Planning for the future of healthcare—Marc Harrison, President and CEO, Intermountain Healthcare
DISCLAIMER: The views and opinions expressed are those of the interviewee(s) and are not necessarily those of McKinsey and Company.
Brendan Buescher: Marc, we’ve talked a lot about big uncertainties in US healthcare. What do you think these challenges require of us as healthcare leaders?
Marc Harrison: That’s a good question, Brendan. I see the industry, we’re staying true to our core, but it’s fundamentally changing. And it’s changing really, really fast. So I think this actually gets down to really basic leadership principles.
Can you have a vision? Can you actually strategize around that vision? Can you get your team excited about it? Can you message down through an organization? Can you organize that organization to be able to pivot quickly? And then can you just be relentless about execution?
So these are all the basics of leadership—right? But they’re hard.
Brendan: You talked a little bit about the pace of change. So you need more agility in your team to do that. How do you instill that in your team and keep them focused on both delivering today but also making sure that what they’re doing is going to deliver in the long term?
Marc: Things are happening so fast that the question is, “How fast can your team move and still communicate through the organization?” It isn’t even about pacing the change. It’s about making sure that you actually can move at safe, maximal speed, not lose folks along the way. And that’s really around communication—and connection of the evolved business model to everything that has come before. You know, making that connection to great history, great past, but recognize that even if you’re doing well you don’t have the luxury of wasting any time.
Brendan: That’s excellent. You took the role at Intermountain, and Intermountain is such a well-known institution, really globally. So congratulations on that. But what did you expect to find? And then what surprised you?
Marc: Intermountain was a bit of a known entity to us. Mary Carole [Ed. Note: Mary Carole is Dr. Harrison’s wife] and I were both residents at Primary Children’s. And then, we left for a year and came back, and I spent another three years being a critical care fellow there.
So, it’s funny how the ethos of the place worked its way into our DNA. Even then, people talked about reduction, variability, and being really careful with using resources in the interest of serving the community. That resonated well with me then, and it resonates well now.
The humility that my teammates show in recognizing they don’t know everything, and that good ideas can come from far away, and that in order to fully execute on them we have to be good partners. I think that is fantastic. And I think it’s going to be a real strength for us going forward.
Growing a new leadership team
Brendan: Tell me more about the team. You’ve expanded the team a little bit. Kind of curious, how have you expanded it? What kind of new roles are you adding?
Marc: I brought a few new people onto the leadership team. I brought our chief nursing executive onto the leadership team, where she joins the chief physician executive, the CFO, the COO, and the chief strategist. So I really needed to bring Kim [Henrichsen] on board. And she has almost 10,000 nurses working for her. That’s about a third of the nurses in Utah.
And, in a transform model, these are going to be a really important part of our workforce, even more than they are today. And they’re going to be very, I think, nimbly and creatively deployed. And I needed Kim’s voice at the table.
I brought our chief people officer onto the team. Joe Fournier—he’s new to the organization. If people really are our greatest asset, I truly believe that I need his voice on their behalf as part of every conversation we have.
I created a new role and I brought Mikelle Moore, who is our Senior Vice President for Community Health, on board. Mikelle is responsible for advanced alternative payment models. And so she’s got an operational role that she’s executing against. But she also has explicit goals around improving our community health. And for an organization that really cares deeply about population health and value, I have a belief that understanding how we pull levers in the community and make our communities quantitatively healthier is going to be a big part of our future.
I’ve brought Pat Richards, who is the CEO of our health plan on board. Pat’s responsible for about $2.5 billion in revenue. She serves about 850,000 members. If a big part of our future is deeper integration of the provider network and the payor organization, we have got to have her there.
And then finally I’m just about to bring a brand new role to the organization, our Chief Consumer Officer. For him to bring the consumer journey to us, and how we use technology to deeply segment and understand the population. And hopefully begin to do really quite advanced analytics around person by person (as well as segment by segment)—I think it’s going to be huge. And that sort of completes the team. We’ll be nine in all.
Brendan: That’s fantastic. Talk to me about the role of the physician. Maybe historically, today, and as you see it going forward.
Marc: Well, at Intermountain we’ve got roughly 1,500 employed doctors and about 3,500 affiliated doctors. The physician organization is about 25 to 30 years old. We’ve brought whole groups on board. And people are really allowed to maintain a lot of their own culture.
Mark Briesacher is our Chief Physician Executive. He is thoughtfully bringing people along. And what I really appreciate is he’s elevating the role of physician leadership in the organization. So, it’s been a production model for a lot of these folks. And they have been great at executing against quality goals. They are pretty far ahead of the rest of the country in terms of having a portion of their salary, of their income, be based on productivity. But also on safety and quality and experience.
He’s trying to create more of a professional model where we get people who want to participate in committees and leadership and strategy. And we’re really listening hard to what they have to say. So, I’m seeing this evolve very fast and much to my pleasure, they’re really leaning in to it.
Priorities for the future
Brendan: Terrific. What can you share about Intermountain’s priorities going forward?
Marc: Well, I think the number one priority is staying true to our mission and vision. So, we are in this to help people live the healthiest lives possible. We make all our decisions based on that.
