zuck says. “It was difficult to achieve the progress we hoped for because implementing the desired changes wasn’t always the top priority for other participants on our sourcing teams.”

At the same time, supply chains, in general, were evolving away from group purchasing organizations (GPOs), a thirty-year old concept in which third-party contractors use the inventory volume of their group members to negotiate pricing. Instead, category management was gaining momentum by creating and executing strategic plans that guide resources and procurement tactics to generate and sustain enterprise-wide value.

After several years at Essentia, Zuck had the opportunity to assume a position with a large energy company that allowed him to experience and learn about category management firsthand. In 2015, he was able to return to Essentia, bringing his newly acquired knowledge and expertise with him.

“Category management enables us to more holistically and proactively manage our expense categories,” he explains. “It lets us drive the sourcing and contracting of our own supply chain—while still working as partners with GPOs—by making more intentional decisions that take our entire value proposition into account.”

An important factor in successfully implementing category management has been building trust into the relationships between the supply chain team and Essentia’s physicians and clinical staff. That process began with the team developing objective analytical data that was combined with evidence-based data provided by the physicians and clinicians. The exchange also helped Zuck gain a deeper appreciation of the important differences between commodities, like saline solution or trash can liners, and complex, highly specialized devices, like orthopedic implants.

“Surgeons learn different techniques that require different supplies to perform a given procedure and maintain individual comfort levels and the highest quality patient outcomes,” he says. “It’s not as simple as standardizing by deciding everyone has to use the same rod or screw.”

In one instance, by accommodating individual physicians’ preferences, the teams cooperated to develop a preferred supplier model with capitated pricing that limited the number of vendors, set a price point for hip and knee replacement joints, and reduced costs by $2.2 million, about 25 percent.

New partnerships have also been created with several important outside vendors. Texsys has supplied Essentia with a logistics platform that has enabled the company to establish truly consolidated service centers. It automatically integrates with all the various modules of the clinical system, incorporates demand history, and results in better management of inventory levels, turn rates, and replenishment.

Brian Zuck Administrator, Supply Chain Management

Essentia Health

Accurate, Consistent, Repeatable

When Brian Zuck left the army as a logistics officer with the rank of captain, he was used to a strict process-oriented system that produced accurate, efficient, consistent, and repeatable results. “There were shortcuts, but they usually ended poorly,” Zuck points out.

He’s brought the same reliable results to Essentia Health, but admits he had to adapt to a level of persuasion to be effective in the civilian word. “It calls for a softer sell,” he says. “That approach, though, forces you to think through what you’re asking people to do, which facilitates beneficial feedback and better buy-in on the back side.”

The system is on its way to providing real-time visibility into productivity and into every inventoried item. Zuck expects that the ability to eliminate expiration date waste alone has the potential to result in up to $1 million in savings.

Nihon Kohden, a manufacturer of patient monitors, is another external partner that participated in Essentia’s first successful system-wide capital standardization effort. Even though standardizing these essential pieces of equipment was a priority, individual facilities followed different capital budget processes and schedules. Additionally, the monitors themselves have a five- to ten-year life span, so if one hospital bought them the year before, it could be up to nine years before it was prepared to replace them. However, according to Zuck, Nihon Kohden was able to create “creative scheduling” and value-based pricing that facilitated a two-year cycle for completing the standardization at fifteen hospitals.

“We approach every customer relationship as an alliance,” says Nihon Kohden America CEO Dr. Wilson P. Constantine. “For Essentia, this meant working closely with their diverse stakeholders to ensure a smooth transition. It also meant delivering value through our premium-as-standard product philosophy.”

When asked to characterize the overall results that the change to category management has produced, Zuck refers to a graphic that used to be common at healthcare conferences. It shows a triangle with sales, physicians, and hospitals and administrators each represented at different points, with the strongest relationships being between sales and physicians. But now, the supply chain team, the physicians, and clinical staff all work together to engage with the supplier market.

“One of the goals of category management is for supply chain to work with physicians and clinicians to drive value for the hospital and suppliers,” Zuck says.

“We want to establish less competitive bidding and to be able to drive value through dynamic supplier relationship management.”

He believes that being inclusive and transparent are critical to achieving those goals.

“We have to engage and include the executive suite, the person that uses a device, and everyone in between,” he says. “When it comes to supply chain in healthcare, it’s definitely a team sport.” AHL

us.nihonkohden.com

By Charlene Oldham

Weathering the Storm

Jennifer Moitoso shares her secret to leading her team in the wake of a merger and the constantly changing biotech industry

Back in 2014, during a major shake-up in Shire’s corporate organization, Shire’s IP team lost three attorneys within a few weeks of one another, making Jennifer Moitoso the sole patent attorney for Shire’s human genetic therapies unit. For a period of time, Moitoso shouldered the workload of four patent attorneys in a company where research and development was incredibly active and business development required a significant amount of her time. While most people in her position would have rushed to recruit reinforcements, Moitoso instead spearheaded a significant search to find just the right people to rebuild the team.

“I knew to get the hiring right and to really get the attorneys that not only had the best skill set for what we needed, but also the right frame of mind to work as a team, it would take time,” Moitoso says. “Even though it wouldn’t be fun for me in the meantime, it would be worth it in the end.”

Filling all three vacancies took more than nine months, but the lawyers who joined the team then are still with Shire today. So Moitoso, now vice president

of intellectual property at Shire, maintained the same patient and attentive approach to integration when Shire acquired Baxalta Inc. in 2016, doubling the size of the intellectual property department.

Moitoso says the biggest challenge was trying to ensure open mindedness to change, regardless of whether you were a legacy Shire or legacy Baxalta employee. “That’s something that’s initially hard to do because people have their own way of doing things and they like the way they have been doing things,” she says. “Change can be stressful and hard to accept, but a team can’t continue to operate on two different tracks because our clients need to be able to expect acrossthe-board consistency.”

And integration, especially at that magnitude, isn’t easy. Something as simple as putting in an expense report or as substantial as obtaining approval to submit a regulatory filing might have changed under the combined company’s new business model. Moitoso says the team is still adjusting to some challenges and changes that came with the merger.

Today, Shire has more than twenty-two thousand employees across more than one hundred countries who work on developing and delivering drugs and other therapies, often to those facing rare, life-threatening diseases. Combining companies hasn’t led to layoffs in the intellectual property group, but combining cultures and doubling the size of the team—and the company as a whole—has forced Moitoso and other managers to make some tough decisions on how to make the best aspects of both companies work together.

Moitoso believes that clear communication, consistent follow through from managers, and a robust team culture is essential for helping employees through growing pains and periods of transition. For instance, even something as basic as sending clear, coherent follow-up emails can make employees more comfortable and welcome in the workplace, Moitoso says. This leadership has also garnered Moitoso praise from her business partners.

“Jennifer is an innovative and insightful leader within Shire’s legal department,” says Angus Chen, partner, PhD, at Haug Partners. “She is able to transcend legal issues and counsel Shire on its ultimate business objectives. It is a pleasure to collaborate with Jennifer in defending Shire’s intellectual property.”

“I really believe that a positive, team-oriented culture is key to retaining people and having them do their best work,” she says. “If you’ve got employees who are happy and feel they are respected and they are doing something worthy of their time and effort, then you’re going to get the best from them.” Moitoso believes employee satisfaction and happiness is the key to maintaining a premier team, as well as respecting each employee’s personal time. As the mother of three young boys, she understands employees have lives and responsibilities outside the office.

“I understand the need for employees to feel like they have some flexibility in terms of when and where they do their work,” she says. Moitoso makes it a point to offer that flexibility to her team members with the understanding that clients must always receive the same exceptional support and service.

Moitoso VP, Intellectual Property Shire

“I really believe that a positive, teamoriented culture is key to retaining people and having them do their best work.”

Jennifer

We congratulate our friend

Jennifer Grant Moitoso Vice President, Intellectal Property of Shire

on her continuing leadership and accomplishments.

The world’s leading organizations choose Proskauer as a strategic partner to drive their business forward. We are entrepreneurial, inclusive, and committed to making a difference for good.

Our 725+ lawyers serve clients from 13 offices in the Americas, Europe and Asia.

“We have to remember that everything we do affects the lives of people with debilitating diseases, many of whom are children who may not live until their first birthdays if they don’t get the drugs we’re providing.”

Moitoso knows that its critical to keep the company’s core business at the forefront of her team’s mind. But that’s not always easy given the dramatic changes going on in the biotech and pharmaceutical industries, or even for her team in the near future. Shire is preparing for a merger with Takeda Pharmaceuticals, which can sometimes make it difficult for people to focus on their day-to-day duties when they are uncertain about their future, she says.

For this, Moitoso will draw from her previous experience and embrace the future as she did in the past. “I think the big challenge is to pull everyone into focus and get them to remember what our ultimate goal is and who benefits from our everyday work: the patients,” she says.

