FALL 2013

CONTENTPresident’s Remarks 4Caleb O’Rear, FACHE

Welcome New Fellows 4

ACHE of North Texas 42014 Congress Scholarship& Grant Assistance

Healthcare 2014 5Strategies to Negotiate the Changing Environment

Meet The Editor 8

Member Spotlight 9

Lead By Example 10Know the Qualities of aGood Leader

News from National 11

Event Encore 12

Calendar 16

ofACHE

North TexasACHE

North Texas

The ACHE of North Texas e-magazine, The Executive Connection, is published quarterly (Spring, Summer, Fall and Winter) and includes information on the latest regulatory and legislative developments, as well as the quality improvement and leadership trends that are shaping and influencing the healthcare industry. Readers get indepth reporting on the issues and challenges facing hospital and health system leaders today. We make it our job to tell you about the great things the organization and Chapter are doing every day to ensure the health of our community. If you have any news and updates that you want to share with other members, please e-mail your items to info@northtexas.ache.org. Microsoft Word or compatible format is preferable. If you have a graphic or picture that you’d like to include, please send it as a separate file. The following are the types of information that our members shared in past ACHE of North Texas magazines: Advocacy Issues, Legislative Issues, Educational Opportunities, Awards / Achievements, Promotions (Members On the Move), Committee Updates, journal submissions, conference submissions, and workshop participations, sharing mentoring experiences, etc.

northtexas.ache.org

Congratulations toSusan Edwards

We appreciate your creativity, time,and dedication to the Chapter.

ACHE of North TexasVolunteer of the Year

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 3

Editor-In-Chief John G. Allen, MHA, MPH, FACHE

Managing Directors Matthew van Leeuwe Joan Shinkus Clark, DNP, RN, FACHE

Contributing Editors Lisa Cox

Contributing Writers Dana Lujan | Meghan O’Quinn | Jenifer Greenway Valerie Shoup

Production Kay Daniel

Advertising/ Subscriptions info@northtexas.ache.org

Questions and Comments: ACHE of North Texas Editorial Office, c/o Executive Connection 250 Decker Drive | Irving, TX 75062 p: 972.413.8144 e: info@northtexas.ache.org | w: northtexas.ache.org

2013 Chapter Officers

President Caleb F. O’Rear, FACHE Denton Regional Medical Center

President-Elect Winjie Tang Miao Texas Health Harris Methodist Hospital Alliance

Secretary Josh Floren, FACHE Texas Health Presbyterian Hospital Plano

Treasurer Pam Stoyanoff Methodist Health System

Regent Michael D. Murphy, FACHE Abilene Regional Medical Center

2013 Board of Directors

Teresa Baker, FACHEJohn Peter Smith Health Network

Beverly Dawson, RN, CCM, FACHEElder Care

Forney FlemingUniversity of Texas at Dallas

Dresdene Flynn – White John Peter Smith Health Network

Jay FoxBaylor Medical Center - Waxahachie

Michael Hicks, MD, FACHE Pinnacle Anesthesia Consultants

Janet Holland Rendina Companies

Jonni Johnson, CPSMRTKL

Ashley McClellan, FACHE Medial Center of Lewisville

Kevin Stevenson, FACHE

Matthew van Leeuwe Lake Granbury Medical Center

Demetria Wilhite

University of Texas at Arlington

Bethany WilliamsZirmed

Chip Zahn, FACHESurgical Care Affiliates

Lisa CoxChapter Coordinator

ofACHE

North TexasACHE

North Texas

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 4

President’s RemarksCaleb O’Rear, FACHE

As we wind down 2013 and prepare for the holiday season and a new and exciting year with ACHE, I would be remiss if I didn’t acknowledgement the many things for which I am thankful. I have thoroughly enjoyed being your North Texas Chapter President and I am thankful for all of you who allowed me to do so. I am very thankful for the upcoming leadership, and specifically Josh Floren. Josh is an energetic and talented professional and his progressive ideas and organization will serve the organization very well in 2014. I am also very thankful for the Board of Directors who have worked hard this year to make sure that the local chapter stays as relevant and crisp as possible. They have all done a fantastic job. Above all else professionally, I am very thankful to be working in the healthcare profession – a profession that is poised for immense growth, a profession that changes every day, and a profession that elicits a passion in me that many of you share. Last but certainly not least, I am very thankful for Lisa Cox, our Chapter Coordinator. She is the glue that binds our local chapter and for her hard work the last few years that I have worked with her, I am tremendously thankful.

I hope you all have a wonderful holiday season and I look forward to connecting with you all in 2014.

Until next edition,Caleb O’Rear, FACHE

Donations and ongoing chapter support by our corporate sponsors allows the North Texas Chapter to continue to provide the ACHE Congress on Healthcare Leadership Scholarship Program. Tuition and travel assistance is available to student members, those currently in transition, or those who do not have access to travel assistance through their employer.

Applications can be found on the chapter website at: http://northtexas.ache.org/

ACHE of North Texas 2014 Congress

Scholarship andGrant Assistance

Recently Passed theBoard of Governors Exam

William A. Garner, DrPH, Fort WorthPaul M. Musgrave, Southlake | Chad A. Barney, Irving

Dresdene E. Flynn-White, Fort WorthMarcus Jackson Sr., Desoto | Valerie Shoup, Dallas

Congratulations to thefollowing members who

advanced to Fellow statusJeanie D. Parsley, FACHE, Keller

Chad G. Robertson, FACHE, PlanoThomas Cutler, FACHE, Denton

James G. Russell, FACHE, LewisvilleEdward T. Dold Jr., FACHE, Fort Worth

Paul Generale, FACHE, Irving

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 5

Healthcare 2014: Strategies to Negotiate the Changing Environment

The Patient Provider and Affordable Care Act (ACA) altered the healthcare environment in the United States. While the legislation became law in 2010, many healthcare providers have been slow to respond to the expected demands in 2014. The ACA created opportunities for hospital systems to collaborate with physicians, insurance companies, and other providers; those who do will likely succeed in the new health care system1.

