Joseph Mack & Associates Alignment of Organizational Culture and Leadership is Critical to Sucess of Clinical Integration and ACO Strategies

1. Alignment of Organizational Culture
to Strategies and Leadership is a
Critical Success Factor for Clinical
Integration and ACOs
 Culture Must Match December 2012
Strategies and Leadership
 How Culture Drives Or- Strategies Must Match Culture and Empower Leadership
ganizational Vision and
Strategies Alignment of strategies tives. Some organiza- formational initiatives is
 How Leadership Influ- with organizational cul- tions develop clinical different. In the former,
ences Implementation and ture and leadership is integration and ACO strong transactional
Management of Organiza- critical to success of approaches that are not skills are often domi-
tional Vision and Strate-
Clinical Integration and supported by their cul- nant and may be suc-
gies
ACO objectives. In our ture. Leadership tasked cessful. In the latter,
 Implementation of Clinical recent work with cli- with implementing inno- one must have strong
Integration and ACO
Strategies
ents developing various vative or “radical” transformational and
collaborative strategies strategies within status transactional skills.
 Critical Success Factors and models we have quo or “conservative” Proper alignment of
found substantial incon- cultures face significant strategies to culture,
gruity between an or- challenges and greater and of management
Inside this Article
ganization’s values, risk of failure. Further- style to strategies is
Culture Drives Hospital 1
Strategies
strategies and commit- more, management critical to successful im-
ment, and management style required to imple- plementation of clinical
Culture and Integration 3
Strategies
selected to develop and ment and improve in- integration and ACO
guide these new initia- cremental versus trans- initiatives.
Traditional Hospital 4
Process Redesign
Leadership Traits Re- 5
quired for Process Re- Understanding Culture and
design its Impact on Organizational Vision and Strategies
Transactional 5
Leadership
Influence of Culture on Hospital Strategies
Transformational Lead- 6
ership Clinical integration re- successful, these strate- hospitals are by nature
How Leadership Imple- 7 quires departmental and gies must match the or- market survivors. They
ments Process Redesign
organizational-wide im- ganization’s vision and are internally focused
Approaches to Clinical 8 provement in functions culture. on such things as qual-
Integration and core processes. ity, cost and customer
Vertical to Horizontal 9 The degree of change The strategies a hospital service. These organi-
Redesign required and committed adopts can be charac- zations typically moni-
Critical Success Factors 10 to is dictated by the terized into three orien- tor the market for stra-
in Alignment of Culture,
Strategies and Leader-
strategic objectives of tations: survivor, adap- tegic opportunities, but
ship the organization. To be tor and enactor. Most are less likely to commit
Case Study 13

2. Page 2 Joseph Mack & Associates
significant resources to their itability generated from inter- their redesign initiatives focus
implementation. Hospitals nal operations to invest in sub- on departmental and organiza-
that are market adaptors are stantial, long term, and higher tional-wide improvement.
also internally focused. Their risk strategies to dominate Market survivors have an in-
strategies focus on short term, their markets. Their strategies trinsic need to be industrious.
incremental strategies that can involve evaluating market They improve and transform
be easily changed or aban- trends to adapt to their own their organizations. Figure 1
doned. They often develop organizations. Extrinsic moti- illustrates the relationship of
copycat strategies. They vations create challenges for strategic orientation to opera-
monitor the market and market survivors and adaptors tional and clinical redesign.
adopt other’s approaches. to overcome inertia within
Market enactors use the prof- their organizations. Many of
Figure 1: Relationship of Strategic Orientation to
Operational and Clinical Redesign
Organization-wide
Organizational
Culture Drives
Departmental
Strategies and
Redesign Focus
Functional Core Processes
Transformational

