5 questions with Dr. Emad Rizk, President and CEO of Accretive Health

Emad Rizk, MD, has more than 30 years of experience in the healthcare industry, with time spent working with providers, payers and pharmaceutical organizations. President and CEO of Chicago-based Accretive Health since July 2014, Dr. Rizk previously served as president of McKesson Health Solutions. Before then, Dr. Rizk was Senior Partner and Global Director, Medical Management/Pharmacy for Deloitte Consulting.

Dr. Rizk is currently a board member of the National Association for Hispanic Health; Accuray, Inc.; Intarcia Therapeutics, Inc.; and the Managed Care Magazine editorial board. He authored The New Era of Healthcare: Practical Strategies for Providers and Payers, and is a lecturer at Wharton, Harvard, MIT, Columbia, and the Kellogg Graduate School of Management.

Here, Dr. Rizk took time to answer Becker Hospital Review's five questions.

Question: What is the most challenging issue or issues facing health systems today?

The confluence of financial challenges. The degree to which each is intertwined with another makes it difficult to separate and discuss any one challenge as more pressing than the other.

Each year, the American College of Healthcare Executives asks hospital CEOs to name the top issues facing their organizations. For 11 years straight, they have ranked "financial challenges" as their No. 1 concern. That term encompasses the adequacy and timeliness of reimbursement, government funding cuts and bad debt.

Looking at the big picture, part of what is so challenging for leaders is the sheer uncertainty about how finances will be handled in the future. Healthcare does not manage uncertainty well. Hospital CEOs and CFOs are already dealing with reimbursement changes, funding cuts and bad debt, and they must address these challenges in a time of dual payment models. Healthcare financing is moving from the pervasive and understood volume-based model to a value- and performance-based system, which still involves many questions and substantial variation between markets. Oftentimes, it feels there are more questions than answers.

It's also impossible to overlook the human element of this. Peter Drucker, perhaps the most influential management guru of our time, said the hospital is the most complex human organization ever devised. There are so many rules, regulations, educational requirements, accreditation processes and areas of expertise and specialty. I believe Mr. Drucker would say that hospitals have only grown more complex since he studied them some 50 years ago. Taking this into consideration, the financial challenges I mentioned are heaped upon what are already the most intricate organizations to manage and lead.

The array of financial challenges hospitals face makes the revenue cycle all the more important. I recently heard a hospital CFO describe the revenue cycle as the lifeblood of any hospital in America, be it a large urban academic medical center or 50-bed rural community hospital. The good news is hospitals and health systems can exercise great control and influence in making insurance eligibility, financial counseling and billing more efficient. In a time when so much change feels out of their control, this is an empowering thing to remember.

Q: Consolidation is making some of the country's largest health systems even larger. Now we're looking at potential consolidation in the insurance sector as well, with proposed mergers between four of the five largest payers. What are your thoughts on consolidation in the industry?

It's interesting to consider the different perspectives in our industry. Providers have voiced opposition to insurer mergers, and their most pronounced concern relates to competition. Hospitals and health systems worry larger insurers will gain bargaining power in contract negotiations with hospitals and provider organizations, which could ultimately result in lower payments to providers.

At the same time, the insurance community maintains a similar argument regarding mergers between hospitals and health systems: The larger provider organizations become, the more leverage they have in contract negotiations and demanding higher prices from insurers.

Regardless of what unfolds, collaboration is paramount. Payers and providers need to align themselves in three ways. The first is clinically: They must agree on appropriate care and the best treatments for patients. The second way they need to work together is economically, meaning they should agree on costs and how they will demonstrate transparency.

Finally, they must work together administratively. A 2014 study from The Commonwealth Fund found administrative costs account for 25 percent of total U.S. hospital spending. High administrative costs do not appear to be linked to better care. If providers and payers collaborate to diminish these burdens of healthcare, it would be mutually beneficial.

Q: What issue in healthcare do you consider a source of frustration? What is one problem in the industry that you'd like to solve overnight if given the opportunity to do so?

Overnight, I'd love to close the gap between the administrative and clinical sides of healthcare. The billing process is the first and last encounter patients have with a healthcare provider or hospital. The ease and timeliness of this process has an incredible amount of influence on patient satisfaction and how they gauge their care experience overall. Yet too often, billing is thought of as something completely separate from care.

The best healthcare professionals practice compassionate and comprehensive care. This is their passion and purpose, so it is a serious disservice when a patient is treated with compassion only to face administrative and payment processes that feel disparate, impersonal and incomplete.

We tend to be more tolerant as consumers and patients when we need to wait for clinical care than when we spend time on the registration and payment process. Think about the expectations we have in healthcare in other realms of your life, for instance. If you have a7:30 dinner reservation, you are not expected to arrive at the restaurant at 7:00. If you get there at 7:25, well, you are early.

Why does healthcare see this differently? If a patient has a 7:30 appointment, we ask them to arrive at 7 to fill out paperwork. Patients are consistently expected to arrive 30 minutes early, because providers want them to get registered in a fashion that is convenient for them. Patients often feel as though their time is not valued. When taking care of yourself feels like a burden, well, that means the healthcare system is not properly working.

There are so many opportunities to make patients' experiences easier. How can we improve patients' financial literacy? How can we include follow-up care, such as asking about the need for home care and confirming check-up appointments, in our follow-up communication about finances? How can we make the cost estimate, authorization, billing and payment processes feel seamless? How can we unite clinical and financial conversations in a progressive manner? These are the things that weigh on my mind.

Q: What is your leadership style and philosophy? If you had to share one tip with an up-and-coming CEO, what would it be?

If you were to ask my team, you would hear that I often refer to the acronym "ACT" to delineate my values. The "A" stands for accountability. We cannot afford to make excuses. I own my setbacks, productivity and performance, and I expect my team to do the same.

"C" stands for clarity, meaning the team has an unshakeable understanding of expectations. What will and won't we tolerate? Defining that is incredibly empowering for any leader, team and organization as a whole.

And finally, 'T' is for team. I believe the power of a team is greater than the power of the individual. It's so important to engage with people personally and build relationships so they feel they are contributing to the success of an organization and a greater cause. In my experience, it is a mistake to focus too much on the tasks at hand, of which there are many for any leader in any organization. Instead of asking, "Can you have this done by tomorrow?" the more important question is, "What do we need to accomplish, and why?"

Q: You have spent more than 25 years working with payers, hospital systems, government, physicians and pharmaceutical companies. What is one lesson you've learned in that time that you could only learn from firsthand experience?

I have a medical background as an intensive care cardiologist and surgeon. I spent years caring for people in life or death situations, which are much less common in the world of business. In business, decisions are important and they have long-term effect, but not one will result in death.

This helps me manage my stress and think about context, perspective and nuance in every decision I make. As a leader, I cannot afford to have any situation, environment or circumstance sway my judgment or overwhelm my decision-making. No decision in business is as devastating as a decision that results in the loss of a life, which was a major risk as a surgeon.

Years spent making life-altering decisions in medicine positioned me well for the world of business. In moments of high stress, I encourage my team to think things through and make choices in the right frame of mind. When you no longer treat everything as life or death, you are much more inclined to think deeply and strategically, ending on a decision that is best for the long-term versus right now.

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