The healthcare law requires everyone to obtain health insurance; policies will be in effect January 1, 2014. In Texas, 25% of the population is uninsured2. There are 26 million people in Texas; 6.5 million people will be seeking healthcare that previously did not have access to care3. Approximately 66% of the uninsured earn less than 200% of the poverty level4. These statistics infer that the number of Medicaid patients will increase in 2014 as many of the uninsured are those in poverty. Hospital administrators must be prepared for changing patient demographics and increasing numbers of patients seeking medical attention.

One in five of the uninsured have preexisting conditions5. Many of these preexisting conditions are related to elder care. Other conditions are related to those who are not natural born. Non-natives are 61% more likely to be uninsured than native-born4. These statistics suggest healthcare providers may consider service line change to meet the needs of the changing demographics.

Through Value Based Purchasing, the Texas Hospital Associations estimates that Texas hospitals will realize $1,900 million dollars in earnings cuts in 2014.6 These cuts require that hospital administrators focus on quality improvement strategies, patient satisfaction strategies, and follow-up strategies to reduce readmission rates. Additionally physician alignment inpatient and outpatient services become an essential part of hospital care strategies.

While hospital administrators must address the economic impact of the changing CMS reimbursements, they must also understand the tax implications that affect hospitals and their employees. Additionally, employers must assess the impact of changes in health insurance coverage. The Texas Medical Association suggests that across the board health insurance premium increases will help cover the costs associated with the uninsured or underinsured4.Employee premiums may vary based on age, family size, smoking status and geographic location.

The changes require that Human Resource departments are highly engaged with employees to ensure they understand the changes. Additionally, increased demands require employers attract new employees while retaining existing employees. Significant human resources challenges are ahead in 2014. Hospital administration must engage all of their departments in delivering the health care of the future.

Business Strategies and Leadership

The healthcare law impacts fall into four main categories, business strategy and leadership, financial implications, legal implications and human resources. Hospital leadership must ensure their employees set the right tone for these changes through compassion, patient advocacy, and education. These changes transcend all hospital departments and departmental leads must be aware of the impending

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By Valerie Shoup and Jenifer Greenway

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changes and their roles in a smooth transition into the upcoming healthcare environment.

In regard to business strategies, hospital administrators must prepare to change the way they deliver medical care. Major strategies include (a) focusing care around exceptional patient experience and shared clinical outcomes, (b) expanding the use of electronic medical records including drug reconciliation, clinical guidelines, alerts and other decision support, (c) redesigning care to include nurse practitioners, physician assistant, care coordinators, and dietitians, (d) establishing patient care teams to determine the distribution of bundled payments and incentive programs, (e)managing preventative care, including follow-up interventions, and (f ) reducing readmissions and hospital acquired infections1.

The Health Information Technology for Economic and Clinical Health Act of 2009 included over $20 billion for HIT9.Through empirical evaluation of the hospital compare database, researchers determined hospitals with high levels of HIT had better quality scores than hospitals with low levels of HIT. They concluded there is clear evidence that patient care quality improves with HIT. While HIT affects clinical process systems, it also affects financial systems.

Through technology, providers must ensure their electronic systems have current information on insurance eligibility and cost of services. The admitting team must be trained to speak with patients about insurance co-pays, and eligibility requirements. Hospital-Insurance company relationships will be an important part of the transition into the new healthcare environment. Educating the admitting staff by insurance company representatives may enhance the transition. The admitting team is the first contact patients may have with the hospital care team and accurate compassionate interactions are critical to customer satisfaction. In order to adequately support the admitting team, hospital administrators may wish to provide financial counselors to engage in compassionate conversation with patients. Process redesign may be in order to provide these services.

The National Institute of Health (2013) supports the redesign of care teams to address the increasing health care demands. Nurse practitioners, physician assistants, and specialists such as dietitians, physical therapists play vital roles in health care delivery. Consideration of coordination of health care teams is a powerful strategy in meeting the trends upcoming in 2014. Coordination may require changes in service lines, hospitals may benefit by partnering with physician practices to enhance existing services.

While quality care during the inpatient visit is essential, care after the visit will reap benefits for both the patient and the provider. Enhanced support reaped positive results for researchers of shared decision making models. Veroff, Marr, & Wennberg (2013) found that enhanced support lowered medical costs by 5.3%. The enhanced support included health coaching through follow up calls, emails, mail, and internet support. Additionally those with enhanced support realized 12.5% fewer re-admissions, and 20.9% fewer heart surgeries. The results suggest that hospitals that provide enhanced support may realize significant economic benefits.10

In order to successfully implement new business and leadership strategies, hospitals and healthcare systems must achieve alignment with participating physicians. Despite past successes, the move to value-based purchasing with heightened focus on coordinated care delivery, improved population health and reduced cost, demands

physician-hospital integration. And as noted in the Kurt Salmon graphic below, there are a number of medical staff alignment options in existence today.