3. Page 3
Influence of Culture on Clinical Integration and ACO Strategies
Strategies must match vision. tivity within their organiza- and physicians from outside
As Figure 2 illustrates, long tions. of their medical centers in
term strategies with bold ob- performance improvement
jectives are radical and trans- As an organization begins initiatives.
formational. Short term, con- to move further towards
servative goals produce incre- becoming a market adaptor, Market enactors focus on
mental successes. As most while still largely focused longer term, higher risk initia-
hospitals are by nature market redesigning functions, more tives that fundamentally re-
survivors, operational and initiatives begin to incorpo- design operational and clini-
clinical redesign efforts tend rate cross-functional partici- cal processes. They develop
to be hierarchical. Most ef- pation, and to implement larger, more complex collabo-
forts are focused on func- more core process redesign rative strategies frequently
tional departmental improve- efforts. The organization involving internal and exter-
ment. To the extent cross- begins to transition from nal constituencies.
functional initiatives occur, vertical to horizontal proc-
they are focused on cutting ess improvement, and begin
costs and improving produc- to involve organizations
Figure 2: Influence of Strategic Orientation on Operational
and Clinical Redesign Strategies
Organization-wide
Most hospital
cultures support
short term,
incremental
redesign strategies,
Departmental
rather than longer
term radical
initiatives
Functional Core Processes
Transformational

4. Page 4 Joseph Mack & Associates
Traditional Strategies for Hospital Functional and Core Process Redesign
An organization’s vision af- level. Some departmental func- on functional departmental and
fects its emphasis on opera- tional improvement involves organization-wide outcomes
tional redesign. Hospitals are high opportunity core proc- are fundamental, necessary,
constantly improving depart- esses that begin to encourage and beneficial. Organizational-
mental functions. Some of cross functional participation wide core process improve-
these initiatives are imple- throughout the organization. ments are transformational.
mented throughout the or- The greatest impact for redes- Figure 3 illustrates the
ganization and provide ign efforts are initiatives fo- strengths and weaknesses of
greater impact than focusing cused on organizational-wide the various redesign ap-
only at the departmental core processes. Efforts focused proaches.
Figure 3: Comparison of Traditional Functional and Core
Process Operational and Clinical Redesign Strategies
Functional
Organization-wide
Departmental
Process
Improvement is
Fundamental.
Organizational-
Departmental
wide Core
Process Redesign
is
Transformational Functional Core Processes
Greater Impact

5. Page 5
Understanding Leadership and its Impact on Implementation and
Management of Organizational Vision and Strategies
Leadership Traits Required for Functional and Core Process Operational and
Clinical Redesign
Operational and Clinical Re- transactional and transforma- plementary and interdepend-
design occurs along a contin- tional leadership. The differ- ent to the transactional style.
uum from conservative to ence between transformational Transformational leaders must
bold; from a focus on func- and transactional leadership lies also employ transactional
tional to core process im- in the way of motivating others. skills. On the other hand,
provement and change; and Transactional leaders work transactional leaders tend to
from improvement to trans- within the organizational cul- have little or no transforma-
formational. ture as it exists. The transfor- tional traits. On this end of
mational leader changes the the continuum, transactional
Research on leadership sug- organizational culture. leadership is independent of
gests two factors to differen- The leadership continuum is transformational skills.
tiate “ordinary” from illustrated in Diagram 1. Trans-
“extraordinary” leadership: formational leadership is com-
Ordinary Leadership is
Transactional.
Extraordinary Leadership
is Transformational
Transactional Leadership
Transactional leadership fo- managers. It focuses on the ba-
cuses on clearly defined goals sic management process of con- Transactional leaders are effec-
and tasks, works within the trolling, organizing, and short- tive in guiding efficiency deci-
existing organizational cul- term planning. Transactional sions which are aimed at cutting
ture, incentivizes staff to leaders emphasize detailed and costs and improving productiv-
achieve goals through re- short-term goals, and standard ity. These leaders tend to be
wards and punishment, and rules and procedures. They rely highly directive, task and action
motivates achievement little on enhancing followers’ oriented.
through appealing to em- creativity and generation of
ployee self-interest. This new ideas.
style is most often used by

