Welcome to the "Lessons from the C-suite" series, featuring Managing Partner Eric Larsen's conversations with the most influential leaders in health care.
In this edition, Marc Harrison, president and CEO of Intermountain Healthcare, talks to Eric about crafting a cohesive team with employees from 71 countries, taking Intermountain from a "horseless carriage" to a Tesla, and leading as a physician—and as a patient.
Marc Harrison, president and CEO, Intermountain Healthcare
Making a difference
Question: Marc, we're now a little more than 8 months into your tenure as CEO of Intermountain Health System. Before we dive into how you're charting course for this storied organization, I'd like to ask you to take your reflections back a bit further. I understand medicine runs in your family—your father was a surgeon, your grandfather was a surgeon, and jumping forward a generation, your son is now in medical school. Was medicine for you always forgone conclusion? And why pediatrics critical care specifically?
Marc Harrison: I used to go with my dad sometimes to the hospital on Saturdays, probably because I was annoying at home. When I was about 10 years old, there was this one hospital in a dying steel town—Homestead, Pennsylvania—that he particularly loved. He was a different person there than he was in some of the other hospitals. And he knew everybody, he knew people in the emergency room, he knew the people sweeping the floors. One day I asked him, "Why do you like it here so much?"
He told me he felt like he was making a difference. He said, "Well, the people here are poor. If I don't take care of them, who will?" And that really just struck me. What I heard was, if you go into health care and you do the right thing, you can really make an impact. That experience shaped a lot of things for me.
I went into pediatrics for two reasons. One, I love the pediatricians and the nurses; they're totally mission-oriented, and they're just great people. And the other is I wanted to be able to advocate politically for a systematically underserved population—kids. I also wanted high intensity, so fortunately I found critical care.
Q: You've described yourself as an "accidental leader," but it's clear that you're a driven person who has a lot of intentionality about your career decisions. Would you talk about your evolution as a physician leader?
Harrison: Early on, I went through a "super-doer" phase where I tried to identify a problem and just fix it. For instance, when I worked in the ICU at Cleveland Clinic, we were treating infants who had been brought in by external helicopter vendors. The patients had been poorly managed, and they would do badly. We realized that we needed to control some of these things to get optimal outcomes for the patients. That simple "need to do it for the patient"—which has always been my bellwether—ultimately turned into a critical care transport program for the clinic.
Over time, though, my mindset became more about understanding "how does this all fit together?"
How can I take whatever talents I have and whatever efforts I put into it and integrate the system and create a unified experience for patients and make a difference to the communities we're in?
Q: You have an exceptionally unique view of our health care system as a physician, CEO and even as a patient. If you're willing, Marc, I'd be curious to hear your observations on your own experience as a cancer patient. Could you share a bit about what you went through?
Harrison:I'll start in 2009. At the time, I was training for an Ironman triathlon, but my training was just horrendous; I didn't feel good. I ran the race, but I had some alarming symptoms. I contacted a urologist and was diagnosed with bladder cancer.
My treatment options were to take not a very aggressive approach and have relatively minimal morbidity, but then the likelihood was pretty good of having the cancer spread. Or I could go big or go home, and hope that I didn't have metastatic disease already. Our kids were pretty young still, and so I went with the aggressive option.
I was diagnosed in early October and got my clean margins report on October 21. I had pain for three years, every single day. I needed another operation the next year for an abdominal complication, but happily the cancer wasn't back.
Q: In past conversations you've shared how profoundly this changed you not just as a physician and administrator, but more foundationally as a person.
Harrison: You know, your options are limited, you can either let it crush you or you can do the best you can with it. It changes you as a person. For me the biggest piece was, in addition to realizing that my time is finite, is that I'd better make the most of it. People were starting to say, "Marc, you seem driven." And I said, "Well, I am driven." Because you really never know, if you want to make impact, if you want to do good for other people, how long you're going to have to do it. So I don't have a lot of time to waste.
Another big change in perspective is just going from being a helper to a helpee. It takes a lot to actually say, "Yeah, it's OK. Bring food over to our house. Mow my lawn. Take my kids to school."
I had two friends who just showed up—one from high school and one from residency—and said, "We'll stay as long as you need us." Cancer's not a blessing—that's nonsense—but I think it was a good thing to realize the power of your community and those friendships. It makes you wonder, what did I do to deserve these friends? Would I do that for another person? And it really changes your commitment to this business. It's really a lot more than a business to me.
But it also makes you wonder how regular people navigate the health care system, and appreciate how unbelievably complicated these systems are.
