..Focus more on holistic health. Reinvest our resources to more prevention and primary care. Incentivize people to work on the front lines and become generalists, rather than specialists.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Rosemarie Day. Rosemarie has over 25 years of experience in the public, private and non-profit sectors, including 16 years of leadership in state government. Most notably, Rosemarie served as the founding Deputy Director & COO of the Massachusetts Health Connector where she played a significant role in launching the award-winning organization that established the nation’s first state-run health insurance exchange. In 2010, Rosemarie founded Day Health Strategies to focus on implementing national health reform. Her healthcare consulting company now serves organizations across the country that want to transform their approach to health care.
Thank you so much for doing this with us Rosemarie! Can you tell us a story about what brought you to this specific career path?
I started my career working on inequality and social justice issues, which led me to the Harvard Kennedy School to study public policy. This program made me excited to work in government, especially in an innovative state like Massachusetts, which exemplifies the idea that states can be the laboratories of democracy. I worked in the Massachusetts government on different initiatives starting with welfare reform and ending in health reform.
When I worked on welfare reform, the pressure was always to get people employed. However, once they were employed, they did not have any benefits. It felt like we were abandoning people because we pushed them so hard to get jobs, but once they did, they lost their Medicaid coverage. I saw that there was a huge gap in the provision of health care for the people who were working but did not receive health insurance through their employer. I wanted to work on health reform to fill those gaps.
I went on to serve as the Chief Operating Officer for the Massachusetts Medicaid program. I then became the founding Deputy Director & COO of the Massachusetts Health Connector where I helped to launch the nation’s first state-run health insurance exchange. During my tenure, the Health Connector became a model for national health reform.
Because I had the experience of launching the first exchange, once the Affordable Care Act (ACA) was passed, I founded Day Health Strategies to help other states implement national health reform. I began working with insurers and providers as well and found that I loved consulting. Day Health Strategies is now serving organizations that want to transform their approach to offering or delivering health care. We have worked with numerous private and public sector organizations in developing and implementing health reform, health care transformation efforts, and related strategies.
Over the course of my career, I have gone from focusing on filling coverage gaps to believing that health care should be a right and should not be tied to other factors, such as employment. I am now focused on improving our health care system and achieving universal health care coverage.
Can you share the most interesting story that happened to you since you began leading your company?
In the early days of Day Health Strategies, I worked with people in a diverse array of states, from Hawaii to Montana to Rhode Island, educating them about the ACA and helping them to figure out their approach to implementing or participating in the ACA. Considering the fact that the path to pass the ACA was so polarized and that there had been so much sharp rhetoric about the law, I was surprised to find that once the law was passed, people in so-called red states put aside the polarization and rhetoric — they rolled up their sleeves and dove into thinking about the best way for their state to implement the law or for their company to participate in an exchange. They were able to take their unique needs, culture, and environment into consideration when they were implementing the ACA. I saw people in these states who were truly focused on serving their citizens and they were able to get away from the polarization. It was great to work in such different places with a wide variety of people who were all just trying to figure out how to make it work. There are 20 million more people with health insurance today as a result.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
After I founded Day Health Strategies, I was really nervous about hiring my first employee — I worried about sustaining enough business to pay their salary. So, I saved up a whole year of their salary before hiring that person! When I told people later that I did this, they thought I was crazy. I did not have enough faith in myself to trust that I would be able to support this employee, even though I had too much work to do on my own. Now I better understand the business and have confidence in my company.
What do you think makes your company stand out? Can you share a story?
I think our integrity makes us stand out. It means so much to me that we have clients say, “you are not the usual consultants.” We are very mission-oriented and truly want to improve the health care system. As a firm, we focus on problem solving with our clients and develop a high level of trust. Our clients trust us to help them determine what they need, while not worrying about us overcharging or taking advantage of them because they know we always have their best interests in mind. Our focus is more about helping solve problems, then just making money.
What advice would you give to other healthcare leaders to help their team to thrive?
