Healthcare Affordability: CFO & Board Perspectives From Corewell Health
In this episode of the “Achieving Health” podcast, hosts Chad Mulvany and Shawn Stack are joined by Corewell Health CFO Matt Cox and board member Joe Fifer. They discuss the ongoing scrutiny on healthcare affordability and the roles of finance and board leaders in advancing transformation that supports a more affordable care delivery system for patients and other stakeholders.
Matt and Joe share their thoughts on:
- How health systems like Corewell can define affordability to help focus strategic initiatives.
- How providers can balance efforts to improve affordability for patients while operating in a challenging financial environment.
- The role of transformation—in technology, the workforce, and care and payment models—in advancing affordability.
Transcript
CHAD MULVANY
On today’s episode of “Achieving Health,” we’ll be joined by Corewell Health CFO Matt Cox and board member Joe Fifer. They’ll share their perspectives on how health system CFOs and boards can contribute to transforming healthcare and improving affordability. Stay tuned.
ANNOUNCER
This is “Achieving Health,” a podcast from Forvis Mazars, where we delve into the topics that matter most to healthcare organizations across the continuum of care. Our goal is to help you navigate the dynamic healthcare landscape and achieve health at your organization.
CHAD MULVANY
Welcome to “Achieving Health.” I’m Chad Mulvany.
SHAWN STACK
And I’m Shawn Stack. Thank you for joining us.
CHAD MULVANY
We have two special guests for today’s episode, Matt Cox and Joe Fifer. Matt is executive vice president and CFO of Corewell Health, the largest health system in Michigan, and he’s currently the national chair of the Healthcare Financial Management Association, or HFMA.
Joe is a board member of Corewell Health, a national healthcare finance leader, and retired past president and CEO of HFMA, whom I had the privilege of working with while I was at HFMA. Matt, Joe, thank you so much for being here. We’re really looking forward to your thoughts on healthcare, affordability, and transformation.
JOE FIFER
Thanks for having us.
MATT COX
Yep. Glad to be here.
CHAD MULVANY
Joe, I’d like to start with you. Before affordability really became the buzzword that it is now, today, with policymakers in D.C., and the state capitals, HFMA, while you were there, had something called a three-circles framework that really challenged healthcare leaders in payer organizations, physician organizations, and hospitals and health systems to work together to improve outcomes and reduce the total costs of care.
In many ways, that feels like an earlier version of today’s affordability conversation. Looking back, what did that framework get right about the challenges that healthcare is facing today?
JOE FIFER
Well, first of all, both Chad and Shawn, it’s great to hear your voices again. It’s like throwback in time. So, thanks for having me. I guess to answer your question, maybe a quick definition of what this three circles: I went back to a board meeting, a board retreat we were having, and I stood up a flip chart and I drew three Venn diagram-type circles of docs in one circle, of hospitals in another, and insurance, you know, third. And then, where they overlapped in the middle,
I said the patient was in the middle. And then I drew one circle around the whole thing, saying that that’s how we really should view healthcare. And what we were hoping to do was to avoid what has happened and that is today’s affordability crisis. Crisis is a word that’s overused, but I think we’re heading in that direction in terms of healthcare economics.
And so, that’s the definition of three circles was that, you know, that effort to try to align those three major components of the healthcare industry. Was it right? I still think so. You know, one of the reasons I was so excited about joining the Corewell Health board is this organization is essentially a three-circle organization with a sizable health plan, a big delivery system that includes both, you know, many, many physicians and a number of hospitals throughout the state of Michigan.
So, yeah, do I think it’s right? I think that coordination between those three major elements along with some others in the healthcare industry, was the right way to do it. Gosh, what would I do differently? I think I underappreciated the severity of the chasm between insurance companies and the provider community, both physicians and hospitals. And I think if I were doing it differently, I would try to broaden the tent, so to speak, a little bit, and to do that without focusing so much on, you know, the association metrics, you know, things like membership and things like that.
I would look at it less like an association and more of the concept that it really is. And maybe to steal the Simon Sinek’s just cause, you know, mindset. Maybe that’s how I would approach it differently now. But it’s a big ship to turn but it’s the right thing to do.
SHAWN STACK
Thanks, Joe. Matt, as HFMA’s chair, you kind of launched this year talking about the central challenge facing healthcare finance leaders is affordability. What are you hearing from stakeholders in your communities that you serve and employers and local governments, state governments, and patients regarding affordability?
