Finding Allies, Building Alliances: Q&A With Gov. Mike Leavitt on the Need for More Collaboration in Healthcare

There are thousands of process improvements required to make healthcare more efficient. Nearly all of these require collaboration at either the macro or micro level. 

"Any organization seeking to increase the efficiency of its problem solving efforts needs to understand the foundational concept of a value alliance," writes Mike Leavitt, former three-term governor of Utah and HHS Secretary, in his new book, "Finding Allies, Building Alliances." What is a value alliance? It's "a group of participants with aligned interests pursuing an outcome with value for each of them." Essentially, a group of people collaborating to meet a shared goal.

The healthcare industry faces deeply complex, and interrelated, problems, and Gov. Leavitt believes that no organization alone has the size and resources to "solve" American healthcare. Instead, our industry will only make improvements toward the triple aim through collaborative efforts that bring competitors together to solve shared problems.

Here, Gov. Leavitt discusses his new book, written with co-author Rich McKeown, his former chief of staff and now CEO of Leavitt Partners, the healthcare consulting firm founded by Gov. Leavitt, and the importance of collaboration for the future of healthcare.

(Editor's note: Interview has been edited for length and clarity.)

Question: When and why did you decide to write a book on collaboration?

Mike Leavitt: "Finding Allies, Building Alliances" started as an observation that grew to a curiosity and ultimately came to feel like an obligation. During my time as governor and later a member of the President's cabinet, I wrestled with complex problem of every sort. I began to observe that solutions to the toughest problems in both government and the private sector nearly always involved collaboration among multiple parties. This was the mid-1990s, the internet was emerging as a new shaping force in society. The internet and the networks enabled by the internet formed a profound metaphor of collaboration for me. I could see that getting computers to talk with each other was process the scientists, with time, could solve. The problem was usually the sociology not the technology.

Q: You write in the book that we already have the technology needed to form value alliances; that isn't the problem. The problem is getting people to work together. Why is the people portion more challenging?

ML: Sociology is often more like art than it is like science. With science you have certain rules that if you follow, everything falls in line. The complexity of human relationships bring to bear lots of human emotions, past tensions and future suspicions, and the complexity of that often clouds common sense. Managing all of those complexities is often more difficult than following exacting rules of science.

Q: Much of your career successes have resulted from your ability to develop and lead what you've now termed value alliances. Did you realize at the time that "Finding Allies, Building Alliances" — or helping others to do so — was the reason for your success?

ML: During my time in public service, I began to establish collaborative processes to solve difficult problems. Obviously some of them were successful and others were not. I became curious as the differences between the successful efforts and the failures. My co-author, Rich McKeown was at the time chief of staff in the Governor's office. We began to make a serious effort to understand the answer. In the process we began to form our hypothesis on the eight elements required for collaborative alliances to work.

In 2003, President Bush asked me to become a member of his cabinet, first as the head of the Environment Protection Agency and subsequently at the Department of Health and Human Services. Both organizations had hundreds of collaborative projects involving a wide array of partners from the public and private sector. It occurred to us that evaluating new proposed projects against the eight elements help us avoid collaborative endeavors that were doomed to failure. We were right. Not only did the eight elements help us avoid those doomed for failure, we were able to increase the speed and effectiveness of our partnerships inside and outside government.

All our experiences added drew us to conclude that collaborative success can be increased. Collaborative IQ can be improved. We concluded to share our observations and learnings in the book.  It is not an academic book. It is a book detailing our experiences and the experiences of others. It is a book about how to get things done in a complicated world.

Q: You argue that one of the key elements of a successful "value alliance" is a "common pain" among the participants. What are some of the common pains you anticipate, or would like, organizations to address related to healthcare in our country?

ML: The most significant source of "common pain" in the healthcare world is downward pressure on reimbursement and the migration to risk based payment alternatives. In the past, most players in the health sector acted as general contractors, receiving payment for each procedure. As population health and risk based payment methods are coupled by fee-for-service payment rate reductions, every care provider is feeling the pitch.  The result is a scramble in every medical market in the United States as providers, payers and service contractors begin to organize networks as a survival imperative. These are by nature, collaborative networks. Many of these feature former competitors merging, others forming alliances. This type of activity is not intuitive often. It is only happening because those involved are affected by a force motivating them to do hard and often less agreeable things. 

Common pain is not always negative. Common opportunity has the same affect. Or, at times some of the payers in a collaborative alliance feel the threat of pain and other are motivated by opportunity. The key is having some force that demands or strongly invites an imperative to act. 

Q: The book highlights Surescripts as an example of a successful value alliance. In founding Surescripts, staunch competitors (pharmacists and pharmacy benefit managers) came together to figure out how to digitize prescription information. What other types of problems like this within healthcare would you most like to see solved?

ML: There are thousands of process improvements required to make healthcare more efficient. Nearly all of these require collaboration at either the macro or micro level. Health information technology standards is just one example. While I was Secretary of Health and Human Services I formed the American Health Information Community, a collaborative alliance of stake holders. Our objective was to bring technology standards for interoperability. Another related example would be quality standards for measuring quality within every area of medicine. Those are macro examples.

Micro examples abound everywhere. The entire concept of integrated care management requires the development of value alliances. For example, if a hospital is to develop better discharge planning, coordination must be achieved among every part of a hospital, long term care organizations and insurance companies. This is a classic value alliance. Those organizations who learn to do it well, will prosper.

Q: This book both promotes the benefits of strong collaboration alliances and provides guidance on how leaders can create them. If you had to boil this guidance down to one or two tips for healthcare leaders specifically, what would they be?

ML: Collaborative alliance building is more successful if it viewed as a skill organizations can get better at. Collaborative IQ is an important skillset in hiring. Forming a deliberate style that is constantly refined and improved."Finding Allies, Building Alliances" discusses eight elements that bring and keep people together. It recounts our experiences, methods and lessons learned. Readers can you the book in two ways. First, as an investment guide. Holding collaborations they are being invited to join or contemplating the formation of, up against the eight criteria will be predictive of their potential success. Second, it can be a starting place for each reader to build their own list of elements that make them successful. Organized deliberate organization allows efforts to succeed that would otherwise fail. You can get better at this, that's the point, and it's important to do so.




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