Thursday, September 19, 2013

Healthy innovation

Published: Wednesday, September 18, 2013 at 3:02 p.m.

Photo by Ken Blevins
Jeff James is the CEO of Wilmington Health.
Jeff James can see clearly now, and it’s a beautiful thing. “I’ve never been more excited about the future of health care, and I’ve been doing this for over two decades,” says James, the dogged and innovative chief executive officer of Wilmington Health. “We are working here to integrate the providers and payors and hospitals.
“If we do it right, Wilmington is going to be a destination for health care.”
Looking in the rear view mirror, though, James was more apprehensive than excited.
James was chief financial officer at the Shannon Clinic (the provider) in San Angelo, Texas, where, typically, the doctor roster doubled and care expanded as he worked endless hours to grab market share, outdo the competition and beat up on the insurance companies (the payors). Then, in the late 1990s, along came his first child, a daughter.
“And I just couldn’t imagine how I was going to explain to my little girl what I did for a living,” says James. “I didn’t just mean all the absences at home because of work, but what were we really accomplishing. I said, ‘No, I’m not going to continue to do that.’ So I flipped from being a competitor to a physicians’ advocate
“We’re working to change the landscape so across the health-care continuum we can collaborate together to become trusted, transparent partners in the community.”
If you think it’s just bluster, get this: “I actually tell insurance companies how to pay Wilmington Health less.” Or, “We have a terrific economy of scale on purchases of supplies, but we let independent doctors in the area get their supplies through us so they can save money.”
James, now nearing 50, is just getting started, so if you want to peek into his future paradigm of community health care, please take a seat and buckle up.
First, some background.
He was a Marine for four years, including two years at Cherry Point, where “I fell in love with coastal Carolina,” developed his competitive edge and got his future college tuition covered. That paid for five years at Eastern Illinois University, in his native state, ending with a master’s in business administration.
This was the early 1990s, James signed up for a pilot program in Illinois to tackle and solve numerous state issues, especially saving money. Teamed with an MBA from Harvard and another from DePaul, James’ assignment was whether to privatize the state’s far-flung motor pool, with its thousands of vehicles, mechanics and garages.
“Both from a cost and efficiency standpoint,” remembers James, “our research showed that it was absolutely clear that turning it all over to a private company made sense. But politics and the bureaucracies got hold of it and ignored our recommendation. We couldn’t impact change.
“So I pointed out to the state another waste of money: me,” says James, “if they weren’t going to listen to our recommendations.”
His wife, Liz, pointed him to the health care industry, and he signed on with a 10-doctor orthopedic group in Springfield, and, sans political intervention, he began to thrive in a profession he had never considered.
“It was a relatively small practice, but I learned health care from the ground up,” says James. “It taught me how competitive health care could be. The growth was focused on growth. And beating the competition. I was a Marine, a Type-A. Worked for me.”
But down in Texas a few years later, just thinking about how to explain himself at “bring-your-parent-to-school day,” Jeff James had his epiphany.
“It was a complete 180,” he says.
And when he was hired in 2008 to come to coastal Carolina and run Wilmington Health, which is 100 percent independently owned by its physicians, including those on its board of directors, James found the perfect landscape to test his theories of collaboration, transparency and trust between the triad of health-care provider, payors and hospitals.
With white boards and posters along the Wilmington Health office corridors on Medical Center Drive, pounding home the mission of everyone rowing in the same direction – especially a medical cadre that has doubled in size to 150 people practicing at 21 locations since his arrival – James is determined to make Wilmington Health a trusted partner in health care and service.
He has champions across the landscape here, including Paul Snyder, the CEO of Glen Meade Center for Women’s Health, who could have been a nay-saying competitor:
“Jeff truly wants to transform the delivery of health care in Wilmington and the surrounding counties,” says Snyder. “He knows Wilmington Health cannot do this without the involvement and support of other key players in the health-care community. (So) he’s always been very transparent and welcoming of all constituents to the table – the major insurance companies and hospitals, down to single specialty practices.
“Success for Jeff is not simply driven by improving the quality and value of health-care delivery at Wilmington Health; rather, he wants all providers to be a part of this rising tide so that health-care consumers across the market place benefit. Wilmington needs advanced health-care thinkers like Jeff James.”
James’ transformation came on two levels: the waning of his competitive streak and the wooing of physicians.
“I realized down in Texas, market share and fighting the competition was ‘scarcity thinking.’ You were taught there was this small pie and you have to fight for your piece of it. Or pieces of it. And if somebody got a piece of it, you were losing. So for you to do better, somebody else has to do worse.
But I came across ‘abundance thinking.’ Guess what? The pie can be infinite. It can grow. As you get better, you let others know how to get better. It’s especially true in health care. The better we all are, the more people will come to Wilmington for health care and the more people will stay.”
 A big cog in James’s triad of collaboration was the doctor. But now, as much as CEO, he actually is proudest of his title: physicians’ advocate.
“In the past, the doctors were the problem to collaboration and integration,” says James. “But they also are the solution. Doctors are trained to be independent, and by nature they are very competitive. Physicians are the only fragmented piece of the health-care industry – there are hundreds of independent practices. But as they do come to group practices, it allows us to finally, clinically integrate.”
He often has meetings well before the crack of dawn or late into the evening with independents who want to test the Wilmington Health waters.
James also firmly distinguishes between collaboration, his touchstone, and consolidation, which, in his view, simply raised costs for patients and payors by grouping tests and services under one roof, inflating prices.
The new paradigm works best if all parts of the triad support transparency to the consumer and the payor around quality cost and the patient experience. James believes that new technologies allow for information contained within the Electronic Medical Record to be married with information contained in claims files from providers to give a clear picture of which providers can provide true value.
James: “True value is the intersection of cost and quality. This provides a legitimate scorecard of the performances of all involved in health care.
“Transparency is the catalyst for this major new health-care model,” James continues. “Historically, all we have had are anecdotal representations of patient experiences as the surrogate for quality, like how long you were in the waiting room. But that’s about to change. Informed choices will be possible and will drive true innovation that will decrease cost and improve clinical outcomes for the patients.”
His daughter, now a straight-A student at New Hanover High, or his 8-year-old son, can now have Dad over to school for show-and-tell, and he won’t melt. In fact, he’ll probably start right in with a message for the sophomores or the third-graders: collaborative, transparent health care, where patients can monitor and track the outcomes of their docs, is coming to Wilmington, and it’s going to bring more and more patients with it.
“The Mayo Clinic,” says James, “it never, in any presentations or speeches or literature, talks about market share. It only talks about quality of care. And here in Wilmington, I think you’re going to see that all of us (providers, payors, hospitals) are going to play the game with our cards face up.
“That’s how we’ll develop trust to make this a health-care destination.”

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