MATT COX
Thank you. So, what I’m hearing is that enough is enough. To put it very plainly and clearly is that they’ve had enough of the ongoing price increases. They’ve had enough of not being able to access care. They’ve had enough of their employees and other stakeholders worrying about what healthcare is going to cost them and can they afford it or not.
And it’s not just one set of stakeholders, and it’s not just patients coming in and complaining about their affordability or getting a bill that they didn’t understand. It’s not just the government that is looking at the national spending and the national debt and saying that it’s too much, or the state of Michigan talking about their Medicaid budgets, or employers.
It’s all of them, all at the same time, saying, we cannot afford to see these types of increases year-over-year. And I think that over the years that I’ve been in healthcare, really over 20 years, I’ve never seen it at a point where all the stakeholders are looking at healthcare and hospital leaders saying, you’ve got to do better.
And I don’t know if we’re at the tipping point now or if we’ve crossed the tipping point, or if H.R. 1 is the tipping point with some cuts that are coming our way. But certainly, I don’t meet with any employers that are saying, hey, we can handle a little bit more. We’d like you to make bigger investments and not get a return on investment on those investments so that we could pay more next year.
What I’m hearing is people questioning our investments, people questioning their bills, people looking at charges and looking at contracts in a different way. And I think that the level of conversations for me is at an all-career high.
SHAWN STACK
Yeah, I agree, Matt. I think the climate is definitely changing around affordability. When people hear the word affordability, they often think about lowering prices. But from a health system perspective, affordability is so much more nuanced. How do you define healthcare affordability at Corewell Health?
MATT COX
Yes. So, we don’t have a single definition that fits for everyone. It would be great if there was a single definition. So, at a health system level, we do things like we benchmark our prices that we charge, and we look at that and say, well, if the prices that we charge are in line with others and we’re getting superior outcome, then that is affordability.
But I also think about it a different way. When patients are going to fill their prescriptions from our health plan perspective and they can’t afford to do it, then we’re not affordable. Or if they want to go to see their primary care physician and they’re concerned about paying their copay, then it’s not affordable. If they need to have a procedure done and they don’t have enough money to pay their out of pocket, whether it be coinsurance or deductibles, then it’s not affordable.
Do they have enough money in their HSA to pay their co-payment or deductibles, or is it coming out of the money that they need for other things, like food and housing and gas, then it’s not affordable. So, if you think about it from a patient’s perspective, they’re mostly concerned about out-of-pocket when they’re accessing services. And employers are looking at it.
And the comments I hear is, you know, our healthcare is going up and we’re not getting efficiencies like we are from our other suppliers. So, I’ll also hear them say the rate of increase there is more than any of our other things that we contract with. So, they also look at affordability based on what is the health insurance cost.
So, we benchmark our health insurance costs with, you know, all the other providers out there. And as long as we’re not the highest, then one could say that they’re affordable. But I do think that defining affordability is something that we can do a better job of as an industry.
SHAWN STACK
But Matt, you make a good point there when you talked about purchasing, I mean, how do you balance affordability with access and health system sustainability, given that even a large health system like Corewell is really a price taker for many pharma drugs and supplies, and many, if not most, markets in the country are facing shortages of clinicians and providers. So, you have to pay competitively there as well. So, how do you balance those and how do you look at that?
MATT COX
Yeah, it’s a central issue that we have because there is a labor shortage of physicians and RNs and other healthcare workers. So, we’re investing a lot in the pipeline. We have partnerships with Michigan universities that we’ve helped them expand class sizes. For example, for RNs, we train medical assistance as an organization and have partnerships with other training facilities.
We have an Earn-to-Learn program where people that don’t have an education, a formal education can get one and still get paid. So, we’re doing a lot in the pipeline to make sure that we have access to talent. And then we have a very robust supply chain organization that works on contracts to keep our inflationary numbers down as much as we can and partnering with our clinicians to make sure that we’re utilizing supplies in the right way, the way that they’re intended, and only buying the right supplies.
So, overall, there’s a lot of work that we’re doing to control costs. I think back to the original question, though, are we doing enough? And I would say that our constituents say we need to do even more.
