Presence Health CEO Sandra Bruce on merger, Medicaid cuts

Sandra Bruce has served as president and CEO of Presence Health since the 11-hospital system was formed in November 2011 by the merger of Resurrection Healthcare and Provena Health, with facilities in the Chicago area and central Illinois. Before that, she served as CEO of Resurrection and CEO of Trinity Health's St. Alphonsus Health System in Boise, Idaho. Bruce is a former board chair of the Catholic Health Association and continues as a CHA committee member. Modern Healthcare reporter Andis Robeznieks spoke with her recently about the challenge of merging cultures, increasing diversity in her system's executive ranks, continuous performance improvement and the economic impact of reducing inpatient hospital capacity on communities. This is an edited transcript.

Modern Healthcare: How are you doing in merging the cultures of Resurrection and Provena?

Sandra Bruce: It's a journey to get to a single culture and we are not there yet. I think it takes five to 10 years. We have been explicit about some aspects of the culture, one of which is to become an organization that focuses on performance improvement. We are making progress there. We all tend to think erroneously that if two Catholic organizations come together, the cultures must be the same. They're not. The two organizations were operated very differently. Resurrection was a highly centralized entity and Provena Health was decentralized. The board made a decision that a more centralized model would be the most effective way forward. That has caused some discomfort.

MH: Is Presence going to expand or merge?

Bruce: We are trying to expand our geographic footprint through our accountable care organization called Presence Health Partners. We have expanded it significantly through our Medicaid accountable care entity, including many other providers that are not Presence-owned and operated. We have over 4,000 physicians participating. A third of them are largely on staff at other hospitals. They set the clinical protocols and also are involved in the negotiation of contracts with the payer. That's been part of our success in attracting them.

MH: How is the state of Illinois treating you as far as Medicaid?

Bruce: If Gov. Bruce Rauner's proposal to cut $1.5 billion from Medicaid is approved, it will have a profound if not devastating effect on our ability to serve as a safety net for the poor and vulnerable.

MH: How do you seek to make Presence Health's leadership diverse?

Bruce: In terms of staff diversity, I have done a good job here at Presence and in my career of having a diverse senior team as far as gender. I have not done as good a job at having a diverse team from a racial and ethnic perspective. We are just now formulating initiatives to make sure that the management team is as diverse as the populations we serve. For a number of years, we have said there will be women candidates in these management pools. But we have not necessarily said, “We will have ethnically diverse candidates in that pool.” So we are beginning that process.

MH: How do you try to improve morale while at the same time maintain a culture of continuous improvement?

Bruce: The engagement level and morale of employees is higher when we bring them into the performance-improvement work, let them describe the problems, seek out the data and come up with solutions. Then they love to have me come in on Fridays when we have the Rapid Improvement Event report-outs to hear not only their great work, but to ask for my help in the solutions. If we could do more of it, employee morale would be higher.

MH: Any particular area where you have seen the most significant improvement?

Bruce: At Resurrection Medical Center, the staff worked out the issue of adding another MRI. We hadn't wanted to spend the capital, but they laid it out and it was something we couldn't argue with any more. It made me very proud. They did significant work around the flow-through in the operating rooms. At Covenant Medical Center in Champaign-Urbana, the staff did work around the pre-admission process—how they could do a better job of finding out patients' insurance and making sure patients had everything done, such as lab tests, before coming in for surgery. They took great pride in delivering a better service to the patient.

MH: How is Presence using telehealth?

Bruce: Presence deployed telehealth in neurosciences about a year ago. We now have every one of our hospitals connected via robots to evaluate a patient in any hospital for conditions of stroke, be able to start interventions immediately in that hospital, and then, if necessary, move the patients to other Presence centers. I can tell you numerous stories of patients being diagnosed, given a blood-thinning drug, moved to our primary stroke center in Joliet (Ill.), and walking out the door in a few days with no residual effects. This is an example of great healthcare in a small or rural community that can't afford a neurosurgeon and a neurologist standing by 24/7.

MH: How far along is Presence in building the health IT infrastructure for ACOs and value-based care?

Bruce: It's no small feat to put in claims-payment systems so you can process an insurance claim and put in health IT systems that say: “Red alert, Sandy Bruce is a high-risk patient, we need to get her an intensive outpatient case manager.” It's a huge technology investment to manage people's health. In retrospect, it's relatively simple to take care of people if they come in with a heart attack. For 50 years, we've known how to fix you if you're sick. Now we are learning how to keep you from getting sick. It requires a different investment in people, in skill sets and in technology. And Presence is well on its way in that journey.

MH: Do you have concerns about reducing hospital inpatient capacity, which Presence did when it sold Our Lady of the Resurrection Medical Center?

Bruce: If I could do everything over again in that case, I would have talked to the community first and tried to give residents a better understanding of healthcare economics and to learn more about the economic impact we were going to have on the community. I fear that as we move from volume to value, with more ambulatory and digital care and less reliance on brick-and-mortar institutions, we will be negatively impacting economic health in those communities. The country and the state need to figure out how we replace some of that economic vitality. What can we do to make sure that jobs remain? Hospital employees go to restaurants, they buy gas, they stop and get milk and bread on the way home. We really do need to be very thoughtful about how to help communities maintain some of that economic foundation.