Health Systems Learning Group: CEO Interviews

1. Health Systems Learning Group: CEO Interviews October 10, 2012 Teresa Cutts, Ph.D. Director of Research for Innovation and Program Development

2. What keeps you up at night?  • Managing massive change/transitions and World 1 and World 2 “Schizophrenia” • Fiscal concerns (e.g., shrinking margins, access to capital, uncertainty in Medicaid expansion at state level, changes in DSH) • Thinking of the whole system vs. being “hospital-centric” • Standardization and consistent delivery of care across our hospital system and integrating that with the values and culture other stakeholders • Deficiency of primary care

3. What relationship, if any, do you see to what keeps you up at night, and how we approach the 2014 Medicaid expansion?   Relevance to the bottom line? • Highly relevant: Loss of GME monies AND no state uptake of Medicaid expansion money, leaving huge gaps in funding • The two are very much related, as the burden of uncompensated care is great—it is currently 9% of our total revenue. We’ve reached the tipping point of only cuts and no expansion.. Total and quantifiable relevance—the bottom line is $60 million for the delivery system of a $3 billion corporation. Currently we have 1.5-2% margin.

4. What tools and supports would be beneficial? Improve access to care for Medicare or Medicaid patients Community partnerships, (e.g., Congregational Health Network) to build community capacity to self-manage care and navigate dual eligibles to care Subsidizing safety net clinics Signing people up for Medicaid expeditiously with as many access points as possible Low cost models of care delivery

5. Beyond maintaining our non-profit status, what role(s) do you see that community benefit programs can play in improving our health systems and community health? Move toward prevention and well care, by preventing acute illness episodes resulting in ED or inpatient admits Focus on social determinants of health All patients are complex, not just those with financial worries; emotional aspects of illness are important to manage; uncertainty on how/where to get “best” treatment Hospital=community resource to improve community’s health via helping with access, providing safe, affordable, accessible and equitable care Hospital must measure impact to see if it is achieving results and benefitting community Need collaborative efforts from many stakeholders

6. Do you believe we have the needed metrics in place to prove it makes a difference?  If not, what metrics are needed? • No!!!! • Collectively create metrics that reflect not only hospital values, but those that are linked to what the community values. • Use public health metrics and identify the role of the hospital in identified interventions • Need a process of deciding the metrics using the current measurement tools and opportunity to develop new ones.

7. How would you envision these metrics would relate to/be informed by what we learn in our Community Health Needs Assessment? • Ideally, these two would be tied together, to make a difference and be incorporated into our planning for the future, with true listening to community members. • Some metrics should be related to CHNA, but not all of them. We need to also consider points of access, quality, affordability and equity.

8. What level of leadership should be held accountable?  100% of our leadership team should be held accountable to this task, not just the visionaries The Board and Executive Leadership The Community Pillar is a foundational measure of performance, but peripheral to many healthcare organizations. The two pillars—academic and community—are what differentiate us. This is where it shows as a benefit. Commitment to the community if part of our fabric.

9. What if any role can you play … Can our governance boards play?  Keep value focus, protection and funding for Innovation and R&D Board supports R&D, while demanding that the hospital be fiscally responsible Policy development and evaluation Public Responsibility and Advocacy Committee [part of our governance structure that focuses on community benefit, community health, access, diversity, equity and wellness] is responsible, connected and on the “offensive”

10. *On a scale of 1 to 5, what priority do you give to community involvement in our overall strategic plan?   • “4” because community involvement is a critical function for us to flourish as a system in the future, but we have to lower costs to be viable, move away from episodic care and think more toward continuum and transitions of care • “4” • “5” Hospital must be relevant and a force in the community. Community litmus test…

11. What characteristics do you believe define the key elements in successful community involvement and partnership?  • Listen to community voices and make those partnerships central to mission (more than expanding access) • Create new roles and job descriptions in organizations promoting community health • Integrative strategies: take a holistic approach and do not make decisions unless you look at the whole • Strategic priority, passion, commitment, leadership and a good strategy for measurement

12. What relevance do community partnerships have to our bottom line? Community partners are critical to our fiscal viability and bottom line in the future reimbursement scenarios, by helping expand access and teaching people to self-manage chronic disease Significant, but it is hard to quantify. Without it, would not have the engagement of our people and sense of purpose and meaning in the work we do. Without it, we would lose our relationship and the energy it gives us.

13. What tools and resources would be helpful for strengthening the role of community partnerships in our health system? How do they relate to what keeps you up at night? CHN Roles: Train people to navigate to resources, improve trust in our system, share resources, learn to self-manage disease, build capacity in community skills See and hear through the “lens of community” and include this in our strategic planning Create job descriptions that promote population health Developing partnerships…helps me sleep well…gives me confidence that we have the support to influence what does keep me up at night—gives us a great platform. With unlimited funds, I’d spend on community partnerships. …more important to preserve resources to make sure we don’t make hasty decisions at the expense of long term community benefit….an important symbolism: Commitment comes not when things are easy, but when they are hard.

14. What else would you like the HSLG to address, that could help solve problems that we have? • What are the baby steps we need to take as a health system to get to World 2? • How can we educate PCPs on what we as a whole group together have to do be viable and better manage population health? • How as a health system do we “hear” and respond to the voice of community? • How do we de-risk this process and really focus on those programs, services and approaches that are most likely successful because of this issue of living in two worlds? • How to think differently about the threats to not-for profit status? How it is going to effect the external pressures because of the taxation issue?

15. Other Problems To Solve How do we change the dialogue and be on the offense instead of on the defense? Let’s identify how to collectively go on the offense. In Detroit, we are close competitors, and yet work together. It is mostly your head that gets in the way. We need all your minds and your heart will get a lot easier.

16. Thanks to our Interviewers and their Leaders! Teresa.Cutts@mlh.org Cutts02@gmail.com 901.516.0593