It is crucial to really listen to people and have empathy for them. It is important to have diverse teams and work collaboratively. Make sure everyone’s ideas are on the table and being heard. This involves thinking about how to include all levels of staff, including front line staff. When people feel like they are being heard and valued, they will give more to their work — it goes way beyond their paycheck.
In health care, you can tie your work to a sense of purpose and develop a mission orientation focused on making peoples’ lives better. Organizations should not lose sight of this focus because it can be a huge source of energy. However, this sense of purpose can easily get lost in organizations, especially large organizations, so it must be a deliberate focus.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
- First, the US does not have universal health care. We do not treat health care as a right, which is leading to people getting sicker than they should and dying unnecessarily.
- Second, when you look at overall population health, we spend too much to get too little. As a country, our system does not focus or invest enough in prevention. We can always point to extreme cases where we solve some medical mystery or do something miraculous, our medical system does this extraordinarily well. However, this comes at the price of insufficient investment in prevention. If we redeployed some dollars from high-end specialty care to prevention and public health, we would get to better overall population health.
- Third, we do not spend enough on social safety net services. Compared to peer countries, the US government spends much less on social services and we have worse health outcomes. As a country, we tend to over-medicalize and under-support people. Generally, our investment strategy is off — we spend a lot of money in the wrong places.
- Fourth is price. Compared to other countries, we have way higher prices for the exact same health care service, whether it’s pharmaceuticals or procedures. There is a lot embedded in what goes into these high prices, some of which is legitimate, but other aspects are wasteful, including excessive profits. Other countries’ solutions are to regulate prices and we don’t, generally speaking (other than for government programs, such as Medicare and Medicaid). Capitalism is not working in the health care industry because it’s full of market failures. While we don’t like to regulate prices or control markets in the US, there needs to be some government intervention to combat these market failures. Other countries successfully have government intervention in their health care industries, but we have been squeamish to do so, and we pay a high price for that.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Make healthcare a right, so there is universal health care coverage. Every other wealthy country has done this.
- Focus more on holistic health. Reinvest our resources to more prevention and primary care. Incentivize people to work on the front lines and become generalists, rather than specialists.
- Keep expanding value-based care models and patient-centered care models, such as Accountable Care Organizations (ACOs). These models incentivize our system to focus on higher quality care and better outcomes, while controlling cost.
- Invest more in social determinants of health and the related social services. We need to address the racial disparities in our health outcomes, and this is one important step.
- Limit profits in health care. For example, as part of the ACA, a Medical Loss Ratio (MLR) standard was set which limits the portion of insurance premiums that health insurance companies can spend on administration, marketing, and profits. Under the ACA, for insurance sold to individuals and small employers, only 20% of premiums could go to administration, marketing, and profits.
Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
On all levels, individuals, corporations, communities, and leaders, need to work to develop the political will to make healthcare a right. There is a way to do this that both benefits businesses and strengthens our fraying social fabric. We need to be fairer in how we treat our citizens. There are too many people that don’t have health insurance or are worried that their health insurance is unusable, because of cost sharing and high deductibles. Others are in a very precarious position: if they lose their job, they lose their insurance. Too many people are dealing with the uncertainty of health insurance and this will only get worse with changes in employment because there are a decreasing number of jobs that provide robust benefits. Certain aspects of our changing economy, such as our growing technology focus and globalization, are eroding our security of employment-based insurance which underscores the need for universal coverage.
Creating the political will to embrace health care as a right is rooted in embracing the value of the public good and a commitment at all levels to be more generous to more people. A focus on creating stronger community connections will benefit all of us, including businesses. Your ability to exist as business relies on having a functioning, healthy, and prosperous society.
As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Mental health and physical health are very intertwined, and many patients are dealing with both physical and mental health issues. Often there is interplay between mental health and physical health conditions where one affects the other or the ability to manage the other. Because of this, the health care systems for both should be integrated. In order to do this, we need to tackle the problem from many angles. One way to push integration is to continue to grow value-based care models, such as Accountable Care Organizations. Many of these organizations are responsible for the total cost of care of a patient, so they are incentivized to not only manage physical health but also mental health and integrate providers of these services in primary care.
