Blend­ing Catholic, Jewish and aca­demic cul­tures into a ‘rich stew’

Modern Healthcare - - Q & A -

Ruth Brink­ley is pres­i­dent and CEO of Ken­tuck­yOne Health, based in Louisville, and se­nior vice pres­i­dent of op­er­a­tions for Catholic Health Ini­tia­tives. Ken­tuck­yOne was formed in Jan­uary 2012 with the merger of the St. Joseph Health Sys­tem in Lex­ing­ton, which was part of CHI, and Jewish Hospi­tal & St. Mary’s Health­Care in Louisville. Later that year, Ken­tuck­yOne part­nered with the Univer­sity of Louisville Hospi­tal; Gov. Steve Bes­hear had blocked a full merger partly be­cause of con­cerns about ap­ply­ing the Eth­i­cal and Re­li­gious Di­rec­tives of the U.S. Con­fer­ence of Catholic Bish­ops to care at a pub­lic hospi­tal. CHI is the ma­jor­ity owner of Ken­tuck­yOne, and the mi­nor­ity owner is the Jewish Her­itage Fund for Ex­cel­lence. Mod­ern Health­care Man­ag­ing Edi­tor Har­ris Meyer and Dig­i­tal Man­ag­ing Edi­tor Gregg Blesch re­cently spoke with Brink­ley about the chal­lenges of the merger and part­ner­ship, the health­care re­form ex­pe­ri­ence in Ken­tucky and her per­sonal lead­er­ship style. The fol­low­ing is an edited ex­cerpt.

Mod­ern Health­care: Has the Oba­macare in­sur­ance ex­pan­sion made a mea­sur­able dif­fer­ence for your hos­pi­tals?

Ruth Brink­ley: It’s too early to tell. Ken­tucky has some of the worst health­care out­comes in the coun­try, and Gov. Bes­hear has vowed to im­prove that and has ex­panded Med­i­caid un­der the Af­ford­able Care Act. We’re re­ally sup­port­ive of what he’s done. The real dif­fer­ence is go­ing to be how and if people change their be­hav­iors. We as a health sys­tem have to help drive be­hav­ioral change to health­ier-type be­hav­iors. I was on the ex­change’s ad­vi­sory board as a gu­ber­na­to­rial ap­pointee, and I’m very proud of both the ex­change and the state’s Med­i­caid ex­pan­sion. People have signed up for plans on the kynect ex­change. It’s been phenom­e­nal.

MH: What was your ex­pe­ri­ence ne­go­ti­at­ing rates with the plans par­tic­i­pat­ing on the ex­change?

Brink­ley: That’s al­ways a dif­fi­cult propo­si­tion. We’re in some ex­change plans and not in oth­ers. In­sur­ance plans al­ways want to de­crease their cost and that’s laud­able. We’re try­ing to de­crease our costs, too. What we’re try­ing to do is cover our costs and have enough to in­vest back in our or­ga­ni­za­tion.

MH: What ini­tia­tives are your sys­tem tak­ing to achieve im­prove­ments in pop­u­la­tion health?

Brink­ley: One of the big­gest things we’ve done is form a clin­i­cally in­te­grated net­work. We are man­ag­ing about 100,000 lives, in­clud­ing our em­ploy­ees and their de­pen­dents. We were re­ally en­abled to do that through CHI, which helped us with the plat­form. We have started or will start three healthy life­style cen­ters. We also have a Medi­care shared-sav­ings ac­count­able care or­ga­ni­za­tion, and we ex­pect to have some bun­dled-pay­ment plans in the fu­ture.

MH: Will Ken­tuck­yOne ac­quire any health in­sur­ers and start of­fer­ing in­sur­ance it­self, as CHI is do­ing else­where?

Brink­ley: I en­vi­sion that it will. I can’t say when. I en­vi­sion that as we move to risk prod­ucts, that will be one of the ar­eas we’ll get in­volved in.

MH: What are the chal­lenges in in­te­grat­ing very di­verse or­ga­ni­za­tions?

Brink­ley: First of all, you start with cul­ture be­cause it all be­gins and ends with people. We have un­der­taken some de­lib­er­ate cul­ture-shap­ing prac­tices. When you’re deal­ing with her­itages of the Catholic, Jewish, sec­u­lar and aca­demic com­mu­ni­ties, it’s a very rich stew. We set about to re­tain each or­ga­ni­za­tion’s re­li­gious her­itage if there was one. Nav­i­gat­ing that and then shap­ing a shared cul­ture around that is one of the first things we’ve un­der­taken. If you can’t re­ally get people to work with you, then noth­ing else is go­ing to work.

The sec­ond big thing is we’re in the process of de­vel­op­ing a shared IT plat­form among the three big sys­tems. We’re in­stalling a Cerner sys­tem. We ex­pect to go live at Jewish Hospi­tal some­time late this sum­mer or early fall, and then in short or­der we’ll bring it out at the Univer­sity Med­i­cal Cen­ter and at Jewish & St. Mary’s. It will cost $400 mil­lion.

MH: In merg­ing with Jewish and now part­ner­ing with Univer­sity of Louisville, the is­sue of the Catholic bish­ops’ Eth­i­cal and Re­li­gious

“This is more than a job, it’s a priv­i­lege, and it takes a spe­cial kind of thought process.”

Di­rec­tives arose. Have there been con­tin­u­ing con­cerns about fol­low­ing Catholic poli­cies on re­pro­duc­tive care, end-of-life care and other is­sues?

Brink­ley: No, be­cause Univer­sity Med­i­cal Cen­ter still man­ages the Cen­ter for Women and In­fants. So that pop­u­la­tion gets the care and ser­vices they al­ways got.

MH: The Univer­sity of Louisville deal says the fac­ulty and staff have to “re­spect” Catholic poli­cies.

Brink­ley: That goes back to re­spect­ing the re­li­gious her­itage of all of the or­ga­ni­za­tions. So while Ken­tuck­yOne Health it­self is not a Catholic or­ga­ni­za­tion, we own and man­age or­ga­ni­za­tions that are Catholic. The for­mer St. Joseph fa­cil­i­ties all re­main 100% Catholic, and the Jewish hos­pi­tals all re­main 100% Jewish. So we re­spect the Jewish her­itage as well.

MH: Doesn’t Jewish have to com­ply with Catholic poli­cies?

Brink­ley: It has to re­spect Catholic poli­cies. That means that nei­ther or­ga­ni­za­tion will do any­thing to vi­o­late the re­li­gious her­itage of the other. There are cer­tain things we re­spect in the Jewish faith. They may not be as prom­i­nent as the Eth­i­cal and Re­li­gious Di­rec­tives. At the univer­sity, it’s a sec­u­lar or­ga­ni­za­tion so there’s a host of state rules and reg­u­la­tions that have to be re­spected there. It’s very com­pli­cated.

MH: Was this sit­u­a­tion un­prece­dented for CHI?

Brink­ley: Yes and no. CHI is also a ma­jor­ity owner of Cen­tura Health in Denver, which is a joint ar­range­ment with the Ad­ven­tist sys­tem. In Omaha, Neb., we part­nered with the Luther­ans. This is the first time we’ve part­nered with a state or­ga­ni­za­tion and with a Jewish or­ga­ni­za­tion. The com­mon­al­ity was our shared val­ues and shared de­sire to im­prove the health sta­tus of cit­i­zens across the com­mon­wealth. When the Univer­sity of Louisville joined us, that gave them ac­cess to a statewide net­work. It gave us ac­cess to teach­ing and re­search mis­sions and the abil­ity to cap­ture grad­u­ates from the med­i­cal and nurs­ing schools and the other health-re­lated pro­fes­sional schools. So it was a win­win-win for all of us.

MH: Ken­tuck­yOne had an ex­tremely dif­fi­cult year fi­nan­cially in 2013, with losses of nearly $100 mil­lion, cor­rect?

