• Value-Based Care Requires a More Versatile Workforce

    By Laura Ramos Hegwer Apr 23, 2018

    As the lines between health plans and providers blur in today’s integrated healthcare organizations, leaders recognize the benefits of sharing and developing talent across traditional organizational and industry boundaries.

    As integrated healthcare organizations position themselves for value-based care, some of the scarcest resources are leaders who understand both clinical and financial operations. Increasingly, integrated organizations—those with both provider and health plan operations—are exploring ways to develop and share expertise across the payer and provider sides of their business, as well as to hire nontraditional talent.

    Crossover Staffing Feature_Amy Compton PhillipsClinical leaders who have worked for health plans particularly are in high demand because of the mindset they bring. “I have never really thought of a leader being on the hospital side or the health plan side, from my background,” says Amy Compton-Phillips, MD (pictured at right), formerly chief quality officer at the Permanente Foundation and now executive vice president and chief clinical officer of Providence St. Joseph Health, Renton, Wash.

    She says leaders need to think about the healthcare industry beyond their traditional sphere of influence. “It doesn’t matter whether your paycheck or direct-line reporting goes up to the health plan, the hospitals, or the medical group,” she says. “We have to have people who can produce high-value care—better outcomes at a lower cost—in a way that delivers effective service for our patients and our communities.”

    Exhibit: Providence St. Joseph Health's Population Health Division

    Crossover Staffing Feature_Exhibit

    Searching for Talent

    Sometimes, health systems do not have adequate internal talent to fill their most strategic positions, especially those in areas that are still evolving, such as population health and disruptive innovation, says Courtney Lada, managing partner of Quick Leonard Kieffer, a healthcare executive search firm in Chicago. To remain nimble in today’s ever-changing healthcare environment, provider organizations are recruiting senior team members with experience in business diversification and merger-and-acquisition strategies, as well as expertise in public health, data analytics, and management of risk-based contracts.

    Health plans are also hiring for cross-functional expertise. “They want clinical leaders who are business-savvy and operationally astute, with well-honed interpersonal skills,” Lada says. “With so much riding on outcomes and patient experience, it is imperative for health plans to have senior leaders who can successfully foster relationships with providers and patients alike so that their performance improvement and clinical integration efforts are effective.”

    In addition, a desire to be more consumer-driven and competitive has spurred some healthcare organizations to hire talent from industries that are highly regulated and safety-driven like health care but have more experience with consumerism, such as airlines, banking, and tech. For example, Providence St. Joseph Health’s new CFO, Venkat Bhamidipati, was previously CFO of operations and technology at Microsoft. “Many organizations are taking cues from tech-based companies and startups to determine how their strategies [to become more consumer-oriented] can be applied to the healthcare industry,” Lada says.

    Crossover Staffing Feature_Rhonda MedowsOf course, the reverse is also true as startups see an opportunity to disrupt the healthcare sector. Integrated healthcare organizations must vie for candidates against other provider organizations, health plans, pharmacy benefit managers, and now tech companies like Google and Amazon, says Rhonda Medows, MD (pictured at right), executive vice president of population health at Providence St. Joseph Health.

    Training More Well-Rounded Leaders

    As Providence St. Joseph Health has grown into one of the largest integrated healthcare organizations in the country, leaders have implemented several talent development strategies, including a cross-functional mentorship program in the population health department.

    Medows, who has worked in health plans and public health and previously was executive vice president and chief medical officer of UnitedHealth Group, borrowed the idea from one of her first employers, Florida Blue. As a medical director in charge of clinical quality, she rotated through marketing, actuarial sciences, e-health, and fraud and abuse for a year. Now at Providence St. Joseph Health, Medows has four mentees: a health plan executive, a nurse, an information services leader, and a communications expert. Her six direct reports also have mentees and use the program to groom new talent with cross-functional expertise.

    Medows’ team also works alongside quality, finance, and health plan leaders to identify rising stars to lead multidisciplinary collaboratives on topics such as Medicare Access and CHIP Reauthorization Act (MACRA) readiness and lowering the cost of care.

    They also work with other groups to identify candidates for open positions across the enterprise. For example, they might discuss whether a leader in quality or clinical operations could move into medical management in one of the organization’s three health plans. “When we are looking at talent that we need to bring in or develop, we look across our entire health system—not just hospitals or health plans, but also ambulatory, virtual, and long-term care,” Medows says.

    Finding Leaders to Drive Change

    Health Plan VBC Products_Brigitte NettesheimAs health plans evolve into broader health services companies, their staffing needs are changing as well, says Brigitte Nettesheim (pictured at right), president of transformative markets for Aetna, Hartford, Conn. Leaders with experience on both the payer and provider sides are always in demand, as are those with consumer expertise, Nettesheim says.