6. Page 6 Joseph Mack & Associates
Transformational Leadership
Transformational leaders focus transformational leadership the intention of allowing them
on adapting to non-routine when adaptation is the goal. In to reach higher levels of
situations, and on changing the these scenarios, it is critical that achievement than might other-
organizational culture by creat- the leader be a change cham- wise have been achieved. Indi-
ing new ideas. These leaders pion who can assemble and mo- vidualized consideration plays a
motivate others by broadening tivate a group with enough key role in neutralizing the in-
and elevating their interests, power to lead the change. evitable resistance that is
generating awareness and ac- bound to accompany the trans-
ceptance of the purposes and A transformational leader pro- formational process. The
mission of the company, and motes the creation of a culture leader must work at getting
stimulating employees to look that encourages team-decision large numbers of people in the
beyond their own self-interest making, and provides individual organization involved in the
for the good of the group. consideration to the specific, transformation process. Oth-
unique needs of their staff to erwise, it is likely to be greeted
Transformational leadership is ensure they are included in the with cynicism and strong resis-
better for non-routine situa- transformation process of the tance from key constituents.
tions. Whereas transactional organization. People are
leadership is well suited to im- treated individually and differ- Table 1 compares transactional
proving efficiencies, organiza- ently on the basis of their tal- to transformational leadership
tions are more receptive to ents and knowledge and with characteristics.
Table 1: Characteristics of
Transactional and Transformational Leaders
Transactional Leadership Transformational Leadership
 Leadership is responsive  Leadership is proactive
 Focus on maintaining status quo and achieving specific  Focus on adapting to non-routine situations
goals
Transactional  Works within the organizational culture  Works to change the organizational culture by implementing
leaders manage new ideas
 Transactional leaders make employees achieve organizational  Transformational leaders motivate and empower employees
and improve
objectives through rewards and punishment to achieve organization’s objectives by appealing to higher
status quo. ideals and moral values
 Motivates followers by appealing to their own self-interest  Motivates followers by encouraging them to transcend their
Transformational
 Emphasizes clarification of goals, follower compliance own immediate self-interest for the sake of the mission and
leaders change through incentives and rewards, with a focus on task vision of the organization
culture completion  Emphasizes understanding of the importance of task
 Followers’ compliance (effort, productivity, and loyalty) is outcomes
exchanged for expected rewards  Followers are encouraged to think critically and seek
new ways to approach their jobs

7. Page 7
Impact of Leadership on Functional and Core Process Operational and Clinical Redesign
Strategies
An overview of the impact of process improvement efforts. organizational-wide functions,
transactional and transforma- Since the transformational often to the exclusion of cross
tional leadership on operational leader also has transactional -functional core process re-
and clinical redesign strategies skills departmental and organ- design. Transformational lead-
is illustrated in Figure 4. Trans- izational wide functions are also ers achieve radical change.
formational leadership fits well improved. Transactional lead- Transactional leaders achieve
with organizational-wide core ers focus on departmental and incremental change.
Figure 4: Overview of the Impact of Leadership Style
on Operational and Clinical Redesign Strategies
Transactional leaders
Organization-wide
motivate by appealing
to employee self-
interest.
Transformational
leaders stimulate
Departmental
employees to look
beyond their own self-
interest for the good
Functional Core Processes of the organization.
Transformational
Figure 5 illustrates the influence of leadership powering teams and individuals to transcend the
style on functional and core process opera- status quo through organizational-wide radical
tional and clinical redesign. Transactional lead- transformation.
ers tend to focus more on functional improve-
ments. Transformational leaders, while focus-
ing also on functions, tackle core process re-
design. They inspire their organizations by ef-
fectively communicating the vision, and em-

