An early sys­tem in­te­gra­tion vi­sion­ary

Modern Healthcare - - 2014 HEALTH CARE HALL OF FAME - By Steven Ross John­son

An in­te­grated health­care de­liv­ery sys­tem was a for­eign con­cept to many in the in­dus­try back in the late 1980s and early 1990s. Hos­pi­tals within the same re­gion of­ten com­peted with each other, as well as other providers, for pa­tients. Fred Brown was one of a hand­ful of hospi­tal ex­ec­u­tives at that time who saw the po­ten­tial ben­e­fit in com­bin­ing the re­sources of many dif­fer­ent health­care part­ners to cre­ate a com­pre­hen­sive sys­tem of care for the com­mu­ni­ties they served.

Those who have worked with him and for him over his 50-year-plus ca­reer say it was Brown’s vi­sion to pro­vide a con­tin­uum of care that led him to ini­ti­ate the 1993 merger of St. Louis-based Chris­tian Health Ser­vices—where he was CEO—with Barnes Hospi­tal and the Jewish Hospi­tal of St. Louis.

“He’s got a very great sense of com­mu­nity,” said Wayne Lerner, Brown’s long­time friend and col­league. Lerner worked with Brown as pres­i­dent of Jewish Hospi­tal be­fore it merged with Barnes to be­come Barnes-Jewish Hospi­tal in 1996. “When he puts to­gether or­ga­ni­za­tions, it’s to ben­e­fit the people we’re serv­ing more than any­thing else,” he said.

It was the union of these three or­ga­ni­za­tions that laid the foun­da­tion for what would even­tu­ally be­come BJC Health­Care, which Brown ran for the next seven years as found­ing CEO and vice chair­man. With 13 acute-care hos­pi­tals in Mis­souri and Illi­nois, BJC was one of the first sys­tems to in­cor­po­rate teach­ing hos­pi­tals, as well as long-term care and home health ser­vices, a med­i­cal school and be­hav­ioral health­care into its net­work. The sys­tem has since ex­panded to serve more than 200,000 res­i­dents in the St. Louis area, with a staff of nearly 30,000 at 200 care sites, in­clud­ing hos­pi­tals, home-care ser­vices, hospice, long-term care fa­cil­i­ties, doc­tors’ of­fices and re­ha­bil­i­ta­tion cen­ters.

“It was prob­a­bly the first megamerger in not-for-profit health­care,” said James Fran­cis, as­sis­tant trea­surer and di­vi­sion chair­man of sup­ply chain man­age­ment at the Mayo Clinic, Rochester, Minn. Fran­cis be­gan his pro­fes­sional train­ing un­der Brown at Chris­tian Health Ser­vices and worked with him at BJC un­til 1998. “Fred was an in­no­va­tor. I think he had a tremen­dous abil­ity to as­sess the en­vi­ron­ment to un­der­stand where health­care was headed and to po­si­tion our or­ga­ni­za­tion ac­cord­ingly,” Fran­cis said.

For his ac­com­plish­ments in es­tab­lish­ing an in­te­grated, col­lab­o­ra­tive ap­proach to health­care, Fred Brown has been cho­sen one of this year’s in­ductees into Mod­ern Health­care’s Health Care Hall of Fame.

The BJC sys­tem was born from a job of­fer and counter of­fer, ac­cord­ing to Brown. When Barnes and Jewish formed their part­ner­ship in 1992, Brown was asked to run the new af­fil­i­a­tion, but de­clined be­cause of his com­mit­ments as the head of Chris­tian Health. In­stead, he went back to lead­ers of both hos­pi­tals to pro­pose that the three or­ga­ni­za­tions con­sol­i­date—an of­fer Barnes and Jewish ini­tially turned down.

It was dur­ing a sub­se­quent trip to Chicago in 1993 that Brown met with Charles Knight, then board chair­man of Barnes Hospi­tal, who was over­see­ing the af­fil­i­a­tion with Jewish Hospi­tal, when an agree­ment was reached for the two sys­tems to merge. “The in­ter­est­ing thing about it was that it hap­pened so quickly that it caught many people by sur­prise,” Brown said. “It was one of those things where we were con­tin­u­ally look­ing at op­por­tu­ni­ties, and then it just kind of fell into place.”

Additional merg­ers with other area hos­pi­tals soon fol­lowed, with the in­clu­sion of Mis­souri Bap­tist Health Sys­tem and the St. Louis Chil­dren’s Hospi­tal Net­work in 1994. By that time, BJC was gain­ing na­tional at­ten­tion for its in­no­va­tion. In 1999, BJC Health­Care was ranked sec­ond among the na­tion’s Top 100 In­te­grated Health­care Net­works by SMG Mar­ket­ing Group, a Chicago-based health­care in­for­ma­tion and mar­ket­ing com­pany.

But Brown said cre­at­ing the largest health sys­tem in Mis­souri was not the main goal be­hind BJC’s for­ma­tion. He said its de­vel­op­ment came more as a re­sponse to the many changes go­ing on in health­care at the time.

“We saw the in­tro­duc­tion of man­aged care in the 1980s, the in­tro­duc­tion of the for-profit move­ment in the coun­try,” Brown said. “And I thought that one of my re­spon­si­bil­i­ties was

“He had a tremen­dous abil­ity ... to un­der­stand where health­care was headed.”

to en­sure that there was sus­tain­abil­ity within the or­ga­ni­za­tion over a pe­riod of time.”