CHAD MULVANY
Matt, that’s a great insight. And, Joe, from the board’s perspective, how do you think about affordability? Is it a financial issue? Is it a strategic issue, a mission issue, or some combination of all the above?
JOE FIFER
I’d say yes, yes, and yes. You know, part of the Corewell Health mission statement is to improve health. And the vision statement is something along the lines of a future where health is simple, affordable, equitable, and exceptional. And so, it’s just one word but you notice it doesn’t say healthcare, it says health. And so, I think the fact that it’s in the mission and vision statement would tell you that it’s absolutely a mission issue, and you can’t have a mission issue that’s not strategic.
And, you know, how do you achieve strategies while we need to be sound financially, so it’s all three. You know, you ask how I think about affordability, I have probably a little bit of an overly simplistic and, probably, a view that might be taken the wrong way in some circles. It’s probably a comment that I wouldn’t feel comfortable making in my old role as CEO of HFMA.
But ultimately, I think our society, we don’t look at healthcare in the right way. We look, we’re looking at the wrong transactions. And so, you know, I’m from Michigan and I like to use—I don’t know a lot about cars, but it’s natural for me to use car analogies. You know, when we buy a car, a car today is a pretty complex machine, right?
It’s got all kinds of things going on in there that we don’t understand. But there’s one transaction to get it. And to make a correlation in healthcare, I think the transaction that we should be focusing on as an industry would be the acquisition of insurance and all the costs that are associated with that. That includes not only premiums, but also other out-of-pocket costs to consumers.
And I think if we focus on the acquisition of insurance, then the rest of the industry becomes the suppliers to that acquisition. And, you know, this is where the, you know, the provider industry doesn’t like to hear this, but, you know, why is that any different from all the suppliers that supply a very complex piece of machinery?
And so, I think if we start focusing on the acquisition of insurance as the transaction and then, you know, focusing on the most efficient model of delivering that insurance to our society, I think that would be a better way to look at healthcare. So, that’s a different way to look at affordability, it would be to look at it like that kind of a retail product acquisition.
CHAD MULVANY
Yeah, it almost sounds like it’s sort of starting from a place of an aligned integrated health system, and then you’re using the premium dollar and figuring out how best to support health, not healthcare.
JOE FIFER
Absolutely. Because in the long run. What do we need to do to really lower healthcare costs is we need to, you know, earlier identify chronic conditions, preclude chronic conditions from developing. Or when they do develop, inevitably they do, to lessen the the severity of those chronic conditions. And, you know, the best way to do that would be aligning the industry, you know, the insurance side with the two big components on the provider side. So, you’re absolutely right, Chad.
SHAWN STACK
Matt, hospitals continue to face a difficult balancing act. They’re being asked to invest in technology, workforce, access, and innovation. So, while you’re dealing with reimbursement pressures and those rising costs, that becomes a difficult balancing act, right? So, can you talk about the financial reality, as you see it, facing health systems today in this modern world of transparency and reimbursement cuts and all these new challenges?
MATT COX
Yeah. So, I’d say at a high level that there’s less room for error than perhaps there’s been in the past. And we have to be more strategic with our investments. And we also have to be bold, and we have to make the right investments that will have the impacts that we believe that they will have. I mean, there are a lot of regulatory and reimbursement changes that are creating all sorts of new questions for healthcare.
You mentioned AI. AI is investing rapidly. The supply chain and other economic concerns are just a whole new level of complexity, more than we’ve ever had to deal with before in the past. We have to deal with, it seems like, more and more hurricanes and more tariffs and more disruptions in the supply chain than ever before. And so, I think that in the midst of that, you know, healthcare finance leaders have to be bold and make wise investments.
And so, some of those investments could be in service lines that can help our country be healthier. So, instead of taking the easy path and focus on what makes money, healthcare financial leaders should make better decisions. And to Joe’s point, we should be investing in things that can help people be healthy instead of just help them get better from a sickness perspective.
So, what that means is we should be investing and make it easy to get early diagnosis of disease, where it’s much better for patients to get treated and much less costly than treating, for example, a stage one cancer versus a stage four cancer. I think the other thing is; what are health systems doing to provide tools for people to be healthy?
Are we focused solely on being sick care organizations, or we also focused on providing things to make people healthier? One of the things that we do at Corewell through Priority Health, our insurance company, is we have outdoor fitness centers that we’ve been building across the state, and that’s a perfect example of how we’re not only giving people tools to be healthier, but we’re helping to shine a light on the way.
