Episode 6:
Serving the Community with an Integrated Health Model
Tina Freese Decker, President and CEO, Spectrum Health
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In this episode of Fireside Chat, we caught up with Tina Freese Decker of Spectrum Health. We discussed physician leadership, the changing definition of healthcare, Spectrum’s integrated model, and her transition to CEO.

Tina Freese Decker is the President & Chief Executive Officer of Spectrum Health, a $6.9 billion, nationally recognized health system with a medical group, health plan and 14 hospitals employing 31,000 individuals in Southwest and West Michigan.
Over her 18 years serving Spectrum Health in various strategic and operational roles, Tina has developed a track record for cultivating culture and driving strategy. She is committed to building a health system that celebrates and reinforces diversity and inclusion for employees, patients, families and members.
As President & CEO, she has successfully implemented a new mission, vision and values. This foundational strategic work has been instrumental to reducing health disparities, lowering cost, and improving health and access.
Tina’s awards include Modern Healthcare’s 2019 Top 25 Women Leaders; Crain’s Detroit Business’ 2019 Health Care Heroes award and 2018 Most Notable Women in Health Care; and Managed Healthcare Executive’s 10 Emerging Healthcare Industry Leaders 2018.
She earned a Bachelor of Science in finance from Iowa State University and graduated with a Master of Health Administration and Master of Industrial Engineering from the University of Iowa.
Tina and her husband, Jay, live in Grand Rapids, Michigan, with their two children.

Transcription

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Tina Freese Decker 0:00
As we created our strategic plan, I took a completely different process than we’ve ever done before. And I spent six months where we sought about 6,000 pieces of input into the plan. And I’m really proud of that work. And what that also did, because it’s an inclusive process, is our strategic plan is not one that we did and now is sitting on the shelf. I hear it, I see it every single day. And that’s what makes me proud.

Gary Bisbee 0:31
That was Tina Freese Decker, President and CEO Spectrum Health. I’m Gary Bisbee and this is Fireside Chat. Tina, who was appointed to her position 18 months ago was commenting on the first strategic plan developed under her leadership as CEO, and how important it is to her the board and the executive team. Our conversation is wide ranging, and includes Tina’s discussion of the importance of this Spectrum Health integrated model to the West Michigan community. How Priority Health the Spectrum Health Insurance Plan assists in aligning incentives among patients, physicians and hospitals. She shares her feelings about the succession process that resulted in her selection as CEO, and the importance of courage in the outcome. Let’s welcome Tina to the show. Tina, thank you for being with us.

Tina Freese Decker 1:22
Oh, it’s my pleasure. Happy to be with you today.

Gary Bisbee 1:24
You’ve done a marvelous job at Spectrum. So let’s explore that today. But first, your background. You’re a good Midwesterner. Share with us how the Midwestern roots kind of inspire you and drive you and then how did you get interested in healthcare?

Tina Freese Decker 1:38
So I was born and raised in Iowa, and I’ve lived in Iowa for half my life. And now Michigan, where I call home is the rest of the last half of my life. And as you said, Those Midwestern values are just embedded in me, and I’m trying to embed them in my kids as they grow up. Staying true to your values, high integrity, focused on the people in the community, and really that hard work of making an impact. So when I became interested in health care, there wasn’t anybody in my family that was in health care. So I didn’t see it every day. But I had this yearning to help others, and to make a difference and an impact for people in the community. And I saw health care as one of the most important careers that you could really deliver that impact. It spans so much more than maybe traditional healthcare is from hospitals. It gets into education, it gets into housing, there’s all the social determinants of health that are absolutely linked to the healthcare system. And so that’s what initially intrigued me and why I wanted to be part of this health system.

Gary Bisbee 2:49
You said, your father is an entrepreneur and you kind of think about healthcare that way, don’t you kind of broadly and expansively?

Tina Freese Decker 2:56
Yeah, I love the fact that I focus on problems from a global perspective, but also understand the details that go into it. And as my father was an entrepreneur, he always had to reinvent his business every, every single time, it started to change. And I saw how hard he worked, how curious he had to be and how dedicated he was to his career. But then I also saw my mother being an art teacher, and how she would have fun and how she could be creative and come up with different solutions. So watching them learning from them every single day helped me, you know, determine my career path and what I wanted to accomplish.

Gary Bisbee 3:36
You got both the right side and the left side covered, right? Yeah, pretty cool. Finance undergrad?