In reviewing the continuum, the Full-Service Professional Service Agreements (PSA), provides single specialty physician groups the ability to consolidate multiple financial agreements and become the exclusive service provider for a select entity. Noting that this is a higher cost alternative, a less expensive option for more cohesive alignment can be found in the form of co-management agreements, which allow primary care physicians and specialists to form a new entity that contracts with the hospital or healthcare system for base management service compensation, in addition to, incentive payments for achieving quality, satisfaction, efficiency or program development goals.16

With more institutions preparing to accept greater clinical and financial accountability for population health improvement, some healthcare systems are choosing to implement clinically integrated networks (CIN). As defined by the Department of Justice and Federal Trade Commission, clinical integration can be achieved by a physician network implementing an active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among physicians to control costs and ensure quality.15 This program may include: 1) the use of common information technology to ensure exchange of all relevant patient data, 2) development and adoption of clinical protocols, 3) care review based on protocol implementation and 4) mechanisms to adhere to protocols. The use of Health IT includes e-tools/EDI, electronic medical records and e-prescribing. Compliance with evidence-based medicine care protocols focuses on inpatient and outpatient clinical core measures, while administrative quality is promoted via patient safety courses, physician education programs, compliance with re-appointment standards and generic medication prescribing.17

Sustaining clinically integrated networks requires physician engagement and leadership, as well as, substantial hospital and/or healthcare system administrative commitment. Furthermore, these groups must be able to establish: a) shared financial responsibility, governance and organizational management, b) common measurable clinical integration goals, transparency and trust, c) change agent mentality for participating physicians, d) management training for physician executives, and e) the right mix of communication vehicles. Building on this foundation, clinically integrated networks can then begin to efficiently engage payors in efforts to move from supporting better care (reporting/coordination) to paying for better performance (P4P, episode-based payments) and, ultimately, to contracting for greater value (shared savings with quality improvement, partial or full capitation with quality improvement).17

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Financial and Legal Implications

Health care executive’s strategic decisions have significant financial implications. As hospitals realize reduced reimbursements from changes in Medicare payment structure, they must show improvement in clinical outcomes and patient satisfaction to offset reductions. While improvements in health care delivery will reap benefits in quality outcome measures, financial departments must help design strategies for reducing costs. The reductions in medical reimbursements must be balanced with improvements in patient flow and cash reconciliation processes. By keeping detailed metrics on expenditures, financial departments can help identify areas for improvement.

Hospitals will realize significant changes in the tax structure as a result of the ACA. Many employers are eligible for transition relief for tax-year 2012 and beyond8. A new net investment income tax goes into effect in 2013. The 3.8 percent NIIT applies to those having investment income above a certain threshold amounts. An additional 0.9 percent Medicare tax applies to individual wages depending on income. Changes to flexible spending accounts and various other medical deductions may be found in the ACA IRS tax laws. The ACA requires the IRS levy additional taxes on medical devices. There are numerous other tax provisions that hospitals must understand, many impact employees and employers have an obligation to inform employees of these changes.

In regard to financial policies, The ACA requires hospitals publish, and update annually, rates for standard services.13 The ACA, however, does not provide clear guidance on how hospitals meet the provision. While providers await guidance, they must begin the process of preparing for transparency and planning how it will take place.

Providers must be prepared to offer access to financial assistance and ensure up-front they are aware of the cost of services. Financial transparency will improve patient satisfaction. Financial discussions are important as it helps patients make informed decisions .13

Authors from the Journal of Financial Management (2013) suggest five strategies for transparency. The first is to develop a well-defined, competitive pricing philosophy, strategy, and pricing structure. Develop written policies for providing patients with cost estimates for procedures with definition of what the estimates include. Train employees on transparency and delicate conversations with patients. Additionally, they suggest negotiating with insurance companies to remove contractual barriers to rational pricing. Finally, they suggest companies must continually improve employee’s cost accounting competencies.14

Human Resources

The success of an organization is highly dependent on the quality of the people it hires12. A strong HR organization can strengthen the organization through hiring practices and training, both which affect patient satisfaction. While individuals may be highly skilled, organizations must train and retrain their employees on both verbal and non-verbal skills. Aydin (2013) found that patients perceive physicians with strong non-verbal skills as highly successful. The patients’ satisfaction levels correlated to physician’s level of non-verbal immediacy. With effective staff training, human resources play a vital role in patient satisfaction.

Not only is quality staffing important in the changing healthcare environment, staffing numbers and mix is another important consideration. Hospital leadership strategies may require change in the staffing mix based on care redesign in response to bundled payments. HR must work closely with executive leadership to carry out new delivery strategies. HR must also help retain employees and improve employee satisfaction which in turn affects patient satisfaction.

In regard to the benefits aspect of human resources, hospital leaders must ensure the health insurance offered to their employees covers essential benefits including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services, laboratory services, preventative and wellness services, chronic disease management and pediatric services7. The human resource department is a key player in preparing employees for changes in regard to their medical insurance. Health insurance premiums may vary based on age, smoking status, family size and geographic location. Additionally, hospitals must provide Wellness programs for their employees.

In order for hospitals to succeed in 2014 and beyond, organizations must embrace change and innovation. The ACO will change the way healthcare providers practice medicine in the United States. These changes will encourage healthcare providers to focus attention around exceptional patient experiences and shared clinical outcome goals1. Care organizations that redesign care processes for reliability, and who offers the patient higher quality and higher value will reap financial rewards11.

References

1. Kocher, R, Emanuel, E., DeParle (2010). The affordable care act and the future of clinical medicine: The opportunities and challenges. Annals of Internal Medicine, 153, 536-539.

2. America’s Health Insurance Plans, 2013. A time for affordability. Retrieved from http://ahip.org/Issues/January-1-2014-Provisions.aspx

3. United State Census Bureau, 2013. State and County Quick Facts. Retrieved from http://quickfacts.census.gov/qfd/states/48000.html

4. Texas Medical Association, 2013. The Uninsured in Texas. Retrieved from http://www.texmed.org/uninsured_in_texas/

5. US Department of Health and Human Services, 2013. At risk: Pre-Existing conditions could affect 1 in 2 Americans. Retrieved from http://aspe.hhs.gov/health/reports/2012/pre-existing/

6. Texas Hospital Association, 2013. Estimated impact of standing Medicare and Medicaid payment cuts: Hospitals in Texas. Retrieved from THA.org.