“We have to remember that everything we do affects the lives of people with debilitating diseases, many of whom are children who may not live until their first birthdays if they don’t get the drugs we’re providing. We need to continue to get our jobs done and get them done well—because people are counting on us.” AHL

By Will Grant

“In our world, the data hole is this strange mix between a black hole where everything gets sucked in and nothing can escape, and the rabbit hole that Alice gets lost in.”

As director of data science for New Jerseybased Holy Name Medical Center, Emma Yamada speaks with a veteran’s respect of a phenomenon she encounters on a daily basis. Yamada has endeavored to keep a recently united analytics team on the same page, both by embracing data’s potential and avoiding the unnecessary. She and her team are helping Holy Name get better data faster, while ushering in exciting opportunities for artificial intelligence and machine learning.

Yamada heads the research and development team under the recently reconfigured data science department. Along with ACOs, bundled payments, and consumer-based data Holy Name purchases from vendors, Yamada says her team has a slightly more abstract charge: “If it’s new and different or something we haven’t done, it comes through us first,” she says. We figure out where we’re going to go with it.”

Although new and different can initially be exciting, it can also mean working to quantify data with thousands of potential variables and limitless potential pitfalls. Yamada says that working to get her team to understand and not fear data holes has been essential to keeping projects afloat. When it comes to code writing or data discovery, Yamada says a data hole can be a wonderful thing. “You become super focused and hyper-aware of the relationships,” Yamada says. “We have timeout days to just bang out projects with no meetings and no phone calls. You can just get in the zone.”

The downside of a data hole can occur when it comes to collaborating on a project. “One person can be zoned in and maybe not clearly articulating their position,” Yamada says. “It’s convoluted and if it’s passed off to the next person, they can’t find their way.” She says weekly check-ins become imperative and she makes sure her team documents as they go, instead of writing about how they did something after the fact. “It helps to take pause,” she says. “You’re not completely outside of what you’re working on, but still taking a breath so you don’t get lost in your own thoughts,” Yamada says.

The recent creation of the research and development team places Yamada

Director of Data Science

Emma Yamada

Holy Name Medical Center

Jeff Rhode

and her team at the tip of the spear when it comes to potential innovation using new technologies. “We look at leveraging artificial intelligence and machine learning to support clinical decision-making,” Yamada says. “Can we make predictions that help our providers make better decisions faster?” She certainly thinks so. Yamada says the influx of monitoring devices such as Fitbits and Apple Watches offer a virtually untapped array of valuable data that could be used by health systems. For Yamada’s team, it comes down to working to prevent both high-cost and high-risk problems.

Using predictive data to manage Holy Name’s ACOs has been a high point of success for the research and development team. By focusing on specific patient indicators, Yamada’s team has been able to successfully manage a patient-doctor population ratio of four thousand to one. “Everyone can see who they need to see, get where they need to be in terms of their health, and it’s not going to burn out the care team,” Yamada says. Yamada’s lean team makes outside partnerships essential. “Leapfrog Group helped us make sure our tech

“We look at leveraging artificial intelligence and machine learning to support clinical decision-making. Can we make predictions that help our providers make better decisions faster?”

Jeff Rhode

stack was built to support getting through the amount of data that we have,” Yamada says. “That was huge for us to have them and their experience. As a leader early in my career, it’s imperative for me to leverage the experience that people can contribute to us. The company has decades of experience and it has been down this path before.”

Alteryx, DataRobot, and Tableau have also been essential for the analytics team to pare down to the essentials to sift through endless data sets. “From a strategic standpoint, we think of every data project similar to writing a book report,” Yamada says. That means constructing an initial outline that helps prevent grabbing unnecessary data irrelevant to the project.

Yamada says the key to improving Holy Name’s analytics processes is the final step of successful data delivery. “How do I make it better even if they didn’t ask for it?” Yamada asks. The focus on evolution and improvement might explain Yamada’s rise and why Holy Name Medical Center’s data science team won’t be losing any numbers down the data hole. AHL

Leapfrog Group is proud to have partnered with the Holy Name team to strategically transform their operational and clinical data analysis to better serve patients and lower the cost of care.

We congratulate Emma Yamada and the entire Data Sciences Department on this well-deserved recognition.

Leapfrog Group is committed to helping today's healthcare and life sciences leaders transform their clinical and operational business processes and technologies to solve today's critical healthcare challenges. Our advisory and consulting capabilities help our clients improve care and financial performance, delivering increased patient, provider, and payer satisfaction.

Learn how Leapfrog Group can help your business!

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Emma Yamada is on a mission to help her team leverage data in a way that helps the business most effectively.

By Lior Phillips

A Commitment to Collaborate

How Heather Obora’s focus on open communication and innovative thinking have made supply chain an essential part of patient care

At first glance, Heather Obora’s move into healthcare might seem like a massive change. Before joining Inova Health Systems as vice president of supply chain management in 2017, she’d spent nearly a decade and a half across roles as chief procurement officer of Chicago Public Schools and the Washington Metropolitan Area Transit Authority. But thanks to her powerful focus and perspective, Obora sees a single thread connecting these experiences quite clearly: each organization focuses on the public good, providing important services to people that rely on them. “I want to be a part of helping people, so the healthcare industry was a natural fit,” she says. “Supply chain is actually closer to the bedside than people think.” And by encouraging open communication and optimizing workflows, Obora is not only ensuring that the entire organization sees the department as essential in the healthcare process, but also making the best possible impact on patients’ well-being.

Beyond the philosophical ties between her leadership roles, Obora notes that there is an inherent similarity in the foundation of the roles. She sees her experience in the diverse array of accounting, contracting, sourcing,

purchasing, and supply chain, among other subjects, as providing the background that Inova required. “My belief is that if you have those foundational tools, you can actually do the work anywhere, in any industry,” she says.

Employing that foundation, however, requires intensive integration with Inova’s large teams. The Washington, DC-area system encompasses 5 hospitals, more than 1,700 licensed beds, and more than 16,000 employees. That scope might be intimidating to some, but because she has worked in large and prominent organizations before, Obora brings a hands-on focus to the role and ensures that the rest of the organization does, too. “It’s easy for me to assist, troubleshoot, and work with my clinical leaders so that they understand what we do, and I understand what they need,” she says. “We can work together to make better strategic decisions that end up in better patient care.”

In addition to communicating on behalf of the department, Obora works to drive collaboration and interconnection for her team members as well. She consistently monitors the workflow to see where she needs to step in, make final decisions, or remove roadblocks

that are hindering the department from providing the best possible solutions. An open-door policy and down-to-earth demeanor make that commitment to team-wide success apparent. “I don’t stand on pomp and circumstance,” Obora says. “I’m a full proponent of having more people involved in process and listening to more people’s opinions.”

The results of those open lines of communication have been remarkable.

Recently, Obora’s team led an in-depth process of identifying which materials needed to be in store rooms at what times, and what materials were being purchased and going unused. To determine those needs, Obora followed a 5S process, in which her team and the clinicians sorted through the analysis of each item, line by line, to ensure that it accurately represented need. “Clinicians know based on their patient population on any given day or week what their material utilization is,” Obora says. “We used this process to streamline and reset.” The takeaways from that analysis led to a 20 percent reduction in storage inventories, which meant significant financial savings for the system as well.

Once they’d determined the right power levels for each item, Obora’s team reorganized the storage rooms, utilizing a two-bin Kanban system—a process by which the inventory of each item is split among two bins. Once one of those bins is emptied, the visual cue signals the need to refill. Rather than waiting until a bin of fifty syringes is completely emptied, for example, clinicians would now be inspired to trigger a refill when only twenty-five of those fifty syringes had been used. Obora’s team would then ensure that any replenishment would

VP, Supply Chain Management

Inova Health Systems

Heather Obora

Debra Troell

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“I remind my team every day that while it might just seem like pulling materials off of a truck or restocking the store room, it matters every day.”

happen that same day. “Instead of guessing what we’re low on or what needs to be reordered, everything is automated through a handheld material management system and bar coding,” she says. “Between projects like that and a structural reorganization of people’s roles and responsibilities in our logistics department, we’ve made massive strides in turnaround time, response time, and stock-out rate.” Although ensuring that all the right supplies are available for practitioners and patients is essential, the downstream value of reducing waste and driving savings is important as well.

Obora’s leadership philosophy relies on leveraging workflows with people, process, and technology all together. Although a new bar-coding system or invented Six Sigma process might be useful, logistics team members are encouraged to keep in communication with clinical leaders, to learn their challenges, and understand their needs for materials. “Communication has gone a long way toward making the system more efficient,” Obora says.

This communication will lead to better work and better relationships with the rest of the system but, more importantly, better care for patients. At the end of the day, that’s the heart of every role in the system.

“I remind my team every day that while it might just seem like pulling materials off of a truck or restocking the store room, it matters every day,” Obora says.

