Tina Freese Decker 0:03
Overall, this pandemic has caused us to say, “We must do better and we must do better now.” We’ve been slow as an industry to change and what I see is consumers are now very engaged in their health. One of the things I see that’s changed is, we’re moving from the sick model to the health model, and people now understand the value of being healthy. And so I think there’s going to be more consumer engagement and that will push the pace for us to change much faster, which will then require us to do some things that we’ve not done before.
Gary Bisbee 0:37
That was Tina Freese Decker president and CEO Spectrum Health, assessing the effects of COVID on empowering consumers to change their demand profiles, which will cause health systems to move faster and in new ways. I’m Gary Bisbee and this is Fireside Chat. In this wide-ranging conversation, Tina covered the effects on Spectrum from COVID and what lessons were learned from the first surge that are being applied to the second. Tina described Spectrum’s commitment to vaccine distribution by referring to Spectrum’s priority of getting shots in arms. She spoke about partnerships between health systems and public health agencies in terms of developing trust, communicating regularly and intentionally, and carefully defining goals. She believes affordability is an all-important issue and notes that consumers will become more engaged in their healthcare if they’re aware of prices and if they better understand the health system’s business model. Tina thinks of a better normal rather than a new normal when effective, which is encouraging leaders to be more authentic. Let’s listen.
Tina Freese Decker 1:42
A lot of people talk about the next normal. I actually think about the better normal and how do we create a better normal. And one of those elements of that better normal is that we all have learned that we need to be more authentic. We’ve been able to zoom in and see people in their home office and hear the dogs barking or the doorbell ring. And you know what? It’s okay. It’s okay to be real. And so I do believe that we’re going to see more CEOs and leaders being more vulnerable and comfortable with being themselves and that that actually is better for leaders and better for organizations.
Gary Bisbee 2:19
I’m delighted to welcome Tina Freese Decker to the microphone. Well, good afternoon, Tina, and welcome.
Tina Freese Decker 2:30
Good afternoon, Gary, good to be with you today.
Gary Bisbee 2:32
We’re pleased to have you at the microphone and this is your second appearance with us. Let’s think about COVID. The last time you and I chatted it was pre-COVID, seems like a world ago. Now we’re in it. So what’s the status of the surge in Grand Rapids in the Michigan area that Spectrum serves?
Tina Freese Decker 2:52
Spectrum Health is in west and southwest Michigan. And the first surge back in March or April, it really didn’t come to the west side of Michigan during that time period. We hovered around that 3% positivity for the summer. But then we started to see the increase as other Midwest states saw the increase in October and November. And we got to a high of about 400 people with COVID-19 in our hospitals around Thanksgiving. We could manage it without going outside of our walls, but we had to scale up our teams pretty significantly. An example is that we typically have three ICU teams and we scaled up to eight. But since we were able to talk to our community and share best practices and remind people to social distance and wash their hands and wear a mask, we have not seen another surge come after Thanksgiving or after the Christmas and New Year’s holidays. And so I’m extremely proud of our community for heading those messages and watching what they’re doing and being careful so that we can keep more people safe and healthy here in our community.
Gary Bisbee 3:58
Some of the health systems are reporting a lot of pressure on the physicians and frontline caregivers. Have you seen that at Spectrum?
Tina Freese Decker 4:07
Absolutely. Everyone has done so much great work in the past year to prepare for COVID-19 and manage for a surge. And then throughout the major surge we were fully engaged with our team. They’ve done a fantastic job of learning how to care for patients, treating them with exceptional outcomes as we move forward, and engaging and innovating new ways to provide it. But one thing I’ll share with our team members is that we measure on a quarterly basis our team member engagement and prior to COVID our score was about 73 out of a 100 point scale, And it kind of dipped in the middle of it, but at the height of our surge we did another survey and it came back as 72. And I think that’s pretty phenomenal to stay right in that 70 range with everything going on both internally and externally to the healthcare system. And so I can tell that the communications, the offerings that we provided to our team members through address the burnout and the fulfillment, to help with childcare or eldercare, to offer my strength and headspace, all of those things were appreciated to help them do what they do best, which is care for patients.
