Mark Green: Tell us about your background. With a career history primarily in the Southwest, what attracted and brought you to Kentucky?
Bruce Tassin: I’ve been in health care now 30 years. I started at an entry-level position as a safety coordinator in the Central Louisiana market and worked my way up over 18 years to administrative president of that hospital. It was part of what today is CHRISTUS Health of Irving, Texas, which was formed when Sisters of Charity of the Incarnate Word Houston and Sisters of Charity of the Incarnate Word San Antonio came together in 1999.
In 2008 CHRISTUS Health started a new ministry in Santa Fe, New Mexico. I was asked to go there and be the COO of St. Vincent Regional Medical Center. CHRISTUS had purchased 50% ownership and a community-based board owned the other 50%. I worked as COO and ultimately CEO of the market from 2008 to 2015, and we did a lot of great stuff. We brought the roots of the Catholic-based faith of the organization back and as a team were very successful. My biggest accomplishment was building a sustaining team there; one of my board members, who I put on my team, Lily Montoya, is now the CEO of that market doing a great job.
We were there about eight years. In 2015, our daughter was finishing grad school at Baylor University; we had an empty nest and were wondering what was next. CHRISTUS Health didn’t have any other opportunities, and I saw there was an opportunity with KentuckyOne Health in the Lexington market. My wife and I prayed on it and said, ‘Let’s go visit and see what it might look like.’ We came and interviewed. We fell in love with the community and fell in love with the mission. It was still oriented in Central/Eastern Kentucky to a Catholic faith base. We loved the history of the Sisters of Charity of Nazareth, and said, “This just feels right.” After 25 years with one organization, my wife and I decided to make the move.
This community is very similar to the community I was raised in in Louisiana. People are gracious, they give you the benefit of the doubt. People were hungry for a leader who would come and help stabilize the Central/East Kentucky market, Lexington specifically, and stay awhile. I don’t jump around; I like to build roots, I like to build a team. We’ve been doing that here in Lexington and have had a great first four years.
MG: It’s been a year since a rebranding from the former KentuckyOne Health, a reduction in the geographic footprint to shift and refocus as CHI Saint Joseph Health. How has that change affected the organization?
BT: It’s been very positive. About 18 months ago we started a process to look at Central and East ending up (as a provider system) on its own. We went through a strategic planning process and did a lot of community outreach interviews, testing to see how people would feel about us going back to our roots. Jeff Murphy, our senior vice president of marketing/PR, led that and we got great positive feedback. People had never lost the Saint Joseph Health (brand); they resonate with Saint Joseph. When we made the decision to rebrand back to Saint Joseph Health it was tremendously positive. We had community leaders, employees, physicians who really got excited to get back to our roots.
MG: Recap what communities you now serve.
BT: In Lexington we have Saint Joseph Hospital and Saint Joseph East. We have a critical access facility in Berea called Saint Joseph Berea; an urgent care facility, 150 beds, Saint Joseph London; Saint Joseph Mount Sterling; and in Bardstown, Flaget Memorial Hospital. We have an emergency room with some other outpatient services in Jessamine County. We also have a large physician practice of about 250 providers that covers all those markets, and we have a clinically integrated network that covers about 100,000 to 120,000 lives that we manage.
MG: Is Saint Joseph Jessamine expected to one day grow into a full hospital?
BT: Not so much into a hospital but more outpatient services. Today the biggest need would be additional outpatient services. We need more physician office space there, and with more outpatient physician office space there’d be other ancillary services that we would need to be added.
MG: What lessons were learned from the KentuckyOne Health era?
BT: KOH started in 2012, a little before I came in 2015. The concept was spot-on: “Build an integrated network that could provide services across the state in all areas of need” was the right thought process. But it was a massive undertaking to bring the legacy Saint Joseph health system together with the University of Louisville health system, with Jewish and with Sts. Mary & Elizabeth. Tie into that the massive need of capital; a lot of those facilities and systems needed more capital investment even before it came together. It was an overwhelming task at a time where there was limited capital across the state and across the country for reinvestment available to truly be successful. The concept was right.