    In her role, Nettesheim hires the agile and diverse leadership teams that manage each of Aetna’s joint-venture partnerships with providers. She is interested in “cross-pollination” of experts with different backgrounds. “We look for experience leading and driving change in an organization—it doesn’t necessarily need to be a health insurance plan,” she says. Nettesheim also looks for previous experience with startups and joint ventures in any industry because such experience helps leaders hone their diplomacy skills. Less important are technical skills, such as deep knowledge of Medicare Advantage or actuarial science, she says. 

    Experience with driving clinical innovations also is becoming more important to health plans as they get more engaged in care delivery. As an example, Nettesheim points to Robert Groves, MD, chief medical officer of the Banner|Aetna insurance company in Arizona. Before joining Banner|Aetna, his experience was primarily on the provider side, most recently as vice president of health management at Banner Health and chief medical officer of Banner Health Network, the health system’s accountable care organization.

    Nettesheim believes that Aetna has an opportunity to create a more entrepreneurial culture inside these joint ventures. For this reason, the company worked with Accenture to develop a new executive onboarding process, including tools to help leaders understand how they can drive value in their business. One tool is a questionnaire that new leaders complete within their first week to map out how they will meet their strategic objectives. Sample questions include:

    • By leveraging the very best of Aetna and the provider partner, how do you envision the combined team innovating the consumer experience?
    • How will the team drive an entrepreneurial culture that challenges the status quo and promotes improving health in the communities that are jointly served?

    Lessons Learned

    Experts offer the following advice to leaders who are interested in serving on today’s evolving leadership teams.

    Assess your skills. Medows suggests doing this at least once a year and determining how to resolve any skill gaps in the coming year. Solutions might include taking an evening class in financial management or volunteering for an informatics project.

    Engage in cross-functional collaborations. Providence St. Joseph Health has a group vice president for care management on the delivery side who works with a care management leader on the health plan side. Together, they use common databases to identify and manage complex, high-risk patients, with the goals of improving clinical outcomes and reducing costs from avoidable emergency department visits and readmissions. By working collaboratively, leaders learn from each other and improve their own skills, Medows says.

    Take advantage of internal leadership academies. This is especially important for physicians and other clinicians whose professional aspirations go beyond the traditional paths of medical affairs or nursing leadership. “The most successful clinical executives that we see are developed from within and then gain exposure through a variety of domains,” Lada says.

    Pursue Lean or Six Sigma certifications. As organizations seek to make the most of their integrations and improve value by standardizing care, reducing costs, and eliminating waste, operational leaders with process improvement experience are highly valued, Lada says.

    Be willing to take risks. This means taking a challenging position even if it is outside of a personal comfort zone. “Don’t take the safe route—there is no safe route if you want to be successful and marketable in a dynamic environment,” Nettesheim says.

    Changing the Mindset

    Compton-Phillips believes leaders who focus only on their own silo or specific business line of revenue will be at a disadvantage as more healthcare entities use targets and incentives to make executives accountable for the performance of their colleagues across the organization.

    But achieving this mindset shift can be difficult for clinical leaders. Recently, Providence St. Joseph Health launched a new initiative called Clinical Leadership 2.0 to give physicians, nurses, and pharmacists the skills they need to manage across the continuum. The new executive training includes a clinical value improvement course, which was developed with the Institute for Healthcare Improvement (IHI). One example of a project that trainees took on as part of the course was improving flow in the ED. “By gathering a team, understanding the entire process, and focusing on small tests of change to make cumulative, incremental improvements in flow efficiency, our clinical value improvement program executives shortened stays for patients in the ED, making care better at lower costs,” Compton-Phillips says. She also expects the initiative to help the organization cultivate more staff with skills that are needed for the future.

    “If you were hired as a CMO [chief medical officer] in the past, you were hired for your ability to deal with cranky docs—you weren’t hired for your ability to create change,” Compton-Phillips says. But expectations have shifted. As she says, “We really need to invest in our leaders in a different way than we have in the past.”


    Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.

    Interviewed for this article: Amy Compton-Phillips, MD, executive vice president and chief clinical officer, Providence St. Joseph Health, Renton, Wash.; Courtney Lada, managing partner, Quick Leonard Kieffer, Chicago; Rhonda Medows, MD, executive vice president of population health, Providence St. Joseph Health; Brigitte Nettesheim, president of transformative markets, Aetna, Hartford, Conn.

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