“If we make a mistake, it really can be life or death. I make sure my team walks the floors of the hospitals to see that their work is part of providing better care to these patients, people that are mothers, fathers, uncles, cousins, brothers, and sisters. We can also treat them like they’re our own family, and they deserve to have the best care that we can give them.” AHL

By Dan Caffrey

A Balanced Blend of Benefits

When the Kraft Foods Group merged with H.J. Heinz Co. in 2015, it was up to Kathi Barton to implement a benefits program that honored the legacy of both companies

Like many legendary companies , Kraft earned its initial fame from a single product—in this case, a processed cheese so revolutionary that company founder J.L. Kraft obtained a patent for it in the early 1900s.

Much has changed over the past century, with Kraft eventually producing everything from cream cheese to frozen pizzas. Even more evolution occurred in July 2015, when Kraft Foods Group merged with H.J. Heinz Co. to form The Kraft Heinz Company. Suddenly, Kraft Macaroni & Cheese, Heinz Ketchup, Oscar Mayer hot dogs, PHILADELPHIA cream cheese, and other iconic brands and products found themselves under the same corporate umbrella.

The benefits department at Kraft Heinz has had a similarly expansive trajectory, thanks to leaders over the years like Kathi Barton. Barton began her career at Kraft Foods in May 1998 as a benefits manager. Today, she serves as Kraft Heinz’s head of benefits, which means she was in charge of heading a brand-new benefits program during the merger—one that drew from the existing benefits packages at both companies. Considering Kraft Heinz has about twenty thousand employees and about thirty thousand retirees in the United States, it was a hefty undertaking, to say the least.

For Kraft Foods Group’s part, the pre-merger benefits package included a single high-deductible healthcare plan accompanied by a health savings account (HSA) and an integrated wellness program through one consolidated insurance carrier. Moving to one highdeductible health plan was the first important component of the strategy to put the buying power in the hands of the consumer.

Traditionally, healthcare has not created a true marketplace environment—meaning the party paying for the care (historically, the company) was not the individual utilizing care (the employee). A traditional plan with low deductibles and low copays has the potential to encourage the wrong healthcare decision-making, Barton says. When employees only pay $10 for a highcost prescription or procedure, they’re not incentivized to make different decisions (for example, request a generic drug or a lower-cost procedure). These types of decisions benefit both employee and employer through better use of healthcare funds—an issue not always addressed in the traditional model and one of the root causes of skyrocketing healthcare costs.

The second important component of the strategy was the health savings account feature.

“Eligible employees could build up these accounts through their own tax-free contributions, and through Kraft’s matching contributions and contributions

employees earned by participating in wellness activities,” Barton says. HSAs allowed employees eligible for this benefit to have control around how their healthcare money is spent, instead of just paying higher monthly premiums for lower deductible plans.

“We felt the only way for them to do that was to have skin in the game,” Barton says. “If employees see these accounts as their own money, they will make different decisions about how that money is spent. But we also provided a transparency tool so employees could really shop around for healthcare—so they could use the tool to make educated healthcare purchasing decisions.”

The final part of Kraft Foods Group’s three-pronged approach to healthcare was a comprehensive—and mandatory—well-being program, which included valuable tips, information, and initiatives related to a healthier diet and overall lifestyle. The well-being program had more than a 98 percent participation rate.

“There were pretty significant surcharges applied if employees chose not to participate,” Barton says, but explains that the initiative was meant to assist everyone in gaining valuable information about their health status and taking small steps to understand and improve their health. If they took those small steps, they could not only avoid the surcharges, but earn significant money that was deposited into their HSAs.

“We felt like we needed to engage employees,” she says. Of course, everything shifted once the Kraft Heinz merger was under way.

Heinz had introduced a group marketplace strategy to its employees in 2015, with multiple plan and insurance carrier options. When initially presented with the higher number of options available from Heinz’s pre-merger benefits program—many of which had a much higher deductible than Kraft’s one plan—Barton was concerned.

“Heinz also had a well-being component in their plan,” she recalls. “However, it was completely voluntary, meaning the only surcharge pertained to tobacco use and people could elect to participate in any of the other well-being initiatives to earn incentives for HSA

“Historically, healthcare has put the ambulance at the bottom of the cliff, when what we actually need to do is put up a guard rail.”

deposit. The strategy Kraft had before the merger was that you had to participate or you paid a lot more money for your premium.”

Barton says that normally the strategic planning and implementation of a new benefits program could take more than a year. But after the formation of Kraft Heinz, it needed to happen much faster, meaning that she and her benefits team needed to make swift yet effective decisions when it came to what kind of healthcare would be offered. The team knew it needed to be all about choice.

Ultimately, the decision was made to move to the group marketplace to allow employees to choose from multiple plans and carriers and to adopt Heinz’s approach to voluntary wellness participation, as well as

Kathi Barton Head of Benefits

The Kraft Heinz

Company

to take advantage of the improved marketplace pricing. And the newly formed company retained Kraft’s practice of guiding employees through the benefits process and providing HSA matching contributions, in addition to a strong emphasis on educating employees about the value of the HSAs.

When all was said and done, Barton was happy to discover that employees weren’t overwhelmed by all of the new options at their fingertips. In fact, it was quite the opposite.

“What I’ve learned is that employees love choice,” she says. “We had phenomenal feedback when we implemented the group marketplace. We were still able to implement matching contributions to HSAs and employees are participating in wellness and earning

HSA contributions. And on top of all that, we’ve been able to control costs.”

Best of all, a high percentage of employees are participating in the wellness program, despite it now being voluntary. Barton believes that this kind of lifestyle change is what will truly lead to a healthier country.

“Historically, healthcare has put the ambulance at the bottom of the cliff, when what we actually need to do is put up a guard rail,” she says of the importance of preventive rather than reactive decision-making. “We’re making strides in so many ways. You see it with the younger population. They’re much more focused on exercise and eating right. I hope we eventually don’t have to provide well-being incentives at all, and that it’s just a way of life.” AHL

Expect the Unexpected

Greg Halvacs develops strategies to keep Cardinal Health employees and facilities safe around the world

By Jeff Silver

Greg Halvacs has been around long enough to have seen nearly every possible scenario when it comes to corporate risk mitigation and disaster recovery. As senior vice president and chief security officer at Cardinal Health, he and his team have dealt with multiple category-five hurricanes as well as other crises across the United States for the global company. His ability to adapt and lead his team through a variety of scenarios has garnered Halvacs praise from his business partners.

“Congratulations to Greg Halvacs on your recognition in American Healthcare Leader. This is a well-deserved acknowledgement of your work in driving innovation and as a leader within the healthcare industry,” says Ken Wimberly, vice president and general counsel for American Airlines.

Halvacs spoke with American Healthcare Leader to explain how he efficiently and effectively covers a wide range of risk management priorities across an organization of about fifty thousand employees in nearly sixty countries.

Greg Halvacs SVP & Chief Security Officer Cardinal Health

How did you come to be responsible for nearly every aspect of safety at Cardinal Health?

Up until several years ago, the structure of our function was divided in a way that made collaboration challenging. Real estate reported to operations; environmental, health, and safety (EHS) reported to the legal departments; and travel reported to procurement. Now we’ve shifted to a consolidated, risk-based approach. Each of those areas, in addition to meetings and events, corporate aviation, and security, now all fall under one umbrella. Instead of being driven by concerns of each individual business group, we have a senior leadership team that meets monthly to discuss common issues, long- and short-term strategies to address any gaps, and to create consistent approaches to reduce risks to our employees and facilities.

Has that consolidation enabled you to streamline processes or improve efficiencies in other ways?

I have been able to lead initiatives to simplify safety management processes. Because the majority of what we manufacture is medical products, such as gloves, operating room drapes, and medical devices, we have standardized our safety management systems and processes. Another example is we’ve automated the system for employee travel so that basic information is pulled from their previous trips and they don’t have to fill out a long questionnaire every time they travel for business. We’ve also standardized our corporate identification badges so they can be used in multiple locations for both access control, time, and attendance.

How have you addressed the many acquisitions over the past few years that have exponentially increased the number of Cardinal’s employees and locations globally?

We’ve developed a standard playbook for the first one hundred days after an acquisition closes. Everything is standardized as we identify gaps in readiness or specific risks that need attention. For example, our acquisition of Medtronic’s Patient Recovery business still presented opportunities for growth as we integrated ten thousand new employees over the course of six months. We had to visit facilities, determine the risk status, and educate them on our crisis management process. We also provided them with key security and safety points of contact.

What are the fundamental components to being adequately prepared?

First is to regularly assess risk factors so you have appropriate plans in place. This includes having local and regional teams for each site because we can’t effectively manage an issue on the ground in Europe, for example, from Ohio. We also have an extensive communication network that extends up through leadership to a global operations center, and local reaction plans that are regularly tested for multiple scenarios. In each one, we prioritize three things: employee safety, keeping

Prepare for the Worst

Hurricane Maria nearly destroyed Puerto Rico’s infrastructure, which made circumstances unusually difficult for Cardinal Health’s more than eight hundred employees on the island. Existing disaster plans rely on local resources, but basic supplies had to be delivered from the US mainland by barges and by air.

