In the past five years, a new cadre of leaders has lled the executive suites of hospitals and medical groups throughout Westchester. Some have taken the place of longtime predecessors; some are helping mergers gel, then solidify; others are leading new alliances that have evolved through mergers or Medicaid reform. Some are doctors and nurses; others, nance gurus and philosophy majors. But each of these new leaders stands ready to steer the local industry through upheaval and instability, and into calmer waters.
As most Westchesterites are aware, the healthcare sector here has experienced a spate of mergers and acquisitions recently. Major players in New York City, such as NewYork-Presbyterian (NYP) Hospital and Montefiore, have taken over smaller community hospitals — echoing a national trend of consolidation and requiring leaders to knit together sets of competing cultures.
“Fresh ideas, respectfully balanced with all of our past accomplishments, are a recipe for success,” says Stacey Petrower, president of NYP Hudson Valley Hospital, where a merger afforded the Cortlandt Manor hospital the chance to enhance clinical services within Westchester. Big-name cachet, says Petrower (who became president in 2016, after longtime president John Federspiel retired), allows the hospital to attract and recruit excellent physicians; give patients access to Columbia University Medical Center’s faculty practice, ColumbiaDoctors; and open access to clinical trials. In turn, Hudson Valley Hospital drew NYP with “the warmth, compassion and friendliness that emanates from being a small community hospital,” Petrower says.
Her challenge is to fuse the best of both worlds, which she hopes to do through “open dialogue with our medical staff, management team, and front-line employees.” Petrower adds, “It is a privilege to be entrusted to lead this hospital through integration with a major system, growth and expansion, leadership and culture change, and I keep that at the forefront of my mind when representing our hospital.”
Michael Fosina, president of NYP Lawrence Hospital in Bronxville since 2015, has led several hospitals through mergers, acquisitions, and integrations — including one between New York Hospital-Cornell Medical Center and Columbia Presbyterian, in 1998, for which he served as director of integration. The experience, and the lessons learned, shaped Fosina’s approach and style as a leader. During the merger, Fosina worked with two sets of experts entrenched in their respective status quos; this quickly showed him that swooping in to “command and control” by forcing change only creates animosity and tension.
Like many leaders, Fosina drew from psychology and sports during that initial integration to spark the “team chemistry” that he says is undervalued in the business world.
“Without team chemistry, people don’t communicate, trust each other or collaborate for a common goal and the good of the organization,” he says. But with it, he’s able to convince leaders they have the chance, collectively, to shape the future of a new organization — a mindset that is “powerful and engaging,” he says. “It creates a new culture while preserving pieces of the past.”
And that new culture is key for community hospitals, he says.
“The way healthcare reform is evolving, there will be very few, if any, independent community hospitals left in the country. There is tremendous value in a community hospital aligning with a large academic healthcare system,” including access to resources, expertise and a wealth of intellectual capital, he explains. From a leadership perspective, Fosina says, “this allows you to become more efficient and cost-effective,” while improving care within county borders.
“When the NYP name is on the door, as leaders, we have an obligation to ensure we have NYP’s one standard of care,” he notes.
And that takes a bold leadership style that doubles as a “futurist vision,” he says. “You have just entered into an unsettled world, and you must lead staff who don’t know you out of a time of instability and tension. You have to be authentic, trustworthy, and someone they want to follow. The reality is that without followers, you are not a leader.”
Treating Patients “Like Family”
Maintaining an awareness of the patients at the heart of the bureaucracy is a challenge for many hospital CEOs. At White Plains Hospital, president and CEO Susan Fox tries to keep that focus, even with chaos at the periphery.
“Healthcare economics are driving a lot of change and confusion,” says Fox, who became CEO in 2015, taking over for Jon Schandler, who’d helmed the hospital for 34 years. “But at the end of day, sitting in this seat, one of the things I need to do is take care of patients, no matter how [their care] is being paid for, and doing that in the best way, patient by patient, day by day.” It’s both an outgrowth of her training as a nurse and a tenet of her leadership. She seeks to lock in the right people and then unify them in a common mission so that everyone on her staff of 3,000 — from surgeons and administrators to housekeepers — understand their role in patient care.
Early in her career, as a nurse in pediatric intensive care at Manhattan’s NewYork-Presbyterian, Fox noticed that a lack of teamwork and collaboration was undermining patient care. “That prompted me to get an MBA with a vision of participating in a different way, where I could make more of a difference in creating the culture,” she says.
Today, the culture that Fox has created includes extensive renovation, expansion, and broadening — and not just through the 173,000 square feet of physical space that was added or renovated in 2016 alone. Fox embraced the trend of aligning with both smaller physician practices and larger health systems by leading an affiliation with Montefiore Health System in 2015, and by recruiting physicians to join the White Plains Hospital Physicians Associates through the county. The hospital now has nearly two-dozen outpatient facilities in Westchester. Its Center for Cancer Care has a six-story tower addition that broadens the range of services for cancer patients. Finally, the hospital has advanced its clinical scope and surgical services to become a tertiary-care center.
“There’s an intense focus on understanding from the ‘patient experience’ side,” Fox says. “Making sure patients have state-of-the-art equipment, the comfort of private rooms.”
In an era of declining patient services and satisfaction with hospitals, she says, White Plains Hospital is bucking the trend with an increase in business: The hospital has generated $927 million through jobs and purchases and has invested $67 million in community benefits and subsidized care. By building up and giving back, Fox says, the hospital strives to be the hospital of choice for physicians, as well as patients.
Fox says she’s taking advantage of enhanced access to metrics: patient outcomes and satisfaction, online reviews, and other information that informs her leadership. “Past administrations didn’t have this level of transparency and measurement,” she says. “We treat our patients like family, and that comes through in their feedback.”
The Paramedic CEO
Daniel Blum, CEO of Phelps Memorial Hospital since 2014, sees opportunity in the upheavals of the industry for a renewed focus on patients.
Financial pressures upon physicians and smaller medical groups were “the first catalysts of major change in Westchester,” he says, referring to aggregation, practice buyouts and smaller medical groups folding into larger ones.
“That really disrupted the homeostasis of the relationship between physician and hospital,” he continues. “Care started to shift away from hospitals and into larger practices. In some instances, that closed a few of the hospitals in Westchester. Over the course of only a few years, there was a sea change in leadership — the way hospitals are organized and affiliated.”
One result, Blum says, is that consumers, meaning patients, exercised their right to make choices, demanding satisfaction ratings and price transparency. And the payers, meaning insurance companies, began to demand patient-outcome statistics and other metrics to make the best business decisions. According to Blum, that meant a new language, new skillset, and new paradigm of thinking.
“When I first started my career, over 30 years ago, a lot of people were of the mindset that including the patient in decision-making and advising with complete transparency weren’t [necessary],” he says. Things like full disclosure to patients, protection of their privacy, including the patient in decision-making, considering the patient’s best interests or desires — or even conveniences like offering evening or weekend hours — didn’t exist, he says. “It was more: ‘We’ll decide what’s best.’ The skillset required now includes an element of flexibility. Taking into account the desires of the patient is a very different mindset,” Blum explains.
That’s why Blum, even from his executive perch, draws upon a far earlier role in his career: New York City paramedic. “It connected me to the importance and the magical nature of having the responsibility to take care of another human,” he says. “People in my role are businesspeople,’ so it’s P&L, balance sheets, business metrics — and all are critically important. But none of those statistics and numbers gives you the sense of what it’s like to deliver a new baby or hold someone’s hand while they’re dying or speaking with a family member about logistics of care.”
His experience working shifts as a first responder also keeps Blum aware of the housekeepers, nurses, and biomedical technicians at Phelps. “I hope our staff members sense that I approach my job with that perspective, and I believe it gives me credibility,” he says. “I feel my principal role is curator: establishing a culture and being voracious in curating that culture. It’s about leading by example.”