Tina Freese Decker 3:41
I was finance undergrad, and then I did my Master’s in Health Administration. But I also did a master’s in Industrial Engineering, at the same time, because I wanted to get into healthcare and understand the health care elements. But I was really interested in how we make healthcare easier? Easier for the people providing care and easier for those that are receiving it. And that’s why the industrial engineering piece of human factors, improving patient safety, operations, research and artificial intelligence, were really key to rounding out my education, so that I can really target my energy on how to make it more simple.

Gary Bisbee 4:20
I mean, at the time, not that it was that long ago, but at the time, that was a pretty unusual combination of healthcare and industrial engineering.

Tina Freese Decker 4:27
Yes, at the time, I had to craft my own degree. And so I took a lot of classes using airplanes and cars. And sometimes I’d be able to craft the learning toward healthcare.

Gary Bisbee 4:39
And here you are in Michigan. So you came to Spectrum, basically out of school for your fellowship program and have been here ever since.

Tina Freese Decker 4:50
Yeah, I chose Spectrum Health for my fellowship because I saw just this wonderful opportunity to be part of the health system and I felt that I could learn whether I wanted to be in an urban setting or a rural setting, whether I wanted to work in a health plan or delivery, and felt that the opportunities were numerous. And I have not been disappointed, it’s been a wonderful 17- now going on 18 years here. Where if you embrace those opportunities, which I did, you can learn a lot. And you can also give back.

Gary Bisbee 5:23
Well, nobody knows Spectrum Health better than you do. Can you describe Spectrum Health for us?

Tina Freese Decker 5:28
Spectrum is an amazing organization. I am so proud of the 30,000 people, plus those in our community that really helped us deliver on our mission to improve health, inspire hope and save lives. Whether it’s through one of our facilities, we have 14 hospitals and 200 plus outpatient sites, or through our physicians, we have 2000 physicians and aPPS who are with our medical group. and we work with another 2000 that are on our medical staff. And so providing the care either in a facility or in a person’s home is really important. Our health plan has done an amazing job at competing in this state, we have almost 1000, I’m sorry, almost a million members, which puts us as one of the top five largest provider sponsored health plans in the country. And I’m really impressed with their focus on serving the individual. Their drive is to make sure that people are healthy, which is what you want in health care. And we focused on care management on how we get the best resources to that patient at the lowest cost possible. And that’s where this partnership as an integrated health system comes together. Because when you have a care delivery organization and a coverage organization, we can have a coordinated, consistent approach to how we take care of people and actually keep people healthy. Now, the conversations aren’t always easy to do. But I believe that having those conversations makes us better. And we can provide a better product, whether it’s insurance or care delivery to the people that we serve every day.

Gary Bisbee 7:05
Going back to 1932, there was a report published called the committee on the cost of medical care. And it laid out integrated care at that point. Of course, it took us years and years to get there. But this is a prototypical model. Let’s explore kind of the learnings from each side because incentives for Priority Health, the health plan are different than the delivery side. So what are the learnings both ways, either at the physician level or at the leadership level?

Tina Freese Decker 7:36
Well, one of the learnings that we’re embracing overall, is we always want to take care of the patients and high quality care is paramount. But there’s different ways to take care of the patients. And from a health plan perspective, you’re always focusing on those that are high cost that utilize the system the most, how do you get them different resources. There’s a patient that’s used our ER almost every single day in the year, well, that’s not the right place for care. We can partner together, once we identify that to provide care in their home, or connect with technologies that help them better manage their health, those incentives are aligned. And so we’re using the technology now and the research that we’ve come up with to make sure that we’re aligning on those patients, to make sure it’s the right care, right place, right time for that individual. That’s been very beneficial. But it does require us to think like a system and to change the way we are incentivized and rewarded across the organization to ensure that we’re focused on health, we all went into medicine or health care, because we wanted to make sure people are healthy. By keeping that type of mind, which is our mission statement. It really helps us align what we’re working on.

Gary Bisbee 8:55
If we think about the finance side for a moment, we’ve seen margins operating margins of our health systems go down steadily for 5, 6, 7, 8 years really. Margins and health plans typically aren’t that great anyway.

Tina Freese Decker 9:11
I think that in the health plan, business is more risky, and you’re managing the risk. There’s things that can change with an election, or what our legislative leaders want to do. But I also believe that we have to be focused on providing true value to the customers or the individuals. So from a health plan perspective, we’ve focused on only having a 2% margin and ensuring that our administration is at a very low rate because we want to make sure that the care that people are paying for the care, we’re actually paying for the care and that most of their dollar goes to the care provided. And that’s where we’ve been good partners with the care delivery because from a health plan perspective, we are paying for that care. And we’re working to ensure that the care is the most appropriate, and finding the clinical pathways to agree on. So we can make it a seamless approach. One example that we recently did is we had a conversation about a pharmaceutical drug. And we found that many people were choosing the much higher priced drug. And we wanted to shift it to the generic, which was significantly lower priced. So we decided to put it into our electronic medical record with the price differential, but also remove the prior authorization for the lower price drug. And so we’re changing behavior, we’re changing the incentive, so you can ensure that it’s easier to get to a generic and easier to get to the lower cost drug. And we made that switch in a day. And that’s the power of being an integrated system

Gary Bisbee 10:57
That is very powerful. I’m sure the physician’s love getting rid of prior authorization, right?