The company had fuel for diesel generators at its facilities, but employees needed basic provisions such as food, water, plastic utensils, and cash.

“We’re re-examining plans for other areas to ensure we can function in the face of a complete infrastructure collapse,” Greg Halvacs says. “That includes having enough satellite phones and gasoline for future disasters.”

facilities up and running or getting them back online, and meeting customer support requirements.

In any major weather event, we have to consider specifics, such as whether employees can get to work even if their own homes have experienced damage. We are committed to our responsibility of being essential to care. We take this seriously given that the products and services we provide really are the glue that keeps healthcare systems operating in many locations. We have to be resilient.

With so much preparation and so many reviews, have there been circumstances that caught you by surprise?

Most weather events—hurricanes in particular—we can see coming, but 2017 and 2018 were difficult years. In addition to Hurricanes Maria and Harvey, there was a major earthquake in Mexico, so our disaster teams were on alert continuously for several months. In all those instances, we were among the first organizations to be able to respond to our customer and employee needs. One instance that did come as a surprise was the avian influenza outbreak in 2012. We have pandemic plans in place and had expected to see it migrate from Asia, but it came to the United State through Mexico, where we have many employees and facilities. It spread faster than expected, so we had to work out logistics to get vaccines to our customers, such as hospitals and pharmacies.

What are the most important lessons you’ve learned over the course of your career?

There are new issues every day—everything from natural disasters to political unrest. You have to stay aware of all types of changes that are happening—or might happen—and be prepared. That’s why constant monitoring, testing, and regular communication with our local and regional leaders is so important. With all the functions I’m responsible for, there’s probably no place in the organization we don’t touch, so constant networking, assessing, and training help us to do a better job. AHL

The Impact

Executives know there is an increasing need to help individuals manage their own health anywhere and anytime. To do that, healthcare leaders are developing products and services and offering resources that cater to different communities’ needs and motivate people to stay engaged with their own health.

134. Finity Inc.’s population health management platform is changing how employees think about their health

138. Alan Sefcik helps craft holistic wellness programs for L’Oréal’s employees that cover everything from mental to financial health

141. David Henley navigates the regulatory waters of care for Medicare and Medicaid recipients at Passport Health Plan

150. Pam Cox and her team at Verizon are working to facilitate a whole new level of connectivity for consumers

154. Lori Szerencsy details how she helped launch Citi’s employee benefits portal

By Charlene Oldham

Engaging the Population

How Finity Inc. is motivating individuals to take care of their health and well-being like never before

Health insurance companies

are constantly confronted with the dilemma of how to most effectively engage members in their health and well-being. To address this issue, Finity Inc. has developed a solution that brings business intelligence to the healthcare space.

Finity is a Portland, Oregon-based health intelligence solutions company serving millions of members across the country. Its mission is to empower people to make conscious health decisions and take charge of their health. The company achieves this through their engagement, incentives, and population health management platform, which gathers health intelligence to learn how people behave and uses that data to engage with each member in the way that is most likely to result in a successful health outcome. Finity’s platform works by engaging members using the right communication medium, activity, and reward to motivate people to complete healthy activities that aim to close targeted gaps in care. In doing so, the platform has been proven to lower overall healthcare costs and improve quality measure compliance for health plans across the country.

“The member doesn't know us as a health intelligence program. They know us as an engaging rewards program provided by their health plan,” says Alexandra MacDonald, Finity’s executive vice president of population health management. “Members are used to getting communications from their health plan that aren’t fun or, frankly, engaging. It’s mostly benefits information, bills, and stuff you don't want to deal with. This program gives health plans a way to engage members in their health that is fun, simple, and rewarding. People want to participate and that is the key to success.”

“This program gives health plans a way to engage members in their health that is fun, simple, and rewarding. People want to participate and that is the key to success.”

Alexandra

Dr. Guerra’s Perspective

Modeling the success of airlines and hotels, the health industry is finally jumping on the rewards program train. It is great to read that Finity Inc. has launched the Health Intelligence Platform where health plan members are rewarded for healthy actions. The use of data to identify the health needs of patients has transformed the health industry over the past five years. The main challenge has been finding ways to communicate with the patient and getting them to take action, and incentives are often a way to motivative populations to not only do something but to document it as well.

Here we see that these reward programs may not only motivate a member but may actually educate the population on what the desirable action is without redeeming the reward itself. This is consistent with a theory that patients may be receiving many messages from unreliable sources but they trust those that come from a health plan or professional to take a deliberate action.

Lastly, we are reminded health actions inherently may not be fun, but competing for a healthy reason can be fun for groups.

Guest Editor

On average, participation rates in Finity’s rewards programs started around 30 percent in the first year of implementation and climbed to about 60 percent by the third year, says MacDonald. For Finity, a health plan member counts as a participant if they have engaged in at least one passive and one interactive encounter with the rewards program and closed at least one gap in care after an outreach effort.

MacDonald says the rewards program opt-out rate is only about 5 percent, which indicates that the majority of participants see the program’s reminders to complete healthy activities as a benefit, not a burden.

Part of this success derives from Finity’s meticulous refinement of engagement strategies during a threeyear Health Care Innovation grant it received from the Centers for Medicare & Medicaid Innovation. During this time, the company rolled out its Health Intelligence Platform to Medicaid participants in Philadelphia. The program launched in July 2013 with about 260,000 health plan members and, over the course of the grant, achieved cost savings, improved the health plan’s quality measures, and boosted care outcomes for participants.

The company also met the grant’s sustainability requirements, which called for Finity to implement its Health Intelligence Platform with at least four more health plans and evolve it to increase its effectiveness. Finity accomplished this requirement by launching the first state-wide population health management and rewards program for Medicaid members in New Mexico across four managed care organizations in January 2014.

Based on the results of the grant, Finity developed a set of successful strategies it still uses with both public and private health plans.

“Many people just get satisfaction from getting healthier.”

One of those strategies is having the rewards program focus on activities that are easy to track and measure. Instead of rewarding people for behaviors such as weight loss and smoking cessation, which can be hard to evaluate, Finity focuses on easily measurable activities such as going to the doctor for recommended health screenings or refilling prescriptions for managing chronic conditions, such as asthma.

“Tracking is really important for all our clients because, if you can't track the activities, you can't measure the outcomes,” MacDonald says.

The company also found that a rewards program needs to be fun. This means balancing rewards for clinical activities, like doctor visits, with interactive wellness activities. To help strike that balance, Finity offers game-like wellness challenges that encourage participants to focus on one healthy behavior for twenty-one days and have fun in the process. Finity’s programs, such as the Step-Up Walking Challenge, give people weekly goals to strive for. If members meet their goals, they earn rewards points that they can redeem for healthy prizes from Finity’s rewards catalog. In private plans, members might compete in wellness challenges against other groups in their company, like a finance team against a customer service team challenge. In public plans, such as staterun Medicaid programs, members could compete against system averages.

By measuring the outcomes across both clinical and wellness activities, Finity proved a correlation between

positive behavior changes and the number of points people earned rather than with the number of points they redeemed.

“Most people just like to play the game. So, you're only going to have about a third of the people who ultimately take that next step and want to redeem points,” MacDonald says. “Many people just get satisfaction from getting healthier.”

Finity’s program requires participants to register before they redeem rewards points, which takes fewer than five minutes and allows the company to collect valuable health information that can benefit both the member and the health plan administrator. In fact, each interaction with program participants helps Finity build a more complete Health Intelligence Profile that allows them to target their communications, wellness challenges, health reminders, and rewards to better suit members’ needs. The data also helps health plan leadership hone their member outreach to save money while providing more effective member engagement.

“We help clients save money and improve compliance, and we help members improve their health. It’s a win-win,” MacDonald says. “When you feel better, when you do things that benefit your body, that benefit your mind; it has a holistic improvement on your health. When you're doing what you should do to take care of yourself—that alone is motivating. And when you're rewarded for that, it's even better. It makes health fun, and that’s rewarding for everyone involved.” AHL

FINITY engages members with the right activity, the right medium, and the right reward to motivate behavior change.

By David Levine

Beauty From the Inside Out

Alan Sefcik is bringing leading-edge health and wellness benefits to the employees of cosmetics leader L’Oréal

As vice president, compensation and employee benefits, for L’Oréal USA, Alan Sefcik and his team are constantly working to enhance the company’s rewards program and its many initiatives. A primary focus is on the health and wellness of the company’s employees. All the initiatives fit into L’Oréal’s global employee benefits program, Share & Care—which is designed to enhance the company’s commitment to employees. Sefcik says the Share & Care program, launched in 2013, “aims to achieve a common foundation for social protection in all the countries where the group has subsidiaries. It is designed to provide a strong foundation of programs under four key pillars.” Those pillars are: protect, care, balance, and enjoy.