MG: How much capital did Catholic Health Initiatives put into the system?
BT: Hundreds of millions. At one point in the Louisville market alone, if you include IT systems, it was about $500 million. And that still wasn’t enough.
MG: Did that essentially become a gift to the communities and the state?
BT: That’s the beauty of being part of a (large) system. That money was coming from CHI, which at the time said it was committed to investing in Louisville, because it thought the strategy of KentuckyOne coming together was the right thing to do. Unfortunately, the focus to get those things stabilized probably limited the capital that could be spent in Central/Eastern Kentucky for that period of time.
MG: Saint Joseph represents the faith-based history of this provider organization. How does that differentiate you from others?
BT: Our mission statement is to always be there for the underserved. We don’t question whether somebody has commercial insurance, Medicare, Medicaid or are uninsured. Our doors have always and will always be open, as a Catholic faith-based entity, to all comers. That’s the biggest differentiation.
There’s a saying by many religious congregations who provide health care, “No margin, no mission.” They’re not there just for the poor, they’re there for all comers. We have to be competitive in the Medicare, Medicaid and commercial ranks to ensure that we can always take care of the uninsured. As health systems grow, you’ve got to be able to pay for the capital, and if you put yourself out there to take care of only the underserved, then you will not be able to pay the bills, attract the labor, pay for your supplies, pay for capital investments. It’s a balance of the portfolio in ensuring that you’re out for business for commercial-covered lives and Medicare-covered lives but always will have a focus on the uninsured.
MG: What is the administrative, financial, policy relationship between Saint Joseph and CHI, which is based in Denver?
BT: CHI, the former parent corporation out of Denver, merged in February 2019 with Dignity Health, a Catholic health system primarily in the West – California, Nevada and Arizona – to form CommonSpirit Health. (Based in Chicago, it is the largest Catholic health system in the U.S.). CommonSpirit Health now has two support offices, one in San Francisco and one in Denver. That’s the parent corporation at this point.
We will continue to maintain our name as CHI Saint Joseph Health. The purpose of coming together was to look at evidence-based best practices, economies of scale in GPO (group purchasing organization) contract pricing – meaning how do we leverage to reduce our costs of supplies and goods by coming together and being able to negotiate? CommonSpirit is going to play a big part in advocacy for the underserved across the country for policies that ensure access for all. Daily operations are going to continue to be local.
MG: Is there a cash flow between Saint Joseph and CommonSpirit? Are they injecting money? Do some of the dollars generated here go to them?
BT: As mentioned earlier, KentuckyOne had the influx of $500 million (from CHI). At that time KentuckyOne was not generating that cash, so it was coming from other markets that were generating good cash flow and it was invested in the Kentucky market. Our goal is to be able to cash-flow ourselves. Typically in a market you look at a margin of 8% or better to be able to cash-flow yourself, but the allocation would be coming from CommonSpirit to the markets as a pool of capital dollars. It’s essential that ultimately everyone gets to sell sustaining capital, but it’s unrealistic when you’re that large that every market will be able to do that. We want to be able to do our best to contribute to that bucket, and then those dollars could be allocated back to us.
Prior to my arrival, Saint Joseph Mount Sterling built a brand new facility that (on its own) would not have been able to generate the capital investment to build that new facility. That’s an example of capital investment from a larger system. Saint Joseph Mount Sterling is new. The London facility is new, and Flaget. And Saint Joseph Jessamine. At that time, Saint Joseph health system would not have been able to produce that kind of cash flow to do that, so that’s where the larger system comes in and invests.
MG: Among major-provider entities and networks here in the state, some are in the black and some are not. Is Saint Joseph near that 8% goal?
BT: Yes. For the last two years, we’ve hit 8-plus percent. And this year through December, we’re hitting our overall budgeted target. There has been a lot of good work, a lot of focus and rebuilding of the Lexington Saint Joseph Health system – reconnecting with our community, rebranding, and reinvesting in Central and Eastern Kentucky.