Tina Freese Decker 11:01
Absolutely.

Gary Bisbee 11:03
Tina for President!

Tina Freese Decker 11:06
Haha. The physician leaders that we pulled on, this was wonderful, because they saw this problem, they worked on it. And again, they solved it really quickly, as well as our technology team to make sure that it flowed smoothly. So it’s, it’s identifying those ideas that if we didn’t have this integrated system approach, we wouldn’t know that that was one of the barriers, and we wouldn’t be able to quickly assess it to put it in practice and actually make it better. And the beauty of it is, it’s better for the physicians when they order it, it’s better for the system overall, because we’re paying for some, we’re paying less for something. And it’s better for the patient because they can afford it.

Gary Bisbee 11:41
So with almost a million members and the West Michigan market is this market large enough to allow you to continue to grow Priority Health to continue to grow membership?

Tina Freese Decker 11:51
We are continuing to grow in our membership every year. It’s like I said, it’s a very competitive market, with new entrants coming in all the time. But we believe we have a value story. And we believe we’re the smart choice. When we talk to our consumers that choose us they do select us because of the value that we provide. We are in all of the products that could be offered with a health plan from Medicaid and Medicare, the small group and large group commercial business, as well as in the individual market and on the exchange. And being in the individual market has helped us really fine tune some of the other products because we learn what individuals are doing when they are paying out of pocket for their health insurance.

Gary Bisbee 12:39
Let’s turn to you as President and CEO. Congratulations. It’s been a year since you were appointed. During that time, you’d been here for 17 years and COO for a couple of years before becoming CEO. So what changed when you became CEO, how different was it?

Tina Freese Decker 13:00
I’m in this position, because I find it extremely challenging, daunting, yet very rewarding. And I am energized every day with the impact that we can have now been in this role. One of the Ha’s that I had when I came in, was that we needed a rallying cry around where we were going, and what we needed to accomplish. And so we decided to have a refresh of our mission, vision and values. Because we see that healthcare continues to change, dramatically change. And I see that the converse, the conversation is all about healthcare. Healthcare is the conversation. And the definition of healthcare is changing from one of sickcare traditional focuses to health and wellness and a number of new entrants coming into the industry or the market, that we need to understand how they relate to the business and how they may help the consumers as we strive collectively to improve their health. So my focus has been on giving our team a rallying cry that everyone can buy into our new vision statement and our new mission statement in my role, the real differences that I’ve built and, you know, leaned on the prior experiences, but I’ve also now the vision setter, and the constant communicator to make sure that everyone has a role and understands their role in US achieving our mission and vision.

Gary Bisbee 14:36
So do you find yourself spending more time externally now? I think you’re on four or five, six boards?

Tina Freese Decker 14:42
Yeah, my time is spent externally and internally. I try to do good integration of those elements, those requirements, but I do believe it’s very important that I get out and talk from a national perspective as well as a local perspective about what we’re trying to accomplish, where we’re going, and also drive the conversation from a national level about how will we address affordability? How will we continue to provide exceptional health care services, whether it’s the care or the insurance, but then internally, I need to be present. So I spend my time at least once a week, rounding and talking with people throughout the system. I’m curious, I’m naturally curious. So I’m always out there asking the questions. How does this work? What are you doing differently? And then how can I help? Because I think having a connection internally and then taking it to the outside rather than having that external view can bring greater growth internally as well.

Gary Bisbee 15:47
So you’ve made a commitment to physician leadership development, I know how do you kind of approach the medical staff? How do you make sure that they understand your views of vision, mission and so on?

Tina Freese Decker 15:59
Well, physician leadership is absolutely critical. And I believe that there needs to be a very strong partnership with our physicians, as well as other caregivers. So investing in the physician leadership program that we have with HMA has been wonderful. The comments from our physicians and APS have, they’ve just appreciated that we are taking the time to invest in them. Now, I expect that they will give back to the organization and we will be able to drive even farther with improved quality and experience and addressing some of the major themes that are coming forward within the organization. I also appreciate their input. So I’ve recently launched a physician and advanced practice professional Advisory Council, we had over 150 applications, we asked for nominations, and we’ve selected the 15 to 20 people who will be on it for the first year, I see this as a great opportunity to engage physicians and hpps in thought leadership and input on our strategic plan, but also to give them experience in a leadership setting, that we can start to rotate people through and have greater conversations about what their role is, what the role is of the organization, how are we going to be sustainable and meaningful for the communities that we serve, but also for the broader geography and the and the national level?

