Max Cohen, M.D., vice president and CMO of the 489-bed Missouri Baptist Medical Center in St. Louis, is the winner of the fifth annual Physician Executive Award of Excellence.
Harris Berman, M.D., CEO of not-for-profit Tufts Health Plan in Boston, is the winner of the first Physician Executive Lifetime Achievement Award.
The American College of Physician Executives, Cerner Corp. and Modern Physician sponsor the awards.
'Champion for quality'
Cohen, 64, a native of Glasgow, Scotland, has seen his surgical and administrative career take him to three countries, six medical schools and numerous hospitals in pursuit of clinical excellence. His passion is to improve quality and patient safety at the operations level.
In 1998, Cohen assumed his current position at Missouri Baptist, part of the 13-hospital BJC HealthCare system.
Cohen has fostered a just culture to promote uninhibited error reporting and accountability. With an interdisciplinary team of hospital administrators and staff effectively implementing his strategy, the number of adverse drug events per 1,000 doses has been reduced from 2.5 to less than 0.5.
Cohen was chosen for the Physician Executive Award of Excellence from a record 35 nominees.
"Max is a phenomenal champion for quality and patient safety," says Claiborne Dunagan, M.D., vice president of quality and director of the Center for Healthcare Quality and Effectiveness at BJC HealthCare. "He has a strategic view of where healthcare needs to go and of what individual programs need to do to get there."
To date, the cost of Cohen's entire patient safety program has been less than $200,000, including salaries, while the reduction in adverse drug events has saved the medical center $13.4 million annually.
"I love to see how one can make changes to the way an organization functions that will result in an improvement to care," Cohen says. "I get very restless with the status quo."
Trained as a surgeon, Cohen enjoyed an academic surgical career and has published more than 100 peer-reviewed works on basic and clinical research, clinical surgery and cost-effectiveness analysis.
Meanwhile, he engaged his long-standing interest in continuous quality improvement in surgery and other hospital departments.
Cohen's desire to expand upon those efforts at the operations level led him to earn a master's degree in health administration at the University of Michigan, Ann Arbor. He says he had an epiphany when his eyes were opened to the potential for performance improvement in hospital operations.
"If I really wanted to be involved in performance improvement as broadly as I wanted, it meant becoming a full-time physician executive," he says.
Mark Eustis, senior executive officer at BJC HealthCare, had worked with Cohen at Grace Hospital in Detroit before recruiting him for the newly created CMO position at Missouri Baptist.
"Dr. Cohen's ability to garner the support of the board, management, medical staff and employees around these initiatives is a significant accomplishment," Eustis says. "He is really passionate about what he does, and that passion came out loud and strong."
Cohen won over the doctors by inviting physician leaders--not only chiefs, but also opinion leaders--to serve on the patient safety council and to perform root cause analyses on the errors that began to be more openly reported.
"Everything else was a matter of people rolling up their sleeves, working hard as a team," Cohen says. "I had been here a year before we launched the major patient safety initiative. That was time for people to learn to trust me and to realize that it wasn't just talk. I was willing to roll up my sleeves and work with them."
He points to the drop in the adverse drug rate, a measurable 80% reduction in patient harm, and notes with pride that it is the same level achieved with a much-touted, multimillion-dollar computerized physician order entry system at Brigham and Women's Hospital in Boston, but without computerization.
Cohen sees the value in CPOE and has laid out a program for selection of a vendor and steps to prepare for implementation in the 2004-2005 budget cycle.
However, he says he is well aware of the cultural change required for success.
"We have deliberately taken the position that we want two to three years of improving and fixing processes before we introduce CPOE," Cohen says. "We need to understand them, improve them, perfect them--and only then introduce CPOE."
Managed care pioneer
Berman, 64, was born and raised in New Hampshire. He graduated from Harvard University and the Columbia University College of Physicians and Surgeons.
Berman, who will retire from the Tufts Health Plan in May, was a pioneer of managed care when he co-founded the Matthew Thornton Health Plan in Nashua, N.H., in 1971.
One of the first health plans in New England that offered an alternative to traditional indemnity medical insurance, Thornton sprang from a multispecialty medical group that offered insurance based on prepayment. It became a not-for-profit organization controlled by a lay board of directors. The group included midwives, nurse practitioners and physician assistants and, later, a psychiatrist, dietician and podiatrist.
"All of those things which now sound rather ho-hum, in the late 1960s and early 1970s were very controversial--and it all worked," says James Squires, M.D., a Thornton co-founder and now president of the Endowment for Health in New Hampshire.