Abu Dhabi to Intermountain
Q: You served as CEO of Cleveland Clinic Abu Dhabi for five years, building it up from the foundations to a gleaming, state-of-the-art hospital that now serves patients from over 50 countries—and employs staff from 71 countries. You've said before that one of the most energizing aspects of this experience was creating and then integrating your team in this culturally heterogeneous setting.
Harrison: That's exactly right. One of the things you learn is that if you lead people well, not everybody has to be the most experienced. They have to be motivated and have good integrity and a great work ethic, but you can do amazing things with people in their 20s and 30s who would be considered way too young for their roles in a Western, well-developed system.
But the thing I enjoyed the most was that what we do in health care plucks common human chords, right? It doesn't matter if you're a man or a woman, if you're a Muslim, Christian, Jewish, Hindu, Buddhist, Taoist. Mostly people want to do the same good stuff. And to see people in abayas and kandoras talking to tall, blonde, blue-eyed people and laughing and joking and collaborating—it made me very optimistic about people.
Q: After Abu Dhabi, you were slated to move to London to run Cleveland Clinic's international business division, but then the call came from Intermountain. Intermountain, of course, is a something of a homecoming for you, having completed your residency here. But what was it about the opportunity that made it irresistible?
Harrison: The thing that attracted me back to Intermountain was its commitment to taking care of everybody without regard for their ability to pay and to make a difference for a group of people who don't get the attention they deserve. And I wanted to work with really mission-oriented people.
I've always followed Intermountain, but when they approached me about the CEO position, I started to read a bit more. I said, 'these people are all about everything that I love. I like the way they practice clinical medicine, they get great results. But I really like about how they're organized and their commitment to the communities. And they have a bully pulpit based on their integrity to actually do the right thing and drive the industry." So I realized I had to do it.
Q: I know what a tremendous mentor Toby Cosgrove has been to you personally. I have to imagine that telling him you were leaving the Cleveland Clinic was a tough conversation.
Harrison: I was totally frank with him. I said, "Look, I love Cleveland Clinic. I have no desire to leave specifically, but Intermountain feels like an opportunity that I really want to check out to understand myself better and understand how another great system impacts people's health."
Toby never hesitated. He said, "This job will be at least as good as my job. You should take a look and they'd be lucky to get you—but I don't want you to go."
It was just such a great piece of leadership on his part, because he understood that my leaving could create disruption, but he never tried to dissuade me from checking it out. I will always regard him as somebody who's very wise and someone I have a lot to learn from.
Q: Intermountain, of course, is one of the preeminent 'leading light' systems nationally. It has also experienced incremental, organic growth over time (now comprising 22 hospitals, 185 clinics, SelectHealth insurance arm, etc.). That said, I know one of your immediate priorities is driving additional, highly intentional growth, perhaps into some strategically adjacent areas that you currently aren't in.
Harrison: Yes, exactly. We can't shrink our way to success. And we do need new sources of opportunities for people to express themselves. And in a static system, you can end up with a lot of young and mid-level people who are blocked if things don't happen. We have an appetite for new buildings and new technology and innovation, like many great systems do.
We want to with patients who actually need the care we can provide, provided in the right setting—which is not necessarily the most profitable setting. An example of that would be tele-critical care services. The data show a 33 percent reduction in mortality in these units, as well as shorter length of stay and a reduction in the need to transfer out. By providing these services, we can keep patients close to home—which is probably not great for us because we don't fill our ICUs with these transfers, but it's really good for the families and for the patients.
Intermountain's also been really lucky with it comes to organic growth, as you said—based on population growth, etc. We have one of the best economies in the United States and a massive influx of really well-educated people.
Beyond that, I'd like for us to find high-margin businesses that can subsidize what I think are going to be tougher and tougher times. We'll be scanning for technologies and approaches that we need but can't provide, find the best in breed, and bring them in-house. We will benefit our population, most importantly, and some financial good should probably come out of it, which we will plow back into our overall mission.
Q: How do you communicate and ignite that growth strategy, especially in such an established, culturally-aligned organization?
Harrison: It requires a lot of humility to tell the people in whatever part of your organization that, "Hey, you've been doing this clinical service forever. But we're going to take a different approach." That's not easy. How do you communicate that to your team?
I explained to the top people in the organization with a presentation that included two images: a horseless carriage from 1905 on one side, and a Tesla on the other. And I said, "See that horseless carriage? That's who we are right now. We're building our own wheels, we're stitching our own upholstery. We've hand-crafted our engine and forged the valves like a blacksmith."
I said, "You see that Tesla? That's who we're going to be in the future, where Tesla is the concept, it's the overall core business, but the battery, the tires, the wheels—everything is subbed out, to be as fast and nimble and as cost-effective for the consumers as possible."
It made some people pretty nervous. They're like, "Hey, am I the battery?" But I'm convinced that we can do these deals in such a way that people will be safe and their jobs will be fine. In fact, if we do the deals right, we can serve other people outside of our company, make some money and plow it back in again.
Q: Intermountain is a vertically integrated system with a robust insurance arm, SelectHealth. You're one of the few systems nationally assuming true capitation. If my math is correct you have nearly 900,000 lives under some degree of delegated risk, and about 350,000 lives that are full global cap. Obviously this is an area of strong proficiency for you all. With that in mind, you mentioned adjacent areas of strategic growth earlier, and your SelectHealth partnership with St. Luke's in Boise, Idaho, is presumably an example of that.
Harrison: Yes it is. We have what I think is an interesting growth model with St. Luke's. Just this year, we went full risk with 120,000 lives up there—it's pretty early, but it seems to be going well. We found a great system that is philosophically well-aligned, committed to our same values of affordability, accessibility, and evidence-based care. And then you layer on a very good health plan, and hopefully we see good things happen for the community that also are sustainable from an economic standpoint.
Q: How open are you to expanding this health plan partnership model to other systems, other geographies?
Harrison: We are open. I am not saying that we figured this all out yet, but we are a mature plan. We have a pretty clear filter about who we partner with and why we partner.
The guiding principles are good ones: Whatever we do has to be good for patients, has to improve affordability, has to be good for providers. Ideally, it creates good jobs in the communities where we serve, including the community we're partnering with. My sense is you can change communities in a way when you're payer-provider that you can't when you're just a payer or just a provider.
Q: I'd like to talk about SelectHealth Share, your innovative insurance partnership with employers that caps rate increases in exchange for mandating healthy behaviors and choices. I think you've signed up 11,000 lives and seven employers, and you committed to keeping the rate of increase to 4 percent over three years, which is one-half to one-third of what it would otherwise be. But reciprocally, they had to commit to wellness programs.
Harrison: I love this program. We use this term "Shared Accountability." The employers are activated, the payers are activated, the providers have to play, and you get the patients involved. They all start to pull in the same direction, and really interesting things happen.
For instance, there are walking groups who go out at noon, and people who organize bike rides or bring in healthy potlucks for lunch. You end up with fellowship and interactions, and that, in turn, addresses loneliness and isolation, which are about as bad a thing that can happen to you. So it creates an engaged, educated patient, and that individual will go on to make other engaged, informed decisions over a lifetime.
We've got two big strategies that support it. The first is sort of a 2.0 version of integration between the payer and the provider. We're as good as any plan out there now, but we can further integrate in how we deploy resources, how we support people, how we provide them with information.
Then there's "precision public health," this idea of building out the patient journeys, understanding all the touch points, what the SLAs are at each point, what sort of predictive analytics you bring into play. We are going to be deploying this over the next year, beginning what will be a long journey.
Career as a physician leader
Q: Marc, you've been a vocal proponent of seeing more physicians in the C-suite. Do you have thoughts on how your perspective as a clinician aids in your work as CEO?
Harrison: When you have a clinical background, you can have a different kind of conversation with clinicians. I remember the night before Cleveland Clinic's Heart and Vascular Institute in Abu Dhabi went live. One of the guys said, "Well, we can't start the program until our Berlin heart program is up and running." I was like, "OK I've deployed our Berlin heart only a handful of times at the big center back in the U.S. So BS, we're gonna get started." I think unless you're a clinician who really knows this stuff, you can't have the same kind of conversation.
That said, there are some really crummy physician leaders and some really phenomenal non-physician leaders. But there is a sort of nirvana if you get the good physician leader.
Q: As a CEO, however, it must be challenging for you to spend time 'on the ground' at the hospital given the many demands on your time. How do you continue to stay connected to the front lines?
Harrison: I still round in the PICU on Thursday mornings when I'm in town. Even when I was at the Cleveland Clinic, I'd be on call in the ICU on Thursday nights. It keeps it real, and it allows you to have appreciation for some the operational challenges that people experience.
It's also fun. It's stimulating to talk with the residents and fellows and see the children. And it's not a bad thing for folks to know that I can haul the mail in a clinical conversation, right?