Intermountain CEO focuses on using data to improve quality

Dr. Charles Sorenson remembers telling the board of trustees at Intermountain Healthcare that a program improving procedures for medication management of cardiac patients had reduced readmissions—and cut the health system's income by several million dollars. The reaction he got was unexpected. “The board, I can still remember to this day, said, 'That's great. That's what we ought to be about. Go find some more things like that,' ” he recalled.

He was thrilled. In the more than 10 years since that early quality-improvement effort, Sorenson, a surgeon who now serves as Intermountain's CEO, has worked with Dr. Brent James, chief quality officer, to find more opportunities to boost quality and efficiency and control the system's overall costs. His system, the largest in the Intermountain West, has achieved national recognition for its record on quality, safety and efficiency. He is also ranked No. 38 on this year's 100 Most Influential People in Healthcare roster.

Now Sorenson, who has led the Salt Lake City-based, 22-hospital system since 2008, faces a new challenge. Intermountain—an integrated delivery system with an insurance arm, SelectHealth, more than 185 clinics and 33,000 employees—faces growing competition from University of Utah Health Care, the state's second-largest system. The university's system gained nearly 9% market share by revenue statewide between 2009 and 2012. Meanwhile, Intermountain's market share has remained stagnant, according to the consulting firm Leavitt Partners.

Sorenson, an affable man who still practices urologic surgery, says he isn't concerned. He stresses that the two systems collaborate in a number of areas. It's never been his goal to eviscerate the competition or snatch every possible dollar, he said, citing his system's not-for-profit mission.

“I can't count the times when an issue has come up when it's between money and a patient outcome; we go with the patient every time,” said James, who began working with Sorenson nearly three decades ago. “I can count on him to put the community we serve first.”

Sorenson, 63, did not originally imagine himself in a CEO's suit and tie. He saw himself in scrubs. Growing up in Salt Lake City, he often was awakened by his father, an internist, talking on the phone at 2 a.m. before brushing his teeth and leaving for the hospital. During the day, the boy frequently gazed up at the hospital near his home, longing to watch surgeons performing operations behind the windowless walls of the sixth floor.

When he turned 16, Sorenson rushed to get a job at the hospital, thinking he'd finally get to peek in on the action. “They gave me this gray uniform. I thought, 'Where are those cool green pajama things?'” Sorenson said. “I said, 'Do I go to the sixth floor?' ” He was told, “No, the kitchen's on the first floor.”

Eventually, he found his path to the operating room. The day Sorenson was accepted to Cornell University Medical College was the happiest of his young life. During medical school, Sorenson, who thought he'd be a cardiologist, was surprised to find that he felt more at home in surgery. He enjoyed working as part of a team.

It wasn't the first time he had discovered an affinity for a part of medicine he hadn't considered before. As a University of Utah undergraduate, Sorenson took a class from Homer Warner, a pioneer in medical informatics. Intrigued, Sorenson spent two years working as a computer programmer for Warner. He learned the power of data to improve healthcare. What he did not know then was how large a role working with healthcare data would play in his professional life.

At Intermountain, James introduced Sorenson to an innovative way to use clinical data to improve patient outcomes and lower costs. James was examining variations in how surgeons performed transurethral prostatectomies for restoring urine flow in men with enlarged prostates. He found wide variation among the 16 surgeons who routinely performed the procedure at the hospital. He asked them why they did what they did.

Sorenson was one of the practicing physicians in the room, James recalled. “In memory, at least, he was not smiling.” James also remembers Sorenson, who stands 6 feet 4 inches tall, “looming above me and kind of scolding me” about a data misunderstanding.

“At first it was awkward,” Sorenson said, “because we hadn't really ever talked about things using this very explicit data. It forced us to ask some questions about how we might improve.”

The surgeons began learning from each other, improving their clinical results and reducing costs. Over the years, James and his colleagues have refined that system of establishing clinical protocols in various areas of practice. They ask doctors to follow those protocols and adjust them as necessary for individual patients, while collecting and analyzing data. It's a process that initially can be jarring to doctors accustomed to following their own instincts and experiences.

Sorenson became a leader in the data-driven clinical improvement movement, James said. It's a process that has since borne dramatic results in many areas, including early inductions in pregnancy and delivery, treatment of pneumonia and the appropriate use of beta blockers to treat heart disease. It's an approach that many other healthcare systems have replicated. “I can document more than 1,000 (patients) per year in Utah that a few years ago would have died, but today they don't because of that approach,” James said.

Health systems across the country face pressure to curb cost growth and improve care under healthcare reform. But Sorenson said his system was working on those goals long before the Patient Protection and Affordable Care Act was passed.

The financial challenge, however, is that under the current predominantly fee-for-service reimbursement system, greater efficiency can mean reduced revenue. For example, Intermountain implemented evidence-based guidelines for the use of CT pulmonary angiograms, leading to a 50% reduction in the angiograms from 2012 to 2013, according to preliminary results. For patients, that has meant reduced radiation exposure, faster time to treatment and reduced costs. But it's also meant a $10 million decrease in revenue for Intermountain.

Despite that, the Intermountain board continues to support such work. “We know there will be decisions that will impact revenue,” said Ann Millner, an Intermountain trustee and former president of Weber State University in Ogden, Utah. “But what's more important is making sure that we do the things that are appropriate for the mission of the organization.”

Sorenson said being an integrated system with its own health plan has given the system greater ability and motivation to focus on controlling costs. Not that Intermountain is hurting financially. Its revenue climbed steadily between 2009 and 2012, topping $4.38 billion in 2012. Sorenson earned $1.75 million in 2012. The system has a AA+ bond rating from Standard & Poor's and an Aa1 rating from Moody's.

Intermountain's market share by revenue has been holding steady statewide at 55%. Meanwhile, though, University of Utah Health Care grew to a statewide market share of 17.3% in 2012. The next two largest competitors statewide are HCA's MountainStar Healthcare and Iasis Healthcare, with 11.9% and 7.7% market share by revenue in 2012, respectively, according to Leavitt Partners.

Hospitals owned by the four systems are within 10 miles of each another, in and around Salt Lake City. “We have strong competition,” said Greg Bell, CEO of the Utah Hospital Association.

Sorenson said he's not worried. “Market share may be a false indicator of success,” he said. “If you think about it, every time somebody comes into the hospital or has to go in and have surgery, maybe it's an indication of failure of the health system to prevent that.”

He describes University of Utah as an important collaborator, not just a competitor. Leaders of University of Utah Health Care, the only academic healthcare system in the state, say the same thing. “The relationship with Intermountain is in many ways a very symbiotic relationship,” said Vivian Lee, CEO of University of Utah Health Care. “We have a very strong partnership I value very much.”

About half of the university's medical graduates who remain in Utah go to work at Intermountain. The two systems collaborate on research and clinical trials. And Primary Children's Hospital, the only Level I Pediatric Trauma Center in the region, is owned by Intermountain but sits on the university's health science campus, with most of the doctors there on the University of Utah's medical school faculty.

The partnership between the two systems is so strong that when Lee was interviewing for her CEO position three and a half years ago, the process included a meeting with Sorenson. “That was one of the best meetings and really set the tone for my relationship with Charles,” Lee said.

Sorenson and others credit many of Intermountain's accomplishments to its original mission of providing excellent healthcare services to the community. The mission goes back to 1975 when the Church of Jesus Christ of Latter-day Saints donated its 15-hospital system to the community. “They were born out of a sense of genuine mission and I think that's made a difference,” said Michael Leavitt, who formerly served as Utah governor and HHS secretary and now heads Leavitt Partners.

Leavitt said Sorenson embodies that sense of mission. “Of CEOs I know around the country, their mission is important, but there are none that are more mission-driven than Dr. Charles Sorenson,” he said. “He's a physician, and he's able to exude among the physicians, medical staff and others the importance of mission. I think he lives it.”

Sorenson said he decided to move into administration because as medical staff president at LDS Hospital, he noticed doctors opening their own facilities and taking profit centers out of hospitals. He felt physicians and hospitals could work better together. So he helped found the Intermountain Medical Group and became chairman of the group's board. In 1998, he became Intermountain's senior vice president for healthcare operations, with the understanding that he would continue to perform surgery. “I've looked at my Wednesdays in the operating room as kind of my mental therapy day,” Sorenson said.

Continuing to practice has kept him connected to doctors, nurses and the clinical issues facing Intermountain, said David Grauer, administrator at Intermountain Medical Center in Murray, Utah, the system's flagship hospital. “It gets him back on the front lines doing what he loves to do.”

Grauer praised Sorenson for his vision, commitment and integrity, which he said have become part of Intermountain's culture. For example, when Intermountain discovered through its regular review processes that it was out of compliance with the federal Stark law governing physician referrals and financial relationships, Sorenson chose to self-disclose those issues to the feds, James said.

As a result, Intermountain had to pay the federal government a $25.5 million settlement. “We could have very easily have let that slip and said we'll just clean that up and not worry about it—but not Charles,” James said. “He disclosed it to the appropriate authorities without being forced to and made it right.”

James said Sorenson, though not an overbearing personality, is demanding and has high expectations, and has helped make sure innovation is deeply ingrained in Intermountain's culture. “You build it into the bones and blood of the organization,” James said. “We've done enough of it that it's not coming out easily.”

Lisa Schencker is a reporter for the Salt Lake Tribune.