Hackensack Meridian CEO talks about how big system handles health care’s changes, challenges

The Interview Issue 2019

By Tom Bergeron
Hackensack | Jan 7, 2020 at 3:45 am
From our print edition

Hackensack Meridian Health is one of the two giant health systems that dominate the state of New Jersey. With 17 hospitals — and more than 500 patient-care locations — Hackensack Meridian Health is a force in health care.

And health care is a sector that’s constantly evolving. That can be a challenge.

There is a current administration that is trying to — insert word of your choice — change, dismantle, disrupt the Affordable Care Act. And then you have potential presidential candidates who are saying, “We want Medicare for all.” It seems as if everybody’s talking about health care — and potentially dramatic changes to health care.

That makes life tough for Hackensack Meridian Health CEO Bob Garrett. We asked him: As a business, how do you create a one-year, three-year, five-year plan with all of this out there?

“You can’t let that necessarily distract what’s the right strategy for your organization and for the communities that you serve,” he said. “So, whether we go Medicare for all, or we go to totally private marketplace, I think having the size and scale we have, and being able to serve the communities that we’re serving today, will work for us.

“And our board has looked at it that way. You obviously look at market conditions and what’s going on with federal subsidies and government intervention, but we’ve been pretty much consistent at Hackensack Meridian, saying, ‘This is the right strategic direction for the right reasons.’ And, no matter what happens in Washington or what happens in Trenton, we believe this is the right way to go.”

Garrett, ranked No. 1 in the most recent ROI Influencers list for Health Care, sat down with ROI-NJ to discuss the industry. Here are his thoughts, in an interview that was edited for space and clarity.

ROI-NJ: Let’s start by continuing with the size question: There seems to be no end in sight to consolidation in the industry. What are the pros and cons of this? And is there any end to it in sight?

Bob Garrett: My feeling is that partnerships and consolidation are going to continue in the industry, like other industries before us. There’s not as many opportunities as there were, because there has been quite a bit of consolidation already. But I think it will continue as long as there’s a value proposition and communities benefit — meaning you can provide better quality, share best practices in terms of clinical care that the community benefits from, and you can make health care more efficient and more affordable in the process. It makes sense.

And, whether we go to a Medicare-for-all system or we amend the Affordable Care Act or there’s a brand new health care governmental system, it just makes sense that individual hospitals are going to need the help of larger health systems to really support the community needs. And that’s really what it’s about.

ROI: Talk about your latest partnership with St. Joseph’s Health.

BG: It’s a great example of one size doesn’t fit all. So, you’re going to have partnerships like Saint Joseph’s Health and Hackensack Meridian, where it makes sense that we stay independently governed, but collaborate in a really meaningful way. The community is the winner, the patients are the winner, but our two organizations also can do some great things together. 

We’re proud to have this strong strategic partnership with Saint Joseph’s because it’s meaningful. It’s really about expanding cancer treatment and cancer care throughout Passaic County. I’m talking about in Paterson, I’m talking about in Totowa, where we’re going to build a new comprehensive outpatient cancer center together. And then there’s the expansion of what Saint Joseph’s has in Wayne now, which is a women’s cancer program.

I’m not a believer in doing a partnership that’s so vague and so ambiguous that everybody reads about it and says, ‘What is this really about?’ I really feel it has to be specific. It has to be meaningful. It has to be focused on a community. So, when we did our partnership with Englewood (Health) originally, which was a strong affiliation, we were very specific. The agreement actually had six or seven very specific deliverables. It’s the same thing with Saint Joseph’s.

ROI: With size comes influence. There’s a lot of issues at the federal level, but there’s also a lot at the state level. Is HMH in a position to influence the way New Jersey might attack certain issues? Do you want to be? Is there a desire to try to influence or steer decisions in a direction that you think makes sense and is most beneficial for you?

… Whether we go Medicare for all, or we go to totally private marketplace, I think having the size and scale we have, and being able to serve the communities that we’re serving today, will work for us.”

BG: I would call it more advocate than necessarily influence or steer. I would say that we have a responsibility as a larger organization in the state and as a large employer. We’ve made major investments in this state. And we should play a role as an advocate for what we think is right in health care for the communities that we serve. I think it’s important.

We do this. A good example is, we’ve supported elective angioplasties to be expanded and we’ve worked with legislative leaders as well as the Governor’s Office on that issue. And we think it’s the right thing because it will provide more access to advanced cardiac care where maybe it doesn’t exist today. It’s established precedent in 48 states. The American College of Cardiology has signed off on it, saying it’s the right thing to do. So, where we see an issue that we feel is important, we do advocate on behalf of it. And because of who we are, a large player in the state, hopefully our voice gets listened to.

ROI: Let’s talk about issues and ailments that you take on and treat. I know you want to do everything, and you want to help everyone, but you can’t make everything a priority. In the past few years, it appears that cancer care, opioid issues and behavioral health treatment have been at the top of everyone’s to-do list. But there are plenty of other issues, everything from juvenile diabetes to hypertension to telemedicine. How do you balance your interests or prioritize your time?

BG: It’s interesting you mentioned hypertension, because that is a big priority for us. Last year, through our care transformation process, we put together a program and a goal to reduce hypertension throughout the state. And we’re making some progress. As a big health network like Hackensack Meridian is, and as diverse as we are in terms of the services and the programs we provide, we can’t afford just to focus on one or two issues. 