Brink­ley: We did. When three or­ga­ni­za­tions come to­gether, there are al­ways re­dun­dan­cies. You don’t need three of ev­ery­thing. So that was part of it. The other part is the trends driv­ing de­creased in­pa­tient uti­liza­tion. Then there was down­ward rate pres­sure from all in­sur­ers. So you have a con­flu­ence of events that oc­curred as we came to­gether, re­sult­ing in some chal­lenges in 2013. We have started to work through those chal­lenges. I feel very good about where we are to­day.

MH: What kind of fi­nan­cial per­for­mance are you ex­pect­ing for this year?

Brink­ley: We’re not ready to say yet, but we have made im­prove­ments. ... We had our work­force re­duc­tions in Fe­bru­ary. Those didn’t re­ally start to hit the books un­til March. They’ll go through June of this fis­cal year, and then some will con­tinue.

MH: Are you are fin­ished with the work­force re­duc­tions?

Brink­ley: Mas­sive work­force re­duc­tions, yes. We’ll have to stay on top of this with man­ag­ing pro­duc­tiv­ity and op­er­a­tional ef­fi­cien­cies. But we hope at this point we are fin­ished with large-scale lay­offs. I can’t pre­dict the fu­ture. If some­thing changes in Wash­ing­ton or Frank­fort, then we may have to change again.

MH: Ken­tuck­yOne also had prob­lems with physi­cian re­ten­tion?

Brink­ley: There is a lit­tle bit around that, not mas­sive. Com­ing to­gether, you’ve got three dif­fer­ent cul­tures and you’ve got three dif­fer­ent sets of val­ues. We had some physi­cians leave be­fore the merger came to­gether. Bring­ing the univer­sity in was an­other dy­namic, and we had some physi­cians leave af­ter that. But we’ve also brought in 58 new pri­mary-care providers. We’ve been very suc­cess­ful in re­cruit­ing and re­tain­ing a ma­jor­ity of our physi­cians.

MH: You also rolled out an un­usu­ally large telemedicine pro­gram, Any­where Care.

Brink­ley: The ba­sis of form­ing Ken­tuck­yOne was to bring care closer to where people live, and you can’t get any closer than com­ing into their homes through vir­tual care. Any­where Care was a way to bring care closer to people and make it more con­ve­nient. It is episodic care, it’s not in­tended for longer-term care. Those people are re­ferred to a pri­mary-care physi­cian within our sys­tem. It’s go­ing very, very well. Re­fer­rals to pri­mary-care physi­cians are up 33%. That’s through a part­ner­ship with Carena. We also part­ner with

Wal­greens clin­ics to bring care closer to where people live, work and shop.

MH: Are you con­sol­i­dat­ing ser­vices?

Brink­ley: We’ve started in our down­town med­i­cal cam­pus, with Jewish and the Univer­sity Med­i­cal Cen­ter. We’re cer­tainly not any­where near fin­ished. We’re look­ing to see what makes sense in terms of ef­fec­tively plac­ing ser­vices there.

MH: What is your per­sonal man­age­ment style, and how do you hire people?

Brink­ley: I look for people who have a pas­sion for what they do. This is more than a job, it’s a priv­i­lege, and it takes a spe­cial kind of thought process. I want people I hire di­rectly to have that pas­sion. Then I want them to be re­ally good at what they do. I try to hire people who are smarter than me be­cause they al­ways make you look good. If we cre­ate the right en­vi­ron­ment to do that, we will be­come a great or­ga­ni­za­tion. It’s the right kind of cul­ture, re­wards and en­vi­ron­ment, and hav­ing a very high stan­dard of ex­cel­lence.

MH: What are the spe­cific ways you go about set­ting that tone across such a large or­ga­ni­za­tion?

Brink­ley: I start with the people who are di­rect re­ports and how I in­ter­act with them. They know I’m tough. I’m tough on my­self as well. I ex­pect them to be tough but fair, kind, com­pas­sion­ate and live our val­ues, which are rev­er­ence, in­tegrity, com­pas­sion and ex­cel­lence. If you use those val­ues, it gives you all the guide­lines you need for be­hav­ior, whether it’s at a lead­er­ship level or at the staff level. I try to live those val­ues ev­ery day, and they pro­vide a com­pass.

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