Another way to support this integration is to increase access to mental health services through solutions, such as telehealth, to make mental health services more readily available. To further increase access, insurance plans could decrease barriers to entry for people by eliminating copays and other cost sharing for patients accessing mental health services. These solutions are the right thing to do from a humanitarian perspective, but also from a business perspective. Patients with mental health issues tend to be more expensive because many times their mental health condition prevents them from being able to manage their physical health issues. In order to better care for patients and control costs, patients should have increased access to mental health services that are integrated into their physical health services.
How would you define an “excellent healthcare provider”?
An excellent health care provider will go above and beyond their job description and give you more than a billing code. They will make themselves available to you when you really need them. They put caring before all else.
I remember the first time one of my children went to the emergency room. It was on a Saturday. That night, as soon as my child was discharged, we received an email from their pediatrician. He had seen the hospital report come in and reached out to make sure that my child was OK and that we were OK as a family.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
- “The arc of the moral universe is long, but it bends toward justice” — Martin Luther King Jr.
I like to think about this quote when I see our society moving in the wrong direction, in order to inspire myself to keep working toward social justice and take a longer view.
- “The most common way people give up their power is by thinking they don’t have any.” — Alice Walker
This quote always reminds me to not underestimate what you bring to the table individually or what you can build collectively.
Are you working on any exciting new projects now? How do you think that will help people?
I am currently writing a book to galvanize women to get active and push for universal health care. I have a publisher and it will come out in early 2020. The aim of the book is to create the political will to make health care a right. I believe that as a country we should be taking a pragmatic path forward to reach universal coverage and to make that happen we must capture enough hearts and minds to embrace the goal and fight for that cause.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
- Make Trouble: Standing Up, Speaking Out, and Finding the Courage to Lead — My Life Story by Cecile Richards. This book is very inspirational and pushes you to have the courage to stand up for what you think is right and to do the hard things even if you seemingly don’t have enough resources or support.
- The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid. I really like this book because it gets you out of just a US focused mindset and broadens your thinking to expand upon what you thought was possible for health reform in the US context. T.R. Reid does a great job of explaining how different countries operate their health care systems and then ties it back to what the US could borrow from those systems to improve our system. The book is very thought provoking because it grounds different health care systems in a countries unique values and demonstrates that these programs are built around values. This is important when considering health reform in the US and reinforces the need to take a values-based lens.
- The American Health Care Paradox: Why Spending More is Getting Us Less by Elizabeth Bradley and Lauren Taylor. This book is great because it really dives into why our health outcomes are so poor, even though we spend a lot on health care. What the book really boils this down to is our underinvestment in the social determinants of health.
- Being Mortal: Medicine and What Matters in the End by Atul Gawande. This book is so powerful because of the impactful way that Atul Gawande weaves together stories and data to create a very engaging and compelling message. He makes the subject of death approachable and opens up the conversation about our tendency in the US to prolong life for as long as possible, even if it means profound suffering.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
I am currently working towards inspiring a movement for universal health care coverage through my forthcoming book. We don’t have to agree on our specific path to get there, but we all need to be working in that direction.
How can our readers follow you on social media?
Please follow me on twitter, @Rosemarie_Day1 (https://twitter.com/Rosemarie_Day1)! You can also follow my company, @DayHealthStrat (https://twitter.com/DayHealthStrat). Check out my personal website (https://rosemarieday.com/) and my company website as well (http://dayhealthstrategies.com/).
We also have a podcast series, Unlocking Accountable Care. The focus of the series is all things accountable care, diving into the transition to value-based care and exploring how innovative organizations are addressing challenges and forging best practices in Accountable Care programs.
Thank you so much for these insights! This was so inspiring!