Dr. Thomas “Tim” Stover admits it hasn’t been easy paddling upstream, and he’s been doing it for years in the health care industry. Stover has been trying to convince hospital staff, doctors and the public that the solution to the health care crisis isn’t to spend less to treat sick people, but to help them not to get sick in the first place.
Stover, president and CEO of the 5,200-employee Akron General Health System, has spent considerable time, effort and money trying to change its mission to a different side of the health care continuum — the prevention and wellness side.
“When you talk about trying to cut the costs or bending the cost curve in health care or in the sick-care model, the only real way to do that is to change it to a well-care model,” Stover says.
By Stover’s accounting, he and his team have spent about $100 million over the years to basically keep people out of the hospital.
“That’s not what most CEOs and hospitals are supposed to do,” he says. “The way we are paid right now is to fill the place up. We are dealing in a volume-sensitive industry, and we are trying to do everything we can to decrease the volume, but the sick-care model really incentivizes you to get sick or stay sick. I think that is totally upside down. It is the wrong message to send to our community.”
The recently enacted Affordable Care Act (ACA) has been turning the examination light on the health care system more than ever. While the ACA is designed to make health insurance coverage more affordable for Americans and reduce the overall costs of health care, confusion and anxiety have arisen over the interpretations of the law, and many critics are not convinced the measure will save expenses.
Here’s how Stover and Akron General Health System are taking a concept that goes against the grain — and gives the customer what he or she wants and needs.
Find a better way
Keeping expenses in line is a fundamental principle of basic economics. You have to judge whether your expenses are too high in light of your sales.
But Stover’s education and experience were telling him that there had to be a different and better way for the health system, which had revenues of $600 million last year.
As he saw it, the only way to cut costs or to bend the cost curve in the sick-care model was to change it to a well-care model. The next step for Stover was to consider what patients really needed. There will always be a need for the sick-care model, but the well-care model is the wave of the future.
“In this area, the expectation for excellence in Northeast Ohio is a given by people who use our services,” Stover says. “So when people walk into any of our institutions, the first thing they expect is that they are going to get the best care that you can get in the country, and pretty much they do.”
While researching the demand for treatment, the ability to analyze cause and effect brings dividends. Stover saw that the ax was falling on what government was going to pay for. Reimbursement was seemingly dropping on a daily basis.
“This effects how services are delivered because the demand is for you to deliver excellence on a daily basis. You’re getting measured on that and fined if you don’t do it [under the ACA],” Stover says.
Drilling down even deeper into the challenge you face may expose some other realities. Stover saw the dilemma he was in and the frustration it caused.
“At the same time as you are trying to deliver that level of quality which is an expectation in Northeast Ohio, you’ve got to do it for a price that is less than everybody else’s,” he says.
Be creative about the buy-in
If you have decided to go in a direction that may rub people the wrong way, you are going to ruffle some feathers. You may have to convert everyone from the bottom up to follow your new idea.
Stover and his team use a “white coat program,” which involves shadowing a doctor. For instance, one of the local community board members will spend a day with a doctor to see first-hand what it takes to meet the challenges of 24 hours.
The experience was particularly successful with one board member who criticized how expensive it was to deliver health care.
“It seemed to him to be very easy to take cost out because there appeared to be a lot of redundancy with everybody checking everybody else multiple times to make sure everything was right,” Stover says.
The board member spent a day with a cardiovascular surgeon and observed a heart operation.
“He was fascinated by the fact that he said the doctor’s nose was 6 inches from that woman’s heart,” Stover says. “He said, ‘The thing I realized that day was I looked around the room and there were 17 people taking care of that one patient. I also realized that you can’t outsource that business or that cost to China’ — which is what he did when he was operating his company.”
Another high-level holdout was a physician who was the chairman of medicine, who was an infectious disease doctor. It took Stover four years to turn around the doctor’s approach.
“He said, ‘You are crazy,’ and, ‘This will never work,’” Stover says. “I made it a personal endeavor to convert him.”
To bring him around, Stover kept him engaged in the effort and showed him the results it was bringing. A particularly effective method was to add the doctor to a medical advisory board of 12 physicians that the health system had in place.
“I wanted him to hear what we were doing,” Stover says. “We were deciding about the programs we were going to put into our facilities, the equipment we were going to buy, why we were using one type over another type of program.
“Those were decisions he had never given input on before; over time, what we were trying to do sunk in for him.”
Stover says that when the doctor retired he had become one of the biggest cheerleaders for the health system.