MG: What are the unique characteristics of the Lexington health care market? How does CHI Saint Joseph Health complement, and also compete with, the other providers in the market?
BT: In a population of just under 400,000, probably serving more like 800,000, the Lexington market is blessed to have two private health care systems and a level-one trauma center. UK Healthcare has the level-one trauma center and that higher acuity access here. It’s a blessing to have that referral for transplant, trauma. If you look at the three health systems, we all fit a different niche, but based on the size, population and need of the community, there’s a need for all three systems.
There are things we work together on such as the paramedicine program here. A lot of patients who call 911 don’t need to go to the hospital; they have chronic conditions and so forth. UK, Saint Joe, Baptist Health together work on how we reduce those calls but provide services to patients who may need it in the home. On the opioid crisis, all three entities are working together with the city and Kentucky Hospital Association. We collaborate on those areas and try to work on them at a community health level.
MG: Saint Joseph Health has a diverse footprint across Central and Eastern Kentucky, ranging from critical access hospitals to major tertiary referral centers. How do you develop a strategy to serve various communities while operating as one system?
BT: Saint Joseph Health has a tertiary facility, which is here, Saint Joseph Hospital, and services including a comprehensive program outside of trauma and transplant. It’s a natural referral center so you would think your outlying facilities should just refer all higher-level care here to Lexington. However, we looked at our three-year strategic plan about 18 months ago, and when we talked to the communities we serve we found people want services closer to home. We’re focusing on trying to keep services in those outlying communities.
We flipped our mindset and our strategy to build better services in the community and only transfer services truly of a higher level of care to the Lexington market like neurosurgery, or heart care for bypass surgery, valve replacement and so forth. Each entity looked at the strategic plan. I’ll use London as a good example because London is a regional referral center for central needs. We saw a need for them ultimately to become a trauma center; there’s not a level-three trauma center in the central/southeastern part of the state. They’re in their year of data collection, acting as a level-three trauma center with orthopedic coverage, with general surgery coverage. Every time they get a trauma patient, they go on trauma call alert – they test it, they look at it, they collect data. That process typically takes a year. By the end of 2020 or January 2021, we anticipate they will be an actual level-three trauma center. That keeps all those patients there.
It’s not that we don’t want patients to get care at UK as a level-one trauma – there’s truly level-one trauma that needs to be taken care of at UK – but there’s level three that needs to be taken care of in Central and East. That population will be able to depend on a level-three trauma center located there. It’s the same thing with neonatal intensive care unit care; we’re working on getting them up and running on a level-two NICU. Right now those babies have to come to Lexington. You want UK to take care of the higher-level NICU babies, but lower-level NICU babies need to be taken care of in that community. We’re focused on investing resources to get them up to that level. People would rather stay home and get care than travel. It’s a burden on families.
MG: Saint Joseph seems to be growing, with recently announced ambulatory centers in Lexington and Winchester. Will centers such as these continue to be an area of focus?
BT: Most definitely. Whenever you look at the need, especially the need of the future, you need a bigger ambulatory footprint for two reasons. You want lower-acuity access for the patient population. As an example, our emergency departments. Whether it’s our EDs, UK’s EDs or Baptist’s, a high-acuity location usually is a higher cost to patients, and we want to be able to expand lower-cost locations for our population. Whether it’s extended hours in our primary care offices or additional urgent cares located throughout Central and Eastern Kentucky, we want to lower the cost and ease of access so patients have more of a lower-acuity retail environment where they can go in and out to get their care. It aligns with the overall population health strategy across the country. We want to keep people well, so we have to have these access points that give people ease of access so they seek care sooner rather than later. If they do it later, it hits a higher-acuity, higher-cost venue.
MG: This ties into how you fit into the market. How do you describe Saint Joseph’s specialization niche among the providers in the region?
BT: Subspecialization offerings is a niche, either the employment of subspecialists or alignment of subspecialists. We have a great network on neurosurgery; it’s a partnership with Lexington Clinic. On the orthopedic side, we have both employed orthopedic physicians and we have also aligned with Lexington Clinic for services at Saint Joseph Hospital; we have alignment with other orthopedic physicians on other campuses. For our services, we’re well positioned both in our network of employed and aligned on subspecialities.