7. Department of Health and Human Services (2013). Healthcare Essential Healthcare Benefits. Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits/.

8. Internal Revenue Service (2013). Affordable Care Act tax provisions. Retrieved from www.irs.gov

9. Restuccia, J. D. Cohen, A. B., Horwitt, J. N., & Shwartz, M. (2012). Hospital implementation of health information technology and quality of care: are they related? MMC Informatics and Decision Making, 12, 109-117. doi:10.1186/1472-6947-12-109

10. Veroff, D., Marr, A., & Wennberg, D. (2013). Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Affairs, 32,285-293. doi: 10.1377/hlthaff.2011.0941

11. Kocher, R., Emanuel, E. J., & DeParle. N. M. (2013). The affordable care act and the future of clinical medicine: the opportunities and challenges. Annals of Internal Medicine, 153, 536-540. doi:10.73260003-4819-153-8-201010190-00274

12. Aydin, M. D. (2013). Nonverbal immediacy in human resources training and development programs: The case of physicians. International Journal of Business and Social Science, 4,156-164. Retrieved from http://www.ijbssnet.com/

13. Mulvany, C. (2013). Focus on transparency. Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 67(8), 36-38.

14. 5 ways to develop a path to pricing transparency. (2013). Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 67(6), 52.

15. Department of Justice and Federal Trade Commission, Statements of Antitrust Enforcement Policy in Health Care, Statement 8 (1996)

16. Armstrong, R., D’Enbau, D., Doucette, D. (2013) Alternatives to Employment for Achieving Physician-Hospital Alignment. 1-6, Retrieved from http://www.kurtsalmon.com

17. Fisk, B., Watson, J., (2013) Clinical Integration as an Effective Physician Alignment Strategy”, 1-30, Retrieved from http://firstillinoishfma.org/wp-content/uploads/2_PBC_Clinical-Integration-as-an-Effective-Physician-Alignment-Strategy.pdf

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 8

MEET THE NEW EDITOR

John G. Allen, MHA, MPH, FACHEProgram Manager, Safe Transitions for the Elderly Patient (STEP)University of North Texas Health Science Center

You’ve spent most of your healthcare administration career with the U.S Coast Guard. What are some of the challenges you’ve recognized that may be unique to that sector of the industry?

I think the Coast Guard, as part of the military health system, faces the same challenges as the private sector does: improving access to care, quality of care, and patient satisfaction, while trying to decrease costs. When you consider those factors in combination with a decreasing federal budget (sequestration), the challenges of trying to care for an entire military family and not only the service member, and military medical personnel leaving their home-based hospitals and clinic to provide medical support overseas, the pressure on the military health system to deliver high quality care in an efficient and effective way is tremendous.

The military health system embraces tenets of the Triple Aim, Medical Home, and Accountable Care Organizations to help it address these challenges. I can think of several ways this is happening: greater integration of public health and medical services that were previously operating independently; integration of specialties into primary care services, such as psychiatry; studying population level data to leverage resources towards a greater number of people, such as health fairs on tobacco cessation, healthy lifestyle choices, patient advocate programs, self-care education, and suicide prevention.

Inspirational quotes can motivate one to achieve a higher level of success. What is your favorite leadership quote(s) and why?

My favorite leadership quote is by CS Lewis: Courage is not simply one of the virtues, but the form of every virtue at the testing point.

Courage motivates and directs people in the direction of success. I’m not only referring to professional achievement, I’m referring to all aspects of life. If you consider the number of times daily that we are tested, we have multiple opportunities to exercise courage; whether it is a decision to follow the speed limit in a school zone when we are running late or counsel a likeable employee for performance difficulties, we have to actively embrace courageous behavior when we are tested. Courage is a fundamental leadership virtue.

Along with a propensity to lead and adaptability, the capacity to navigate ambiguity is one of the predictors of a successful leader. When have you had to make important decisions without all of the information you would usually prefer? What other skills did you have to rely on to make the decisions?

I recall a situation when I was a Regional Practice Director in Seattle, where we had providers and allied health staff relocating or positions were being eliminated (due to the federal budget sequestration) in short amount of time. Consequently, we had to consider multiple strategies to ensure ongoing services for the population under our care were not interrupted. We would be faced with provider shortages, a limited budget, and a small pool of qualified providers to provide backfill. After considering the options at our disposal, we developed a multi-disciplinary planning team to not only consider the resources we had at our disposal, such as providers, community health resources, and the needs of our population, we also considered the necessary quality factors and contingencies that needed to be upheld, regardless of how we leveraged our resources. The result was a well-designed and executed coverage plan that ensured there were no gaps in services and no drop off in the quality of the services we were providing.

The newsletter has not had a style or format change since 2009. As the new editor of the Executive Connection of North Texas, can readers look forward to changes in 2014?

Yes, but we do not what the scope of the changes will be. We are planning a newsletter strategic planning session for the newsletter at the beginning of 2014 to develop some ideas and strategies for the newsletter going forward. Though we are still working on the content and process for the planning session, an area of emphasis will be on leadership, particularly in light of the changes in the American healthcare system. We need effective leadership with the right leadership, administrative, and technical skills to navigate healthcare organizations through these immense changes and hopefully the newsletter can serve as a forum for supporting these initiatives.

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Lorrie Normand, MS, BSN, RN, NEA-BCChief Nursing OfficerTexas Health Harris Methodist Cleburne

What are you doing now?