"Harris is extremely efficient; his organizational skills are tremendous. He works incredibly hard himself, thus to work with him and for him is not too arduous. He fostered a common bond among us all."
But it was a very different kind of experience that piqued Berman's interest in healthcare management through a population approach. After the first year of his internship in internal medicine, Berman spent two years as CMO of the Peace Corps in India. He credits the country director--a former CEO of a steel mill in California who, in the Peace Corps, oversaw a staff of eight for 1,500 volunteers--for teaching him that good management is fostering a team of people with individual specialties.
"It was a very useful management experience for me for the future, because I didn't go to business school, but I've been running organizations all my professional life," Berman says. "It was based on how to coordinate people of multiple talents and motivate them."
While completing his training in infectious disease at New England Medical Center in Boston, Berman was influenced by another mentor, Samuel Proger, M.D., and his talk of the German "polyclinic" of the 1930s. Proger built such a clinic in Boston, which became an early example for the multispecialty group practice model that would take off in America.
"It seemed that kind of cooperative effort among specialists provided better care," Berman says.
When he met up with Squires, they coupled the idea with a prepayment mechanism and embarked upon the Matthew Thornton Health Plan experiment, facing strong resistance from the medical community
"We overcame it by setting out on our own," Berman says. "If people didn't like it, too bad."
When Berman assumed the helm at Tufts Health Plan in 1986, he says he was "really changing sides" by joining an organization that contracted with physicians in private practice rather than building its own clinics and hiring physicians.
He says he was interested in working with physicians who were trying to catch up with a world that had changed around them.
"I found a number of physician leaders in the groups I worked with who really (understood) that they could be more efficient and control costs as well as provide quality care," Berman says. "They were willing to try to bring along their peers into this new environment."
He notes--wistfully-that most of the staff-model HMOs similar to what he had pioneered at Matthew Thornton eventually failed when doctors started looking for nine-to-five lifestyles instead of trying to be active agents for change.
"When physicians in private practice turned their minds to how they would compete, they really ended up doing it better," he says.
Berman became active in a number of organizations dealing with insurance and managed care issues at the national level. Meanwhile, he influenced global healthcare as a consultant for the U.S. Agency for International Development in Russia, Hungary, Pakistan, Indonesia and Jamaica.
His motive was always the same.
"He has a desire to reach out to people who are less fortunate and develop new and different ways to address the world's problems," Squires says.
Under Berman's leadership, the number of Tufts enrollees has grown from 60,000 to more than 900,000 and the plan became one of the first HMOs to offer preventive benefits such as fitness center memberships, smoking cessation programs and nutrition classes. And despite the low reimbursements that have driven many health plans out of Medicare+Choice, Berman says he is particularly proud that the Tufts plan, Secure Horizons, has been remarkably successful in New England.
"What stands out is his very thoughtful and very effective manner of leadership," says Karen Ignani, president of the American Association of Health Plans, who has worked closely with Berman.
"He listens. And he has always believed in coalitions. He is great at developing alliances, at influencing individuals with the power of his intellect as well as his passion for the issues."
The JudgesSusan Freeman, M.D., is senior vice president of medical affairs at St. Francis Hospital and Medical Center in Hartford, Conn. Freeman is an endocrinologist and president of Saint Francis Care Medical Group. She serves on the board of directors of the American College of Physician Executives.
Francine Gaillour, M.D., is a business advisor and executive director of Creative Strategies in Physician Leadership, a professional-development coaching resource based in Seattle. She has served as medical director of many healthcare technology companies and is an ACPE board member.
Chalmers Nunn, M.D., is senior vice president and CMO of Centra Health in Lynchburg, Va. Nunn is a board-certified internist and gastroenterologist whose primary responsibilities are quality improvement, clinical effectiveness and medical staff development and management. He serves on the boards of the Lynchburg Chamber of Commerce, VHA Central Atlantic and the ACPE.
Scott Ransom, D.O., is vice president at Witt/Kieffer, a healthcare executive search and consulting firm. He teaches health management at the University of Michigan, Ann Arbor, and teaches and practices OB/GYN at Wayne State University in Detroit. Ransom is vice president and president-elect of the ACPE.
Thomas Royer, M.D., is president and CEO of Christus Health in Irving, Texas, one of the country's largest Catholic health systems. A surgeon with more than 30 years of administrative experience, Royer won the 2002 Physician Executive Award of Excellence.