“He said the best things that ever happened to Akron General were the health and wellness centers,” he says
Have skin in the game
If people don’t think they have any skin in the game, whether it is tangible or intangible, there is no reason for them not to just do whatever they want to do, suffer the consequences of that and let someone else pay for them getting back in a state of wellness, Stover says.
So he narrowed his focus.
“This is not about the success of the Akron General Health System, but this is about the wellness of our Akron community,” he says. “The entity that should be doing that should be taking care of you when you are sick. It’s just that most health care systems don’t do that.”
By establishing wellness facilities that offer exercise equipment, physical therapists and rehabilitation nurses — and charging a fee to encourage commitment — outpatient services are blended with the lifestyle change service.
“We don’t charge a lot for the memberships,” Stover says. “Our Health & Wellness Center — West (Montrose) facility is full. It has 9,000 members. Of the members, 285 are doctors.”
While Stover has been CEO and president for 1½ years, he has been with Akron General since 1993.
“I just knew years ago that we needed to take health care to the patient — we should not make the patient come to us,” he says. “I think that’s arrogant. So I knew that was right. I had practiced for 30 years, and I was not from this system. I was from the other system so there was an immediate distrust of me for the first five years.”
The old adage that persistence pays off rang true.
“I just kept saying the same thing over and over again: ‘We’ve got to keep doing the right thing. We shouldn’t be afraid of this. We need to embrace this concept.’”
At some point, people will start to listen, Stover says.
Unexpected benefits may be the reward for your persistence. Stover has been getting interest in the well-care program from all over the world.
“We can show them our model, show them the success that all of these facilities basically break even before year three; usage of all the facilities usually more than doubles, sometimes triples in the first six months because people have a choice where to go for therapy — and they choose us because it is convenient,” he says.
A for-profit partnership has been formed between Akron General Health System and a local developer that not only finances but also builds facilities for other parties.
“We have business leads all over the country and actually at some point, we will be going to China because the developer has business leads in China,” he says.
“They are seeing the same thing. Their hospitals are full of sick folks. And they have to figure out how to keep them out.”
How to reach: Akron General Health System, (330) 344-6000 or www.akrongeneral.org
Look for and focus on a better way to do business.
Be creative about the buy-in once you have a plan.
Have skin in the game to ensure involvement.
The Stover File
Thomas “Tim” Stover, M.D.
President and CEO
Akron General Health System
Born: I was born in Wheeling, W. Va. I practiced medicine in Wheeling before moving to Akron in 1981.
Education: Bachelor of science and doctor of medicine degrees from West Virginia University. Stover completed internship and residency in obstetrics and gynecology in 1976 at Akron City Hospital. He completed business courses at The Weatherhead School of Management at Case Western Reserve University and at the Wharton School of Management before completing his MBA at the University of Tennessee in Knoxville.
What was your first job and what did you learn from it?
My first job was actually working for my dad, Harl ‘Ben’ Stover. He was a small-business man in the small town that I grew up in of less than 600 people. He ran a general store, and he worked on cars. What I learned from him was that he took care of the family with that business. If he wasn't working, and doing the right thing by the customer, the people could drive to the big city to get what they wanted. He taught me a lot about working hard. He knew the basics of business, which were first to treat the customer right and then they will come back. That's the way I feel about patients too.
Who do you admire in business?
The system that I admire, because I was a patient there, is the Mayo Clinic. It is an enormous system but when you interact with the system, it actually feels small. The staff pays incredible attention to detail. I had to go there for a very serious illness. The reason that it is successful is not just because of the medical expertise and the research, but it was how the clinic delivers service. The first thing that hit me was that they were nice people first, and then they were really smart. But they didn't try to impress you with the fact that they were really smart first. They try to impress you with the fact that you actually mean something to them and that they were treating you the way that they would want to be treated.
What's the best business advice you have ever received?
I heard a great line the other day: ‘Cash is king and profit is an opinion.’ I love that, so I'm going to remember it. I know exactly where that pertains. I know there is a way we take care of patients clinically, and then there's a way that we get paid, and somehow they don't connect. The chairman of my department when I was a resident told me if you take great care of patients, both clinically and with your personality, people will be able to pick that up and they will come back. If you are bringing your ticked-off personality with you to work, the patient senses it and the customer definitely gets it, and you really just need to leave that at home.
What is your definition of business success?
When I took this job as a doctor I thought I would be paying attention to the finances as much as I would be to the patient. Well, I was wrong about that. I am paying attention to the finances. But I still think that the proof of the fact that you're doing it right is the ability to be sustainable. I think the measurement of success to me is that actually people come back.