Mark Clement, president and CEO of Cincinnati-based TriHealth, and a population health advocate, says it plainly: the U.S. healthcare system is broken.
In a recent conversation with Becker’s, Mr. Clement stressed the importance of aligning the economic incentives of health systems to improve community health. He said a strong organizational culture has been vital to TriHealth’s decade-long journey to value-based care — adding that he will rely on that culture as the health system navigates the next wave of challenges in the form of potential cuts to federal healthcare programs.
Mr. Clement shared insights on his journey leading the five-hospital system since returning to his hometown Cincinnati in 2015.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s something the healthcare industry isn’t talking about enough?
Mark Clement: It’s recognized by most of us in healthcare leadership, but our nation’s healthcare system is broken in many ways, and we could be talking about that more.
We spend far more on healthcare than any other nation on the planet, yet our outcomes are pretty average. For an American, the average life expectancy is about the same as a resident of China, and they spend a fifth of what we’ve spent on healthcare. You could look at other examples — Canada, Great Britain, France, other European countries — where they spend far less and their health outcomes are better.
Our system is fragmented and it tends to be reactive. I oftentimes refer to it as a “sickcare” system, as opposed to a healthcare system. The real question is: Who’s going to fix our nation’s underperforming healthcare system? Are we going to leave it to the government, or regulators, or payers? Or should it be our responsibility — as healthcare providers who know the industry best — to step up and find a better way? Because there are better ways.
Q: What’s an unpopular or uncommon leadership or healthcare opinion you have?
MC: One way our industry is broken is through a perverse set of incentives. The fee-for-service system that finances the vast majority of healthcare across our nation is based on volume, not value. The underlying economic incentives are to provide more services, because that will generate more fees, which will generate more revenue.
We need to hold the mirror up and ask: Is there a better way to finance healthcare that aligns economic incentives with our underlying missions? TriHealth’s mission speaks to improving the health of our community. Shouldn’t we have an economic model that rewards and incentivizes TriHealth and other organizations for doing just that?
At TriHealth, about half of the 600,000 primary care patients we care for every year are under value-based payment models and care relationships that we’ve forged with payers and the federal government, including ACO REACH [accountable care organization realizing equity, access and community health] and Medicare Advantage.
Those arrangements incentivize us to deliver on the triple aim: better care, better health and better value. We get rewarded for keeping people healthy, for better management of chronic conditions, for performing annual well visits and for early detection. We get rewarded economically for providing care in the most appropriate setting, which oftentimes and increasingly is outside of our very expensive acute care hospitals.
We operate five hospitals, but we also have 13 major ambulatory campuses and another 100 sites of service in the community. We’ve built care models to provide care in the right part of our continuum at the right time, to produce the right clinical outcome.
I understand why more health systems haven’t embraced value-based care. The regulatory environment has been uncertain, and embracing and succeeding with value-based care models requires systemic change. It requires development of new competencies, construction of new infrastructure and changes in workflows for physicians so they can focus not just on episodes of care, but on improved health, managing chronic conditions and early detection. I understand it’s not an easy transition, but in our opinion, it is the right thing to do.
Q: What’s an industry or business outside of healthcare that you think the industry could take notes from?
MC: Aviation. If you look back 65 years ago, the industry was not very safe — we were experiencing roughly 40 fatal airline crashes per million flights, the equivalent of a 747 crashing every week. Since then, the industry has embraced safety and reliability principles, from cockpit safety protocols to team huddles. We’ve seen a remarkable drop to 0.1 fatal crashes per million flights.
TriHealth has taken a page from aviation’s safety playbook. Eight years ago, we began our safety and reliability journey, bringing those principles into our health system. We’ve hardwired practices like daily huddles, which cascade all the way up to the executive team and ensure regular reporting of incidents and safety issues.
Since then, we’ve seen more than a 300% reduction in serious harm events, fewer falls and hospital-acquired infections, and improvements in team member confidence around the organization’s commitment to safety. Anonymous reporting dropped from about 25% of all safety reporting to well below 1% today. We celebrate our team members for averting harm events by being situationally aware and being proactive. We recently took 30 of our team members to a Cincinnati Reds game as a thank-you for what we call “great catches.” A lot of the progress we’ve made is because we’ve emulated best practices from the aviation industry.
Q: If you could give one strategy to other health system CEOs, what would it be?
MC: Build the right culture. It requires intentionality, leadership and focus, but a highly engaged culture produces multiple benefits. It enables an organization to overcome virtually any challenge that it’s facing externally or internally and to more successfully execute its strategy.
When we began our journey to population health about a decade ago, we knew success would require a strong culture. For us, it’s about engaging our people to actively support the strategy and the vision of the organization.
We don’t really measure team employee satisfaction anymore — we measure engagement. Engagement is the degree to which an individual team member will commit their discretionary efforts to support the organization’s goals and vision. That’s more than just punching a clock and showing up for eight hours. It’s coming to work every day saying, “I’m going to do my part in helping TriHealth to achieve industry-leading performance for those we serve.”
Our engagement scores have gone from bottom quartile 10 years ago to the 97th percentile today. That culture helped us navigate COVID five years ago and has helped us to successfully put in place innovative care and financing models. It is going to help us to navigate the next set of challenges that are coming out of Washington, D.C., related to the likely cuts to federal health care programs, Medicaid expansion and discontinuation of the Affordable Care Act, all of which are going to challenge our industry to work with less.