6 Questions For Lloyd Dean ‒ President And CEO Of Dignity Health
The bio for Lloyd Dean on the Dignity Health website is fairly standard and relatively austere.
Mr. Dean is the president/CEO of Dignity Health. With over 20 years in health care operations and leadership experience, Mr. Dean is responsible for overall management, strategy and direction of Dignity Health’s hospitals, ancillary services, home health care and medical group foundations.
All of that is true, of course, but it’s also easy to see ‒ in the reflected image above ‒ a man who once played football and has shoulders broad enough to turn around a failing healthcare delivery system. When he arrived at Catholic Healthcare West in 2000, the hospital system was losing $1 million a day. Under his leadership, the system has blossomed under a new brand ‒ Dignity Health ‒ and has made money (as a not‒for‒profit) every year since 2002. Today, Dignity Health is one of the largest health systems in the nation and the largest hospital provider in California.
Here then, are 6 questions for the principle architect of Dignity Health’s amazing turnaround.
Munro: Can you tell us a little about your “Just Thinking” memos? It sounds like a great leadership technique, but also pretty direct and potentially high risk. What was your last one and how often do you send them?
Dean: I initiated the “Just Thinking” memos to communicate directly with the leaders at Dignity Health. The purpose of the memos is to motivate, provide clear direction on the path forward, give my leadership a chance to respond to my thoughts and ideas, and then set clear expectations for success relative to a key issue or strategy. In a typical year, I share 6 to 7 “Just Thinking” memos and the topics and content is meant for the addressees only.
Munro: The Affordable Care Act has effectively reduced the rate of those uninsured from about 18% to about 12% ‒ which is a major achievement ‒ but there are still roughly 30 million Americans (including about 5 million kids) without insurance ‒ and that has a direct effect on large hospital systems like Dignity. Any thoughts on how we address this sizeable gap in coverage?
Dean: We believe that the modifications to the ACA enrollment and registration process have improved access and have made it easier to participate. But more needs to be done to inform and motivate people to enroll and use their coverage. Education is key and reaching enrollment goals will take time.
However, it is naive to suggest that universal access will be the result of health policy alone or that more education will, by itself, cause a sharp rise in the number of those covered. It is important to note that a large portion of the residually uninsured are undocumented immigrants and their children. Congress should continue to seek consensus on comprehensive immigration reform that will create paths to citizenship and allow immigrants in the process to access insurance coverage and needed health care. Only a holistic view of the real barriers and the political will to remove them will yield a society where no one goes without health insurance.
In the meantime, we are fulfilling our mission to provide care for anyone in need. We have one of the most generous financial assistance policies in the nation, offering free and discounted care to families making up to 500% of the federal poverty limit.
Improving health extends beyond health care providers to the entire community. We pioneered the nation’s first Community Need Index that maps the level of community need for each zip code in the United States. Our community investments include loans and grants that help build affordable housing, support youth shelters and domestic violence prevention programs, among many other services. We recognize that sometimes health care starts with providing a safe home, a warm meal, or an outstretched helping hand.
Munro: We’re heading into a presidential election cycle ‒ and while Obamacare has reformed health care in many significant ways, a fair criticism is the ever increasing cost of health care. As a country, America remains the highest priced health care in the world and while we’ve slowed the rate of growth, the average consumer only sees higher premiums, deductibles, co‒pays and prescription drug costs ‒ every year. Any thoughts on how we fundamentally change the ever-rising cost of health care?
Dean: We can and must do better at controlling costs. We have taken significant cost out of all aspect of our system. However, we believe we are now implementing additional policies, incentives, and programs already showing great promise in bending the cost curve and keeping people healthy and out of the hospital. I am proud that we participate in more than one hundred value-based agreements designed to align incentives among health plans, hospitals, and physician organizations to address the Triple Aim for 600,000 people. For example, one of our accountable care organizations saved the system $108 million in its first four years while providing better patient experiences and achieving better quality outcome.
Dignity Health is also a member of the Health Care Transformation Task Force, which brings together patients, payers, providers, and purchasers to align public and private sector efforts to transform the U.S. health care system, in part by moving away from fee-for-service medicine within the next five years. We have committed to be a leader in this transformation by putting 75 percent of our business into value-based business in the next five years.
Munro: One of the biggest themes at this year’s annual HIMSS conference was the technology challenge of what’s known as ‘data interoperability.’ Unwieldy nomenclature aside ‒ as a large, influential system, what’s Dignity’s role in helping bring meaningful data exchange to a highly competitive and recalcitrant industry?
Dean: At Dignity Health we want to set an example in lifting the walls on data. We believe that sharing information and technology among doctors, hospitals, and health care providers will lead to a more positive patient experience, higher quality, and reduced health care costs. We have made strides in two ways.
First is to improve the delivery of patient care directly. Dignity Health uses technology to connect nearly 8,500 physicians and 39 hospitals in three states to our private health information exchange, treating more than 5 million patients across the inpatient and ambulatory care settings. That same technology is a foundational element of our Clinical Integration initiatives and is used as a tool to better incorporate physicians into our care community to provide safer, more timely, efficient, effective, and equitable patient-centered care. Dignity Health is also working at a national level as an anchor participant in Healtheway’s eHealth Exchange, which is a group of federal and non-federal organizations committed to improve patient care through health information exchange. We are continually working to expand our current level of interoperability with other health care organizations throughout the communities we serve.
The second is to find a way to harness data to improve population health. Our recent partnership with SAS is one example of a platform that will eventually help make the benefits of big data available even to the smallest of health systems in our industry. The platform hosts a growing collection of predictive analytic models and data visualizations that will help our clinicians determine the best course of treatment for each patient, based on past disease, treatment, and outcome data gathered from our hospitals. This resource will allow us to improve the quality of our care and the overall patient experience by better informing our medical decisions before they are made, not learning from decisions afterward.
Munro: Another big issue gaining momentum on the consumer side is the whole idea of pricing transparency. How is Dignity Health addressing this hot‒button, consumer‒facing issue?
Dean: We want patients to ask tough questions. We work hard to earn people’s trust and we make listening and communicating with them a priority. One way we are working toward better transparency is by working with Optum360, our revenue cycle company, to redesign the way bills are written so that they are easier to read.
But as we move away from a fee for service pricing model, we want to be partners in empowering people to make more of their health care decisions and healthy lifestyle practices. Health plans are in the best position to communicate to their members the cost of receiving services from the providers that participate in their networks. Our health plan agreements provide health plans the right to disclose this information to their members; we have always encouraged these disclosures.
Munro: Using the broadest of definitions, what’s the most innovative thing you’ve seen in health care in say the last 3 years?
Dean: It may surprise you, but the most innovative thing that I’ve seen in health care yet is a simple and proven idea – that kindness has the power to heal. During my time at Dignity Health, I have seen firsthand the power of kindness to heal and now science is confirming it.
We recently sponsored a research review by the Center for Compassion and Altruism Research and Education at the Stanford University School of Medicine. It showed that when patients are treated with kindness – when there is an effort made to get to know them, empathize with them, communicate with them, listen to them, and respond to their needs – it can lead to significant positive health outcomes such as reduced pain, reduced anxiety, reduced blood pressure, faster wound healing, shorter hospital stays, and even a reduction in the duration of the common cold. The research also found that a kinder work environment benefits caregivers as well, who are likely to feel more engaged, less exhausted, and have more satisfied patients.