Our mandate is to be a model system. And the question then becomes what does a model system look like in 2017 versus 1975, when Intermountain started? And in order to meet that mandate, what you’re going to see us doing is emphasizing the consumer in some pretty profound ways. So, I am going to try as hard as I can to disrupt our operating model internally without disrupting our mission, vision, and our commitment to the people who work at Intermountain.
We’re going to drive productivity in a way that Intermountain has not had to do before. It’s already happening. We have a management operating system that goes from the front lines all the way to the executive suite that we use every day in terms of looking at how the place runs.
We are going upstream into the community and we’re going super deep on digital. At the same time, we’re integrating the payor organization into the provider space. I think if we put all this together, I think we’re going to have an organization that’s healthy and thriving and actually primed for growth.
Brendan: Why is growth so important?
Marc: I’m interested in growth for a couple reasons. So, first of all, what great company has shrunk its way to success? We’re going to have to do this. So, I’ve got a lot of talented people. And one of the reasons I want to grow is to give them opportunities. And I want us to have all these bright people in their twenties and thirties, and they can see a trajectory where they stay within Intermountain and where they can see themselves with us in the future—but just in a million different and new roles. So, that’s really important.
And then, finally, I’m looking for fresh, different, higher-margin revenue streams that will support our mission and commitment to the community. One of the things we’ve always said is, “We take care of people without regard for their ability to pay.” And we love that and are proud of it. But now we also have to be able to afford it. And I think healthy, interesting growth subsidizes our ability to do that.
Brendan: We’re entering a stage of advanced analytics—big data becoming increasingly available and important. What is Intermountain doing or hoping to do with advanced analytics, AI, ML, to drive improvement?
Marc: Advanced analytics, machine learning, AI, I don’t think we can even completely fully understand how it’s going to change our model. But we know that it’s a place where we need to go deep. Some of it’ll be productivity. But I think it’s mostly going to be around understanding our patient or members better.
I want to understand what each customer needs, what each patient member needs in order to stay well. Instead of having precision cancer or precision cardiology, I’d like for us to have precision health.
So, we look at Brendan and he’s a healthy 50-year-old guy. He may need nothing, right. And he may need just the minimum in terms of preventative healthcare. But I’m a wreck, so I may need a lot of help. By really looking at your medical record, your family history, your genotype, your pattern of use—comparing you in a big data sense to lots of people like you, or comparing me to lots of people like me—be able to customize that person’s level of intervention.
And then part of it is we identify just like any company does. Who are those members who we just can’t afford to lose? They’ve been a stable member of our plans. They seem to be really happy and satisfied with the work we’re doing. What’s that little extra that we do for them to make sure that they never exit the pattern? And if we put all of that together, I think this is going to be really successful for everyone.
Hard work, dedication, and excellence to serve people better
Brendan: As an incumbent, the risk is being disrupted by others. But what can an incumbent do beyond what you’ve said or shared?
Marc: External disruptors clearly exist, some of them are very good. They don’t have necessarily that full spectrum of services that we currently have. And I think we’re going to be even more complete as we partner different parts of our system and we can fill in gaps quite quickly.
But what they definitely don’t have is the good will and history. And that actually counts for something. We deliver 30,000 to 35,000 babies a year at Intermountain. We’ve saved a lot of lives in our ICUs. Our eight helicopters have picked up people from road traffic accidents and from other hospitals for 25 or 30 years.
If we take all that good will and all that history that we’ve earned through hard work and dedication and excellence, and combine that with a model that is open and respectful, and puts the consumer in control in the right places, where they want to be in control—external disruptors are going to have a really hard time replicating that.
Now, it’s on us to keep the costs down. Because all that good will is going to be moot if we’re way too expensive for people who are paying a lot out of pocket. But I think we can do it.
Brendan: I remember years back I saw spirit of your true, I’d say, competitiveness come out. You had an analogy to cycling, and you said you look around for when your competitor might be suffering a bit or when there’s just an opportunity. And you said, “You know what, regardless of how you feel, that’s when you put the hammer down.”
Brendan: So I’m wondering to leaders in healthcare, what advice would you have on kind of when, where, how to put the hammer down.
Marc: An endurance sport, if you’re passing somebody on a hill and you’ve got a gap, you ride the top of that hill really hard. Or you run it hard and you open up as you’re heading down the other side, you open up as big a gap as you can.
And you know, to some extent we compete with other systems, and I actually think that our business is a lot like endurance. But you’re primarily competing with yourself. You can only be as good as you can be. And I think we are very open to collaborating with other systems.
We’re happy to have people come and see what we do. And we’re happy to share that. But from a competitive standpoint, I want us to be way better than anybody else. And I want us to be everything we can be for our own team and for the people we serve.
And now at this inflection point in evolution—of model, change in payor mix, change in expectations, immense pressures, wonderful and intense innovation, right. Now is the time to drop the hammer. And you can expect for us to, in a very focused way, invest in innovation. We’re going to find the very best partners out there. We’re going to incorporate them into our operating model. We’re going to have very high expectations of our team and we’re going to reward people with great experiences and a stimulating work place. We’re about to drop the hammer. But it’s not to hurt other people in the industry. It’s just to serve the people who are trusting us better.