Gary Bisbee 5:23
You’ve covered this, but let me ask you a question directly. What lessons did you learn from the first surge?
Tina Freese Decker 5:29
I’ll say two lessons that I think are really good for what we learned. The first is communication. It’s just so critical to communicate, to listen, and to communicate. We didn’t have a process where we regularly connected with our team members. And because of COVID-19, we now have monthly town halls, we had regular webinars, we send out daily newsletters, and we had this two-way communication going back and forth. And so I think that was critical and I expect that to continue as we move forward and get out of this current pandemic. I think the other lesson is adaptability. We had a plan, but with anything, especially pandemic, you have to pivot from that. So that plan cannot stay in stone. And so our team created plans and then found new ways to do it and implement it better. And so we were always iterating, which is what I appreciate from what they did. They didn’t just stay with what we’ve always done, they didn’t stay with the status quo. And I think that agility and that adaptability is a really good lesson to learn. And it’s hard to do, especially in a large organization.
Gary Bisbee 6:37
Turning to vaccines, which is all-important, of course, what role is Spectrum playing in vaccinations, Tina?
Tina Freese Decker 6:43
Our goal is to get shots in arms. And so we are stepping into the process to be a lead as a strong collaborator and leading with our own operations and processes, but also collaborating with others in our region, to share information and to make sure that we’re agile with it. We’ve actually created this collaborative called the West Michigan Vaccinate Collaborative that includes other health systems, health departments, pharmacies, and many others to coordinate. Because, like I said, much of what we’re doing is communicating and so we wanted to give one process for people to follow, where to go for information. And as we’re collaborating, we’re doing it internally and externally so that we can approach this to our community and give them the resources that they need and ultimately get the shots in their arms.
Gary Bisbee 7:30
We’ve made a reference to Spectrum Health. Can we ask you to provide us an update on Spectrum please, Tina?
Tina Freese Decker 7:36
Spectrum Health is an integrated health system. We have a health plan called Priority Health that currently has over a million members and is the third-largest provider-sponsored health plan in the country. We also have a robust network of physicians and advanced practice providers within our clinics as well as physicians that are part of our medical staff. And then we have 14 hospitals. And those hospitals range from critical access to trauma, tertiary level facilities with heart transplant. And we also have a children’s hospital that just celebrated its 10th birthday in this big blue building that we have here. And as a child, you always want to celebrate those birthdays. It’s a great thing to do for our community because we have all these services available so people don’t have to go elsewhere to get exceptional care here.
Gary Bisbee 8:25
Well, happy birthday to the Children’s Hospital. Thinking about 14 hospitals plus a children’s hospital plus medical groups, how does scale matter during a crisis like this pandemic?
Tina Freese Decker 8:36
Sometimes size can be a detractor. But we’ve found that, especially with this pandemic, it’s actually been a booster. And we’ve mobilized in such a way that they’ve been able to move with agility. We’ve removed that traditional hierarchy of slow decision making. We lived our values every single day. You and I talked about that last time and I just think that’s so critical. And we also innovated constantly, like I said, reiterating, trying to find the best way to do things to provide the best services for our community. And so I do think scale matters, but it matters if you get it to where you need to go to actually be more agile, communicate, be trusted in the environment.
Gary Bisbee 9:18
What are you picking up from your CEO colleagues in terms of M&A, particularly following this crisis? Are you expecting to see more M&A over the next several years?
Tina Freese Decker 9:30
I do think there will be more M&A, but it may be the traditional type, it’ll also be the non-traditional ways of M&A. I think overall, this pandemic has caused us to say, “We must do better and we must be better now.” We’ve been slow as an industry to change and what I see is consumers are now very engaged in their health. One of the things I see that’s changed is we’re moving from the sick model to the health model and people now understand the value of being healthy. And so I think there’s going to be more consumer engagement and that will push the pace for us to change much faster, which will then require us to do some things that we’ve not done before.
Gary Bisbee 10:12
We talked about M&A in general or national terms. What about your region? Is Spectrum likely to be participating in mergers and acquisitions over the next several years?
