A. Marc Harrison, M.D., just stepped into his new role as CEO of Utah-based Intermountain Healthcare last month, taking over for Charles Sorenson, M.D., who retired. Harrison comes by way of the Cleveland Clinic, where he was head of international business development and CEO of Cleveland Clinic Abu Dhabi in the United Arab Emirates. There, he helped to assemble a multinational hospital workforce, which cared for patients from more than 30 countries in its first year. H&HN recently spent a few minutes with Harrison during his first week at the 22-hospital Salt Lake City system, discussing international strategy, precision medicine and the opioid epidemic.
How have the first days gone at Intermountain?
HARRISON: I arrived here on Aug. 10 and Dr. Sorenson and I have been a team over the last several weeks. He's introduced me to many people, shared a lot of the history of the organization and really counseled me. He's been fantastic. And this is now my third morning as CEO (Oct. 19), so, I'm just getting my legs under me and it feels pretty good. It's been great, actually. One of the things that the board emphasized when I took the job, and all my early experiences suggest, that this place is just great. It is not broken and I'm trying to listen carefully and think a lot to make sure that I don't disrupt what is a great organization, even as I'm assessing it.
It sounds as though your first days as a hospital CEO were filled with building tours and listening to employees?
HARRISON: Having previously completed some projects that were more of a turnaround, you need to come in, assess very quickly and just get to work. I am so fortunate here to be able to do a lot of listening, and it's probably going to continue until the end of 2016. I'm working with my executive team, but I'm also spending a lot of time on the road visiting our various facilities, talking to people and meeting leadership teams and boards, and putting my thoughts together. I think that by the beginning of 2017, we'll really have put together a plan to go forward.
Besides listening and touring, what are the first few items on your to-do list in the coming months?
HARRISON: Well, I've always taken to heart the advice given to me by Bob Rich, chairman of the board at the Cleveland Clinic when I went to Abu Dhabi. He said the first thing you do is build trust because, if you come in and make a lot of operational changes, people don't trust you. So, even as I'm watching and learning our operations and making some suggestions, what I'm really doing is connecting with leaders and the folks who work for them so that they understand where I'm coming from, which is a place of great respect for them and for the organization they're serving, and especially for our patients. So, I'd say that building trust is the first thing that any new leader needs to do. Operationally, it's mowing the lawn, right? There's always work to do to make sure access is great, to continue to work on quality, think about clinical programs, worry about cost structure, etc. The usual tactical operational stuff is the same here as it is elsewhere, except in many cases much better. But the first job really is to develop relationships with the right people.
What first interested you in pursuing this role at Intermountain?
HARRISON: It's kind of funny. I wasn't looking for a job but I was approached to see if I would like to be a candidate. I was super happy at the Clinic. It was good to us personally and professionally and, in turn, I tried to be good back to the Cleveland Clinic and always figured I’d end my career there. I had always followed Intermountain from a distance as a place where I thought people lived their mission, vision and values and the commitment to value-based care and population health in the context of keeping care affordable. Intermountain was always intensely interesting to me, so, given the opportunity to take a look at this this role, I leapt at it.
Did you ever think you'd one day be CEO of the health system where you trained as a medical resident years ago?
HARRISON: No, I was just hoping to be invited back to give grand rounds. That would have been a huge success. I actually gave up a long time ago on this idea of career trajectories and making plans on those fronts. So many things can happen, right? Life can be random. Business is random. So, I try to get up every day and work as hard as I can and I've been fortunate that doors present themselves. Whenever they do, I've tried to open those doors and see what's behind them and then do the best job I can. In some ways, it feels that fate brought me back to the place I trained, and Intermountain certainly trained and shaped me as a clinician.
You mentioned Abu Dhabi already. What sorts of lessons did you learn in that position that you can apply at Intermountain?
HARRISON: I think there are some real commonalities there. We had great partners. We had great people, but it was a complicated environment just as U.S. health care is complicated now. The issues may be somewhat different, but health care is a complicated field and what I've learned is that if I have a great team, if I empower them properly, if I support them, they can solve just about any problem. Trust in the power of the group is something that I learned at Cleveland Clinic in Ohio. I took that with me to Abu Dhabi and it got us through some pretty tough times. Belief in the people here at Intermountain will have similar results and I will say that, as I make my way through this very large system with 35,000 caregivers, what I'm struck by is, person by person, how mission-oriented and talented folks are. I am fortunate to get to work with these people.
The United Arab Emirates is just about three years older as a country than Intermountain Health Care is as a system, and so it's a young country that has come an extraordinarily long way in a short period. I loved the people and the mission there. I’d say that Intermountain has this extremely well-developed primary care ethos and system that goes a long way toward keeping people well, and it is still evolving in the UAE. I also know that because the right people are working on it there, it will come along quickly.
Intermountain is collaborating with companies in Southeast Asia around personalized medicine and the distribution of your health system’s genomics test overseas. Could you talk about the thinking behind that partnership? And do you think that the future of health care systems like yours might lie in further international partnerships like this?
HARRISON: I can't speak for systems as a whole, but I think that Intermountain is uniquely positioned to have an impact locally, regionally, nationally and internationally with everything from direct care delivery to companies that support health systems to thought leadership and the use of intellectual property. On the international front, the work that you're referencing around precision genomics won't be the only one of these kinds of ventures that we do. I think it holds a lot of promise for Intermountain but, more importantly, these are services that will really help the people who receive them from far away, and it's good economically for the communities that we serve, and for us to develop a broader and more diversified base of revenue streams, never forgetting that our primary business is taking care of patients.
Certainly, as hospitals move from one curve to the next, with one foot on the dock and one foot in the boat, as the cliché goes, old revenue streams are going to dry up and you're going to have to find new ones like this to fill that gap, right?
HARRISON: Here's how I think about it: If we end up doing the right thing, the business case often will follow. As you well know, Intermountain, in addition to striving to keep care affordable — and it has done a really admirable job at that — has always been able to figure out new ways to float the boat economically. I give our board and Dr. Sorenson enormous credit. They've systematically tried to identify things that aren't good for patients and then just stopped doing them, even though it may have had a negative impact on revenue. Being focused on always doing what's right is incredibly important, and it will stand us in good stead going forward.
Are there other international projects you're eyeing for the future?
HARRISON: We already have a fair number of contacts internationally. Dr. Sorenson will be leading our new leadership institute, and we will be bringing both administrative and physician leaders in from around the United States by invitation. We also will be inviting people from abroad who seek to understand how we do things, and I think those are the great relationships to build. Even now, our quality group is working with the Royal Free Hospital in London on a demonstration project on safety and quality. So, we're very fortunate to be taking care of the community in the Intermountain West region that's quite globally connected already.
Can you tell me a little more about the transformation center and leadership institute that you are launching?
HARRISON: This field is changing fast, moving from volume to value with an emphasis on safety and quality, face-to-face care, telehealth and the personal digital revolution. With that, we wanted to have a physical structure that will put in place our clinical programs, from which stems a lot of innovation, with room for other folks to collaborate. I think that becomes one of these catalysts for a place where change can evolve, but also can be tested. I won't be the least bit surprised at the number of new business opportunities in addition to new ways to serve in our mission, vision and values that come out of that center, and we are thrilled by the generous [$20 million] gift that [Utah philanthropist] Kem Gardner gave us to name that building.
Is it nice to have your predecessor helping to shepherd this forward and lead this current transformation center to completion?
HARRISON: As you and I both know, it is not conventional for outgoing and new CEOs to rub elbows in any field. However, it speaks to the character of Charles as a human being and as a leader. We understand our roles, we've become good friends and I feel fortunate to be able to learn from his wisdom.
Circling back to precision medicine, I know it's been a key area of focus for Intermountain. Why has genomics been so important to your system and to the future of medicine?
HARRISON: I hope cancer hasn't touched your life, but it's touched our lives. I'm a cancer survivor. On Sunday, I had my seven-year anniversary of having clean margins after surgery for bladder cancer. When you're a cancer patient, you don't want to be just a number. You're an individual with individual risk factors, needs, hopes, health status and age. You want both evidence-based care, but you also want personalized care. This idea that you can genotype somebody’s tumor, identify candidate genes and match them with novel therapies that can prolong their life in a nontoxic way is quite remarkable. We're only in the early days of this, but we've been incredibly gratified by the number of systems that have come to us. We're starting to genotype their patients and, even better, the team has put together a virtual multidisciplinary tumor board of people from some of the best academic institutions in the United States. They are collaborating to look at each individual patient and the genetics of the tumor and make a very discreet recommendation about what's best for that patient. That combination of old school professional consultation in concert with highly personalized genetics and novel therapies is really where we're going on the intense medicine side. It's really a contemporary, fabulous approach. On one end, we're striving to keep people well. We don't want them to get cancer, we want them to eat well and we want them to exercise and not smoke. Right? But when people do, we want them to get the most personalized, successful, nontoxic therapies so they can get back to their lives as quickly as possible.
I understand that opioids have been a key concern for you, too.
HARRISON: As you know, this is an epidemic and it's touched a lot of people I know here in Utah — people you wouldn't expect, based on conventional stereotypes of opioid misuse. It's just horrible. It's touching all facets of society and, for whatever reason, Utah seems to be relatively disproportionately affected. Part of our community health needs assessment is to work collaboratively with the community to address that. The University of Utah looks as though it will be a great partner around many of these community initiatives, and opioid misuse is one of the things that we're going to take on. In some of our emergency departments, as many as a quarter of the visits are due to substance use. It's very sad.
Any initiatives Intermountain is looking at that are tied to this issue?
HARRISON: There is something that's really cool. We don't have results yet, but I think it's the right approach. As a large provider, Intermountain has an opportunity to impact the number of pills that are in the community. A group is putting together a consensus document based on the kind of operation or problem that a patient has, what medicines and how many should be prescribed and whether refills should be available. I think it’s a responsible, thoughtful approach to reducing variability and it’s something that, again, as almost all good things do, this opportunity was identified by the clinicians.
Are any other things going on at Intermountain that we haven’t talked about?
HARRISON: On the other end of the provision-of-care spectrum, we're evolving quickly on the telehealth front — telestroke, tele-critical care, keeping people close to home — using those technologies is producing great results and keeping costs down. For instance, the tele-critical care program is now implemented in about 33 hospitals, 22 of ours and 11 partner hospitals. In each case, the risk of mortality has gone down and the likelihood of transfer to a higher-level center has decreased. Results continue to be great and actually have improved, and I think that's the wave of the future: How do bring technologies to the patient wiothout moving them around? You may have seen this mental health integration article in the Journal of the American Medical Association that talks about how, although it looks expensive on the front end, embedding mental health professionals in our primary care clinics is great for the patients and, in the long run, is also cost effective. I am inspired by Intermountain where the whole spectrum includes keeping people out of the hospital, taking care of them at a distance, offering innovative primary care that includes mental health at the point of service, and this crazy sophisticated science of precision genomics. The commonality is that it's all focused on the same mission, vision and values. Other than that, I probably won't be busy at all.