Gary Bisbee 17:25
Looks like a great idea. How often will you be meeting with your advisor committee,

Tina Freese Decker 17:29
We’re gonna meet on a quarterly basis. And I’ve already started to think through what the first topics will be. And I’m sure it’ll be a balance of global conversation, and then, you know, smaller issues. But I think that having that two way communication in a purposeful way, will be beneficial for the overall organization, I receive some of that when I round or when I go talk to some of the physicians every day, but having this group that will understand what what I’m looking at, but then I can also understand what they’re seen and bring it together. I know our strategies will be even better because of that terrific.

Gary Bisbee 18:05
Let’s turn to succession, we were talking earlier about the fact that many of the kind of original CEOs of these health systems are retiring, which is the case here, Rick of course retired, adn then you followed him. Many of the systems are going through a succession process. Could you just describe the process here? How did that work? Because you were on the inside looking at it.

Tina Freese Decker 18:32
I commend the board for putting together really robust succession planning or interview processes. They said from the start that they wanted to do a national search, which I agreed with. And that was a very good strategy to make sure that they’re selecting the best person to lead Spectrum Health. And so it was interesting to be an internal candidate to hear all the different things that were said. But I focused on this interview and the process with what I really wanted to accomplish. So I enjoyed the time I embraced it because I spent time thinking about what my vision was and where I really wanted to take the organization. I also spent time thinking through my leadership skills, and what leadership skills are needed to help an organization transform, especially in this era. And as I thought about those skills and the strengths, one of the things that kept coming up to me was my courage. And I don’t say that in a boastful way. I think you have to be courageous, to be vulnerable, and to be flexible and to ask questions and be curious. And so or to make those tough decisions that you know you have to make. And so I paired that courage as well as my compassion. With the strategy and the vision that I set out during the interview process. I always joke with the new employees that come in, I try to go to orientation every week, I ask them if they had 61 interviews, and I’m looking for one that had had more than me. I just embraced those interviews, it was a really fun time to talk to people and get their sense about where our organization needs to go. And they could see my passion and ideas about where I wanted to go as well.

Gary Bisbee 20:23
Well, you mentioned courage. And we had talked earlier about, you’ve got a characteristic that you’re willing to ask questions and in areas that you may not already know the answer, which is somewhat unique these days. But I would think that that would be viewed by the board as a substantial asset.

Tina Freese Decker 20:41
Yeah, our board meeting meetings have really transformed because we’re being very transparent with our strategies and where we are to date, and what we need to do going forward. And I think part of the process with the board and with others is to help bring them along with the strategies that we’re developing today, I don’t need to have everything completely baked to go in and propose something. In fact, I think people like to be able to give input before something is completely dead. And so that’s my approach is to gather that input to ensure that we have the best possible solution, and then present it later, as we created our strategic plan, I took a completely different process than I than we’ve ever done before. And I spent six months where we sought about 6000 pieces of input into the plan. And I’m really proud of that work. And what that also did, because it’s an inclusive process, is our strategic plan is not one that we did and now is sitting on the shelf. I hear it, I see it every single day. And that’s what makes me proud.

Gary Bisbee 21:49
We talked about disruption and government pay and differing margins, and so on. How do you compute all of the change that we’re facing in healthcare today and integrate that into your plan? How did you go about doing that? I got 6000 pieces of information.

Tina Freese Decker 22:07
I got 6000 pieces of information. The first area is to start with a mindset shift, we have to be willing to come up with new opportunities. And so that’s when you talk to people, do they have a performance limiting mindset, or performance accelerating mindset? And so my conversations, as I said, about being a constant communicator is how do we help people feel comfortable with opening up their mindset, and embracing something that may be really different than what they’re used to, and what they’re willing to accept? If we can get to that point, then there is more innovation and more transformation that can come from just being open to these new ideas. So our strategic plan, put some bold steps out there, that this is the direction we’re going in, but then it spend some time talking through, how are we going to do that, because we know that you can have that bold vision, but you want to take the small right steps first to get there. And as you create those win wins, in a small way, it’ll start to snowball, and we’ll be able to get to that bold vision.