Tina Freese Decker 10:23
We’re always looking and interested in opportunities to partner as long as it provides value and is consistent with our culture and our mission. We’re really focused on being an integrated health system and applying that approach to both the provider and the payer to the community to deliver that value. So I believe that growth is always an option is there, but it has to be growth to deliver that value, not just for growth’s sake. I see that we have a lot of opportunity in our industry to actually transform the current healthcare model to be something that consumers would really value. That’s what we have to focus on, is how do we deliver that value to consumers.
Gary Bisbee 11:04
You made reference to Priority Health earlier. Could you describe Priority Health for us, one, and then two, how does it benefit Spectrum as an integrated care model?
Tina Freese Decker 11:15
I think it’s fantastic that we have an integrated health system where you have Priority Health and then the delivery system of our Spectrum Health team equal partners at the table. So as I said, Priority Health just now has over a million members. It’s the second-largest health plan in the state of Michigan and it’s the third-largest provider-sponsored plan in the nation. We offer a broad portfolio of all of our health benefits, Medicaid, Medicare, Medicare Advantage, small and large employer groups, and the individual market. And we’re also really proud that our network for Priority Health includes 97% of the primary care physicians in Michigan. And so the advantage of having Priority Health as part of the Spectrum Health is that we are really focused on what consumers and employers want out of healthcare. And so Priority Health really adds to that voice to say, “How can we get more affordable?” We’ve put it in our vision statement to be affordable. So we’ve focused on ensuring that we are reducing the total cost of care, providing that value back to consumers and then the employers as they purchase healthcare coverage or care, and we’re reinventing our services in both areas to make sure that it’s more simple, it’s easy, it’s what the consumer wants, and that there’s a benefit for that integrated approach because we can provide that to the consumer. I think the other benefit, especially because of the pandemic, is that having a provider and payer offered us some stability going through this past year in relation to where the revenue is and the risks. We did pay returned funds to some of our members from Priority Health because we wanted to make sure that they were sustained when they weren’t using health care. But even though we did pay some of that money back, we were still able to have some stability and we are margin target.
Gary Bisbee 13:10
Priority Health, it looked like to me, acquired Total Health 12 or 18 months ago. What did that bring to Priority Health?
Tina Freese Decker 13:19
Total Healthcare is a health plan in Southeast Michigan. And about 50% of that membership is Medicaid and the other 50% is commercial. Very well run health plan and we wanted to make sure we connected with that market. What they were looking for is a connection in a bigger organization to get the kinds of scale and to do different reaches. What I’ve seen with Total Healthcare and also with Lakeland that joined us two years ago, is that there’s value in both sides when you do these integrations. And you have to be open to that, you have to be wanting to identify that value and approach it with a view of collaboration because there’s a lot that a smaller player can bring to the larger player and there’s things that a larger player can bring to a smaller player. And the benefit is combining that and finding what the best connection is and you make it work.
Gary Bisbee 14:09
You’ve made reference to this on and off over our discussion, but let me ask the question directly. What would you say Spectrum’s priorities are for 2021?
Tina Freese Decker 14:18
We are laser-focused on our mission and our vision. Our mission is to improve health, inspire hope, and save lives. And our vision is personalized health made simple, affordable, and exceptional. So we are focused on creating that simplified experience. We want to make sure we achieve outstanding outcomes and part of those outstanding outcomes is focusing on health equity. We want to ensure that we’re affordable, that we have purposeful growth, and that we simplify the process for not only our consumers but also our team members. So that’s a lot of our focus right now. We’ve found through going through COVID that we needed to focus all of our initiatives and so we have taken a number of them and simplified it down to just a few to make sure that we can accomplish our goals going forward.
Gary Bisbee 15:07
Do you think this crisis will cause a change in the next generation of CEOs in terms of what boards of directors might be looking for?
Tina Freese Decker 15:17
I do think that there will be changes in what people are looking for. One aspect is, you’re going to look for people that can manage under stress and can pivot, can change when things happen, can communicate effectively with others. I think the other area is authenticity was really valued. And I’ve been thinking a lot about what’s next and a lot of people talk about the next normal. I actually think about the better normal and how do we create a better normal. And one of those elements of that better normal is that we all have learned that we need to be more authentic. We’ve been able to zoom in and see people in their home office and hear the dogs barking or the doorbell ring. And you know what? It’s okay. It’s okay to be real. And so I do believe that we’re going to see more CEOs and leaders being more vulnerable and comfortable with being themselves and that that actually is better for leaders and better for organizations.
Gary Bisbee 16:16
I think that’s true. Same question for the board of directors. Do you think over time, a crisis like this will cause a reevaluation in terms of the types of board members that you recruit?
Tina Freese Decker 16:30
I’ve seen that there was pride and value of being on the board of the healthcare organization prior to the pandemic, there’s even more pride and value and understanding of the importance of good healthcare in a community now that we’re going through this pandemic. So I think that everyone understands the role that they have and the role of others even better than they did before and I think there’s now more focus on how do you provide that role to the best of your ability. And I’d also add one more thing to that. I think people are realizing what brings them joy. And they’re going after what may bring them joy and stopping the things that don’t bring them joy because they’ve identified they need to spend their energy and their time on the things that matter.
Gary Bisbee 17:17
That’s absolutely well said. Transformation is a term that we frequently use, but really change or evolution of the health systems. What will COVID cause going forward? For example, telehealth, obviously huge uptick in telehealth services, demand for that. How do you see that playing out over the next several years? Will telehealth become even more useful, give the consumer more influence over the care they receive? How do you think about that?
Tina Freese Decker 17:50
I think for telehealth, we will use it even more just because consumers are using digital activities everywhere. And so we’re becoming more and more comfortable with that mode of communication, that mode of interaction. And we probably will require it because it creates greater convenience and simplicity. You asked about what is COVID accelerating. When I think about what’s happened in this world just in the past year, it causes me to think that there’s a lot of things that are changing dramatically. Telemedicine is one of those. There’s things that haven’t changed and one of those is clinician burnout and behavioral health. We know it’s an issue, we need to address it. And then there’s some things that are just more magnified. And I think some of those things that are magnified is, you know, the value of our own health and that we have to take care of that. And we can do that in a number of different ways, telemedicine being one of them. So I think there’s just some nuances to what change will occur and it will vary over the next year and see how it plays out.
Gary Bisbee 18:52
Going back to telehealth for a moment. When the surges began, it seemed like a lot of the telehealth was for primary care. And I’ve heard from some of your CEO colleagues that they’re now extending that to post-surgical care, specialty care, and so on. Are you finding that’s the case at Spectrum?
Tina Freese Decker 19:12
We had already expanded to post-surgical care and other specialty type of care, so when the pandemic hit, we didn’t have the numbers that we had going through all of our telemedicine offerings, but we had already spread it to, I think, it was at least 20 specialties that we were doing that. Again, it significantly increased during the pandemic. We increased the number of physicians and APPs that were trained to do the telemedicine and so now they’re capable to do that. But it’s also spurred them to think differently about how do we practice medicine and how do we need to see patients. One of our physicians is actually working on a research study to see how do we do remote surgery and to make sure that it’s safe and effective in those processes. So I believe that a lot of innovation, especially around the capabilities of digital and telemedicine will come forward in the next year.
Gary Bisbee 20:03
Are you budgeting about the same number of telehealth visits for 2021 as you had in 2020 or do you think it’ll go down a bit, Tina?
Tina Freese Decker 20:13
I think it will go down a bit because people still want that relationship with their physician. And I think people want to see people. And right now, that’s one of the places you can go to so they will go out and see it. But I think in attracting others, especially those of a younger population, they will definitely gravitate towards a digital solution and create that convenience and simplicity for them.
Gary Bisbee 20:38
Let’s turn to public health for a moment if we could, we spoke about this earlier. And the question is, how can the assets of the health systems be helpful in terms of public health, think about distribution of vaccines, for example.
