The CEO of Presbyterian Healthcare Services is putting into practice what he's learned from having held multiple senior executive positions in his 17 years at the integrated health system.
Dale Maxwell was hired to lead New Mexico's 12,000-employee Presbyterian Healthcare Services in late February.
He wanted the job badly. But it was far from a given that he would get it.
Despite his 17 years at the organization in diverse senior leadership positions of increasingly higher levels of responsibility, the board at the 108-year-old health system conducted a national search using a major executive search firm.
Even after he was named interim president and CEO following James Hinton's departure to Baylor Scott & White Health, Maxwell says he was "on pins and needles" while waiting for the search to conclude.
On another level, he didn't mind the wait. "It was important to me to know that, if I was offered [the position], the offer came in the context of being the best candidate," he says.
Now that "interim" has been removed from his title, Maxwell plans to build on Presbyterian's record as one of the more advanced integrated delivery systems in the country—especially its health plan operations. He recently spoke with HealthLeaders about how his team will execute that plan. Following is a lightly edited transcript of that conversation.
HealthLeaders: What are your top priorities?
Maxwell: We have the right business model, the right strategy, and we're starting from a position of strength. That said, we've landed on three areas of focus.
First, we continue to develop our people and give them the tools and skill sets they need to thrive in this changing environment.
Second is around our product, and that means improving experience for patients and members and their health outcomes. We'll continue to work on improving those results and eliminating variation.
Lastly, we'll focus on growth. In New Mexico, we have just over two million in population, so growth within the state is somewhat limited. But growth as an organization is important.
We're a little over a $3 billion system [revenue], but in today's world, that's not enough to take advantage of our back office infrastructure and scale. Some growth will come from the opening of a new Santa Fe medical center in 2018, but more of it will come from expansion of our health plan to providers outside the state.
HealthLeaders: How will that work given the states' varying regulations that govern health plan behavior?
Maxwell: One of our key advantages is our experience and expertise in an integrated system that handles both the financing and delivery of healthcare. We have been doing it for 30 years. Right now, we're partnering with 11 systems in North Carolina to create a health plan that will bid on its Medicaid population.
We have not yet finalized a definitive agreement but we're close. We have also talked with other provider systems throughout the country on projects like this and continue to develop these types of relationships.
We don't want to be consultants, but our core competency is running the insurance component, and we know how to link an insurance company with a provider system to deliver care in very different ways.
HealthLeaders: Presbyterian built its reputation on value-based care. What would hospitals and health systems that aren't as integrated find surprising about competing on value?
Maxwell: When you have an integrated system where 65% to 70% of revenue is fixed on a per-member, per-month basis, you're less worried about the number of units you're pushing through and the revenue associated with each of those units and more concerned with where you're going to deliver the care and what is going to drive the highest level of quality at the most efficient cost.
That causes you to make different decisions in treating patients.
HealthLeaders: Can you share an example?
Maxwell: One is our ED. A few years ago, we implemented a patient navigation project. Patients enter and are triaged, and if the patient's condition is not at the level of acuity for an ED visit, we navigate that patient to a primary care setting and take care of the patient in the clinic rather than the hospital.
You're moving your revenue stream from an expensive ED to a less expensive physician office and also attaching that patient to a physician. In most cases with these patients, the ED is where they think they enter healthcare.
We're trying to change that behavior, but it's not going to happen on its own. With an integrated system, the incentive piece is right. If your revenues are fixed, you're more motivated to move it out to a different venue.
If instead you're more aligned with the idea that delivering more units equals more revenue, why would you move the volume? Our strategy and experience comes from being an integrated system. We think that's the right model, but truly what is different is you have to be able to take the risks and manage the patients in a completely different fashion.
HealthLeaders: What about growth in services outside the state?
Maxwell: At this point I don't see that as huge opportunity. We're believers in managing care and we can do that through our health plan partnerships. We don't have the capital resources to go outside of New Mexico [in services].
HealthLeaders: What advantages will you bring to this role, given that you've served in so many other senior leadership roles at Presbyterian?
Maxwell: I've been the CFO of the health plan as well as for the hospital and physician practice and then CFO for the entire system. I know how those components work separately, but more importantly, how they work together.
Also, I've had the opportunity to be chief operating officer for the physician practice for two years, which was a nice learning experience in getting into delivery of care options. The new roles for me will be the community involvement that's required of a CEO and becoming the public face of Presbyterian.
Philip Betbeze is the senior leadership editor at HealthLeaders.