I am the Chief Nursing Officer for Texas Health Resources, Cleburne. In addition, I am currently pursuing my Doctorate of Nursing Practice at Texas Tech University Health Science Center with an anticipated graduation date of May, 2014.

In your opinion, what is the most important issue facing Healthcare today?

With limited resources, it is critical that we as nurse leaders are flexible and open to learning new delivery care models that reach across the continuum of care to best serve our patients in the communities we serve.

How long have you been a member of ACHE?

I have recently rejoined ACHE after being a member several years ago.

Why is being a member important to you?

The opportunities ACHE provides for professional growth and networking is invaluable to me as a healthcare leader. We must stay current in the complexities facing healthcare systems today and as a member of ACHE we are provided additional resources to assist us with this important component of leadership.

What advice can you give to Early Careerists or those considering membership?

Take advantage of this professional organization of healthcare executives and don’t let your membership lapse. It is so important to participate in professional organizations and network with content experts at the local, state and national levels. ACHE provides a great avenue to accomplish this by providing access to healthcare executives across the country.

Tell us one thing that people don’t know about you.

I love traveling and have had the opportunity to live in South Korea and visit Sydney Australia!

MEMBER SPOTLIGHT

Deborah Bostic,R.N., M.S.N.Vice President /Chief Nursing Officer

What are you doing now?

I joined Texas Health Resources in October of 2011 as the Chief Nursing Officer at Texas Health Presbyterian Hospital in Denton, Texas

In your opinion, what is the most important issue facing Healthcare today?

Healthcare is facing many challenges as well as many opportunities. However one of the most important issues facing healthcare today is the cost of healthcare in addition to overuse or unnecessary care.

How long have you been a member of ACHE?

I have been a member of ACHE since November 2006

Why is being a member important to you?

Membership in ACHE affords me the opportunity to network with colleagues in the healthcare sector and engage in sharing of best practices. In addition the educational programs are tailored specifically for the healthcare executive without the need to travel a great distance. I have also enjoyed the benefit of using the career service center for posting and filling vacant positions.

What advice can you give to Early Careerists or those considering membership?

Membership in ACHE is one of the single most important steps a new executive should invest in for their career development. It is important to be on the leading edge of change in healthcare, and membership in ACHE provides varied opportunities for members to obtain the necessary information to advance their practice and career.

Tell us one thing that most people don’t know about you.

I am a Native Floridian and I enjoy outdoor activities

A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 10

Lead by ExampleKnow the Qualities of a Good Leader—Adapted from “5 Ways to Wow Execs—Don’t Get Mad, Get Even More Prepared,” Nancy Duarte, www.linkedin.com.

Becoming a leader requires that you understand the roles and responsibilities of leadership and that you practice the qualities of a good leader until you begin to emerge as a leader in your personal and professional life.

You are always free to choose and have the ability to choose, to take command and to assume a leadership role in your life through several different leadership styles. In fact, your life is the result of the choices and decisions you have made up until this moment. Leaders are those who make better choices and decisions than others more often than not, and choose to lead by example.

3 Different Leadership Styles

The good news about leaders is that they are made, not born. Leaders are largely self-made as the result of continuously working on themselves over the years. No one starts off as a leader, but you can aspire to leadership by learning the qualities of a good leader and how they think and feel, and then by emulating them until you become one yourself.

Position Power

There are three major forms of leadership styles in our society today. The first is position power. Position power refers to the powers of rewarding and punishing that go with a particular title or role.

If you are made operations manager or vice president of development, you have the power to hire and fire people, to raise their pay or leave it where it is. You have the power to hand out privileges or punishment and to alter the terms and conditions of employment to make them more or less agreeable. But whoever has your title has those powers. They are conferred upon you by the title itself. They go with the position.

Expert Power

The second type of power is expert power. Expert power arises when you are very good at what you do and as a result, people defer to your opinion and your judgment. Experts in critical areas for the survival or growth of organizations have tremendous power, even though they may have no staff at all. Their decisions and their judgment carry a tremendous weight.

One of the most important decisions you make during the course of your working life is to develop expert power in what you do. By becoming exceptional in your area of expertise, you develop

power out of all proportion to your position or title. The most respected and valued people in any organization are those who have developed the ability to make the most valuable and most consistent contributions to the business. By being excellent at what you do, you set up a force field of energy that attracts power and respect to you.

Ascribed Power

The third form of power in organizations is called ascribed power. This is power that is conferred upon you by other people because they like you, trust you, believe in you and want you to have more influence and authority.

Ascribed power is a combination of being very good at what you do, being likable, being results-oriented and being perceived as the kind of person who can be the most helpful to others in achieving their individual goals.

The effective leader always begins with the “needs” of the situation. The effective leader always asks, “What does this situation most require of me? What am I most uniquely capable of contributing to this organization? Of all the things that I can bring to this organization, what are the one or two things that I and only I can do that will make a difference?”

Have a Vision, Make a Difference and Lead by Example

The most common characteristic of leadership, throughout the ages, is that leaders have “vision.” Leaders can see the big picture. Leaders can project forward three to five years and imagine clearly where they want to take the organization and what it will look like when they get there.Leaders have the ability to articulate this vision in such a way that everyone around them can see and understand where they are going. The leader is the person who has the ability to articulate an exciting vision of a compelling future that everyone wants to be a part of.

Perhaps the most compelling vision that you can articulate for the people around you is the decision and determination to “be the best” at whatever you do.

One of the most important qualities of a good leader is for you to lead by example, to be a role model, to be the kind of person that everyone else looks up to and wants to be like. One of the characteristics of leaders is that they carry themselves at all times, even when no one is watching, as if everyone was watching.