MG: What is your view on the question of whether some of the rural community hospitals in Kentucky are likely to go out of business in the near term?
BT: That is a big worry in the industry today across the country. Saint Joseph has several rural facilities across Central and Eastern Kentucky. We’re lucky to be a little bit larger size. There is a big possibility, unless they align with larger systems, that community hospital closures could come to pass. More facilities will either have to sell or ultimately go out of business. We have an affiliation agreement with Taylor Regional Hospital in Campbellsville; that relationship is more of, “How do we help you?” They access our GPO, through which they can purchase supplies off our contract pricing. We help them in managed care negotiations and we actually employ their CEO under Saint Joseph Health. The point being, we don’t want to own every hospital, but if there’s a way that we can help them access lower cost and expertise, that’s the route we need to go as a state to try to help smaller facilities stay viable. This is not just about Saint Joseph Health; that would be any other larger system aligning with smaller facilities.
MG: What are Saint Joseph Health’s top operational and financial goals?
BT: Number one would be increasing patient access, and I would start with primary care. It’s no surprise that many folks in the industry say the No. 1 priority is access to preventative care. That means primary care providers. It’s a struggle not just for us, not just for the state of Kentucky but across the country to continue to develop and grow. That requires recruitment and alignment for everybody to provide access to lower the cost of care. Second to that would be improving the ambulatory footprint that would provide ancillary care services at a lower cost that primary care providers can use – again, services closer to people in the populace and not coming in to the heavily dependent acute-care facilities.
MG: What major takeaways came from Saint Joseph’s most recent community health survey? And do you have to do separate surveys in every community?
BT: Every community we’re in, we have to do a separate health survey. For the most part, the top priorities align in all of them. Obesity and diabetes are in the top three. Opioid or substance abuse would be No. 2. And No. 3 is mental health. For all our markets, those are really the top three.
So for those three, what are we doing? One of the big areas of success for us is our diabetes program. We have certified diabetes outpatient programs at every one of our facilities. We’re trying to improve our inpatient discharges. If a patient has a primary or secondary diagnosis of diabetes, we’re trying to use our clinically integrated navigators (CIN) network to attach with those discharged patients and connect them to our outpatient diabetes program. It gives them a venue for outpatient preventive care once they’re discharged, and it helps us to monitor and provide services to them to keep them from being readmitted – that’s where that higher cost of care is. Our biggest push this year is taking that outpatient diabetes program to that next level for discharged patients, trying to utilize our CIN network and care navigators.
MG: Your system recently affiliated with Cleveland Clinic for cancer care. Why Cleveland Clinic?
BT: We’re very excited and have had tremendous feedback from our community on how positive it is. Why Cleveland Clinic? For top cancer treatment, you have Cleveland Clinic, you have MD Anderson (Cancer Center in Houston), you have Vanderbilt (Ingram Cancer Center in Nashville), you have Mayo Clinic (in Minnesota). We tested perception of those top-flight programs in the community. Cleveland Clinic is in the top 10 in cancer programs in the country. When you talk to our providers about patients who have asked for a second opinion, the majority of them have been done by Cleveland Clinic. It has close proximity. Just as our strategy has been trying to keep care closer to home, the “why” of affiliation is that even though Cleveland Clinic is only one state away, it’s still one state away. A lot of patients want second opinions in our community; they don’t want to travel. This affiliation provides access to the Cleveland Clinic right here at home, working with their local medical oncologists collaborating with the Cleveland Clinic on a second opinion.
MG: Is it financially significant to CHI Saint Joseph Health (and other Kentucky providers) whether the commonwealth has “expanded” Medicaid coverage?