We know that people that routinely exercise are going to be healthier than people that don’t exercise at all. And we’re making investments for people that can’t afford it to have exercise equipment in their communities that’s free, that’s accessible. And I’m proud that I work at an organization that is focused on making investments in health, just not in healthcare.
SHAWN STACK
That’s a great point. What concerns you most about the trajectory if the traditional financing model remains unchanged and providers and all stakeholders don’t begin to think outside the box in modernizing the traditional financing models?
MATT COX
Yeah, I think that there’s not going to be enough money in the system to continue to do the things the way that we’re currently doing them everywhere. So, I think incrementalism is going to be one of the biggest things we have to avoid, as leaders in healthcare. And we have to think bold because I think that if you’re not making bold investments in AI and in your supply chain and in clinical standardization, all these other things that we know will help us be more affordable and have better outcomes, then eventually you’re going to get into a situation where people just don’t want to pay for the services that you’re providing at the cost that you need to break even. And the end of that is hospitals will fail.
And my goal as CFO for Corewell Health is to make it so that we can continue to thrive into the future and embrace these new technologies so that we can be more affordable. And so, just to answer your question real plainly, my biggest fear is that people don’t embrace the future and cling to the past. And then they no longer have a future.
SHAWN STACK
I mean, lessons learned from past transitions, right? I mean, we’ve seen this before in the industry. It just seems to be moving much faster now with the technology, correct?
MATT COX
Correct. I agree 100%.
CHAD MULVANY
And Matt, I think you make a great point. You know, we’ve been talking about transformation for almost as long as I’ve been in the industry, but I don’t think we’ve actually sort of taken those first big steps because in some way, shape or form, the care model is going to have to change so that it can be delivered more economically, providing the same high level of care. And I think that’s just going to be an incredibly tough nut to crack. But certainly, organizations like Corewell I feel like are at the vanguard of that.
MATT COX
Absolutely. So, you know, when I think about delivering care differently, the things that I think about are how are we using technology to deliver care? So, if you’re receiving care the exact same way in 2026, that you received it in 2006, then there’s a problem and we’re not transforming. However, if you’re using things, like in our hospitals, in our clinics, we’re using ambient listening, where when you come in and meet with your physician now, they can be so much more efficient and effective because they don’t have to write everything down because the ambient listening is recording it for them, and it’s writing their notes for them. And they can deliver better care. They can be focused on the patient and not on the patient’s notes that need to be written down so that we can do the billing.
It’s things like that times 100 that I think that our industry needs to embrace. One of the things that we’re talking about is what does the patient room of the future look like? And there’s amazing technology now. There are cameras that can take the temperature of a patient and look at their blood pressure and all these things that weren’t possible 10 years ago. And so, as we think about the next 20 years, what should our nurses be doing in the patient room and what can technology do for them.
Do they need to come in and, you know, take your temperature every two hours or can the room be set up in such a way where the technology can do that automatically? So, those are the things we’re exploring now and are really excited on changing, in a real transformational way, how we deliver care. And then for big systems like us, it’s not enough to say, hey, we’ve figured it out and we put it on our newest patient tower.
But what organizations like Corewell Health have to figure out is how do we scale it to every single patient room within our system within two or three years, not within 20 years, as we do new towers.
CHAD MULVANY
No, great insight. And, you know, I love the part about the scaling because there’s a certain amount of capital investment that’s implied and sort of retrofitting to update those facilities that aren’t the newest buildings in the portfolio. You know, Joe, from your vantage point, what conversations are boards having today that they weren’t having, say, five, 10 years ago?
JOE FIFER
First of all, I think when we think about things like inflation and supply costs, things that, you know, that Matt has mentioned, some of the regulatory environment, revenue cycle pressures, those kinds of things. Those conversations, if you put those in a sentence, that could have been written 20 years ago. And so, in a lot of ways, those pressures on the industry are the same as we’ve been dealing with for many, many years.
What’s different now is the intensity of that, as you heard it from Matt, the intensity of those pressures coming from the outside and from the inside are much higher than they used to be. So, that, so, I don’t know if that’s different from five or 10 years ago, but it’s certainly more intense. But the easiest answer to that question is: the whole technology world and, you know, specifically AI. I mean, we’ve had a number of conversations.