Captain of a “Team Sport”
Within the thickets of Medicaid redesign, new state-funded networks to address community health have sprung up, such as the Montefiore Hudson Valley Collaborative in Yonkers, one of 25 networks funded by the New York State Department of Health in 2015. These networks are giving leaders such as Allison McGuire, MPH, the chance to bring hospitals and community organizations together to keep patients healthy, especially those with barriers to medical care.
“Healthcare has become a team sport,” says McGuire, executive director of the Collaborative. “Leadership in this new domain is about connecting to community partners. What are the win-win solutions that provide high quality and more patient choice?”
To explore this, McGuire brings providers and partners together — emergency-room doctors and primary-care providers, food banks and nursing homes, even the police — to knock down silos and fuel collaboration in patient care. “Providers tell me: ‘We’ve always wanted to sit with our colleagues and brainstorm ideas,’” McGuire says. “The new Medicaid design lets us be a convener, facilitator, integrator…creating opportunities for that conversation, allowing connections to be made.” And McGuire makes sure the patient experience guides each conversation.
“Instead of saying, ‘What’s the matter?’ we’re asking patients what matters to them,” she says. “That’s a simple statement, but it’s been incredibly powerful. Our partners use it as a training tool for every level of their organizations, from front lines to clinicians to executives.”
McGuire sees vast differences between the era she’s ushering in and her early career days dealing with HMOs, where a lack of data and technology failed to link providers, undermining the chance for networks of shared resources and joint efforts. “The pieces are coming into place to create communities of care,” she says. “To be a leader in healthcare today is to look through a broader lens.”
Exporting “Crown Jewels” of the County
Many Westchester healthcare leaders have touted the benefits of New York City care arriving in Westchester County. But Jeffrey Menkes, the new CEO of Burke Rehabilitation Hospital in White Plains, hopes to expand a known asset of Westchester to surrounding counties farther upstate — a logical extension of this leadership trend. The acute-rehab hospital, which recently celebrated its 102nd anniversary, is now part of Montefiore Health System, and Menkes, who came onboard at Burke in April 2017, partnered with his predecessor, Mary Beth Walsh, MD, on the new alliance.
“Montefiore’s vision is to expand the full scope of care [that Burke offers], which is unique to the region — rehab for [traumatic brain injury], amputees, and stroke and cancer patients — to make Burke the jewel in the crown for rehab inpatient and outpatient throughout the eight counties that Montefiore serves,” Menkes says. “As you go farther north, there are gaps in the concept of rehab and continuity of care, and we’re filling in those gaps.”
Speaking with Menkes gives a palpable sense of the hometown pride that underlies his business model of expansion. “I live in Westchester, and I’ve used Burke’s services as an outpatient,” Menkes says. “There’s something unique about living in Westchester and taking responsibility for an institution like Burke, taking care of our neighbors.”
Red Carpet, Not Red Tape
In today’s culture of time-scarcity and fierce competition, saving patients time and redundancy, along with other flourishes of customer service, also hold appeal for leadership. At CareMount Medical, a group provider with 550,000 patients in 43 locations in Westchester and surrounding counties, Deputy Chief Medical Officer Fran Ganz-Lord, MD, also serves as chief medical value officer. That means she’s rolling out patient-centered touches such as the red-carpet exit, in which the nurse walks the patient to the front and warmly hands her off to the person scheduling the follow-up, explaining the next steps of care.
Like other leaders, Ganz-Lord is also instilling teamwork for improved morale, which translates into better patient care. “Rather than sliding things from one plate to the next,” she says, “we’re functioning as a true team. Patients are not being asked the same question 10 times.” But another layer of value is serving as interface among doctors, patients, and administrators, to clarify legislation that’s both shifting and bewildering and to avoid risks like burned-out physicians or overwhelmed staff.
“‘Medical value officer’ is an unusual title,” Ganz-Lord concedes. “It speaks to the value we provide for our patients, our providers, our community, even the insurance companies who pay us. It’s not enough to provide excellent care; you have to prove it, show your value.” While many leaders achieve this by gathering data, Ganz-Lord shoulders the awareness of CareMount’s physicians, which numbers don’t always reflect, in terms of capturing the true quality of care.