That’s why we took on vaping as an issue. That’s why we’re taking on hypertension. We’re focused on making our communities healthier, focusing in on the social determinants. That’s why we’re focused on reforming medical education through our new medical school. It’s not about one or two issues. Now maybe those one or two issues get more attention — and they are very important issues. That’s why we’ve made major investments in cancer and cancer research with an NCI designation. We made the move to merge with Carrier Clinic to really provide better access for patients with mental illnesses and addiction disorders. But we still have a multifaceted approach and we’re constantly looking at our strategic priorities.

Every year, we have a summit with our leadership, our board, our executive leadership, our physician leadership, and we say: ‘Here are our seven or eight major strategic priorities. Are they in the right order or do they need to be amended?’ We just had that process. And we’re going to make some tweaks. One example is on population health. We want to make sure that we continue to be even a stronger leader on making sure that our communities stay healthy and that we have new partnerships with social agencies focused on housing and transportation and food and things of that nature.

ROI: Let’s stay on the size of your system. With that, you are seen as a thought leader and often get invites to prestigious events — and are asked to collaborate with industry-leading partners. How much has this enabled you to get some best practices you can bring back to New Jersey?

BG: It helps a lot. And I’ll give an example. When I attend the World Economic Forum in Davos (Switzerland) — and I think we’re invited to a large degree because of our size and our reputation and some of the innovation that we’re involved in — you get to talk with leaders like Bernard Tyson, the CEO at Kaiser Permanente, who unfortunately, just passed away. Bernard spoke in Davos about behavioral health and what they were doing. And, in terms of some best practices, that certainly gave us some great ideas. And he talked about what they’re doing in telehealth. He said 50% of their provider-patient contacts are now done through telehealth, which was incredibly impressive. As a result of that, our team followed up with the folks at Kaiser. And I think we’re on a path and we certainly have a goal to do the same thing — to have over 50% ultimately of our visits done by telehealth.

The other advantage of our size and scale is internal. So, best practices are shared constantly within our own network to improve quality. We just had a meeting where we were talking about the urology service line. And there were some physicians from Hackensack (University Medical Center) that were talking about some of the practices they put in that will benefit some of our community hospitals. So, rather than having those community hospitals develop their own protocol, which would take time, the folks from Hackensack are going to help them implement this. And, then, on the other side of it, some of the community hospitals have the best practices that folks at Hackensack can learn from. So, it’s really a two-way street.

I think, as long as the market continues to change and develop, Hackensack Meridian is going to continue to grow and take advantage of it. We do believe that the partnership model does work, it just takes different forms.”

ROI: Let’s talk about payment issues. There have been a number of examples recently where hospitals have sued patients for payment. Is that a wave of the future?

BG: I think it’s a difficult issue, but I would say this: Shame on providers who can’t figure out a plan to work out with patients. We’re in the business of providing service and, of course, nothing in life is for free. I understand that. But I think there’s always a way to figure out a plan. And that’s what we’ve done here at Hackensack Meridian. I find it very objectionable to sue patients and sue families, especially those that are in need, those that may be sick and compromised. So, work out a plan. And probably 99% of the time, you can figure that out. It shouldn’t get to court. I understand that there may be some circumstances where providers have really made a genuine effort to do that and they just can’t get there. But I think it should be an absolute last resort. I don’t think it should be a policy of a health system or of an individual hospital to routinely sue patients.

ROI: We’ve joked over the years that you’ve thrown more spaghetti at the walls than anyone I’ve ever seen. That is, you’ve taken the basic idea of health care and tried to expand it in 20 different areas just to see which ones work. Is there ever a point where you’re just going to take a breath and say: ‘We’re just going to sit back and evaluate the dozens of things that we introduced last year. How far can you go?’ What do you see in the future as more potential innovations that are striking your fancy and have you thinking, ‘Hmm, let’s look into that?’

BG: I think, as long as the market continues to change and develop, Hackensack Meridian is going to continue to grow and take advantage of it. We do believe that the partnership model does work, it just takes different forms. We also believe that we should not ever get big for the sake of getting big alone, that it should be where we really integrate health care. As I’ve studied health care systems around the country and around the world, the most effective systems are those that truly have that a strong system feel to them — ones where they actually make a real effort and they’re successful in integration.

That’s why we’ve invested so much in electronic health records. That’s why we have a steering committee months before a merger is completed to start planning. We can’t execute until you get the regulatory approvals, but we get a head start on that, so that we can start to really hit the ground running on Day One. So, I see that continuing. But I also see more development on the ambulatory care side of the business, because consumers are looking for better access to care. They’re also looking for more affordable care and ambulatory care and the expansion of ambulatory care really addresses those issues.

The other thing that I see, moving forward, is really looking at the health system from an internal perspective and trying to improve wherever we potentially can. We’ve been doing that from the beginning, but we really have an intentional focus on that. That’s what I would call the basic blocking and tackling and making sure that as great as the patient outcomes we’ve been able to achieve, that we can get better. And we constantly challenge the team. Last year, I hired a chief operating officer, Mark Stauder, who’s doing an amazing job of really looking internally as we’ve grown. We have to keep our eye and our focus on the communities that we serve and making sure that we can continually improve the care that we’re delivering.