We dedicated a significant chunk of our last board retreat to talking about AI, including hands-on, you know, modeling how it works. And so, how that plays into the acquisition of insurance and the delivery of care is mind-blowing. And so, that’s the easiest answer to the question is that’s very different than just even maybe one year ago, much less five or 10 years ago.
SHAWN STACK
Matt, you’ve talked about several transformation initiatives Corewell is currently focusing on, but are there others you have not touched on so far in the conversation that Corewell is pursuing that you’re most excited about?
MATT COX
You know, there are a lot of things that Corewell Health is pursuing to be more affordable and more efficient that I’m excited about. Yeah, I’ve mentioned earlier our ambient listening for physicians. We’re looking at doing ambient listening for our nurses. AI happens every day throughout our organization. We do an annual hackathon now, is what we call it, where people come in and explore how to use AI in different ways in different areas.
And I’m proud that our revenue cycle team always shows up so well there. And we come up with new ways to use AI to make it more efficient and more effective. But it’s happening everywhere, even in our system-wide leadership team meeting, which is kind of the direct reports minus two from Tina (Note: Tina Freese Decker, president and CEO of Corewell Health), that there’s about 125 of us that get together.
We’re having education on AI and tools and how we can individually use it to make our jobs better and more efficient. So, beyond that, you know, the whole ability for patients to use technology, digital access, consumer engagement. We’re doing some pretty neat things in our clinics now where we’re able to, with Epic, people can walk in and they’ve already been able to pre-register and they know where to go next. And when they walk in, we’ve got people that can help them use the technology and ask them, hey, have you already registered on your phone? And if not, here’s a kiosk. Do you need help with that? And really inviting our patients to use the tools that we’ve invested in to make their experience better.
As an organization that has both care and coverage, we’re using all sorts of technology to eliminate the need for things like prior auths. By aligning our care and coverage system, we’re actually with Epic on our hospital side, which is our electronic health record. We’ll be going live with Epic in our plan so that it talks seamlessly one with another, eliminating a lot of friction. So, we’re excited about that. We’ve got value-based care contracts in between care and coverage and not just within our organization, but when we find things that work really well between Priority Health and Corewell Health delivery, we expand that.
So, we’ll go have conversations with other insurance companies and other hospitals that we contract with and show them the data and say, hey, this is working, this is something that we could expand with you. There’s all sorts of focus on care model redesign as an organization where we’re looking at how we deliver care and how we can do it more effectively and efficiently, sometimes at home, sometimes bringing specialists closer to people so they don’t have to drive into referral centers to meet with specialists.
And I guess the last thing I’ll hit on just for a minute, I mentioned it earlier, is kind of our workforce transformation. We need to make sure that our workforce is comfortable with these AI tools, and that they see how it makes their time at work better, so that they can focus on what matters more.
I don’t think there’s a nurse out there that loves spending an hour a day doing documentation, so how can we make that more seamless and efficient through ambient listening as one example, so that they can spend their shift talking to and helping patients heal instead of sitting in a corner with a laptop typing their notes. I’m really excited about that. I’m really excited about that patient connection that we can make even better.
SHAWN STACK
Yeah, I agree Matt. I think it’s been inspiring to hear a lot of executives at healthcare systems talk to me about the surprises they’ve seen in the different age groups of patients and consumers really kind of embracing AI and those digital front doors because it’s a convenience, right? And so, don’t underestimate your consumers and your patients and your clinicians, I think, from using those tools.
MATT COX
Yeah, I agree 100%. And I think the trick there is we need to make the right thing to do the easiest thing to do. And so, if we think the right thing to do is for patients to talk to their PCP versus going to the emergency room, we need to make talking to the PCP easier than going to the emergency room. It’s just that simple.
SHAWN STACK
Joe, what does transformation mean from a board perspective? And how does a board look at transformation and set goals and strategic pathways?
JOE FIFER
First thing I’d say is it’s a lot more fun talking about transformation as a board member than it is as an executive in a health system, you know? Just because the challenge is, again, as we said, in a variety of ways in the last, you know, 30 minutes or so, it’s just the intensity is just ramping up all over the place.