8. Page 8 Joseph Mack & Associates
Figure 5: Influence of Leadership Style on Functional
and Core Process Operational and Clinical Redesign
Transactional
Organization-wide
leaders tend to
focus more on
functional
improvements.
Transformational
Departmental
leaders tackle
core process
redesign
Functional Core Processes
Greater Impact
Implementation of Clinical Integration and ACO Strategies
Approaches to Clinical Integration
Clinical integration occurs along ships and pay for call that are models that may move the or-
a continuum from targeted ini- targeted to improve certain ganizations further along the
tiatives by a hospital and a sub- clinical areas or processes are continuum towards clinical in-
set of its voluntary medical staff “basic” forms integration. tegration. Integrated delivery
to address a particular clinical Independent Practice Associa- systems, ACOs, and physician
condition or procedure, to in- tions (“IPAs”), Management owned hospitals focused on
tegrated delivery systems Service Organizations patient centered care are the
where hospitals and medical (“MSOs”), Physician Hospital most sophisticated models
groups are under one umbrella Organizations (“PHOs”), and aimed at achieving financial and
organization, and physicians are Specialty Institutes are exam- clinical integration.
employed. Medical Director- ples of structural and financial

9. Page 9
Clinical Integration and ACOs Demand a Shift From Vertical to Horizontal
Redesign
As Figure 6 illustrates, the medi- paradigm shifts. As has been emphasis on horizontal redesign
cal home approach conceptually previously discussed, much across organizations to improve
demands a shift from vertical to redesign historically has oc- system performance. Essen-
horizontal operational and clini- curred vertically within a par- tially, the organizations are
cal improvement to optimize ticular institution. Ideally, turned 90 degrees so that vital
success of patient centeredness these efforts extend horizon- processes are emphasized,
and population health manage- tally as well in order to gar- rather than sites of care.
ment objectives. When two or ner the most cross-functional
more organizations are in- involvement of staff and core
volved, such as hospitals and processes. Patient centered
physician organizations, the care requires an increased
Figure 6: Comparison of Vertical and Horizontal
Approaches to Operational and Clinical Redesign
Hospital and Health System ACO and Clinical Integration
Hospital Hospital Medical IPA Hospital Hospital Medical IPA
1 2 Group 1 2 Group
Medical Clinical Support Admin. Medical
Mgmt. Ops. Services Services Mgmt. Maximum Realignment
& Core Process Redesign Patient Centered Care
Some Cross-Function Realignment
Management Requires
& Core Process Redesign
High Opportunity Areas & Processes
Clinical a Shift in Focus from
Ops.
Vertical to Horizontal
Support
Services Redesign
Support
Services
The success of the approach used is dependent upon the culture and leadership of the organization
to create, implement and manage the selected initiative. While structure is important, especially to
mitigate legal and business risk, alignment of organizational culture and leadership with clinical inte-
gration and ACO strategies is critical.
.

10. Page 10 Joseph Mack & Associates
Critical Success Factors in Alignment of Culture, Strategies and
Leadership to Clinical Integration and ACO Initiatives
Figure 7 compares culture, in- empowered to improve existing alignment of strategies and
ternal and external strategies operations or transform the cultural orientation. As has
and leadership. To be success- culture. Misalignment of or- been discussed, there is some
ful, strategies must match cul- ganizational objectives to lead- cross-over between leader-
ture. As an organization moves ership style may inhibit success- ship characteristics and inter-
further along the clinical inte- ful implementation and manage- nal clinical redesign efforts,
gration continuum it must have ment of strategies. particularly from transforma-
the infrastructure and proc- tional to transactional. Simi-
esses to promote evidence- The roles and columns in Figure larly, a market adaptor organi-
based medicine and patient en- 7 illustrate the alignment of cul- zation may employ skills from
gagement, report on quality and ture, strategies and leadership both types of leaders, depend-
cost measures, and coordinate to one another. Typically, ing on degree and breadth of
care. Leadership must match there is little if any diagonal its internal and external strate-
the organization’s values, and be gies.
Figure 7: Alignment of Strategies
to Culture and Leadership
Who Are We?
Where do We Want Survivor Adaptor Enactor
to Go?
Strategies must  How Do We
Get There? Culture Low Risk Medium Risk Higher Risk
follow culture. Lead industry
Incremental Adapt to
structure,
Strategies focused on
Leadership must be capitalize on all
infrastructure & opportunities standards, &
change
customers
empowered by Transactional Transformational
culture. Departmental  Variance and cost
reduction
 Service and Value
Enhancement  Does Culture
Functions Match Our
 Reducing avoidable,  Work is redesigned to Intent?
Organizational unproductive and consolidate roles into new
Functions duplicative services and different configurations
 Does Culture
 Treatment in the  Work is realigned around
Empower or
Departmental optimal setting by the care complexity and Prohibit
Core Processes right provider optimal patient flow Leadership
Organizational  Improving Patient  Work redesigned shifting Success?
Experience focus to preventive care
Processes and population health