The company’s annual Save Our Skin initiative that has been in place for about six years is a prime example of the benefits program in action. “We are able to leverage the brands within our company to provide unique offerings to our employees,” Sefcik says. In collaboration with the company’s dermatological skincare brand, La Roche-Posay, the Save Our Skin event gives employees access to a free skin cancer screening with a licensed dermatologist. This year, more than 1,100 employees received a free screening, he says.

The company, whose US subsidiary is based in New York’s Hudson Yards, is a world leader in beauty products with annual revenue over €26 billion. It has a presence in 150 countries on 5 continents. The

Sefcik VP, Compensation & Employee Benefits L’Oréal USA

company’s thirty-four international brands include Kiehl’s, Lancôme, Giorgio Armani Beauty, Yves Saint Laurent Beauté, Ralph Lauren, Maybelline New York, Diesel, Garnier, L’Oréal Paris, and more. But Sefcik found himself far away from the beauty industry at the beginning of his career.

He started his career as an actuary, utilizing his affinity for statistics and mathematics. He then moved into the HR space. He worked for AT&T for fifteen years, managing benefits strategy, planning, and design and, from there, moved to Aon, where he was a human capital consultant. He followed that post by serving as benefits leader for Alcatel-Lucent, before joining L’Oréal in September 2011.

Along with preventive measures like Save Our Skin, Sefcik is also deeply involved with providing twenty-first century healthcare treatments to employees and is particularly intrigued by innovations in telemedicine. “In recent years, the L’Oréal employee benefits team has incorporated a number of new technologies to improve the lives of our employees and their families,” he says. L’Oréal implemented virtual doctor visits in 2016, allowing employees and their families to video call a licensed doctor, receive care, and obtain their prescriptions for routine medical issues. “We believe that programs such as virtual doctor visits can ensure employees receive the most efficient care whenever it is convenient for them,” he says.

That care includes mental health coverage as well. This year, the company introduced teletherapy, which gives employees access to FaceTime or Skype for therapy sessions. He feels personally connected to this offering; his nephew died by suicide, and he has since been very active in suicide awareness, with groups such as Out of the Darkness, outside of L’Oréal.

Alan

Understanding people and risk – the new path to growth.

At Willis Towers Watson we design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand the power of capital to protect and strengthen institutions and individuals. Our unique perspective allows us to see the critical intersections between talent, assets and ideas — the dynamic formula that drives business performance.

Together, we unlock potential.

“L’Oréal recognizes the importance of mental healthcare, so we’re excited to provide employees and their families access to a mental health professional so they can receive personalized care from anywhere.”

“L’Oréal recognizes the importance of mental healthcare, so we’re excited to provide employees and their families access to a mental health professional so they can receive personalized care from anywhere,” he says. “This offering is not only convenient but also quick and cost-effective, as virtual visit provider groups are expected to deliver care within thirty minutes from the time of a patient’s request—day or night. As someone who has suffered a personal loss to suicide, I am proud that L’Oréal is implementing these programs and prioritizing the physical and mental health of our colleagues.”

Although virtual therapy sessions are available to employees as a mechanism to help manage stress, Sefcik and L’Oréal recognize the need to look at the underlying issues that can cause stress. “Through internal research, we found that employees strongly agree that concerns about personal finances distract them from their work,” he says. “Using these insights, the team is currently reviewing the types of programs that can help support L’Oréal employees to improve their financial wellness.”

In the coming years, Sefcik hopes to see all these efforts expanded, as well as employee benefits offerings overall. “These innovative programs, like virtual doctor visits, virtual therapy sessions, and events like Save Our Skin, have the potential to expand internationally and improve the lives of our eighty-nine thousand employees globally,” he says. AHL

Congratulations to Alan Sefcik on all your success in evolving L’Oréal USA’s wellness program experience for your workforce. On behalf of Willis Towers Watson, it has been a privilege and pleasure working with you and your team throughout the years.  We look forward to our continued partnership!

By Jeff Silver

Fulfilling the Passport Promise

As chief compliance officer, risk management leader, and culture leader for Passport Health Plan, David Henley focuses his work using a simple philosophy: put people first, be purpose-driven, and act with passion. These three things guide Henley as he collaborates with internal audit, IT security, and other departments to help the organization achieve its business goals. To do that requires Henley to navigate multiple responsibilities and areas of expertise.

First, there is the responsibility of handling three different interconnected areas, each of which is critical to the organization’s success. He must also adapt to the constantly evolving healthcare environment in which Medicare and Medicaid—the company’s exclusive markets—have experienced exponential change.

To steer through these changes, he has learned to focus on rules and regulations to help provide stability. “When so many things are shifting, maintaining compliance, attending to the needs of our members, and sustaining a culture that supports those efforts is what guides us,” he says.

Changes were in play from the beginning of Henley’s role at Passport. The organization is a local nonprofit, community-based health plan administering Kentucky Medicaid benefits and is contracted with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Advantage benefits in four counties throughout Kentucky. Passport’s value proposition is to work closely with local providers and community advocates to fulfill its mission, which is to improve the health and quality of life of its members, Henley says. Passport accomplishes that, in part, through its Partnership Council and through its community engagement team.

The Partnership Council includes local providers and allows participants to provide feedback that is coordinated with the company’s various specialty committees, such as pharmacy and behavioral health, to directly address specific needs and issues.

“We emphasize community relationships through regular communication and processes and structures, such as the Partnership Council and value-based contracts with our providers,” Henley says. “It’s vital that we work together as partners to reach our shared objectives.”

People, purpose, and passion guide David Henley through ongoing changes to Medicare and Medicaid compliance

Those partnerships are especially important because healthcare is an industry that is subject to a number of outside factors, including legislators, regulators, insurance companies, and more, which means its constantly evolving, Henley says. He also helped develop a partnership with Evolent Health LLC to take advantage of its mature technology capabilities.

David Henley Chief Compliance Officer & Risk Management Leader & Culture Leader

Health Plan

Passport

“We do everything we can to facilitate income stability, neighborhood safety, and improved access to care.”

The goal of this initiative was to maximize Passport’s clinical and financial performance and mitigate financial risk while enabling provider organizations to control their own destiny, Henley says. Ultimately, he says the will help lower the cost of care and deliver better health outcomes for patients. Henley wants initiatives such as the partnership with Evolent to begin to change the perception of compliance at Passport.

“Compliance is typically viewed as Big Brother looking over everyone’s shoulders,” he says. “We’ve let everyone know that we’re actually here to help.”

To further this effort, Henley has spearheaded the creation of events such as Compliance Talk with Your Chief Compliance Officer, written informational articles surrounding compliance’s role in the company, and completed compliance tips presentations. As a result of these events, engagement is up and employees seem to understand what steps should be taken to reduce the likelihood of an adverse regulatory action or inappropriate HIPAA disclosure, Henley says. A strong culture of compliance goes hand in hand with a successful business, he says.

“Without strong support for and from our culture, we won’t meet our goals and objectives,” Henley points out. “Acting accountably, staying engaged, and being aware of how our moods and actions impact others all become tools that fuel our success.”

Externally, Passport emphasizes a community focus and efforts to understand the social determinants of

healthcare issues. Many of its members are of lower socioeconomic status and experience medical conditions that contribute disproportionately to healthcare costs. A majority also face inadequate access to pharmacies and medical care, as well as grocery stores that provide options for healthy diets.

Despite Henley’s large scope of responsibilities, it all stays in focus for him because of the organization’s central mission.

“So much change can be overwhelming,” Henley says. “To stay focused, the best approach is to remember the Passport Promise—to always put our members first— and to do everything we can to help Kentuckians live healthier lives.” AHL

Senn Delaney congratulates David Henley for his strong leadership and forward thinking in shaping Passport’s culture into an asset prepared to face challenges in an uncertain healthcare industry.

Senn Delaney has helped hundreds of companies like Passport prepare for change, uncertainty, and disruption by actively shaping their cultures to improve business performance. Visit Senn Delaney.com to learn how we can help you shape your culture into an asset in uncertain times.

Senn Delaney is part of Heidrick Consulting, a leader in culture shaping, leadership assessment and development and organization and team acceleration.

By

Extending a New Lease of Life

How Jill Fragoso ensures healthier futures for staff at Texas Children’s Hospital

The old adage, “Everything is bigger in Texas,”

also applies to the healthcare of its youngest citizens. Texas Children’s Hospital is the largest pediatric hospital in the United States, leading a global community in patient care, education, and research. Yet Jill Fragoso is also turning that acclaimed care inward through more holistic benefits and services for employees.

“It has always been paramount that we in human resources provide the best possible plan designs and programs to support our staff who make our mission a reality,” Fragoso says.

She explains that nurses suffering from presenteeism due to lack of sleep from worrying about financial difficulties, or are distracted because they are struggling in their marriage and need counseling services, are not going to perform their best while caring for critically ill patients.

“We need to offer them all the tools necessary to inspire them to perform at their top level, as patient safety is incredibly important,” Fragoso says.

Fragoso joined Texas Children’s as the director of employee health and wellness for 8,500 employees and 2 hospitals in 2013. Today, the Houston-based organization comprises thirteen thousand employees, three hospitals, ten urgent care centers, and more than seventy community sites.