You know, the reality is that we’re still on a classic, you know, “foot on two boats” environment here. You know, as a, and this is some of the conversation we have as a board, you know, we still need to provide the best, most up-to-date primary, secondary, tertiary, even quaternary care on our provider side of the organization.
And yet we also have a focus on premium affordability. And sometimes, you know, those two things are in conflict. What do we mean by, you know, the, you know, transformation? You know, Matt captured it in a couple of different ways. He used the word bold twice or three times throughout this conversation. And, you know, another way of talking about being bold is being courageous.
You know, one of the things, again, the reason I kind of laugh about it, it’s easier as a board member because we can sit back and say: big picture, what does all this mean to the total cost of healthcare in our community? You know, and how do we look at that differently? And I’ll give you an example.
You know, one of the things that I’ve been able to talk about on the board is just looking at primary care differently than what we’ve had in the past. And, and you know, here’s a finance guy talking about, you know, primary care. But, you know, how do we look at that different to really keep people healthier? You know, in some organizations that would be a threatening conversation because it would, you know, ideally hold down the amount of care that’s provided in our hospitals.
But in this organization, because there’s a transformation mindset, you know, I didn’t get kicked out of the room for making those, you know, asking those questions or raising those issues. And I think that just shows that this board, this organization, that Matt has done a nice job of leading a lot of that conversation.
We’re serious about changing how healthcare is accessed and delivered in this community. And so, I think that’s what we mean by transformation is, what does it feel like? What does it cost the consumer at the end of the day. And that consumer can be an individual, or it could be a somebody in the business community.
CHAD MULVANY
Joe, Matt, we have a document called “Our Market Point of View,” which we’ve titled “Achieving Health.” And one of the reasons why I thought you guys would be perfect for this conversation is very much kind of with the direction that Joe you started at HFMA, where they’re constantly focused on affordability. The place where this market point of view document lands on achieving health is that all of the stakeholders in the ecosystem—so your providers, your purchasers, communities—need to work together, rally around the individual and create the optimal conditions for them to achieve health.
As part of that work, we identified five core capabilities that healthcare organizations need to succeed: aligned growth—so, mission-aligned, margin-accretive revenue growth; fiscal discipline—on the cost structure side, making sure that’s efficient, making sure that you’ve got a high-performing revenue cycle so that you’re collecting what you’re entitled to by contract, and then also on the managed care side, making sure you’re being paid appropriately to market; regulatory excellence—making sure that you’re capturing all the allowable reimbursement that you’re entitled to; strategic agility—you know, this entire conversation has been about a complex, transforming ecosystem that we’re involved in, so, making sure that you are monitoring that and can react to it appropriately or react before something changes significantly; and then obviously the through line through all of this is talent optimization, both on the administrative side and the clinical side—that you’ve got the right people in the right roles, and they’re all working at the top of their license.
Which of these capabilities do you think will matter most over the next five years?
MATT COX
Well, I think it’s a hard question, but I think there’s also kind of an obvious answer. And you kind of already said it, Chad. I think the last one, talent optimization. If you don’t have the right people in the right jobs and they don’t have the skills that they need to and the tools that they need to be successful, the other things are really hard.
And I think we need to be able to deliver on all five of these to really, you know, achieve that health framework as you describe it. But without the right people with the right training in those roles, financial discipline, for example, is really hard. If you don’t have the right leaders and the right people on the finance team with the right structures, financial discipline is almost impossible.
JOE FIFER
Yeah, I think it’s just really hard to pick. I mean, first of all, you know, these five framework, the framework with the five capabilities, I think, is rock solid. You know, I think Matt’s absolutely right. I mean, if you don’t have the right talent, you know, the rest is just, you know, a mental exercise. I do think strategic agility would be maybe 1A on that list because, you know, if you’re not thinking broadly, then again, the talent isn’t going to move in the right direction.
So, I don’t know. Gosh, all of them are so important. You know, none of this will work if you don’t have the financial discipline. So, it’s really hard for me to say one is most important, but Matt’s probably right. If you don’t have the right people, then, again, it’s just a mental exercise.
CHAD MULVANY
You know, as we’ve been talking about transformation. And, you know, Shawn certainly brought it up earlier with the, you know, as we’ve thought about getting the care models right and optimizing those, I think one of the things that will drive some of that is, unfortunately, just the fact that we are facing a scarcity of talent and key clinical roles.