11. Page 11
Table 2 illustrates the critical success factors, and common causes for failure of alignment of cul-
ture, strategies and leadership in developing clinical integration and ACO strategies. An organiza-
tion must take an honest look at its own culture to determine the classic strategic questions: who
are we; were do we want to go; and, how do we get there. Everything else flows from and is sub-
servient to culture. If the strategies selected conflict with culture then they will fail, unless culture
is transformed. There are leaders whose expertise is transformation. Others concentrate on im-
provement within the organization. Culture either enables or hinders their success.
Table 2: Critical Success Factors and Common Causes of
Failure in Alignment of Culture, Strategies and Leadership
Strategies that are
misaligned with
culture will fail.
Unless empowered
by culture,
leadership will fail.

12. Page 12 Joseph Mack & Associates
Case Study Example
In our recent experience with several clients developing clinical integration and ACO strategies
there has been little or no discussion of the alignment of organizational culture, strategies and
leadership. Culture receives only general comments, sometimes referencing the organization’s
mission and vision, reputation in the marketplace and executive leadership. Strategies are often
stated with somewhat more precision, especially when they mention such things as to become a
Centers for Medicare and Medicaid Services (“CMS”) ACO, create a risk bearing organization,
etc.
By contrast, leadership responsibilities are often described in significant detail. The following is
one example:
“…responsible for administering the overall policies and procedures related to the care coordi-
nation and integration of patient care activities across the continuum of care. … responsible
for ensuring optimal, achievable and sustainable standards of care, maintain-
ing positive staff morale, and promoting cooperation between patient care
services and other hospital departments, medical staff and physician organi-
Alignment of
zations. In conjunction with the Executive Leadership Team, is accountable
strategies and for strategic planning, setting priorities, allocating resources, quality assur-
ance and building strategic partnerships to improve care coordination
leadership to
across the system.”
culture receive
Organizations are similarly detailed about desired leadership experience and
little if any
skills. Profiles focus on such things as understanding hospital functions and
attention processes; role of physicians, especially hospitalists; finance, especially man-
aged care; quality; population health/coordinated care; outcome improvement
and care redesign; information technology; etc. Leadership traits mentioned
include vision; communication skills; integrity; strategy; influence; reputation and trust; courage
and forthrightness; ability to inspire, including strong change management and problem solving
skills, able to identify obstacles and solutions, demonstrated success in building teams and reducing
silos, and demonstrated success in developing team champions.
Organizations must honestly ask themselves: does our culture match our intent; and, does cul-
ture empower or prohibit leadership success? Is it reasonable that we will go from little or no
integration to collaboration, and in what time? It is important to have lofty aspirations. It is more
important that they are realistically supported by culture.
All of the organizations we work identify, among other traits, that they want inspirational leaders
to develop and manage these strategies. However, when culture is misaligned with strategies
leaders are inhibited or prevented from successfully deploying charisma and motivation that en-