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A Publication of the American College of Healthcare Executives of North Texas Chapter | FALL 2013 11

NEWS FROM NATIONAL

Register Now for 2014 Congress on Healthcare LeadershipACHE’s Congress on Healthcare Leadership brings you the best in professional development, exceptional opportunities to network with and learn from peers, and the latest information to enhance your career and address your organization’s challenges in innovative ways. The 2014 Congress on Healthcare Leadership, “Where Knowledge, Ideas and Solutions Connect,” will be held March 24–27 at the Hyatt Regency Chicago, and registration is now open at ache.org/Congress.

Join us and be part of the dynamic, energizing event that draws world-class speakers and more than 4,000 healthcare leaders from across the nation and around the world.

This premier healthcare leadership event provides: • Educationoncurrentandemergingissues • Morethan140sessionsofpracticallearningfromhealthcare’s top leaders • Opportunitiestoconnectwithyourpeers • Career-enhancementworkshops

Diversity Program Scholars SelectedSix scholars have been selected for the inaugural Thomas C. Dolan Executive Diversity Program from a pool of 85 applicants. The year-long program will help further prepare these mid- and senior-level careerists to advance to higher leadership roles. Scholars will benefit from specialized curriculum opportunities addressing barriers in career attainment and developing executive presence, one-on-one interaction with a specially selected mentor and participation in formal leadership education and career assessments.

Congratulations to Jaquetta B. Clemons, DrPH, system director, community health/benefit, CHRISTUS Health System, Irving, Texas, for being selected for the program.

Nominations for Regent-at-LargeThe ACHE Board of Governors is calling for applications to serve as Regent-at-Large in Districts 2, 3, 4 and 5 beginning in March 2015. ACHE Fellows are eligible for Regent-at-Large vacancies within their district.

District 4 consists of Alabama, Arkansas, Kansas, Louisiana, Mississippi, Missouri, New Mexico, Oklahoma, Tennessee and Texas. The goal of the Board of Governors in appointing Regents-at-Large is for the Council of Regents to mirror the diversity of ACHE Members and Fellows. To that end, the Board seeks applicants who are female or persons of color as these groups are underrepresented on the Council of Regents. The responsibilities of the Regent-at-Large, including suggested knowledge, skills and experience, are included in the position description posted at ache.org/RegentAtLarge. Appointments will be made by the Board of Governors in November 2014. Candidates should not directly contact members of the Board of Governors to request letters of support.

Apply for a Tuition Waiver ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs:

• CongressonHealthcareLeadership • ClusterSeminars • Self-StudyPrograms • OnlineEducationPrograms • OnlineTutorial(BoardofGovernorsExampreparation) • ACHEBoardofGovernorsExamReviewCourse

If you have questions about the program, please contact Teri Somrak, associate director, Division of Professional Development, at (312) 424-9354 or tsomrak@ache.org. For more information, visit ache.org/TuitionWaiver.

2014 Management Innovations Poster SessionACHE would like to invite authors to submit abstracts of their posters for consideration for the 30th Annual Management Innovations Poster Session to be held at the 2014 Congress on Healthcare Leadership. We are interested in innovations on issues affecting your organization that might be helpful to others, including improving quality or efficiency, improving patient or physician satisfaction, implementation of EHRs, uses of new technology and similar topics. All accepted applicants will be expected to present their posters on Monday, March 24, 2014, between 7 and 8 a.m., and posters will remain on display at Congress from March 24 – 26. The top innovations will also be published in the 2014 Management Innovations booklet placed on ache.org. Award winners will be announced at the Malcolm T. MacEachern Memorial Lecture and Luncheon on Tuesday, March 25. Visit ache.org/CongressPosterSession for the selection criteria and to submit your one-page abstract by Jan. 21, 2014.

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EVENT ENCORE

Written By: Meghan O’Quinn, MHA

The discussion around providing care to the uninsured and underinsured is ever-present, especially in the healthcare hub that exists within the Dallas-Ft. Worth Metroplex. It is a topic which has a direct impact on healthcare executives, providers as well as the large population of uninsured and underinsured that exists. This ACHE North Texas event focused on issues pertaining to cost and reimbursement, provision of charity care, state law as well as community collaboration and benefit. The evening provided an interactive forum, including a robust panel of both healthcare executives and physicians. The panelists include:

Ron J. Anderson, M.D., Sr. Consultant to the CEO & Co-Chairman Delivery System Reform Incentive Pool (DSRIP) Task Force Regional Health Partnership (RHP) Plan (9)

Dr. Christopher Berry, Medical Director, Mission East

Ray Dziesinski, Chief Financial Officer, Childrens Medical Center

Walter “Ted” Shaw, Interim Chief Financial Officer, Parkland Health & Hospital System

The event was well attended, with over 60 participants. Their interactive discussion with the panel allowed participants to gain a better understanding of the obligations and opportunities that exist in caring for the uninsured and underinsured. Below are some of the highlights from the discussion that evening. Q: How and when was your charity care policy developed? Have you reviewed them currently with consideration of new policies? What modifications, if any, have you implemented or are currently under consideration?

A: Ron Anderson – “We began work back in 1964, to try and take away the power of the county lines determining whether or not someone could receive care. Some major problems that exist [in the realm of providing care to the un/underinsured] are that there is a challenge in finding out who qualifies for care, a lot of the responsibility falls on the local hospitals and our current policies of Medicaid coverage creates a cliff in that if you’re really poor, you’re not covered. The 1115 waiver, which is still in the approval process, can provide better access to care for un/underinsured patients by expanding Medicaid managed care to the entire state. It would also replace the upper payment limit [the cliff ] with two new pools of funding, the uncompensated care [UC] pool and the delivery system reform incentive payment [DSRIP] pool. The UC pool will reimburse hospitals for the cost of care for Medicaid and uninsured patients and the DSRIP pool will provide payments to hospitals and other providers upon their achieving certain goals that are intended to improve quality and decrease cost of care.”

