An early system integration visionary

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 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.”

Follow Steven Ross Johnson on Twitter: @MHsjohnson