RWJBarnabas Health President and CEO Barry H. Ostrowsky: The case for finding a trusted partner and diving in headfirst

Hospitals and health systems are seeking partners left and right to pool resources, combine strengths and come out on top in an increasingly competitive environment. The goals of these partnerships are often lofty — they involve innovation, care coordination, patient access, cost efficiency and quality. With the stakes high and regulatory concerns complex, striking an agreement often takes years, pushing any potential improvements off onto a distant horizon. But lengthy negotiation processes don't have to be the norm and, in fact, shouldn't be the norm in an industry that is begging for transformation and disruption. 

When RWJBarnabas Health began to explore a potential public-private partnership with Rutgers University in 2017, we too set the bar high for what we wanted to accomplish. New Jersey was lagging behind other national leaders in funded research, which translated to fewer clinical trials, less donor interest and more difficulty attracting and retaining top physician talent. Ultimately and most critically, this meant patients had fewer options. To address these challenges, we wanted to enhance the relationship between the healthcare delivery system and academia, invest in research and education, expand access to high-quality care and make New Jersey communities healthier.

We chose to approach this partnership differently because we were simply unwilling to delay on moving toward those goals. RWJBarnabas Health and Rutgers signed a letter of intent to partner in July 2017 and, within 12 months, we reached a definitive agreement to invest more than $1 billion over two decades, establish the state's largest comprehensive medical group and form an overarching integrated academic health system. Typically, agreements of this scope are formed after five years or more at the negotiating table. However, we went into this knowing we wouldn't have specific conditions for every possible scenario spelled out in the definitive agreement. The idea was we wouldn't need them. Instead, we would work together to develop and present solutions in a singular voice as the partnership progressed and matured.  

This swift approach to a major partnership was driven by two things. First was the strategic importance of the relationship. At RWJBarnabas Health, we felt it was so essential to work with a partner of international renown like Rutgers that we didn't want to waste years at the negotiating table crafting the "perfect" agreement. We wanted to get to work making our shared vision a reality. In the year and a half since we signed the definitive agreement, we have put the building blocks in place to begin attracting greater investment in medical research, retaining physicians and other top talent, and restructuring the clinical practice structure to streamline care delivery. This work has involved heavy investment in recruiting principal investigators to our system's medical schools and, with them, more NIH grants. We've also doubled down on recruiting new clinicians to serve as chairs of our medical school departments and increased funding for loan repayments for rising star medical school graduates who agree to stay and care for patients in our communities.

Even the most carefully crafted definitive agreements do not spring to life with a signature. Instead, that's when the hard work begins. Not only did we want to get to work, but we also wanted to limit the amount of time spent on opposite sides of the negotiating table.

This was the second main driver for accelerating the negotiation process — to ensure we were building a singular foundation for our future. Five-plus years of being hyper-focused on conditions and details can build an adversarial relationship that's difficult to shed when the paperwork is signed. In my view, the sooner two parties can reach collaboration, the greater chance they have of accomplishing their goals. That mentality is essential to success.

Such an approach may seem like a leap of faith. We don't see it that way. The bottom line is the healthcare industry is built on trust. Patients must trust their physicians. Physicians must trust their care team. Hospitals must trust the payers and other partners. While it takes time to build trust, it can be enabled by the fact that the vision around the common goals and interests is so persuasive that organizations are compelled to do the work necessary to get there. When two partners get together, if you can't trust one another, no document can make it work.


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