Q: What types of programs/collaborations have been most successful in developing an effective healthcare delivery system for the un/underinsured in your community?

Care for the Uninsured and UnderinsuredA: Dr. Christopher Berry - “Project Access Dallas is a great example that immediately comes to mind. This program no longer exists, unfortunately, due to its inability to maintain funding. This program brought together most of the key components of care for its members [i.e.primary care, emergency care, pharmacy and diagnostic imaging coverage]. Another great example is Mission East Dallas. This is a Federally Qualified Health Center [FQHC], which means that the government partners with the clinic at the beginning to help get it started, with the intent that the clinic has a plan to become a self-sustaining business”.

Ray Dziesinski - “Community Out-Patient Clinics [COPCs] are a great example of successful collaboration. Children’s Medical Center has these and they are called ‘My Childrens’ and are successful in serving as medical homes for many children within the metroplex. The COPCs provide a primary network for children, but primary care is not enough to meet their care needs. Specialty care is also a great need. The key is to learn how to collaborate across specialties in addition to primary care.”

Q: What local regulations or policies exist to help you provide care for these patients? What factors are hindering your ability to provide care?

A: Ted Shaw (answering the first part of the question) -“Certified Application Counselor [CAC] training is available through CMS. The purpose of this program is to have designated CACs assist individuals in applying for coverage. Also, if passed, the 1115 waiver has the potential of bringing $1 billion to Dallas County in the next 5 years [a potential $29 billion to State of Texas].”

Ron Anderson (answering the second part of the question) - “A phenomenon has occurred that I like to call ‘Suburbanization of Poverty’. Over the last twenty years, the public health infrastructure [in the Dallas-Ft. Worth Metroplex] has dissipated, but the indigent population has grown. This has created primary care ‘deserts’. What we have is a failure of the local counties working together on a regional level. We need to collaborate and we need to hold our officials to that standard.”

It was apparent from the discussion that efforts of collaboration must continue and grow in order for us to address the issues related to Care for the Uninsured and Underinsured. Many efforts are underway to put legislation in place to bolster the care available for this population. The panelists all seemed to agree that we must continue to bring this topic to the forefront of discussion in order to continue to address the critical issues as our nation’s healthcare system evolves.

We’d like to thank the participants for attending as well as the organizers for all of their hard work in making this event a success.

Organizers:Stan Kovarik with Ingersoll Rand Global HealthcareJason James with Parkland Health & Hospital SystemCrystee Cooper-Walton with DFW Hospital Council Foundation

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The “groundbreaking, breathtaking, mind-shaping” Perot Museum of Nature and Science was the site of August’s ACHE-North Texas After Hours Networking event. And it did not disappoint! Wolfgang Puck’s restaurant, 360, catered the event from high above the Dallas skyline. The delicious and savory experience had even the busiest networkers pausing for bite, after bite, after bite!

After socializing with old allies and connecting with new ones, the 65+ ACHE members in attendance and their guests enjoyed endless opportunities to exercise their brain in engineering, technology, and conservation. The six (of 11) museum exhibits we explored provided hands-on activities, 3-D animations, life-like simulations and educational games.

Thank you to all who joined us and to the sponsors who helped make this enriching and educational event possible. For more information on future events, please visit us at ww.northtexas.ache.org or send us an email at info@northtexas.ache.org.

After Hours Networking EventPerot Museum

Board Member Dresdene Flynn White and Education Committee Member

Corey Wilson

Dave Hefler, Karan Patel,Adriane Wilson

Carol Boehnke, Jonathan Leer,Shelly Miland

Breakfast with the CEO: Kirk King

Drawing Prizes with Board Member Beverly Dawson and Host James Little

Non-Members Patrice Durden, Peter Henderson, and Angela Morris

recruited by Member Zach Harris

Drawing Winners Justin Stokes and Michael Carr with host James Little

Membership Drive at the Ballpark

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On Wednesday, October 2nd, Ken Malcolmson, Market CEO, Humana, and Kate Blackmon, Vice President, Concentra Primary Care Strategy, hosted the North Texas ACHE Breakfast with the CEO event at the Palomar Hotel. With an overall mission of ‘well-being’, Mr. Malcolmson outlined current strategy for this Fortune 71 company serving more than twenty million members nationwide and employing close to twenty thousand associates in the Dallas-Fort Worth area. As an executive for one of Humana’s recent acquisitions, Concentra, Ms. Blackmon rounded out the discussion with a comprehensive overview of their goal to move to individualized, proactive and connected care via more than 500 worksite wellness and urgent care clinics nationwide.

Breakfast with the CEO - Humana

Attendees Sarah Bridges, Richard Cheng and Amanda Ward with

Host Kate Blackmon

Hosts Ken Malcomson andKate Blackmon

Congratulations to the Fourth Annual Case Study Competition Winners

UNT Health Science Center

George Alaniz, Garrett Boland, Darin MacCatherine, Dante Ridgell, Adedoyin Akinlonu, Zarna Shah, Matthew Stabe, and Bhaavika Patel.

With the insurance exchanges go-live date a mere day before, insight imparted from this $39M healthcare insurer was both intriguing and well received. Highlighting the need to move from a transactional to experiential mode that is simple, technically fluid and customized, Mr. Malcolmson identified four key areas of focus for the myriad number of companies, falling under the Humana umbrella and actively engaged in promotion of the “halo of health”: care delivery, member experience, clinical & consumer insights and data analytics. Building on this topic, Ms. Blackmon reiterated the need for focus on individual and population health management in order to reengineer care coordination and delivery.

