‘We’re re­ally look­ing for op­por­tu­ni­ties where we can serve new com­mu­ni­ties.’

Modern Healthcare - - Q & A -

Wright Las­siter III took the reins of Henry Ford Health Sys­tem on Jan. 1 from re­tir­ing Nancy Schlichting, its long­time CEO. Las­siter was re­cruited from Alameda Health Sys­tem in Oak­land, Calif., to run the six-hospi­tal sys­tem two years ago. Henry Ford re­cently ac­quired Al­le­giance Health in Jack­son, Mich., and HealthPlus, a state in­sur­ance plan. Will the dra­matic po­lit­i­cal shift now un­der­way af­fect the health sys­tem’s ex­pan­sion and other strate­gies? Mod­ern Health­care re­porters David Barkholz and Maria Castel­lucci re­cently spoke with Las­siter about those and other ques­tions. This is an edited tran­script.

Mod­ern Health­care: What are your one or two top pri­or­i­ties in 2017?

Wright Las­siter III: High re­li­a­bil­ity (of care) is a re­ally big fo­cus. We went through an as­sess­ment dur­ing much of 2016. We’ll be rolling out in 2017 a plan for high re­li­a­bil­ity.

High re­li­a­bil­ity is both a sci­ence and a cul­ture you’ll find in avi­a­tion, the nu­clear in­dus­try and chem­i­cal man­u­fac­tur­ing, where there are very, very low tol­er­ances for fail­ure. You can’t get it right 98.5% of the time be­cause get­ting it wrong that 1% can cause a melt­down.

In health­care, it’s dif­fer­ent. The fail­ure rate, or er­ror rate, is much higher than in those in­dus­tries. So we spent the bet­ter part of 2016 as­sess­ing our or­ga­ni­za­tion around how we could be­gin in­still­ing a high-re­li­a­bil­ity cul­ture at Henry Ford Health Sys­tem be­cause it will con­tinue to en­hance the qual­ity and safety of the care we pro­vide. We’ll be rolling out the staff and leader train­ing to move us down that path.

Over the years, we’ve won a lot of qual­ity and safety awards. We’ve won a (Mal­colm) Baldrige (Na­tional Qual­ity) Award. But how qual­ity and safety is de­fined to­day is dif­fer­ent than what it was five or 10 years ago. We just want to move to the next level.

MH: Are you talk­ing about stan­dard­iz­ing prac­tices more than you have? What are some of the el­e­ments?

Las­siter: Yes. It’s about stan­dard­iz­ing prac­tices across the sys­tem. We im­ple­mented safety hud­dles across the or­ga­ni­za­tion last year. Like on a sub­ma­rine or a nu­clear power plant, there is a daily meet­ing meant to raise the bar. Can we ex­pect 100% suc­cess to­day? What could be some of the is­sues that could al­low fail­ure to en­ter into that set­ting? It’s that and teach­ing the sci­ence around high re­li­a­bil­ity that will al­low our clin­i­cians to op­er­ate at a high level with less er­rors.

MH: Why are you pur­su­ing a statewide foot­print with your Al­le­giance Health and HealthPlus of Michi­gan ac­qui­si­tions?

Las­siter: When I first ar­rived here two years ago, be­sides learn­ing the or­ga­ni­za­tion, my job was to give guid­ance to the board around a strate­gic growth strat­egy. We es­tab­lished three pri­or­i­ties: Es­tab­lish our­selves as a leader in value-based care in the state of Michi­gan; en­sure that we had lo­cal mar­ket es­sen­tial­ity (high mar­ket share) in our tra­di­tional

On the pos­si­ble re­peal and re­place­ment of the ACA: “I don’t know if it makes sense to re­act to any in­di­vid­ual’s plan, whether it is Tom Price’s plan or any­one else’s, be­cause you don’t know if any of those will pre­vail un­der the Trump ad­min­is­tra­tion.”

ser­vice area in south­east Michi­gan; and es­tab­lish a dis­trib­uted statewide net­work of care. We needed to es­tab­lish part­ner­ships be­yond the seven coun­ties of south­east Michi­gan.

But we also wanted a part­ner­ship that would drive the first goal of es­tab­lish­ing our­selves as a statewide leader in val­ue­based care. So the Al­le­giance part­ner­ship fit two of those three cri­te­ria very strongly. It is a sole provider of a fairly de­cent­sized ge­og­ra­phy 75 miles west of Detroit. The re­gion was out­side our ge­o­graphic halo, so it gave us the abil­ity to have a de­liv­ery sys­tem com­po­nent that is out­side of our pri­mary base.

It gave us new mar­kets for our in­sur­ance com­pany, Health Al­liance Plan, to be­gin mar­ket­ing to con­sumers. It gave us a part­ner­ship with the health sys­tem that has done a lot of things well and has a lot of shared val­ues – a com­mit­ment to qual­ity and pa­tient safety, and a com­mit­ment to serv­ing its com­mu­nity as broadly as pos­si­ble.

