As health care organizations across the nation progressively commit to value-based care and boldly move ahead to make it a reality, many of the organizations that are still oriented around fee-for-service reimbursement models will need to transform themselves to build new business models, operating models, and care models in order to succeed. This transformation is driven by a shift from fee-for-service models, which reward volume of care delivered (e.g., quantity of procedures, tests, and relative value units) when patients get sick and need care, toward value-based care models, which reward high quality and excellent health outcomes delivered through careful deployment of resources to keep populations healthy. The implications for individuals in leadership roles when their organization makes this shift are profound and require these leaders to adapt by developing new capabilities and skill sets.
Kaiser Permanente and CareMore Health, both of which I have been honored to serve, are important examples of health care organizations that have excelled under value-based care. A common theme that I have observed across both organizations is the conspicuous presence of specific types of leaders who deliberately build internal culture and set examples for their organizations to follow. The following four leadership personas (unique outward expressions of leadership style and approach) are common across both Kaiser Permanente and CareMore Health and may serve as a guide for leadership development in any health care organization committed to moving toward value-based care.
One of the most important overarching goals for health care organizations pursuing value-based care is to reduce the overall need for health care services through proactive approaches that keep patients healthy and prevent medical conditions from deteriorating. However, we know that 60% of the factors that influence health status are outside the control of our legacy health care systems in the forms of social, behavioral, and environmental circumstances.
More broadly known as social determinants of health (e.g., economics, food, community and social supports, education and physical environment, etc.), these factors have a powerful influence on physical and mental health and traditionally have been addressed by a patchwork of community service organizations and nonprofits that exist outside the boundaries within which many health care delivery systems have always operated. Therefore, moving toward value-based care requires “Community Connectors” — individuals who explicitly recognize that social determinants of health present an important opportunity to think and act beyond traditional health care organizational borders.
Kaiser Permanente’s Chief Community Health Officer, Bechara Choucair, MD, is an example of a Community Connector who focuses on building innovative programs and capabilities that have a positive impact on the social determinants of health. His Community Health team creatively identifies opportunities to serve patients outside the organization’s legacy scope of care delivery and health plan services. Dr. Choucair leads teams that focus on (1) identifying and forging new relationships with community service organizations that are skilled in addressing social determinants of health and (2) redesigning internal processes (e.g., patient coordination, data sharing) to facilitate collaboration with these organizations.
Coordinated Care Champions
Value-based care requires health care organizations to rethink the ways in which they organize people, processes, and technologies across different disciplines, functions, and settings to deliver high-quality, high-value health care services. Indeed, the Institute of Medicine (IOM) identifies care coordination as a key capability for delivering high-quality care. However, building an effective coordinated care capability often requires leaders to confront significant obstacles borne out of the ways in which our legacy health care industry has operated in the past — for example, the persistence of fragmented, disjointed processes and organizational entrenchment in the status quo.
To overcome these obstacles, leaders of organizations that are committed to value-based care can function as “Coordinated Care Champions” by encouraging other leaders to think above and beyond the way health care systems are organized today and by leading stakeholders to adopt and build the new coordinated care models of tomorrow.
CareMore Health’s Chief Medical Officer for New Markets, Vivek Garg, MD, is an example of a Coordinated Care Champion who is responsible for leading the expansion of an innovative value-based care model into new markets that often have a longstanding fee-for-service legacy. His leadership approach when bringing CareMore to new markets is to equip local teams with new sets of care coordination goals, principles, and frameworks that address financial alignment (to reward high-quality care), training (to reinforce accountability for each role within a new care model), and the use of technology (to facilitate communication and reinforce the care model). In this role as a Coordinated Care Champion, Dr. Garg helps CareMore teams in new markets navigate a sea of complicated changes that are brought about by the shift to value-based care and, in doing so, positively influences other local care providers that collaborate with CareMore.
The significant cultural changes that underpin a transformation from a legacy fee-for-service model to a new value-based care model require an explicit approach to redefining and strengthening many critical relationships throughout the health care industry, such as those between clinicians and patients and those between physician leaders and non-physician leaders. Value-based care also introduces new complexities in the form of new relationships among organizations (e.g., health care delivery organizations and payers, health care delivery organizations and community service organizations), organizational models (e.g., matrix leaders that operate across several clinical and operating functions), and leadership models (e.g., dyad leadership, in which accountability is shared between a physician and a non-physician manager).
The management solution chosen by Kaiser Permanente and CareMore Health to enable local teams to navigate these complexities is to deploy “Trust-based Dyads.” In this model, a business leader and a clinical leader share accountability for both financial results and health outcomes in a defined territory. At Kaiser Permanente, which is organized as three distinct yet interdependent legal entities, the Trust-based Dyad leadership team in each of eight geographic regions is composed of a Regional President for the Kaiser Foundation Health Plan and Hospitals and an Executive Medical Director for the Permanente Medical Group. At CareMore Health, the Trust-based Dyad team in each market is composed of a General Manager and a Regional Medical Officer.
In both examples, the dyad leaders must be skilled in establishing and nurturing highly productive interpersonal relationships that are built on a foundation of mutual respect, transparency, and accountability. Trust-based Dyads have proven to be a key factor in enabling both Kaiser Permanente and CareMore to successfully manage complex value-based care models across different markets. This business-clinical leader dyad can serve as a model for other organizations to emulate as they move toward value-based care.
The proliferation of value-based care models will bring about change for health care professionals across the spectrum, from the ground floor of care delivery to the highest ranks of executive leadership, all of whom will need to challenge the status quo of how the industry has operated for decades and embrace transformational changes in culture, organization, processes, and technologies.
At Kaiser Permanente and CareMore Health, Chief Executive Officers Bernard Tyson, MBA, and Sachin Jain, MD, take on the leadership persona of a “Value Evangelist,” guiding their organizations to overcome both the magnitude and pace of change that are required to relentlessly pursue value-based care. Through both their stated strategic intentions for their organizations and the ways in which they engage the industry by contributing to public discourse, these two CEOs define the vision for what the future under value-based care looks like and seek to inspire teams to move forward with a sense of optimism that transformational change can be achieved.
As Value Evangelists, they capture hearts and minds and they motivate complex organizations to persevere through change that disrupts established norms and habits. In their own words:
- “We need to turn up the volume [about moving] from a sick-based system to a health-based system.” — Bernard Tyson, MBA
- “Innovation is often stifled by our lack of self-awareness of the world around us or our own (sometimes bitter) resistance to change. Innovation requires humility and disciplined disruption of our own thinking.” — Sachin Jain, MD
Emulating and Gravitating Toward These Leadership Personas
The deliberate nurturing of specific types of leadership personas seems to be a critical factor in the successful leadership of value-based care organizations such as Kaiser Permanente and CareMore Health. The managers and clinicians who will be successful in guiding their organizations and this industry through the transformation to value-based care may consider emulating similar traits, capabilities, and mind-sets. Moreover, health care organizations also may seek to emulate these personas when creating and filling key leadership roles. These leadership personas represent the types of magnetic leaders that young, aspiring future leaders can work with and learn from as they build their own careers.
Looking ahead, the Community Connectors, Coordinated Care Champions, Trust-based Dyads, and Value Evangelists will serve as important examples of the types of leaders who will enable organizations to succeed in a value-driven health care industry.