“We feel we have to dance for these numbers, and it adds to the pressures and frustrations of the administrative burden as we become a data-driven business,” she says. “Physicians might feel they provided quality of care when they made the right decision in a difficult situation, versus ordering the most mammograms for their patients.” Add to that the burden of deciphering changing healthcare legislation, and she finds that doctors can feel “scared and under-informed… thirsty for knowledge but fatigued.
“I saw an opportunity to be the person who could support physicians by explaining new policies and changes in a way that made sense: not give them the hundred-page book but rather the critical pieces, and let them do what they do best,” she adds. “That has informed my leadership strategy.”
Predictive Patient Health
The concepts of care communities and broad lenses resonate with Anthony Viceroy, Westmed Medical Group’s CEO since 2015. With its expansion, Westmed now has more than 500 physicians in over 60 medical specialties, with 13 locations and 350,000 patients. Unlike Westmed’s previous CEO and founder, Simeon Schwartz, MD, Viceroy has a finance-and-marketing background; he previously served as the group’s CFO and has worked at such behemoths as Omnicon Group and Novo Nordisk.
Yet, in addition to his fiscal knowledge and cost-analysis experience, Viceroy also values the dynamics that fall outside the spreadsheet. “A strong doctor-patient relationship leads to more trust, more information-sharing, better diagnoses, and better outcomes,” he says. Viceroy regards this bond as the “foundation” upon which the traditional pillars stand: better outcomes, more efficiency, and the emphasis on excellence. His marketing savvy led him to spend this summer talking to patients one-on-one: “sharing ideas, listening to what they want for the future and how Westmed can provide services they value.”
“We have Medicare patients, Medicaid patients, a rise in Millennial patients,” he says. “Their health statuses, their wants and needs, are completely different. It was important to me to start the process of understanding what’s important to them as individuals and not just doing this as a marketing gimmick.”
Under Viceroy’s leadership, Westmed initiatives like polyclinics — integrated centers for comprehensive care, from urgent to diagnostic — yield convenience and peace of mind (“something I don’t know how to place a value on,” he says), not to mention better outcomes. He’s overseeing the launch of a website redesign, the “My Westmed” mobile app, and a new patient portal that lets patients make appointments, exchange messages directly with physicians, view test results and treatment plans, update personal information and access health records. And like other CEOs, Viceroy taps into the power of medical data — but in this case, to create models of predictive health that will keep patients out of the hospital.
“The greatest value we can bring is to predict a stroke or heart attack before it occurs,” he says. “That lowers the cost of care — there’s your economic benefit — but saves the patient a lot of hardship. It possibly saves their lives. We take great pride in that.”
Fighting Injustice in Healthcare
A heightened recognition of diverse backgrounds throughout the Westchester Medical Center Health Network led to its hiring Mecca Santana in 2015. Her résumé — including roles as assistant district attorney in Manhattan investigating sex crimes and domestic violence, and chief diversity officer for the State of New York — lacked even a single day of healthcare experience.
Santana says she felt trepidation initially but adds: “My role now is still the work I’ve always been passionate about — fighting for the vulnerable and being a voice for the voiceless. The only thing that’s changed is the realm in which I’m doing the work. And now, I’m absolutely invigorated.”
Santana addresses diversity “in a meaningful way: folded into our strategic planning, aligned with our mission and tied to our goals.” Those include an equitable and inclusive environment for patients and workforce, supplier diversity, and community engagement. “If diversity lives and dies with [a sitting] CEO, it’s not really embedded in the organization,” Santana says.
She embraces the new leadership philosophy that it takes a village, not just a clinic or hospital, to keep patients healthy. “The best oncologist treating a woman for breast cancer is of no use if she returns to a domestic-violence situation,” Santana says. “Sustainable health and wellness requires more than great clinical care. It’s a wraparound collective impact: schools, churches, food pantries, housing, social services — all keeping people healthy.”