And so, I think some of that will, just by default, knock down some of the, shall we say, stakeholder barriers to innovation that organizations have faced over time, simply because we’re not going to have enough people to function in the way that we historically had, so we’re going to be forced to innovate, to still deliver the same level of care with a different talent mix.
MATT COX
Yeah, I 100% agree with that comment. I think that innovation is necessary for us to have continued impact in this industry and continued success and viability going forward.
CHAD MULVANY
Joe, healthcare has arguably never been more complicated, and I feel like every time you and I have this conversation we sort of make that comment. We’ve got reimbursement pressures, you’ve got challenges with commercial payers, particularly Medicare Advantage plans. You’ve got AI as an opportunity and also a disruptor. You’ve got workforce challenges, value-based care. You’ve got employer expectations around affordability and access, and you’ve also got public policy changes. And all of these things are coming together at the same time.
What does, given these different strands that sort of influence the environment, what does effective board governance look like?
JOE FIFER
Well, you know, I laughed earlier about, you know, some issues that are, you know, it’s easier to talk about transformation as a board member than it would be in management. This is one where I think it’s really hard for a board member to keep up on all of these changes, and it’s hard, you know, when I was in the industry, it was hard to keep up with changes.
It’s even harder when, you know, when you’re retired and you’re watching grandkids and, you know, playing around in retirement stuff to stay up with what’s going on in the industry. So, you know, effective board governance, I mean, I would go back to the basics. You know, Matt and Tina and the rest of the executive team here prepare a great board packet for us.
There are hundreds of pages, it’s filled with videos so we can get the, you know, a picture of what’s going on. But it takes time. And, you know, part of it is to prepare for our board meetings that it’s really hard to understand where the industry is going, all the complexities that you mentioned. So, the bottom line, the best way to be a board member is to be prepared for the board conversations.
And then secondly is to engage in some of the debate. You know, not just roll over on all kinds of directions that, you know, management might want to go without dialog and why and what are we doing? Or what about, you know, x, y, z. So, engaging in constructive debate as a board member I think is really important. And so—and they’re not fights. I mean we, I’ve been on the board a couple of years, every vote has been unanimous. And so, you know, it’s not like we disagree at the end of the day, but it’s not without pretty substantive dialog throughout the way. So, to me, that’s what being a board member is—trying to stay up on the industry through adequate preparation.
CHAD MULVANY
No, Joe, that’s great to hear that, you know, Matt and Tina and the team are taking the time to put together a comprehensive board packet. And it’s also great to hear that you’ve got that internal dialog. I guess the other thing I would say is, don’t hesitate to reach out to me or Shawn with questions, given, you know, we both worked for you, have a tremendous respect for you, and would be happy to answer any questions that you got.
SHAWN STACK
Matt, Joe talked about it shortly, but what do you, what are the keys that you lean on to educate your board about, you know, the current realities of the healthcare environment and how those are impacting your organizations and your communities?
MATT COX
So, I think that what I would say is I take every opportunity that I can to educate and talk about not only how Corewell health is doing but then compare it to the industry and then share what we think is coming. So, some of those opportunities, as Joe mentioned, include videos. We find that very effective with our board where we’ll pre-record a video, send it out, let them watch it before the meeting so we can spend more time in conversation in the meetings versus presentations in the meetings, so that, I find that very effective.
The other thing is we’ll send out articles. Tina sends out an email every Friday to the board with all sorts of information. And sometimes it does include information around the industry and some linked articles. And I’d say last play, we do an annual board summit from all the boards across our system because we have, you know, our system board and we have some regional boards and a Priority Health board, and we bring everybody together and we talk about the industry and the future together and in small groups and with videos.
And I think it’s just it’s there isn’t one thing that we do to spread the message. It kind of goes back to what I said originally. It’s every opportunity that we can, we have the conversation where it makes sense.
SHAWN STACK
We’ve had so many changes in, not just regulatory and policy areas of healthcare, but also lately, I mean, in the last couple of years, legislative changes at the state and federal level. How do you make those actionable, those items actionable for your board members during those meetings? I mean, how do you funnel all that information down?
MATT COX
Well, the finance team, myself specifically, have a very close relationship with our government affairs team members, and we’ll co-present sometimes to our board with particular asks around things that we would like our board members to do, whether that be to write a letter or sign a letter or make a phone call so that we can get our feedback to those that are in our nation’s capital and in our state capital.
