While proposed Medicaid cuts have become a frequent topic in healthcare, the broader implications for a country where healthcare comprises 20% of the economy are less often discussed, according to Tim Bricker, president of CommonSpirit Health’s central region.
The effects are likely to be felt the most significantly by rural populations — including those where Mr. Bricker oversees critical access hospitals in the Upper Midwest. He leads the region covering Dignity Health hospitals in Arizona and Nevada, as well as CHI Health sites in Iowa, Minnesota, Nebraska and South Dakota, all part of Chicago-based CommonSpirit.
Becker’s connected with Mr. Bricker to discuss his top priorities in today’s healthcare environment, his leadership philosophy and what he wishes he had focused on a decade ago.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is something the healthcare industry is not talking about enough?
Tim Bricker: We’re certainly talking a lot about proposed Medicaid cuts, but not enough about the broader economic impacts of the proposed reductions. We’ve spent a lot of time analyzing how cuts would affect beneficiaries, like loss of insurance and access — which represent the most significant impacts — but the broader economic impacts to the U.S. economy are not getting enough attention.
Healthcare is 20% of the U.S. economy, and about half of our expenses are in labor. We know that Medicaid doesn’t come close to covering the costs of care, particularly in the hospital environment. The overall impact, and the disproportionate impact on already very vulnerable, small rural communities around this country, is going to be potentially quite significant.
Q: What is an industry or business outside of healthcare that you think leaders could take notes from?
TB: Some of the things that the airline industry does well that we don’t are related to access on the front end: the ability to get what you want up front, conveniently and easily online. We do a better job once you get into the system, but the airline industry sure has done a far better job than we have in terms of enabling you to use online tools to facilitate quick, easy access to what they’re offering.
The record that the airline industry has achieved in safety over the past few decades has been amazing. I know there’s been a lot of work done on patient safety initiatives in healthcare, and we’ve actually incorporated a lot of lessons from the airline industry, but I think there’s still a lot to learn. We could take a lot of notes from tools and processes and procedures that the airline industry has incorporated over the last couple of decades.
Q: What was your first job? Biggest thing you learned?
TB: My first real job was as a nursing assistant in a long-term care facility in the Pacific Northwest when I was in college. I had no experience or training; there was no certification at the time, and I spent that summer taking care of residents, most of whom were in various stages of dementia and Alzheimer’s. I was doing incredibly hard work, both physical and emotional.
I didn’t know it at the time, but I became really interested in the delivery of healthcare, organizations and the correlation between being a good place to work and a good place to receive care. I experienced how critical the way an organization supports its employees and makes them feel about what they’re doing is in instilling a sense of pride and ownership. It’s a lesson that I have carried for 30 years, and it is something that has been and will always be central to my philosophy and my approach to leadership in healthcare.
Q: What is an uncommon or unpopular leadership or healthcare opinion you have?
TB: One thing that makes the U.S. healthcare system unique is the prevalence of private health insurance, and I question the compatibility of a for-profit health insurance industry with one intended to improve the health and wellness of individuals and communities.
The relationships between delivery systems and commercial payers are harder than they’ve ever been. These challenges — like out-of-network experiences — create barriers to care that people really need. A lot of that comes down to a for-profit incentive that feels questionable to me in the industry that we’re in.
Q: If you could go back in time 10 years, what would you tell yourself to start doing or start learning about? What ended up being a bigger deal than it seemed at one point?
TB: We turned our attention to the wellness of our caregivers most during and coming out of the COVID-19 pandemic, but provider wellness has been an issue that goes back a lot farther than that. The intensity of the work that our caregivers do — combined with workforce shortages that were pronounced during the pandemic — brought the issue into focus. But it’s too bad that it took a global pandemic for us to recognize how significant an issue this is.
I wish I could go back 10 years and be more thoughtful about it, listen to our caregivers, understand what they’re experiencing, and help our organizations be more prepared to be supportive. This issue is going to be with us for a long time, and it would have been nice to have been more thoughtful about it 10 years ago.