In the absence of well coordinated and engaged care, Humana & Concentra have embraced consumerism to improve care delivery, enhance productivity, lower employer cost and increase profitability. The North Texas ACHE chapter thanks these presenters for sharing their knowledge and experience in this groundbreaking arena. For more information on future events, please visit us at ww.northtexas.ache.org or send us an email at info@northtexas.ache.org.

Attendees Betty Berg, Kena Johnson and Maria Murray

Panelists Rebecca Hurley,Pam Stoyanoff and JaNeene Jones

Mina Castaneda, Amy Rickman, Robyn Krivacic, Kellye Stephens

Women’s Breakfast - October 23rd

Tanya Corbin, Misty Barth,Tina George, Sadie Wright

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On Thursday, October 17th, Ken Hutchenrider, President, Methodist Regional Medical Center hosted the North Texas chapter double feature category I event, “Physician-Hospital Integration in the 21st Century” and “Medical Staff Relationships”. Following introductions and comments by Dr. Michael Deegan, University of Texas at Dallas Clinical Professor for Healthcare Leadership & Innovation, concerning physicians’ interest in seeking relationships with hospitals & healthcare systems in order to gain financial security, strengthen negotiating power, achieve work/life balance and leverage the organizational structure, a group of integration experts, including, Randy Hoffman, Vice President, Finance, for Baylor Quality Alliance, Mark Coughlin, Senior Vice President, Hammes Company and Warren Skea, PwC Health Enterprise Growth Practice Director, delivered insights regarding this evolving topic during their panel discussion.

Throughout the question and answer session, audience members had the opportunity to learn more about physician integration strategies, goals for these relationships and inherent concerns moving forward with these initiatives. While the ultimate goal is to achieve the triple aim of enhancing care delivery, improving population health and reducing healthcare cost, various strategies addressed were: a) shared financial responsibility, governance and organizational management for value-based performance, b) establishing common measurable goals, transparency and trust, c) utilizing physicians participating in provider integration as change agents, d) management training for physician executives, and e) finding the right mix of communication vehicles. Concerns outlined regarding implementation of these strategies include private inurement, violation of Stark law and potential market cap issues.

Directly following this event, Russ Armstrong, Senior Manger with Kurt Salmon, chaired a second panel discussion focused on medical staff relationships with Ken Hutchenrider, Ann Roberts, Children’s Medical Center Senior Director, Medical Staff Affairs and Roger Rhodes, CEO, Baylor Surgical Hospital, located in Fort Worth. Russ introduced the subject by presenting an overview of the growing medical staff expectations as healthcare shifts focus to population health management and accountable care, mixed medical staff concerns and concluded his talk with an analysis of medical staff alignment options and tips for enhancing medical staff relationships.

Key takeways from Mr. Hutchenrider for productive medical staff relationships included: a) identifying physician champions, b) accurately assessing physician skill set for committee participation, c) keeping meetings small with focused agendas, d) providing full access to comparative data and e) maintaining a feedback loop to determine if the strategy is relevant. According to Ms. Roberts, healthcare administrators should: a) engage MD’s in governance and management, b) develop physician training programs, c) create a physician driven clinical effectiveness committee that collaborates to develop clinical pathways, d) share data with division/service line managers and e) focus on communication. And while Mr. Rhodes seconded much of the information mentioned above, he also highlighted the need to listen, align financial and operational incentives and post data.

As hospitals, healthcare systems, payers, providers and vendors search for new models to solidify accountability for individual and population health management, physician-hospital integration offers the opportunity for collegial, productive, forward-thinking relationships to grow and prosper. The North Texas ACHE chapter thanks both group’s presenters for sharing their knowledge and expertise regarding these pivotal and timely issues. For more information on future events, please visit us at ww.northtexas.ache.org or send us an email at info@northtexas.ache.org.

Physician-Hospital Integration inthe 21st Century& Medical Staff Relationships

Attendees Chris Burton & Jeanie Parsley

Hospital-Physician Integration in the 21st Century Moderator Dr. Michael Deegan

Hospital-Physician Integration in the 21st Century Panelists Mark Coughlin, Randy Hoffman, and

Warren Skea

Medical Staff Relationships PanelistsKen Hutchenrider, Ann Roberts and

Roger Rhodes (4)

Program Oranizer Kevin Smith and panelistKen Hutchrider

2014CALENDAR

We are currently working on new educational and networkingopportunities. For the latest updates please check our website or

watch your inbox for the event guide.

ACHE of North Texas thanks the following Corporate Sponsors for assisting the organization’s mission. By sponsoring various events throughout the year, these sponsors are provided local and national exposure with an opportunity to showcase their organization, brand, career opportunities, products and services to the ACHE membership and its affiliates.

Thursday, January 16Education EventMarketing & Money: Linking New Services to ROICredit: 1.5 Face to Face credit apply Time: 5:30-7:30 pm Location: Texas Health Presbyterian Hospital Dallas

Wednesday, January 22ndBreakfast with the CEO: Jeff ReecerTime: 7:30 - 9:00 am Location: Texas Health Presbyterian Hospital Allen

Thursday, February 20 Early Careerist Panel and Networking Event

Thursday, February 20Career Positioning: Proactively Managing Your Professional DevelopmentCredit: 1.5 Face to Face credits pending Location: Children’s Medical Center

Thursday, March 6thAfter Hours Networking Event Time: 5:30 - 7:30 pm Location: TBD

Thursday, April 2ndBreakfast with the CEO:Steve Newton, FACHETime: 7:30 - 9:00 am Location: Baylor Regional Medical Center at Grapevine