SHAWN STACK
What topics receive the most attention from your board today?
MATT COX
Well, I think the big topic, so big changes. We spend a lot of time talking about, you know, H.R. 1, for example, has a pretty big impact to us as an organization. Spend a lot of time talking about that. Also, we spent a lot of time talking about big investments, and not just in capital, but in people and in equipment. That’s where we spend a lot of our time. It’s not, we don’t spend most of our time simply doing report outs.
What I look for as CFO is I want advice from experts like Joe that are on our board that can help me see the blind spots that we have. And we all think that way at our executive team. So, we’re not going to the board hoping to have a quick board meeting and just say what we want to say and have them vote yes. We’re going there with a group of experts to challenge our thinking and to help us make better decisions as an organization together.
SHAWN STACK
That’s interesting, Matt. I mean, you talk about challenging your thinking internally, you know, and with the board, with your board, I know you also are on finance committees. How do you use your finance committee as a sounding board and to kind of help you challenge your thinking at the industry level?
MATT COX
Yeah. So, it’s very similar but really heavily focused on finance. So, in our finance committee, that’s where we bring all of our capital projects. And typically we use videos to have the board or the finance committee prepped to so that they understand the background of what we’re investing and why. And then we come with usually two to three questions on the screen.
And that’s where we really want to spend our time, is getting feedback on it and looking for alternatives and talking about the alternatives we consider. And I would say that there are several times where we’ve brought something and then it got better because of the conversations we had at finance committee.
SHAWN STACK
You know, Matt, in one sentence, what’s the most important capability health systems you feel must develop to remain stable in today’s climate?
MATT COX
Yeah, I think that that’s a really interesting question. And you might be surprised a little bit by my answer, because I think that what you have to get really good at is you have to try new things, even if you fail, and then you have to be able to scale the things that work better than anybody else. It’s not going to be enough to have one area that’s working really good. You have to be able to test and scale in all areas.
SHAWN STACK
What gives you the most optimism about healthcare’s future despite all the challenges we’re discussing today? I’ll ask you both that.
MATT COX
You know, what I would say is, anytime I need to pick-me-up, I go around and talk to the next gen leaders that are coming up, the managers, the new directors, and ask them about their day and what they’re working on. There are some incredible things that are happening two or three levels down from the C-suite. And I’m actually really excited about these next gen leaders and what they can do 15, 20 years from now.
SHAWN STACK
Joe, anything you want to share there about your optimism about healthcare’s future?
JOE FIFER
I, you know, I think I would share what Matt just said. I, you know, I think sometimes it gets, this industry feels overwhelming to me and that, you know, I think that, you know, mathematically, we can’t continue the way that we are now. I mean, just by definition, you know, whether it’s at the federal level or within the business community.
So, that can feel overwhelming to me until you start talking to the people that are delivering care and the people that are, you know, the management team here and the things that they’re thinking about, that’s what that gives me hope. I would agree with Matt 100%.
SHAWN STACK
I really thank, want to thank you again for joining today’s episode and sharing your insights with our listeners. You guys are both folks that Chad and I very much respect throughout the industry.
CHAD MULVANY
Just want to add my appreciation for your time. I know it’s incredibly valuable. I’ve enjoyed the conversation. I think the audience will too. It’s been packed full of great insights.
MATT COX
Well, thank you both for inviting me to participate, and it’s always a pleasure and an honor to present with Joe.
JOE FIFER
Same here. Appreciate all you guys.
SHAWN STACK
Well, with that, we’d also like to thank all of our listeners for tuning in. You can follow “Achieving Health” on Apple Podcasts, Spotify, Amazon Music, or wherever you listen to podcasts. You can also now follow us in the Health Podcast Library. If you want to learn more about the topics we discussed here today, be sure to check out the show notes for related content.
You can also subscribe to our healthcare FORsights and follow us on LinkedIn to get regular insights and updates. And we welcome you to reach out to me, Chad, and the team at Forvis Mazars if you have any questions about how these topics may affect your organization.
CHAD MULVANY
Shawn and I will be back next week on Wednesday, September 16, for the next round of “Washington Watch” updates. Until then, here’s wishing good health for the communities you serve.
ANNOUNCER
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