We are look­ing for other op­por­tu­ni­ties for part­ner­ships where it makes sense. Henry Ford has not just been a hospi­tal op­er­at­ing com­pany. We have hos­pi­tals but we have a large am­bu­la­tory foot­print as well so we’re not just look­ing for hos­pi­tals to join our or­ga­ni­za­tion. We’re re­ally look­ing for op­por­tu­ni­ties where we can serve new com­mu­ni­ties.

Bring­ing HealthPlus in al­lowed us to grow our Medi­care Ad­van­tage lives by about 30% to 70,000. It al­lows us to grow our in­sur­ance plan up in Ge­ne­see County and the Flint area where we didn’t have a lot of in­sur­ance pres­ence. So while our in­sur­ance plan is the se­cond-largest in Michi­gan, we’re still only one-sev­enth of the size of Blue Cross Blue Shield of Michi­gan.

MH: Is Detroit and Michi­gan fully con­sol­i­dated now?

Las­siter: If you look solely at Detroit and south­east Michi­gan, I’d call it 95 to 98% con­sol­i­dated. You re­ally have three sys­tems in Detroit – us, Tenet and As­cen­sion. Then be­yond Detroit, you have Beau­mont, which is al­most as large as we are. We’re a shade un­der $6 bil­lion in rev­enue and they’re about $5.5 bil­lion. And in­side south­east Michi­gan, you have McLaren and Trin­ity. There aren’t any un­af­fil­i­ated hos­pi­tals any­more.

If you look statewide, you have some un­af­fil­i­ated ru­ral hos­pi­tals, but also a num­ber of small sys­tems, which at some point have to de­cide whether they want to op­er­ate with $500 mil­lion in rev­enue in a state with large na­tional and re­gional play­ers and stay in­de­pen­dent. There’s still a lot more con­sol­i­da­tion that could oc­cur across the state.

MH: How did your time as CEO of Alameda Health Sys­tem pre­pare you for your role as CEO of Henry Ford?

Las­siter: Any lead­er­ship role pre­pares you for the fu­ture be­cause you get bat­tletested in mul­ti­ple ways. The op­por­tu­ni­ties are very dif­fer­ent. Alameda had sig­nif­i­cant strife as an or­ga­ni­za­tion. It had lots of lead­ers so it had some lead­er­ship in­sta­bil­ity. It had a very dif­fer­ent board struc­ture. It had a lot of fi­nan­cial chal­lenges that were deeper and broader than what Henry Ford has faced in its near term.

At Alameda, I had the op­por­tu­nity to lead a fi­nan­cial turn­around and fo­cus on be­ing very lean. That is al­ways a help­ful ex­pe­ri­ence. We also had op­por­tu­ni­ties there to fo­cus on how you raise the bar on qual­ity and pa­tient safety and re­duc­ing harm.

MH: Given the changes in Washington, what are chal­lenges Henry Ford faces as one of Detroit’s safety net providers?

Las­siter: We just don’t know what will hap­pen with the new ad­min­is­tra­tion and what will and won’t hap­pen for both Med­i­caid and the ex­change. But Henry Ford is po­si­tioned very well to meet the needs of un­der­in­sured pop­u­la­tions be­cause we have a large num­ber of am­bu­la­tory sites in many lo­ca­tions through­out south­east Michi­gan.

We plan to add am­bu­la­tory sites so we im­prove the amount of ac­cess that we have to pri­mary care and to higher level care. So we are eval­u­at­ing very care­fully where we should ex­pand our foot­print within our mar­ket to make sure that ac­cess is at an ac­cept­able level. It’s not just the unin­sured. We serve Medi­care, Med­i­caid, dual-el­i­gi­ble pop­u­la­tions and, ob­vi­ously, com­mer­cial pop­u­la­tions. So we’re look­ing very crit­i­cally to cre­ate new ac­cess points.

We are also ramp­ing up our telemedicine ca­pa­bil­i­ties so you don’t al­ways have to come to Henry Ford sites to get ac­cess to your doc­tor. We have pi­loted on­line sched­ul­ing ap­point­ments so you don’t have to pick up the phone for an ap­point­ment. We are look­ing at ways to of­fer sup­port for in­di­vid­u­als with trans­porta­tion chal­lenges to get ac­cess to Henry Ford.

MH: What are your thoughts on re­peal­ing and re­plac­ing the Af­ford­able Care Act?

Las­siter: I’m not one who be­lieves that if a law gets passed, and the law isn’t per­fect, that you just get rid of the law. My view is the law had good in­ten­tions and had some pos­i­tive ef­fect. Let’s fig­ure out ways to im­prove it.

I’m con­cerned about the rhetoric of re­peal and re­place, be­cause I don’t know what re­plac­ing it is. I don’t know if it makes sense to re­act to any in­di­vid­ual’s plan, whether it is Tom Price’s plan or any­one else’s, be­cause you don’t know if any of those will pre­vail un­der the Trump ad­min­is­tra­tion.

On his pre­vi­ous po­si­tion as CEO of Alameda Health Sys­tem: “Any lead­er­ship role pre­pares you for the fu­ture be­cause you get bat­tle-tested in mul­ti­ple ways.”

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