The co-CEO model, and whether or not it works and is sustainable, has been debated around the country for years. Large health systems have dabbled with it nationally, but, in New Jersey, only one system has experimented with it to date.
Cooper University Health Care will be the second in the state to do so, with newly-appointed co-CEOs Kevin O’Dowd and Anthony Mazzarelli taking on their new titles in June.
O’Dowd, a former chief of staff to Gov. Chris Christie, will take on the business operations, while Mazzarelli, a longtime emergency physician at Cooper, will be the lead on the clinical side. The two are currently serving as co-presidents of the organization.
They have clearly defined their roles, but want to ensure that only they have to worry about the differences.
“There’s obviously crossover in the day-to-day,” O’Dowd told ROI-NJ in a recent interview.
“If someone comes to me and it has something ultimately that has something to do with Kevin, I won’t say go talk to Kevin, we’ll have that conversation … we work hard not to confuse people, and it increases the communication between us,” he said.
In fact, the titles are just a formality. Mazzarelli, affectionately called “Mazz” by many, will continue to be called by his nickname.
“A lot of people have their identity through their title — you know, their title is what defines them — and titles are important, to be sure, but the titles that Mazz and I have outside of Cooper are more important to us — dad, husband, brother, son,” O’Dowd said.
“So, this isn’t our identity. We are convinced this is the right structure to serve our patients and to serve our employees.”
How does that play out for the future of the standalone health system? O’Dowd and Mazzarelli explained.
ROI-NJ: Any concerns about this new leadership style? Did you get a say in it?
Kevin O’Dowd: The concept of approaching the leadership of the of the organization in a dyad fashion, in a partnership fashion, is something that Mazz and I have talked about for years, not knowing if that opportunity would ever be ultimately available to us. But it’s how we run our business at the various service lines, so it’s a model that is very familiar to us — having both a physician and an administrative person running the business within the business. It’s not a model that is uncommon in health care. Other businesses throughout the U.S. are moving into more of a shared governance, shared leadership model. But, that said, it’s not for everyone. It has to be the right fit, it has to be the right people, it has to be people who are confident. It has to be people who have a partnership where they can trust each other. If you are not confident and you can’t trust your partner, it’s not for you.
Anthony Mazzarelli: We were able to spend several years working together. As Kevin said, we have reorganized how we look at all our business lines. To be organized in a dyad model.
ROI: What do you see as the biggest goal you have to achieve?
AM: Our big goal is to never give anyone a reason to leave New Jersey for their health care — particularly not to leave South Jersey. Over the last 6-7 years, we have really focused on what we can do from a tertiary care perspective. We really want to be the tertiary care provider of choice and not have people go across the river to Philadelphia. There’s about $2 billion that goes across that bridge, and we want that to be here. New Jersey and Pennsylvania have required reporting of inpatient admissions, so you can calculate that.
KO: We’ve had tremendous growth here the last couple years. We sit as a $1.3 billion revenue organization … the premier academic medical center in the region. What a lot of people don’t realize is, while we are a single hospital system, (we) reach beyond just our core hospital here. In addition to our 650-bed academic medical center and our MD Anderson cancer center across the street, we have 100 outpatient centers … ranging from Mercer County all the way down through Salem County … and all the way out to Atlantic County. So, we have a significant reach that isn’t necessarily top of mind when people think of what Cooper was.
Over the period of the past 5-7 years, there has been significant growth here with a mindset of (how) we will continue to control our destiny and define our own future using some of the partnerships, like MD Anderson, our Inspira cardiac partnership, which has been extremely successful for us. We know that, as health care evolves so rapidly in this age of consumerism, we shift from ‘The doctor will see you now’ to ‘The patient will see you now.’
ROI: Partnerships appear to be the new way around consolidation. Is Cooper still looking to acquire anyone, or are the partnerships the new strategy here, too?
AM: We are not close-minded to the idea of partnering with others in greater ways that could end up being in some kind of consolidation, but we are not chomping at the bit that it has to happen. We announced our affiliation with Advanced Recovery Systems, so we are going to be opening an addiction recovery hospital inpatient facility, so we are going to be dissolving our addiction care in Cherry Hill. So, those kind of partnerships with people who have expertise.
KO: We are not looking at mergers or acquisitions of other health systems or hospitals. We are constantly looking for the right kind of partnership and right kind of affiliation.
ROI: There are a lot of pricing pressures today in health care. How are you handling that?
AM: As the world has gone price-sensitive — there’s a difference between price and cost — as primary care physicans get paid more on total cost of care, as physicians take risks on pay for performance, we have made sure we are the tertiary care provider of choice because we are actually lower-cost than the tertiary care across the river. So, in a price-sensitive world, that’s what we are preparing for. We had a strategic plan in 2012, and a lot of that has been, how do we lower our costs? We look at not just our costs or the price to people, but also, what are our utilization rates and what are the tests and are our physicians using more care at end of life than others? Some of that data, particularly Medicare data, you can look at.
ROI: On that note, investing in AmeriHealth New Jersey was a part of that, correct?
KO: It was a window into, as we move into a value-based environment, and health systems are going to be on this journey to take risk, it was a way to learn this business, get a familiarity with risk-bearing entities and how they manage risk. That’s not a gear, that’s not a muscle that health systems necessarily had. We are not involved in management of the company and are less than a 1 percent minority owner.
AM: If you think about it, 2012-2013 wasn’t that long ago, but it is, and, particularly then, we were in the business of sick care, and insurance companies were in the business of health care. They made money when people were healthy, we made money only when people were sick. We saw this future where that’s going to change, so we need to try and figure and get insight into what happens when we start to take on risk. That was the original idea.
ROI: Where do you see the greatest growth sectors of health care? And how does this all relate to the future of health care education?
Our big goal is to never give anyone a reason to leave New Jersey for their health care — particularly not to leave South Jersey. Anthony Mazzarelli
AM: There are 10,000 new people on the Medicare rolls every day, so there are things around that — cancer still has a lot of growth potential, so does neurosciences and so does orthopedic. I see us growing in those areas. The newer medical schools have very similar models to the one we have, where it’s a health system that wanted to push having a medical school and they have an academic partner. In the hospital, we employ the physicians and they are the faculty for the school. We didn’t create this model — Harvard has had this model; there is no Harvard hospital, they work with Mass General (and others). That model has been around for a while, and Harvard was really the first to do it. But newer medical schools are driven by the health systems, which seems to make a lot of sense. We are fortunate, because we are a brand-new medical school with a 30-year history of graduating medical students. We were a clinical campus for (what was previously) Robert Wood Johnson University Health, so we already had that model. We are seeing a spike in applicants — 7,000 applications for 100 spots. We are doing a lot more students. In the old model, you used to take a biology class before you saw a patient. They are seeing patients and involved in the system as first-years, and a lot of our physicians teach in small group fashion and do case-based learning. I’m jealous of the curriculum they’ve been through. That’s the wave of all the medical schools.
ROI: How is this helping with keeping more physicians local, rather than having them leave the state?
AM: We have tracks where you can go to medical school for three years instead of four. If you agree early in that track to do primary care or pediatrics, we put you right in our residency programs and you can do one less year of medical school. We do loan reimbursement, if you were one of those people who chooses the primary care track and you do your residency here and then we hire you here, between the loan reimbursement and only doing three years, you really begin to eat into the total cost of medical school.
ROI: There has been growth in community-based hospital care rather than a focus on brands like MD Anderson and Memorial Sloan Kettering. How do you see the brand affiliation you have with MD Anderson playing out in this environment?
AM: If you only partner with someone for a brand, that doesn’t help anybody. The reason we are sitting in this room is because administration was initially on the second floor of this hospital and with our relationships with MD Anderson, it’s very prescriptive — to meet their quality standards, we had to double the size of our pharmacy and move out of that space. So, we look at the partnership as not a brand play, it was actually a way to improve the care that we give to cancer patients, along with the idea that people know they are the best in the world. All of our physicians are credentialed through MD Anderson; we want there to be no daylight between the care you would get in Houston and the care you get here. In fact, when Houston had all their flooding problems, we were ready to credential people and we were the one site they talked about sending patients up here. If you just do it as a branding play, maybe you get a little short-term gain, but you don’t get the long-term impact that we are seeing.
ROI: You recently released a report about your ambulance response times, which is a result of a fight two years ago that took place between Cooper and Virtua in which Cooper emphasized its Trauma I status to win the battle. In a world of more outpatient care and a focus on lowering cost (ERs are notoriously expensive visits), why did you go after the ambulances, and why is your trauma designation so important?
AM: It’s interesting to hear about the political hubbub about EMS, whereas, as an emergency doctor here at Cooper, the faculty was continually frustrated with the service that was being provided. That was an outcry of quality needs and now, very happy to be a part of shaping that. So, no matter how much we try to keep people out of the emergency department, there will still be an emergency department. So, we want to make sure people get the best treatment. We actually have physicians that go on EMS rounds now. That didn’t happen before. And the concern about having a hand in that pre-hospital space before those patients come in is important. We cracked 80,000 visits (annually) in our emergency department for the first time ever; even if we get it down to a lower number, you’re still going to get the sickest people. And, in fact, if you keep people out of the hospital, only the sickest people will come, so you’re always going to be able to do those things. I would love a world where trauma centers aren’t needed, but we are always going to have car accidents and those kinds of things. So, that’s a big part of what we do. And the cost structure, in order to do the things you have to do, it helps with the infrastructure of cancer care and other things.
ROI: What are you doing in the tech space?
AM: We are constantly diversifying the way in which we do things. So, we are looking at wearables and other technologies. Telehealth is an interesting one because those that jumped in early did so assuming that everyone would want it. It’s not necessarily panning out as quickly, so we don’t mind not being the first in on that technology. We want to use it in the right circumstances. So, that is something we use, for example, in our stroke care, with neurology consults. The use of technology, and the responsible use of technology, is important. We are doing telepsychiatry, teleneurology and telestroke. On wearables, we have done a program where we gave Apple Watches out for a very limited number of things, but we try to focus on, how does this directly support the patient?
ROI: What other trends are you on top of? I know Cooper played a role in getting the Camden Coalition off the ground.
AM: We still play a major role with them. We took an interesting model a few years ago where the head of the coalition was also one of our physicians. So, we designed a clinic because of the social determinants and those issues, where we had the doctors rotate around the patients rather than have the patients going to different offices.
KO: We’ve also established a coder program for students who graduate Camden High School. It’s a two-year program and it’s tuition-free and, when they come out, they have a guaranteed job with Cooper. Cooper led the way with the $15 minimum wage, which just became the law. We’re at $15 right now, we’re not part of a phase-in, so the advantage we have of being out in front (is) attracting and retaining talent.
ROI: Last question, for Mazz, are you still going to see patients even when you become co-CEO?
AM: Yes. That is the core business we do. I get to see exactly how things work. The $15 per hour (as an example) was about investing in our workforce, and I get to see how that works. Every hospital is four different hospitals — it’s a day hospital, a night hospital, a weekend hospital and a holiday hospital. So, it gives me a chance to see that. Our senior team has rounds after hours because the night team has a tendency to not feel — that started with us doing it — like they get as much attention. We got to see how it all works. If you’re going to have a future world where you have lower costs and providing just as much care, you need your workforce to be invested.