In this special Speaker Series, Becker's Healthcare caught up with Patricia Richesin, president of Kootenai Care Network, a clinically integrated network based in Couer d'Alene, Idaho.
Ms. Richesin will speak on a panel at Becker's Hospital Review 7th Annual CEO + CFO Roundtable titled "Clinical Integration, Data Analytics and More" at 12 p.m. on Monday, Nov. 12. Learn more about the event and register to attend in Chicago.
Question: What keeps you excited and motivated to come to work each day?
Patricia Richesin: Our clinically integrated network is transforming the way care is delivered, outcomes are achieved and costs are managed for our community. We have the engagement of more than 500 providers and the regional health center. We have more than 50 volunteer physicians and other providers on committees and subcommittees tackling quality, pain management, palliative care, post-acute strategies, behavioral health, and care integration and management. These are all supported by robust leadership from our board and the committees for quality, membership, health information technology and contract/finance. Additionally, the primary care service line, pediatric work group, chronic care affinity group and practice leaders work team up us operationalize clinical pathways, transition of care initiatives and community standards for care delivery. Using a robust population health analytics tool, our teams are deploying effective strategies for chronic care management, medication therapy management, utilization management, identification of patients at risk, cost containment and provider engagement.
Q: What major challenges, financial or otherwise, are affecting hospitals in the markets you serve? How is your hospital responding?
PR: Redesign of payment strategies, along with high deductible plans, threats to provider-based billing, 340B, consumerism, alternative treatment modalities — all the above. The sheer volume of work being undertaken by providers, hospitals and other settings of care in our market is reflective of the work undertaken across the country. The cost of doing business is influenced by the wide range of payment models including high deductibles. Also of note is that Medicaid expansion is on the ballot for Idaho in November. While engaging in transformational initiatives, we struggle with meeting new demands in the throes of all the course corrections in all settings.
Q: If you could pass along one piece of advice to another healthcare leader, what would it be?
PR: The advice I would give to another healthcare leader is the same advice that has been shared with me. That is not to become so distracted by the pressures applied on our industry that I fail to exercise sufficient organizational discipline to be successful in the long run. No one benefits if we celebrate short-term success without a long-term strategy.
Q: What initially piqued your interest in healthcare?
PR: I was a medical services specialist in the Air Force and found I had a passion for helping those in their time of need. What I also learned was that my role was limited as a provider of services because those of us providing services were lacking infrastructure. I began training as a physician assistant at Johns Hopkins University in Baltimore and found I was more interested in what the program administrator was doing to manage the funding and operations of our program. I entered healthcare administration and subsequently spent 11 years in the School of Hygiene and Public Health in administrative roles. I have devoted my career to ensuring that those caring for people have the resources necessary to ease their way and that we have viable, sustainable, contemporary business models to support the work.
Q: What is one of the most interesting healthcare industry changes you've observed in recent years?
PR: A hospital bed is not a destination, but we made it one. The emphasis on population health and the movement into ambulatory care are the driving forces of change. Ambulatory care is where care starts. That is where it is managed. This is where we can achieve outcomes — patient engagement, clinical outcomes and bending the cost curve. And this is where we will see the influence of consumerism, technology and the changing face of how we all will care for ourselves and have others care for us.
Q: How can hospital executives and physicians ensure they're aligned around the same strategic goals?
PR: Truly engaging with each other in meaningfully collaborative ways. Even in the early development of our network, the trust level between providers and the hospital was exceptionally fragile and volatile. By creating groups — such as our primary care service line, pediatric work group and chronic pain management work group — and executing programs impacting clinical pathways for chronic conditions and ineffectively referred acute conditions, chronic care management and transitional care management, admission and readmission rates, and numerous other initiatives, trusting conversations and relationships are happening.
Q: What is one piece of professional advice you would give to your younger self?
PR: Recognize the responsibility that comes with leadership and be a good servant leader. It is my responsibility to develop and demonstrate my credibility as an authentic leader and then lead with informed conviction. A leader/mentor I admired introduced me to servant leadership and shared that I needed to see myself more clearly in that role. I began to understand how important it was for me to reflect in my work the attributes others were ascribing to me as a leader, and the responsibility that comes with supporting others in achieving our mission.
Q: Describe the most challenging decision you had to make as a healthcare executive. Why was it so challenging?
PR: Taking on my current role to lead a clinically integrated network in north Idaho. While providers and the regional health center asserted their commitment to clinically integrating, was there the broad and deep understanding of the work required? All too often the planning is interesting, but executing the plan results in many saying, "Oh, I didn't think you meant that!" Fast forward to today and we are not shying away from the hard work. The outcomes achieved to date are remarkable. The engagement is beyond our expectations. And those patients we serve benefit from this sincere commitment to make a difference in care, quality and cost.
Q: What do you see as the most vulnerable part of a hospital's business?
PR: I view ambulatory access to care as a significant vulnerability for a hospital. Despite studies to the contrary, hospitals and health systems with employed providers still invest in brick and mortar locations for services that are and will be delivered in other settings or not at all. Consumerism, technology and generational differences represent a small fraction of the changes in healthcare. Hospitals are vulnerable to any change in access to care and access is being redefined on a daily basis.
Q: What's one conviction in healthcare that needs to be challenged?
PR: Two challenges: The meaning of "healthcare is local," and speaking in terms of patients and not people. Local is being redefined continually. Is it close to home? In the community? Within driving distance? Delivered by mail or by drone? Offered on an app? Accessed elsewhere in the country? At the same time healthcare is being defined globally, it is being embraced more personally. We need to learn how to deal with both.
Editor's note: This article was updated at 1:45 p.m. CT on Oct. 8, 2018.