Making the difference

With the complicated state health insurance exchanges going live in October, CMS Administrator Marilyn Tavenner has a lot to think about at the end of the day.

“What keeps me up at night is, how do we get the message across to this country about the importance of health insurance and the importance of preventive care?” she told attendees last week at Modern Healthcare's Women Leaders in Healthcare Conference in Nashville. “For many people, that's not something they understand until they have personal experience. And that's where women leaders make the difference.”

In a keynote address to some 250 healthcare executives, Tavenner explained that the public education process to enroll people in exchange plans will focus initially on individuals and small businesses. It will involve navigators, who will guide people through the enrollment process and will start training at the end of this month. It also will involve agents and brokers, who recently started their training.

She said there's a significant role for healthcare executives in helping the exchange rollout run smoothly.

Tavenner urged attendees to help educate their friends, family, patients and colleagues about the insurance exchanges, where people with incomes under 400% of the poverty level can buy subsidized coverage and others will be able to sign up for expanded Medicaid coverage. With women making 80% of healthcare decisions, “I think this is an easy mission for all of us,” she said.

But she added that while half the focus of the Patient Protection and Affordable Care Act is on expanding health coverage, the other half is on controlling healthcare costs. “One of the criticisms of Massachusetts (which established an Obamacare-style system in 2006) is that they did a great job with access, but they didn't deal with the cost,” she said. She acknowledged that Medicare has seen the lowest cost trends of the past 50 years, but added, “We will have to stay focused on costs.”

Reducing cost growth was also one of themes of a panel on blending cultures after a merger or acquisition.

Judith Persichilli, interim president and CEO of CHE Trinity Health, whose merger went live in May, said that operational efficiencies were not where the merged systems saw the most potential for savings. “The real savings are in clinical transformation,” she said, citing the focus on behavioral health in the Pittsburgh market.

Panelist Keith Pitts, vice chairman of Vanguard Health Systems, which recently announced a merger with Tenet Healthcare Corp., said providers need to take out 20% of the total cost of care.

He focused on one of Vanguard's most recent takeovers, Detroit Medical Center. “Everyone wants to know: Why would you buy Detroit Medical Center?” he said. “Detroit wasn't a broken health system from an operating standpoint. But they didn't have any capital. They were scrappy, but they didn't have any cash.”

That 2010 acquisition allowed Vanguard to inject funding for deferred projects. “If you drive around Detroit, you'll see cranes up,” he said. “Most of those cranes have our name on them.”

Detroit Medical Center, a safety net hospital for southeast Michigan, also applied and was selected to be a Medicare Pioneer accountable care organization. “We did save 4.5% the first year so we stayed in a second year,” he said. “The health status of Detroit is one of the toughest in the country. I see a very bright future in Detroit in being able to accomplish that.”

The event celebrated Modern Healthcare's Top 25 Women in Healthcare, a biennial list of visionary female leaders in fields including health policy, government, health systems, payers and medicine.

As the national conversation focuses on how to get more women to “lean in” to the highest levels of their profession, healthcare delivery is being overhauled by woman-led teams at the CMS, HHS and Food and Drug Administration. Women also head the watchdog group that grades hospital performance as well as industry groups for physicians, nurses and health insurers.

But while the event celebrated how far women have come, it also acknowledged the tradeoffs.

Susan DeVore recalled the moment when she knew she had reached an unsustainable point as a mother and a healthcare executive. It was late at night, and she was rocking her baby son. She stroked his hair and marveled at how angelic a sick child looks. And then her mind wandered to a big presentation she was supposed to give the next day and she thought: “I'm going to be so tired tomorrow.”

DeVore is president and CEO of the Premier healthcare alliance, one the country's largest group purchasing organizations, and a mother of three. She knew then that roles would have to change. She and her husband would have to share the cooking and cleaning more equally. He would have to play dress-up and she would go to baseball games.

DeVore continued: “We also told our kids that they owned the family's success, too—they had to do their part. ... And I think the same thing applies to healthcare.”

Just as working moms have made their own rules about motherhood and leadership, DeVore said, the healthcare industry is now disposing with old notions about who should do what. Physicians need to work closer with mid-level providers, and patients should be empowered to take more control of their own health. “I think it's up to us, collaboratively, to listen to ideas, no matter where they come from,” she said.

Follow Beth Kutscher on Twitter: @MHbkutscher