Tina Freese Decker 20:55
I believe that public health and health systems need to form a really strong partnership. They need to trust each other and align on a common goal to accomplish what we need to do. We’ve partnered with our public health entities on mental health and we’ve partnered with them on COVID-19 testing as well as now on the vaccine. The criticality of it is develop the trust, communicate about what we’re trying to do, and then figure out a solution of how we can accomplish the goals to make sure that we’re improving our community’s health. We are aligned in that. We have our community health needs assessments, we have identified areas on ways we can improve health equity. Public health has resources that health systems don’t have and vice versa. And so we should make sure that we’re collaborating and communicating in the best way possible.
Gary Bisbee 21:44
Let’s turn to a bit of a trickier issue, I think, and that is the percentage of revenue for our health systems that come from governments. And we’re now at the point where, on average across the largest health systems, more than half of the revenue comes from governments and most of that from the federal government. As we see more baby boomers coming to Medicare and the pandemic clearly increased the Medicaid rolls, do you see that increased payments to health systems from government is that going to present a problem or a challenge for our health systems do you think?
Tina Freese Decker 22:22
I think that the increased payer mix from government will be a problem if it is at current rates and if we cannot remove the waste and reduce the cost of healthcare. I think there is waste in healthcare and that’s what we work on every day to find better ways, more efficient, more affordable ways to provide that healthcare. We have to get better at that. But there are some things that really do provide value to the community that I don’t want to lose. Having the infection prevention team and their expertise and capabilities was phenomenal during this pandemic. And sometimes we don’t think about that at the normal course of business, but when you need it, I was so thankful that we had them here and they’re part of the great team that every daycares for patients. So I think we need to really evaluate how can we provide health care in a better way, focusing on some of the efficiencies but still have it be personalized and exceptional outcomes as we go forward. This is one of the biggest challenges that we have facing our industry right now. One other thing to add for that, I know that the government is continuing to shift and so more and more from our payer mix will be government-focused, but consumers are now much more engaged in healthcare and they will demand more affordable premiums as well as procedures from healthcare systems. And we must be better at providing those price estimates, making sure that our business model is understandable to consumers. I think that’s going to be the true revolution and how we’re going to change to be more affordable is because we need to make this understandable and reasonable to the people we’re serving.
Gary Bisbee 24:08
Just to follow up your point and support it, we’ve definitely seen over the last decade risk shifting from payers and insurers to consumers and providers. Now you’re kind of in the middle of it because you’ve got Priority Health as part of Spectrum, but how do you see that risk shift? Do you think that will continue, Tina?
Tina Freese Decker 24:30
I do think that the risk shift will continue. I’m not sure how far, but I believe people are going to be talking about the affordability or unaffordability of healthcare until we find those solutions to make it more affordable and understandable. For a long time, Priority Health has had our cost estimator tool available. And it’s interesting that only 17% of our members use that tool to shop for care. I say only 17%, but I should be extremely proud of that because that’s three times what the national average is. And so we do need to have consumers more engaged and I think that they will be. And we need to make sure health systems and payers are engaged to provide the information and ensure that we understand the business models.
Gary Bisbee 25:17
We spoke about M&A earlier which brings up the regional health networks and a lot of people think that over the next five-plus years we will see more of that. You look at Spectrum particularly with Priority Health and you have to say, Spectrum would be an ideal base for a regional health network. How do you think about that, Tina?
Tina Freese Decker 25:40
I agree with you. I think that being an integrated health system is an ideal place to be a regional health network. I’ve heard studies that show that the best performing health systems have that balance of a provider and a payer because you know how to work together and you’re aligned in caring for that community. And I think that having an integrated system, plus a culture that puts our people first, both the team members and the people we’re serving really creates an opportunity to model that and to expand it into other areas.
Gary Bisbee 26:11
You mentioned health equity and social determinants of health earlier. Practically speaking, what can be done in those two areas by a health system?