As con­sol­i­da­tion gained more at­ten­tion from health­care or­ga­ni­za­tions across the coun­try, aca­demic in­sti­tu­tions were largely left out of the con­ver­sa­tion be­cause they usu­ally car­ried high op­er­at­ing costs. But Brown saw the in­clu­sion of area teach­ing hos­pi­tals, Barnes-Jewish and later St. Louis Chil­dren’s Hospi­tal, in 1994 as es­sen­tial com­po­nents in the sys­tem’s mis­sion to pro­vide its com­mu­nity with an­other pri­mary re­source for well-trained physi­cians and other providers. Yet many thought bring­ing the fa­cil­i­ties into BJC Health­Care would prove dis­as­trous.

“When the merger took place, it was a sur­prise to many across the coun­try and within the St. Louis mar­ket,” Brown said. “What we at­tempted to do is what’s be­ing done to­day with the Af­ford­able Care Act and the move­ment to­ward ac­count­able care or­ga­ni­za­tions—so now, as we look at pop­u­la­tion health, we were in essence on the cut­ting edge of that back in the ’80s.”

Now re­tired, Brown, 73, said his ca­reer was first in­spired by a de­sire to en­ter into a field that could pro­vide so­cial ser­vices within a busi­ness en­vi­ron­ment. Af­ter com­plet­ing his grad­u­ate stud­ies at Ge­orge Wash­ing­ton Univer­sity in 1966, Brown be­gan his ca­reer as an ad­min­is­tra­tive as­sis­tant at Methodist Hospi­tal in In­di­anapo­lis. Within a year, he was of­fered his first chance in a lead­er­ship role and be­came an as­sis­tant ad­min­is­tra­tor at Methodist, where he su­per­vised the hospi­tal’s ser­vice ar­eas, such as di­etary, house­keep­ing, laun­dry, main­te­nance and con­struc­tion crews.

“Here I was, a young 25-year-old, work­ing with older depart­ment heads, some of whom had been there for a num­ber of years,” Brown said. He cred­its his early ex­pe­ri­ences with teach­ing him the abil­ity to lis­ten to other voices and in­cor­po­rate their skills and in­sights to achieve the best re­sults.

While at Methodist, Brown moved up to be­come vice pres­i­dent of op­er­a­tions in 1972. Af­ter two years, he left to ac­cept a po­si­tion as ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer of Elmhurst Me­mo­rial Hospi­tal in sub­ur­ban Chicago. Six years later, Brown be­came vice pres­i­dent and COO of Elmhurst’s par­ent com­pany, Me­mo­rial Health Ser­vices, now Elmhurst Me­mo­rial Health­care.

His first op­por­tu­nity to run an en­tire oper­a­tion came in 1983 when he be­came pres­i­dent and CEO of St. Louis-based, CH Al­lied Ser­vices. The com­pany was de­vel­oped as part of Chris­tian Health Ser­vices as a man­age­ment ser­vices firm that leased and man­aged five hos­pi­tals in the St. Louis area. Those hos­pi­tals even­tu­ally be­came part of BJC.

Soon, Brown be­gan re­ceiv­ing recog­ni­tion as a leader in health­care man­age­ment. In 1990, he was named Health­care Ex­ec­u­tive of the Year by the Amer­i­can Academy of Med­i­cal Ad­min­is­tra­tors, and re­ceived the academy’s States­man in Health­care Ad­min­is­tra­tion Award two years later. In 2000, Brown won a Gold Medal Award, the high­est distinc­tion from the Amer­i­can Col­lege of Health­care Ex­ec­u­tives, and also was the re­cip­i­ent of the Amer­i­can Hospi­tal As­so­ci­a­tion’s high­est honor, the Distin­guished Ser­vice Award, in 2008.

Though his roles have changed over the years, those who know him best say it was the ba­sic lead­er­ship lessons Brown learned early in his ca­reer that be­came his trade­mark—a col­lab­o­ra­tive, in­clu­sive ap­proach to man­age­ment. It has been an ap­proach that Brown has spent most of his ca­reer seek­ing to in­still in the many health­care lead­ers he has men­tored over the years.

“I think ev­ery­one needs some­one who be­lieves in them, and Fred was big in help­ing me un­der­stand that I should have the con­fi­dence to go do what­ever it is I wanted to do,” said Sarah Woodrum, a for­mer col­league at BJC who is now se­nior as­so­ciate dean and chief ad­min­is­tra­tive of­fi­cer at West Vir­ginia Univer­sity. “So I have tried to give back as a re­sult of what Fred gave to me.”

Fred Brown

Brown in 1999 with then-AHA Pres­i­dent Richard David­son, left, also a mem­ber of the Hall of Fame, and Mary Pittman, then-pres­i­dent of the Health Re­search and Ed­u­ca­tional Trust.

Brown was named chair of the Amer­i­can Hospi­tal As­so­ci­a­tion in 1999. Long­time health­care ex­ec­u­tive John King, who held the post the pre­vi­ous year, pre­sented him with the Chair­man’s Medal.

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