Gary Bisbee 23:11
So the business models are evolving, Are you positive about all this change?

Tina Freese Decker 23:16
I’m excited, that’s who wouldn’t be this is an enormous change in healthcare, but we have the opportunity to shape it, to where it could go for the future for many generations to come. And so I see this as a great time to be in healthcare, because we have an open canvas to really make it better.

Gary Bisbee 23:37
Good. Well, thinking about the governance process, some of the details, how many members of the board do you have now

Tina Freese Decker 23:42
We have 15 members of our board, they are a fantastic board representing a number of different industries, and perspectives. And I’ve embraced all of their years of experience and ideas and diversity of thought, to help us make sure we’re looking at all the components of our strategy in the organization, especially as we hear and see the disruption coming into healthcare. And so this board is helping me navigate some of these large changes that we know will occur.

Gary Bisbee 24:14
And you’re on the board. Right? So are you the 16th member. That’s a good number.

Tina Freese Decker 24:23
I know we’ll probably be a little bit smaller as we have some transitions, but we are also spending a lot of time about succession planning for board members, and how do we recruit the right people to be on the board especially as those turn them off of the board. We do spend some time talking about what it means to be a board member of a health system. It’s not a hospital. It’s not an insurance company, but it has responsibility for both of those. So there’s quite a bit of education that’s required to be on this health system board. And with that, we get into very robust strategic conversation. trends that span the entire health industry.

Gary Bisbee 25:02
Those are primarily regional boards.

Tina Freese Decker 25:05
We have a lot of local people here. But we also ensure that we have national representation. It’s not representation, but we want to ensure we have the national voice. And we have voices from diverse partners from retail from banking industries, for example. It’s it’s really about the competencies that help this board be the best it could be

Gary Bisbee 25:27
Competencies has been an issue, diversity has been an issue as well with with our boards. How are you thinking about that?

Tina Freese Decker 25:37
That is one of the top of mind issues for our board. Again, very good people on our board. But as we as people turn off the board, we have key areas that we want to ensure are more reflected in the board membership, whether it is diversity, but it’s also different skill sets that we’ll need to have as our industry evolves.

Gary Bisbee 25:58
One of the things that we’ve heard at our trustees summit is as the risk Enterprise Risk of our organizations, health systems increases that some may be a little bit more difficult to recruit board members, have you found that Tina to be the case,

Tina Freese Decker 26:13
I have not found that people don’t want to be part of our health system board. In fact, there’s many people that want to be part of our health system board. And so we’re trying to engage many of our community leaders as well as national leaders into advice and helping us figure out the next steps for this. We hold a board summit every year. And we’ve traditionally only invited board members and physician leaders to the summit this year, I’ve now opened it up to business leaders, because I do believe we need to get a broader understanding of what’s going on in healthcare. It impacts every one of the businesses with paying for the health insurance for their own employees, and their own personal experiences. So I think bringing people together, because we know healthcare is the conversation. So let’s have the conversation together and find the solutions together.

Gary Bisbee 27:06
You have a number of awards that you’ve received through the years does anyone stand out to you as being more important than others?

Tina Freese Decker 27:14
Well, I’m very appreciative of all the awards that I’ve received. And I always thank my wonderful team, because I don’t do it alone. The one that stands out most to me is the Robert S. Hudgens award. It’s provided to the young healthcare Executive of the Year for all of American College of Healthcare executives. And I think that one was probably the start of some of my career aspirations and where I was going. And I’m appreciative that ACG selected me and recognized me, but also appreciative that one of my colleagues here at Spectrum Health nominated me, and I just appreciate the support, and all the great work that the team members have done, because every Ward is amazing. And it reflects on the great work that we’re doing here.

Gary Bisbee 28:01
Well, national visibility is in your case, certainly indicated. At what point did you decide, hey, I really would like to be healthcare CEO?

Tina Freese Decker 28:11
I’ve been preparing for this since school because I feel that that’s how we can really impact the health of our communities. And I’ve enjoyed leading the organizations but I’ve also enjoyed now that I’ve gotten engaged in the national boards and policy of how we can impact it there. to spread the great work that we’re doing and Grand Rapids, Michigan in West Michigan, to the rest of the country has been rewarding and beneficial.

Gary Bisbee 28:40
Why don’t we land here, Tina, thanks for your time. This has been a terrific interview and spectrum is in great hands.

Tina Freese Decker 28:46
Thank you Gary.

Gary Bisbee 28:48
This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capitol in Washington DC, where we explore the intersection of healthcare politics, financing and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat, contact me through our website, firesidechatpodcast.com, or gary@hmacademy.com. Thanks for listening.

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