Tina Freese Decker 26:21
I think the first thing we need to do is we need to listen. We need to understand what’s going on, we need to look at the data, we need to engage with communities to address the issues that are going on. Health matters and it’s more important than ever that we address this and we help people get back to health or stay healthy. But first, we have to develop that trust. We won’t be able to move forward if we do not have that trust. So for Spectrum Health, we’re starting there. We’re starting with creating health equity committee of the board. We’ve created a health equity council for our system and then have the division levels for coordinating processes in a way to understand what communities could we talk to to learn more about it, what is the data-sharing telling us so that we know where to start with the information. We’ve done a lot of this work already, but I want to go even deeper and I want to make a bigger impact. One of the areas that I’m most proud of is our Strong Beginnings work, which is a collaborative with eight other organizations within our community that has been working over the past 20 years to make an impact on infant mortality. Back in, I think it was 2000, the infant mortality rate for black infants was so much higher than white. And now we’ve seen that the disparity has been eliminated or very close to being eliminated between the black infants enrolled in the program and all of the white infants in the county. So if we can make that progress in 20 years, I’m really excited about what we could do in the next 20 years to impact the life expectancy and the health equity of our communities.
Gary Bisbee 27:57
Congratulations. That’s just awesome results. Tina, this has been an absolutely terrific interview, as the last one was. If I could wrap up with questions on leadership, we all know leadership is always important, seems like it’s even more important in a crisis. What do you think of the characteristics of a leader in a crisis?
Tina Freese Decker 28:18
I’ve been thinking a lot about leadership lately, especially because of this pandemic and crisis that we’re in. And one of the things I thought about are six paradoxes that effective leaders must be able to do. And what the paradox is, you have to be good at both whereas previously you may have only had to be good at one or the other. And so these six, and I’m sure it’s not a complete list. But the first one is think big and small. So you have to use a telescope and a microscope when you’re looking at issues. The second one is to have a clear, defined plan, but also be ready to adapt. The third is to over-communicate and over listen; we need to make sure we’re connecting with our audiences. The fourth is to be decisive and collaborative. Sometimes it helps to have the seat at the table and sometimes you need to let others have a seat at the table too. And so you have to balance those and the situation. You also have to build a team and you have to build a team for today and for tomorrow. And then the last one is to be authentic and vulnerable, as I mentioned before. And as I think about it, there’s really no rulebook for being an effective leader and so it’s figuring this out as you go. But being consistent with your values and understanding what needs to be accomplished and communicating that out to your teams and the community that you’re serving.
Gary Bisbee 29:41
It seems that COVID has affected us all differentially. How has the crisis changed you as a leader and a family member, Tina?
Tina Freese Decker 29:49
I think the crisis has helped me focus more and respond with greater agility. Like I said, there was no playbook but I knew we had to focus our energy, our communications, our timing on a very few things. It has also crystallized for me the value and importance of our mission, of our vision, of developing that trust with the community through two-way communication. And then, I knew this before, but I really think that there’s value in this integrated health system approach and how we can offer many things to the community by being this integrated system. As it relates to changing me as a family member, I valued my time with my family before, but it’s nice to be able to go home every day and to be with them. And what’s crystallized is what is bringing me joy and to make sure that I’m really focused on that and I don’t forget that it’s easy to push things off and we just can’t push those things off right now. We need to make sure we embrace it and live every minute.
Gary Bisbee 30:52
Do think you’re gonna travel as much in the future as you did before COVID?
Tina Freese Decker 30:57
Well, I’m certainly looking forward to traveling for pleasure to see new things. I don’t think we’ll be traveling as much in the overall sense, but I do believe we’ll travel because we do need to get together. Relationships do matter. And sitting face to face in the hallway with somebody, it does create something more than just this digital relationship. But I think you could have a bit of both, you could have that hybrid approach. And so I think that’s where it will go. You’ll have a mixture of virtual and you’ll have a mixture of in-person where it matters to be in person.
Gary Bisbee 31:30
Developing relationships is a great place to land here. Tina, this has been a terrific interview. We thank you very much.
Tina Freese Decker 31:37
You’re welcome. Thank you so much for asking me. It’s great to have a relationship with you, Gary.
Gary Bisbee 31:42
Fireside Chat with Gary Bisbee is a Health Management Academy podcast produced by Think Medium. 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’ve found that podcasts are known through word of mouth and we appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington, DC where we explore the strategies of leading health systems through conversations with CEOs and other interesting leaders. For questions and suggestions about Fireside Chat contact me through our website firesidechatpodcast.com or firstname.lastname@example.org. Thanks for listening.