As its footprint expanded, so has its benefit and well-being offerings, thanks to Fragoso, who was promoted to the director of benefits and well-being in 2017.

“If we can improve the health of individual employees, we can have a significant impact on improving the overall health of the system from a financial perspective as well,” Fragoso says.

Earlier in her career, Fragoso focused on improving individual behavior and improving employee health in an episodic, personalized fashion. She started as a campus nurse at Kirkwood Community College, the largest community college in Iowa (she was also a facilitator of the American Lung Association’s Freedom From Smoking program).

At Kirkwood, she organized health fairs, blood drives, and 5K races while giving guest lectures. That’s when Fragoso says she fell in love with the preventive side of nursing and healthcare.

After a bachelor’s degree in nursing, Fragoso earned a master’s degree in health promotion and wellness at the University of Iowa. Prior to Texas Children’s, she led employee health services for Rush-Copley Medical Center, Northshore University HealthSystem, and Presence Health.

Now at Texas Children’s Hospital, Fragoso oversees the occupational health clinic, the on-site health clinic for employees, the employee assistance program, and benefits.

Her team is offering employees better health and wellness choices, options, and tools based on the insurance plans and benefit offerings provided through the emerging partnership with health insurance provider Cigna.

“An employee may not even think about the diabetes education sessions until they learn at their annual screening they have the disease,” Fragoso says. “They may not pay attention to the grief courses until a coworker’s adolescent child attempts suicide. But, our offerings can make all the difference in the world to a single employee and change the trajectory of not only their career, but their life.”

Cigna delivers the One-Guide platform for the health journey of Texas Children’s employees. It addresses current healthcare, optimizes benefits, and connects them to coaching programs such as chronic condition management, weight management, healthy eating, physical activity, stress reduction, smoking cessation, mental health, and preventive care.

That collaborative approach has manifested in the “Well-Being Physical,” which encourages employees to meet with a physician or nurse practitioner on staff in addition to a Cigna health coach for a comprehensive physical followed by personalized health-coaching sessions over a twelve-week timeframe.

Fragoso also developed community partnership discounts. Last year, Texas Children’s teamed up with Benefithub.com to offer an online discount platform for its diverse, 24/7 workforce. It also partnered with financial services company Fidelity to provide financial well-being programs.

Free or low-cost activities inspire active lifestyles, including bootcamps, yoga, stairwell challenges, water challenges, 5Ks, and the summer self-care series.

“If we can improve the health of individual employees, we can have significant impact in improving the overall health of the system from a financial perspective as well.”

Training for the Win

When Jill Fragoso is not ensuring employee well-being at Texas Children’s Hospital, the lifelong athlete is training to swim 2.4 miles, ride a bike 112 miles, and run 26.2 miles in less than 17 hours—also known as the Ironman triathlon.

She works out twice a day, six days per week, starting between 4:30-5 a.m. every day. Here’s a glimpse into Fragoso’s training regimen leading up to the race:

“Another goal focuses on more robust financial well-being offerings best suited for the incoming workforce,” she says. “It’s a way to both attract and retain them.”

Yet Fragoso believes the best engagement starts with the foundation of trusting relationships. Her team enlists the support of more than three hundred Texas Children’s wellness ambassadors, nominated employees trained to serve as extensions of the well-being staff, to promote inspiring patient and employee success stories.

“Our brains are wired for stories and connections,” she says. “We want to encourage our employees to build a relationship with our healthcare providers to provide them with support, accountability, and resources.”

Her strategies, based on market segmentation, meet employees where they are, whether through word of mouth, in-person promotions, apps, or social media campaigns. She’s also added Vidyo conference ability through a HIPAAsecure site.

90 days to go:

“I follow a ketogenic nutrition plan, which is a nutrition plan low in carbohydrates, moderate in protein, and high in healthy fat. I’ll be eating about 2,500 calories per day during this focused portion of my training. I will be swimming, biking, running, and strength training about 18–20 hours per week.”

30 days:

“I eat closer to three thousand calories per day. This is the most intense portion of my training calendar, with approximately twenty-five hours of training per week.”

7 days:

“During this taper period, my mileage is reduced and workouts take less than ten total hours per week. My caloric intake is decreased as well, and I’m also conscious of the amount of water I’m drinking to ensure I’m properly hydrated and flushing out any toxins. I try to still my mind by practicing mindfulness activities and decrease any anxiety I might have as race day approaches.”

1 day:

“Breakfast consists of eggs, bacon, and avocado. Lunch is a salad with 4 ounces of protein, and dinner is wild-caught salmon, asparagus with butter, and keto-friendly cookies I make at home and pack for the trip. Snacks are macadamia nuts and celery sticks with almond butter. I might go for a quick swim to familiarize myself with the water temperature and course.”

Race day:

“I start with a Rocket Fuel Latte or a cup of coffee with one tablespoon of coconut oil, one tablespoon of hemp seeds, one tablespoon of ghee, a half scoop of protein powder, and a bit of vanilla and cocoa powder. I also try to keep my muscles warm. Finally, I visualize a safe and successful race, and get ready to have fun.”

Dr. Guerra’s Perspective

Focusing on a healthier healthcare worker is such a worthy cause. I am thankful Jill Fragoso and Texas Children’s Hospital are tackling this challenge headon. In sales, employees get told, “You can hear a smile over the phone,” and therefore, employers work to make their employees satisfied. In healthcare, we should say, “Patients see health in their nurse or doctor,” so that health systems focus on making the professional healthy.

Rewarding employees for healthy activity is an investment an employer will not regret. Improving the health of an employee has the benefits of reduced absenteeism, increased productivity, reduced healthcare expenditures, improved satisfaction, and increased recruitment and retention. But in the healthcare industry, when we improve the health of those who are patient-facing, we add the benefits of reduced nosocomial infections to patients, reduced patient errors, and positive role modeling for patients.

The “well-being physical” is a great approach that resonates with healthcare professionals. And finally, having healthy and fit leaders in an organization drives the culture from within to support employees reaching for better health.

Guest Editor

As healthcare collectively engages in digital transformation, Fragoso anticipates the increased convergence of technology and individual wellness. “The best wearables and monitoring devices will be incorporated into a total well-being suite of services for the end user,” she says.

Fragoso is also targeting the wellbeing of senior leadership staff, predicting that fitness and well-being is crucial for Texas Children’s leaders. She cites the book The New Leadership Literacies by Bob Johansen, a distinguished fellow at the Institute for the Future, which details ways leaders can thrive in today’s disruptive environments.

Johansen writes: “Fitness will be a price of entry for top leadership roles. Extreme fitness—physical, mental, and even spiritual (though not necessarily religious) will be required for most leadership roles.”

As a leader herself, Fragoso says she hopes to maximize the potential of others by focusing on their strengths, while passionately and purposefully leading them to achieve common goals.

“As leaders, the way we lead is always on display, so we need to be authentic,” she says. “I also believe successful leaders must display energy, passion, and purpose in all they do, at all times.” AHL

By Dan Caffrey

Is this reality or science fiction?

A patient in a remote town needs emergency surgery. But after being transported to the only trauma center in the area, there is no specialist available to complete the procedure. Luckily, a surgeon in New York City is able to strap on a VR headset, connect to a 5G network, and perform the surgery remotely with a robotic arm at the hospital. The patient survives.

This is one scenario the team at Verizon envisions for the future of healthcare. Over the past year, the company has begun deploying a next-generation broadband network that will enable people, businesses, and society to do more new—and do more good.

Dubbed Intelligent Edge, the network could allow for remotely performed surgery and expand upon the current innovations run on 4G networks.

This is also the promise that excites and inspires Verizon executives like Pam Cox, the company’s director of corporate environmental health, safety, and compliance. She is proud of the advancements Verizon has made in this arena and has already seen numerous examples of how the company’s technology can make a positive impact for everyone who uses it.

“The surgery example underscores the importance of the speed and reliability of our network,” Cox says. While she is not responsible for the company’s 5G efforts, her work is an integral part of the common vision shared by Verizon employees: using connectivity not just for convenience, but to make the world a little bit better and safer. The company calls it “humanability.”

“We’ve been a proud part of Verizon’s success over the past four years,” says Peter Hermans, CEO of Enhesa. “By providing the environmental, health, and safety compliance intelligence our clients need, we make it possible to successfully and efficiently operate globally.”

Cox and her team are responsible for everything from analyzing audit findings to ensuring that Verizon works with safe vendors to staying compliant with policies of the federal Occupational Safety and Health Administration and other regulatory agencies.

Aside from compliance, much of Cox’s team’s work is focused on the simple and human goal of making sure Verizon’s employees stay safe at work, at home, and on the road. To keep employees safe on the road, company vehicles are equipped with advanced telecommunications (telematics) equipment that transmits a wide range of vehicle

Pam Cox Director of Corporate Environmental Health, Safety, and Compliance Verizon

“The surgery example underscores the importance of the speed and reliability of our network.”