BT: It’s extremely important. Our mission is to cover all who come, regardless of ability to pay. Before the Affordable Care Act and the expansion of Medicaid, we had a substantial number of uninsured patients who had nothing. But we took care of them. Expanded Medicaid allowed us to at least collect some level of reimbursement for services provided. We, at least at CHI Saint Joseph Health, are a lot better off with expanded Medicaid. The community is better off because you’ve got a group of our population who now have some level of insurance and feel like they can go to their primary care doc or ancillary services or hit EDs where appropriate and say, “I have insurance, I want to be taken care of.” Previously there was a vast percentage of that population who would wait until it was a true emergency and be a larger burden of cost on the system versus now proactively being able to do it preventatively. Our whole community, the whole health care system here, is a lot better with the expanded Medicaid.
MG: The Lane Report last year published an article about the complex job duties of hospital administrators. Your responsibilities over the system regionally exceed even that. As a leader, what are your key components of success? What are your must-haves?
BT: The No. 1 area for success is the team you pull together. You look in the industry at individuals who have been very successful in large health systems, but when you talk to them it’s never been about them. No one person can make it happen. It’s the success of pulling a strong team together. I was blessed to have some leadership already here. Like Jeff Murphy, (vice president marketing/communications), who has a legacy of years working with Saint Joseph Health system and an ability to identify top talent and recruit. I am so excited about the leadership team here in Lexington in the corporate office for CHI Saint Joseph Health. They’re from different backgrounds. While I’m from faith-based, we have recruited some from the for-profits: HCA, Lifepoint. They have to commit to the mission, and they have, and bring a skill set that allows us to leverage the best of their knowledge from their historic perspective, whether it’s for-profit or not-for-profit, to help us align and build a strategy and an operating model that allows CHI Saint Joseph Health to be successful.
Number two is community integration, the expectation not only at the system-structure level but at every facility in the community. We’re here because at some point we were asked to be here in each market. And if you ever lose that then it’s time to ask, ‘Should we stay in this market or not?’ Our expectation is that our local leadership at each one of our markets is ingrained in that community, giving back to that community.
And No. 3 is about relationships. When you look at how wonderful an opportunity we all have to serve in this ministry, in this community, and in this state, it’s about building relationships in the communities we serve and keeping those relationships strong, positive; ensuring people understand that it’s about a relationship that is built on trust and transparency.
MG: How has being a health care CEO changed over the course of your career? What have been the major adjustments and trends?
BT: The biggest piece is being nimble on what the focus is today and where the need may be different tomorrow. A lot of people over the years looked at five-year strategic plans, 10-year strategic plans, some down to three years. It’s getting to the point where you have to look year to year at the focus that we need to have as a community health system. You have to be nimble, you have to be flexible. You have to have a great team around you, helping you keep the pulse of what’s going on in the industry. You have to regularly be looking at what’s happening in other markets and is that coming towards your market.
MG: Where do you see Saint Joseph Health in 10 years?
BT: You’re going to see a system that will still have a high acuity operation but heavily invested in and more focused on population health. We’re going to be geared more towards trying to take care of more outpatients. More inpatient surgeries are going to be pushed to outpatient, which means we have to be flexible on changing our mindset and our model on how we do outpatient surgery, how we provide a footprint of other ambulatory sites, whether it’s imaging, therapy services or telemedicine. You’re going to see a bigger digital footprint to allow for that to occur over the next 10 years. ■
CHI Saint Joseph Health
CHI Saint Joseph Health, part of Chicago-based nonprofit Catholic system CommonSpirit Health, consists of 135 locations in 20 counties, including hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies. The system serves patients in 35 Kentucky counties.
• Flaget Memorial Hospital, Bardstown
• Saint Joseph Berea
• Saint Joseph East, Lexington
• Saint Joseph Hospital, Lexington
• Saint Joseph Jessamine, Nicholasville
• Saint Joseph London
• Saint Joseph Mount Sterling
• Women’s Hospital at Saint Joseph East, Lexington
Long-Term Acute Care
• Continuing Care Hospital, Lexington
within Saint Joseph Hospital
Taylor Regional Hospital, Campbellsville
Express Care, Bardstown
Express Care Palomar, Lexington
Home Care & Hospice
VNA Health at Home, Lexington
Mark Green is executive editor of The Lane Report. He can be reached at [email protected]