13. Page 13
courages innovation and creativity. Development of and evangelizing the vision of the
“redesigned” organization and the clinical integration approaches is impossible. Unless values are
clearly understood and shared among all those who work together, intense commitment and im-
plementation success is impossible. Proper alignment of strategies to culture, and of management
style to strategies is critical to successful implementation of clinical integration and ACO initia-
tives.
Case Study
Background
We recently worked a multi-hospital system with over 30 clinic and outpatient centers dispersed
over a large geographic area. Over a year previously, the system had acquired two large physician
organizations and placed them into a medical foundation (“Foundation”). The physician enter-
prises consist of a large medical group, and an independent practice association, physician practice
consulting and Medicare Advantage insurance agency. The organization is an approved Account-
able Care Organization. Together, these organizations represent over 600 employed and con-
tracted primary care and specialty physicians. In addition, they contract with over 1000 additional
physicians through managed care agreements.
The system’s strategies include market differentiation and growth, improve
quality and value, improve profitability, partner with physicians, governance and
Partnering with
leadership, and develop people and culture.
physicians for
Goal #1
alignment across
The first goal was to consolidate and streamline the operational and clinical
roles and functions of the two acquired physician organizations to improve effi- the system is not
ciency and profitability. The health system had acquired each of the organiza- fully supported
tions over a year previously, but had not “merged” them together. The initial
objective was to improve the efficiency and profitability of the combined busi- by culture
ness.
Observation
The strategies to create the Foundation and acquisition of the two physician organizations are con-
sistent with what one would expect from a market adaptor or enactor.
To ascertain more clearly an organization’s cultural orientation, it is informative to examine how
the strategies are actually executed, and whether the particular objectives are achieved. Develop-
ment of population health and partnering with physicians across the system, among others, are
stated objectives. Integration of the two physician organizations had not occurred several months
after acquisition. Each had its own leadership, functions and processes. The Foundation held a se-
ries of meetings with Foundation and system executives and a “leadership consultant” to brain-
storm on the desired skill set of the of the Foundation’s Chief Executive Officer (“CEO”).

14. Page 14 Joseph Mack & Associates
Findings
Streamlining the operational and clinical roles and functions of the two acquired physician organi-
zations, from the systems perspective, is transactional rather than transformative. Other than
profitability, it has little bearing on the system. Creation of the Foundation, and its physician ac-
quisition strategies appear to be copycat strategies, which are indicative of a market adaptor. We
would expect organizations with this orientation to focus on departmental and system-wide func-
tional and core process improvement. However, the strategy included little or no integration of
the leadership, functions and processes. The system also spent a lot of time and money engaging a
leadership consultant focusing on the desired skill set of its CEO, rather than on actually creating
the reconstituted organization.
There is a disconnect between the system’s stated objective of “partnering with physicians for
alignment across the system,” and lack of attention to consolidating the operations of its largest
physician enterprise. This suggests that the system’s culture does not fully support its strategies.
Goal #2
The second goal was to position the Foundation to play the key role in devel-
Using the oping and implementing clinical integration system-wide.
Foundation to Observation
drive clinical Similar to our initial observations about Goal #1, we viewed the strategy of de-
ploying the Foundation across all clinic and hospital processes as suggesting the
integration organization is at least a market adaptor or enactor. The system has other
system-wide is “virtual” physician enterprises that play roles varying in degree across the sys-
tem. Additionally, the system continues to acquire primary and specialty physi-
not supported cian practices. Frequently, the system CEO places these organizations under
by culture the Foundation to manage. The system has not held substantive discussions
with the Foundation about the tactics required to deploy it as the clinical inte-
grator across all hospitals and physician enterprises.
Findings
Positioning the Foundation to play the key role in developing and implementing clinical integration
system-wide is a noble and lofty aspiration. The system’s lack of commitment to implementation
of the strategy suggests that, this too, is a copycat strategy. Once additional physicians are ac-
quired, the responsibility for their management is shifted to the Foundation without a view to-
wards how to use them to assist in system-wide clinical integration. There has not been consoli-
dation of the Foundation and other “virtual” physician enterprises. Rather than being complemen-
tary, their roles and functions are conflictual. