Here’s the latest in my Local Heroes series that profiles Northwest leaders creating organizations with strong cultures. Today, I’m sharing my recent conversation with Dr. Rick MacCornack, CEO of Northwest Physicians Network (NPN), based in Tacoma, Washington. NPN is a good example of the energy an organization can harness when it is clear about its “why”, or purpose in life, and creates a culture aligned with that same purpose.
Tell me about Northwest Physicians Network.
Northwest Physicians Network (NPN) is an independent practice association, formed in 1995.
The physicians who founded NPN were really thinking about the philosophical and social issues behind medicine and the need to provide more value—stretching the dollar if you will—for publicly funded patients. Over the years, we’ve evolved and done a lot of different things. We started our own insurance company, our own third party administrator which provides even more value to self-insured groups who are trying to manage their own cost of care, and we’re providing many services to private practices to try to help them deal with the increasing complexity of administration of care. At the core of the business are global risk contracts for which NPN is delegated by insurance carriers to manage with the participating providers. By managing resources wisely following evidence-based medicine guidelines, we are able to provide additional services to patients who need extra assistance in the management of their care.
We have seven nurses and a behavioral health therapist who work mostly by telephone, sometimes with patients in the clinic, sometimes in the home in between visits. These patients are typically people living with two or more chronic conditions. Our nurses are helping them coordinate care to help them to figure out how to use the medications that they’ve been prescribed, or where to get medications cheaper, if they can. Or, accessing services in the community for housing, for food, for clothing, for whatever it might be; behavioral health, and mental health services when they are not readily accessible through the main channels. So our nurses are working alongside with the nurses, the medical assistants and the physicians in the practices. Our program is at NCQA level. (Note: NCQA stands for National Committee for Quality Assurance and is a professional certifying organization that sets the standard for how such services are provided.)
Today, we have nearly a thousand private practitioners who are participating in NPN. In 2008, we had about 375 providers in our network. We anticipate that our growth will continue for the next few years. A lot of this growth is outside the South Puget Sound area, so we’re seeing participants join up as far south as Vancouver, Washington and as far north as Whatcom County.
What’s the legal structure of NPN? Who owns it?
We are owned by providers. Currently, we are structured as an LLC. We have about 45 shareholders. We’re investigating other corporate structures that would encourage wider participation— “each person has one vote” kind of an arrangement because we are a multi-specialty organization. We represent 56 different medical specialties and sub-specialties.
What’s your role and how long have you been with the NPN?
I took over as CEO of NPN last year. I originally came to NPN in 2001 as the hired gun to do everything from analysis of data to planning to strategic development. I’m an epidemiologist by training. I started out in cancer research and saw the lack of good fit between that work and me. I was much more broadly focused- more interested in the structure of the industry and how care gets developed and the behavioral components of that. So when I came out here from New York, I started working in a visiting nurse association because I was very interested in the nursing side of the care process, particularly in the home. I went from there to Group Health, which was a natural fit, being an HMO (Health Maintenance Organization). So in other words, population-based care has always been part of my DNA. When I came to NPN in 2001, it was really a population laboratory to me. If you don’t provide value, your patients don’t return. There’s a good alignment for motivation to do a job well. And that’s exactly what I saw in these independent practices. The challenge is that these are fiercely independent providers. So the puzzle is how to lead large group of very independent professionals?
So what’s it like working with physicians?
It really is all about professional cultures, subcultures and creating alignment among them. How do you create alignment in an industry that is anything but well aligned? Well, you can get it through value. While value for person A is different than person B versus C, there are some underlying themes. It’s understanding at the granular level how each practice works, how different specialties look at the world, how individuals look at the world, finding the common threads, and building on those common threads. It’s taken us a long time but I would say we are becoming a very different network of a thousand providers than we were at 375 back in the mid- 2000s.
I would say that what’s different about us is that, as a virtual network, what’s required is a very hands-on, press-the-flesh type of interaction with the network participants. So we’re out and about a lot.
What do you think your most important role is as a CEO?
There are two. About half of my job is internally focused. We don’t have a Chief Operating Officer (COO) here. But a lot of what I do is COO work. So in the team of 50 people that we have, we have everything from claims payment, customer service, a nursing staff, an analytics staff, and administrative staff that does contracting and credentialing for all the providers in the network. That’s a wide range of activity to comply with a highly regulated industry’s requirements, while doing it in a creative, coordinated and integrated manner.