“The promise of a digital world is becoming a reality.”

Trial by (Virtual) Fire

Like many companies, Verizon has recently begun implementing virtual reality (VR) and augmented reality (AR) into their training programs. Thanks to motion sensors, immersive sound, and VR headsets, employees can make sure they are a good fit for the job by replicating the experience of venturing into the field.

“You put on a headset and it feels like you are already in those spaces, even though you’re standing in the middle of a conference room,” Cox says. “In traditional training, you could go all the way through class and never realize you were claustrophobic and couldn’t work in a manhole.

“Now, in a safe learning environment, you can experience realistic scenarios like working aloft in a bucket truck, going into a manhole under the busy streets of New York City, or climbing a ladder to install equipment on rooftops.”

information. The telematics equipment can be paired with a mobile application from Verizon Connect, called Coach, which gives drivers same-day data on speeding, hard breaking, aggressive acceleration, and much more. The data will allow Cox and her team to effectively analyze and recalibrate company safety protocol. The telematics system in the vehicle can also alert management to real-time events in the field via email or text messages that can help report any emergencies to rescue personnel if a vehicle is in an accident or veers off the road for any reason.

Just a few years ago, these attributes of the Coach software application may have seemed as futuristic as the promise of remote surgery. But the capabilities of Verizon’s Intelligent Edge network are already giving the roads we ride on the power to think in cities like Sacramento, California. Verizon’s network is also connecting smart sensors to Hawaii’s power grid as the state pursues its goal of having 100 percent renewable energy. Cox loves the fact that technology is being used to build a safer and more connected world.

“The promise of a digital world is becoming a reality,” Cox says. “People don’t realize how many connected devices they have. I was recently in a training class, and we started counting how many devices we each had in our home. The numbers are astronomical, from phones to televisions to coffee makers. In the future, your refrigerator will be able to reorder your eggs at the grocery store if you want it to. I am very excited that Verizon is instrumental in building all that connectivity.” AHL

By Jenny Draper

The Cultural Investor

Citi’s Lori Szerencsy upgrades how its international locations administer benefits

Today, Citi employees around the world are managing their life within Citi with the click of a mouse—a portal recently launched by Lori Szerencsy and her Citi team in partnership with Willis Towers Watson. The web portal, My Total Compensation and Benefits, will enable more than two hundred thousand employees across the global financial services firm to access their personal compensation and benefits information all in one place. The resource was launched in four countries last May, and it will continue to expand to other markets in the coming months.

“Citi has the ability to add so much value to employees’ lives beyond their paycheck,” says Szerencsy, the organization’s global head of benefits. “The portal puts all of their benefits and rewards at their fingertips. No matter where they are in the world, it’s easier than ever for employees to engage in their healthcare decisions, choose a healthcare plan, or prepare for retirement.”

This new portal is the culmination of several years of work for Szerencsy, whose team is focused on creating offerings that are relevant and functional across the more than 160 countries where Citi has a presence.

The biggest challenge initially in creating the common global portal, Szerencsy adds, was balancing the offerings of a unified brand with the legal and cultural nuances of the thousands of Citi locations across the United States, Mexico, Poland, Russia, Pakistan, India, the United Arab Emirates, and more.

Szerencsy is no stranger to challenges like this. Previously, in the decade after joining Citi in 1999, to streamline the Travelers and Citibank merger, she began a decade-long integration of about two hundred different medical plans into what Citi offers now: two national plans with a strategy that subsidizes based on employee compensation level.

Technological applications have been key to elevating Citi’s holistic benefits mantra: “Live Well, Save Well, Choose Well,” to the world’s stage, according to Szerencsy. The dexterity of an online portal streamlines benefits and covers defined contribution plans

“We think of benefits not just as what policies and offerings we already have in place, but how employees engage with these benefits and how are we continually improving them based on employee needs and feedback.”

and pension plans. In the US, the interactive benefits tool ALEX uses artificial intelligence to help employees select a medical plan and ALEX videos educate employees about preventive care, telehealth, and nurselines.

“Lori has made it her mission to make it easier for employees to understand their benefits and provide them with tools and resources to make better decisions,” says Michael Sigmund, president of health and wealth solutions at Alight Solutions. “Under her leadership, Alight is now working with Lori and her team to make the benefits enrollment experience simpler and more intuitive for Citi employees, which will have a positive impact on the way employees view their enrollment experience, as well as the overall value they see in the benefits provided by Citi.”

Szerencsy and her team understand the value that they can provide employees around the world and the impact it can have on the company’s business. “We think of benefits not just as what policies and offerings we already have in place, but how employees engage with these benefits and how are we continually improving them based on employee needs and feedback. When done right, employees are more apt to use the benefits, and are more satisfied and more productive in their day-to-day jobs.”

Mercer congratulates Lori Szerencsy on her leadership and accomplishments. We are honored to work with Lori!

“If we learn what the most important questions and answers are, we can diffuse any change angst because even when change is good, it can be hard.”

We wish her continued success.

In addition to creating the global portal, Szerencsy and her team are focused on sharing local programs and approaches more broadly across the firm. For example, the team is working on ways in which to share aspects of the “Minds that Matter” campaign, a mental health program launched in the United Kingdom, in the US, and elsewhere.

“I come from a long line of teachers and principals in my family,” Szerencsy says. “It set the tone for how I approach my projects now, because it’s about understanding your audience. If we learn what the most important questions and answers are, we can diffuse any change angst because even when change is good, it can be hard.” She cites a college psychology class in which she learned more about the personalities that people take on in a group setting, a lesson in group dynamics that continues to influence her adaptable leadership style today.

Citibank, announced their merger. She was consulting on-site to help harmonize their two different benefits philosophies, and joined the firm officially in 1999. At Citi, she also covered pharmacy, medical, and 401k functions before her promotion to the director of health and welfare and then again to global head of benefits.

She describes her entrance into the world of benefits as a leap of faith and a function she continues to enjoy leading at Citi. After wrapping up the “enormous and exciting undertaking” of the My Total Compensation and Benefits portal, she says her team will continue conducting demographic reviews and stay vigilant about the changing needs of Citi employees’ core and non-core benefits, referred to as the “Little Bs.”

www.mercer.com

Yet Szerencsy did not set out to be in benefits. She first studied to become a physician while earning a bachelor’s degree at Binghamton University, but soon realized she didn’t want to pursue medical school. However, she remained passionate about the healthcare field. She found her niche at Hunter College, where she earned a master’s degree in public health, focusing on community health education. After graduation, she worked for a consulting firm handling health and productivity management analytics when two of her clients, Travelers Group and

“From the lunch subsidy in Israel to museum discounts and from uniform allowances to Mother’s Day cards, we’re changing how we look at these little benefits that may be equally important to our employees,” adds Szerencsy, who is reframing what total rewards looks like for the global workforce. “Employees need to know that when they give their all at Citi, their firm is dedicated to giving back to them.” AHL

Mercer is honored to partner with Citi in creating a diversified benefit offering to meet the needs of its employees. We congratulate Lori and her team for enabling Citi employees to Live Well and focus on the moments that matter most.

The future of work is brighter, simpler and designed around people.

Alight Solutions would like to recognize Lori Szerencsy, global head of benefits at Citi, on her many accomplishments. Her leadership inspires success in times of ongoing change and exemplifies how to build a culture always focused on the health and productivity of her workforce.

Together, we are reimagining how people and organizations thrive.

To learn more about Alight, please visit alight.com.

Be Healthy, Wealthy, and Wise

Medha Rishi helps tech innovator Square innovate the employee experience as part of the company’s global expansion efforts

By Jeff Silver

Medha Rishi

Global Head of Benefits and Mobility Square

Medha Rishi began her career in HR consulting with Mercer and Aon Hewitt. As she got back in touch with her international roots, she transitioned to a more global HR focus, which provided the opportunity to work with multinationals in nearly forty-five countries. In 2016, that experience and expertise perfectly positioned her to move to Square, where she is spearheading employee experience efforts as global head of benefits and mobility.

Her dual role is critical to the company’s globalization efforts. Square has already tripled its reach to include about one hundred employees (the company refers to them as “Squares”) in Canada, the United Kingdom, Ireland, Australia, China, and Japan, in addition to about 2,500 in the United States.

Rishi spoke with American Healthcare Leader to highlight the importance that these functions play in supporting the company’s objectives.

From a health and benefits perspective, what are the biggest challenges as the company grows so quickly?

Square has a philosophy of being “fair and square” across the board. As the company expands internationally, it means maintaining sensitivities to different cultural norms. I call it “glocalization” as we customize our policies accordingly. For example, we worked on introducing flexible time off in a way that it would be consistent across borders and would work with existing local time-off statutes. It was a challenge in countries such as Australia and France where extensive mandated time off was balanced in Workday’s Global Leave Management software by creating customized tracking rules and allowing for manager discretion disciplines. Whatever the challenges are, I take a holistic view that incorporates and customizes for all elements of health and wellness and balances cross-border requirements under an overarching umbrella of global philosophies.

What other specific priorities help guide your development of global benefits?

I have created a six-tier assessment model: philosophy, culture, benchmarking, finance and compliance, principles, and innovation along with a benefits philosophy based on Maslow’s Hierarchy of Needs model. We map those different motivators under the hierarchies of physiology, safety, belonging, esteem, and selfrealization to each one of our benefits programs. Then we focus on our culture and employee feedback to define core principles around healthcare, well-being, retirement, and mobility. Keeping those in mind, we conduct research to make our programs competitive, financially balanced, and compliant. Last but definitely not least, we develop an innovation angle to every program to ensure we act as benefits pioneers.

Sutter Health | Aetna: Striving to create affordable health care products that give members seamless access to care in Northern California.

“Anytime you get to build things from scratch and see their evolution and market recognition, it’s rewarding and fun.”

Health benefit plans are administered by Sutter Health and Aetna Administrative Services LLC (Sutter Health | Aetna). This material is for information only. Information is believed to be accurate as of the production date; however, it is subject to change.

©2018 Sutter Health and Aetna Insurance Holding Company, LLC

7S.12.901.1 CA (5/18)

You mentioned mobility. How do benefits and mobility work together?

Mobility comprises relocation and immigration components and other aspects of skill transfer and career growth. Each of these functions serve the same purpose—to reward, recognize, and promote employees’ overall well-being. I’d classify it all under the umbrella of employee experience. As an example, we will be developing a platform called Square of Life, which walks our employees through their professional life cycle and what’s available to them each step of the way. Any time someone is experiencing a change in their lives—whether that’s marriage, a baby, or relocating to a new position or country—the platform is a resource that references all the benefits that are available and how they work together. It’s also a tool that helps us to keep pushing the boundaries with benefits that address changing demographics as baby boomers and Gen-Xers retire and millennial employees need help with things like elder care. It’s all part of making benefits integral to the overall life cycle in every location and at all phases of one’s career.

As a technology innovator, does Square take an innovative approach to HR?

We have a people leadership team designed to ensure that the company’s top priorities are always represented by a specific leadership person. The team currently includes benefits, compensation, analytics, HR, programs, and talent.

Do you provide any offerings that directly address changing healthcare delivery models?

I want to make accessing healthcare as easy as possible. I am evaluating partnerships with some other tech peers to create a wellness clinic based on shared services as well as childcare centers in San Francisco. The clinic model integrates all aspects of mind-bodyhealth services such as primary care, labs, prescriptions, physical therapy, acupuncture, massage, and group and individual counseling. The childcare center could be a babysitting, education-based solution for our “Squarents.” I’m also exploring a complete telehealth virtual services model (via phone and FaceTime) and a doctor-on-demand model that brings a physician to the patient. Some components of telehealth are already in place through our insurance providers, and we are assessing a broader service platform with a doctor-on-demand model this year.

How do you feel about your tenure at Square so far?

It’s been a fun ride. My team has tripled in size and we’ve built core functions like the HR operations team, a business partner team, mobility functions, and our culture focus. Anytime you get to build things from scratch and see their evolution and market recognition, it’s rewarding and fun. I always keep in mind something my grandfather taught me: “Be healthy, wealthy, and wise.” AHL

Sutter Health | Aetna brings together Sutter Health’s network of doctors and hospitals with Aetna’s leading health plan experience. This joint venture aims to deliver a differentiated, personalized experience for members and is designed to improve efficiency and lower the cost of care, resulting in greater affordability.

Health benefit plans are administered by Sutter Health and Aetna Administrative Services LLC (Sutter Health | Aetna).

7S.12.900.1 CA (5/18)

SUPPORTING YOUR MOBILE TALENT

In today’s global economy the success of an organization is driven by talent, and the search for that best-fit talent now, more than ever, transcends borders. At TheMIGroup, we understand that effectively recruiting, managing, deploying, and retaining this talent is vital to the health and longterm success of your organization. Managing your workforce on a global scale requires a proven partner to seamlessly guide you through the relocation process, delivering hassle-free talent mobility solutions. TheMIGroup, a leading global relocation management solutions provider, is proud to be Square’s mobility provider of choice.

In Conversation With Changing Perceptions of Population Health

Humana’s Dr. Sandra Guerra shares with American Healthcare Leader how a new approach to healthcare— one that includes data, analytics, and Humana’s Bold Goal initiative—can drastically improve people’s lives

By Joe Dixon | Portrait by Cass Davis

Population health has become somewhat of a buzzword in the healthcare industry over the past decade. But long before it became a popular topic of conversation among healthcare professionals, Dr. Sandra Guerra knew this approach to healthcare—analyzing health outcomes of groups of people—would be vital to improving patient outcomes and reducing healthcare costs.

As the vice president and chief medical officer for Humana Military TRICARE, Guerra uses population health analytics to improve health outcomes for United States military families across thirty-two states. Humana focuses on population health through programs such as the Bold Goal initiative, which is aimed at improving the health of communities by 20 percent by 2020.

Guerra sat down with American Healthcare Leader to discuss the future of population health, why it’s taken on such prevalence in the industry, and to share the latest on Humana’s Bold Goal initiative.

What factors do you see contributing to the increasing use of population health methods?

The evolution to a value-based reimbursement model, where everything from the federal government on down started to look at a different pricing model where we say, “We’re going to give you this population of people, and we’re going to give you a certain dollar amount to take care of that population,” was big. Suddenly, healthcare executives have an incentive to keep patients healthy so they spend less of that healthcare dollar and maintain profitability for their organization.

I think the other thing that has happened is we’re finally at a point, from a technology perspective, where we can see a population’s health data that we couldn’t see twenty years ago

when we first introduced a capitated model of compensation. Now we have systems in place where we can look at a population and learn a lot about them based on their healthcare claims, lab data, pharmaceutical usage, frequency of visits to an emergency room or hospital, and frequency of 911 calls.

Improving health outcomes by 20 percent is a major goal. Could you elaborate on the details of Humana’s Bold Goal initiative?

San Antonio, where I live, happened to be the first community where Humana made a commitment to improve the health of the population. The way we did that was by setting up a health advisory board in San Antonio that I’ve chaired for the past five years. That’s where we bring other traditional and nontraditional health influencers—health systems, food banks, and the city’s parks and rec department—at least once a quarter to work on synergistic projects together.

We found that each influencer was working on different projects and trying to improve health in different ways. We discovered that if we could bring everyone together and find ways that we could help push the needle, then we could improve the health of the whole community and not just people who carry Humana insurance.

How are you measuring improvement in health outcomes?

One of the first questions everyone asked was, “How do we come to an agreement on what improved health means?” Our team found that the Centers for Disease Control and Prevention already had an easy metric called the Healthy Days measure. It’s a group of questions you ask people to gauge how many unhealthy days someone had in the past

“Health is influenced more by factors outside the clinic than inside. All health organizations must rally behind the need to fix those issues too, not just what happens within their walls.”

thirty days, and it gauges both physical and mental health.

Once we did that, we had a baseline when we started of how many unhealthy days people in the San Antonio community were experiencing. We’ve been successful in replicating that questionnaire, and we are on track to hit our goal of reducing the number of unhealthy days by 20 percent by 2020.

What advice do you have for healthcare professionals looking to adopt a population health approach to their work?

Looking at organizations that have proven themselves in this space and seeing what you can replicate is a good start. Healthcare organizations should also pay attention to social determinants of health such as food insecurity, social isolation, financial insecurity, housing, access to transportation, and more. Health is influenced more by factors

outside the clinic than inside. All health organizations must rally behind the need to fix those issues too, not just what happens within their walls.

For instance, in our military population, there was an assumption that food and financial insecurity would not be negative social determinants of health because these individuals are employed and have healthcare access. But when we did research, we realized that food and financial insecurity were extremely important for this population, despite the safeguards in place. When an organization is looking at the social determinants of health for their populations, they must keep an open mind. The population you serve might not fit your assumptions; it is worthwhile to investigate. And though initially this may seem overwhelming, it is worth the effort to interrupt these negative social determinants so the population can achieve their best health. AHL

People & Companies

Amid uncertainty, one certainty.

Unsettled health-related legislation. Unexpected mergers. Evolving consumer expectations. Digital acceleration. Today, health care leaders plan for uncertainties as challenging as they are inevitable. But one certainty is clear. Success depends upon current employees, in their current culture, addressing unfamiliar challenges. And that’s the biggest uncertainty of all.

Excelling amid uncertainty requires a new type of culture. Nimble. Creative. Accountable. A culture that engages and empowers employees amidst change. Senn Delaney culture shaping has helped many health care companies turn their cultures into an advantage in the face of uncertainty. Find out how. Visit heidrick.com.

Senn Delaney culture shaping is a proven methodology that shapes company cultures into assets, ready to embrace change and achieve company objectives.