We also have staff who are working with the clinics, face-to-face, to figure out how we can better assist them administratively in terms of work flow, helping to solve questions about administrative efficiencies and assisting practices in becoming more efficient in managing patient care.
What’s the culture of your company?
When I took over last year as CEO, I chose to reinvest in operational development systems design work. I hired the Brighton Group to assist us. Their team has been working alongside us in many ways since 2015. We now have newly integrated systems –hardware and software applications and the staff training required to support them. That work is almost done. We also did some realignment of staffing. We had about a 10% turnover. We needed some skill-sets we didn’t have and we also had some attitudes that didn’t need to be here anymore. That alignment is all done. So now we have a well-greased, highly-aligned culture of 50 people. We have what we call a ‘LEAD team’: these are four different directors representing claims, clinical services and technology, finance and practice support, credentialing and contracting. There are two executives, Scott Kronlund, MD, our Chief Medical Officer, and me. Every Monday the LEAD team meets for two hours and all our discussions are focused on integrating work which has been siloed by the larger industry.
The Leadership Team decides what’s going to get done. Scott and I are the ones who are always focused on the outside as well as the inside so we’re strategically pushing new ideas into the leadership team. The Leadership Team decides what’s going to be worked on as system solutions. Decisions get pushed into what’s called Team Delta. Delta is made up of a variety of staff anywhere from 10-15 people, depending on the issues. Delta comes up with the solutions—specific system solutions to specific questions. We also have a business intelligence team, the “BI Team”, using a new analytics platform that pulls data from a warehouse that we’re constructing as we go. The data are both financial as well as utilization and clinical data.
Our opportunity is to try to build a coherent system for managing, organizing, and analyzing, then providing information from which we can make better decisions.
Over the years, we’d naturally developed silos of work because that’s the way the industry is structured. We’d have weekly team meetings to try to trade information to and from the clinical area and the claims area that would be like shouting between Mars and Venus. But now we meet at the core and figure out to solve problems at the patient level. The silos are gone. We no longer have departments. We have functional areas. I can’t tell you how difficult it is to break from the past when the whole industry in which you work is itself made up of complicated, technical and uncoordinated functions. From a program director’s standpoint, the work can consume a hundred percent of your attention to manage the detail, so integrating traditionally siloed service functions is a very difficult thing to juggle. That’s the stage we’re in right now.
We have three goals in our company: the first is customer service, internally and externally focused. Second is to double our network size and the third is to quadruple our revenue over the next five years. We’re fast progressing on each of these three goals. Our success is tied to how we treat people, how we communicate, and how we support each other.
How do you find people who are a good fit for your culture?
In our aspect of the industry of managed care, there are people who get it and have the technical skills to make it work well for patients. It’s a value system as much as it is a skill set.
How do you determine if they “get it”?
You can tell within two minutes of a conversation. Here are some questions you ask: where you had your work experience, what are your values, do you see the health care industry as a place to show up in a cube and punch data into a keyboard or do you see it as something bigger, a mission. Do you understand the plight of the patient who is trying to get care? Do you understand the plight of the provider who is trying to provide care in a Byzantine empire?
And are you asking these questions to potential manager types? Or everyone?
Everybody. There are people who would rather give than take. And we tend to attract people who’d rather give. Our staff are just incredible human beings and they’re always going the extra mile. It’s just their outlook in life. And they’re very interested in the concept of community. They understand that the community is not defined by bricks and mortar and logos. These are people who probably couldn’t be happy in a work environment where one’s work is divorced from a tangible effect for other people.
Another way to say it is: we have a very difficult time coloring inside the lines. We like to create things, we like to look for creative solutions, things that aren’t being done. This is a human enterprise and it’s about building community.
The most successful organizations are the ones that know their “WHY”, as in WHY they do what they do, and are clear about it to all their stakeholders- employees, customers, key partners, etc. What’s NPN’s “why”?
Know Your Why
The founders of NPN were driven to find better ways to do what’s best for patients. They believed that there was not enough value in the medical care they provided for the patient. They thought that they could do a better job as a coordinated network of providers. That philosophy runs deep. It’s part of the DNA of this place. The company culture that has grown from this “why” is very real.
How do you go about articulating this “Find A Better Way” why and the values around it?
Words are so important. Communication in this industry is very difficult. It’s like you’re in the Middle East. You’re trying to communicate well to different cultural tribes. I think Scott would chime in if he were here and say the same thing. We’ve both come from our professional traditions. We have both been on many sides of the industry. I will speak for myself: I was essentially looking for meaning for 30 years. When I walked into NPN, it was a highly risky move for me because the company was hanging on by a thread. The prospect of managed care growth in the state was unknown in 2001. People thought I had just signed on to work for a dying breed. And I would say just the opposite has been the case. It was a huge risk but I have never been so energized, so focused, so absolutely convinced that what we are doing is the right work.
It sounds like there’s an incredible alignment between the “why” of the organization and your own personal “why”.
Yes. There’s a huge amount of alignment and energy which is created from it.
One of the most important jobs for a CEO is that of Chief Cultural Officer. What do you do in that role?
We use the Gallop Strength Finder as a start. I think my first strength is strategic. As a relator I love to communicate. I believe that if you can’t do something with enthusiasm, just stop! It’s not worth it. And what I love is the enthusiastic interaction among our 50 employees and with those out in our network. You can’t do that unless you really believe in what you’re doing, obviously. But that’s the cultural glue. When we have all-staff meetings every month, we have birthday parties. We all have all kinds of reasons to get together, either the entire team or in subgroups. This is what it’s about. It’s engaging people at the level where they’re living. We do a lot with our staff that would probably raise the eyebrows of human resource people in larger corporations worried about liability and all of that stuff. It’s that level of caring, of really paying attention to each other. But it’s delicate – it’s not getting into people’s lives inappropriately. We’re not a big family. We’re a business.
There is a difference, yes.
But it’s human. It isn’t a bureaucratic response; it isn’t just an EAP (Employee Assistance Program) phone number. It’s, “Let’s talk about what’s going on with you.” There is EAP available, but there are also some other resources. That’s where Eric Black, our outsourced human resource person (from Blacksmith HR), fits in very, very nicely. He has been a huge source of information and guidance.
So I’m thinking about my replacement when that time comes. Scott thinks about it all the time. Who are the people out there? I don’t care what your degrees are so much as who you are as a person and what skills you have and how they can be brought to bear in this culture. That’s how our board looks at it. There are lots of talented people out there but they may not have the “right stuff” for this culture.
What’s your leadership style like and how has it evolved? What are some leadership lessons you learned throughout the years?
I would say I have had to learn to get rid of my academic professional shroud that is basically elitist and based on a model of exclusivity. I’ve learned to listen. I’ve learned to be direct, sometimes to the point of being blunt. I don’t play games very well. I’m purpose-driven.
Were you not as direct when you started out as a leader?
I was reticent about being direct because I was afraid of breaking things. I think the staff would describe me as approachable and fair. They’d sometimes be bewildered because I can be two things. There are times I can be somewhat autocratic. Because sometimes decisions need to come quickly and consensus is not necessarily the best way to get there. But usually I’m not that way. I’m always asking for input from the directors and front line staff. I see myself as a facilitator in that role. And, I’m a good teacher.
What does NPN look like in 3-5 years? Are you still here?
No. I’ll be retired. But Scott will be here. I would say everybody else will be here and NPN will be bigger than it is today. NPN will also be working in very close alignment with other organizations.
We are, today, having conversations with everybody: hospital systems and large multi-specialty groups everywhere in the Puget Sound to figure out who are best aligned with our purpose. Who gets it? Where is there good alignment? Ultimately, patients need choice. And that’s really the proposition. Choice gets to the issue of financial value as well as the outcomes of care and the experience of care. I think NPN has an instrumental role in promoting choice for patients.
We are collaborators, we are partners, we are not go-it-alone, solo types, which is a bit ironic because this is what our network is made up of. But that is, I think, our real strength. We are a democratic, mission-driven network with very loud voices coming from the specialty and primary care sides of care delivery. You should listen to some of our board meetings! They are like a democratic caucus – very strong feelings, but underneath all of it is deep respect and appreciation for the diversity and for the common mission of what we’re all trying to do together as a virtual community of people caring for people.
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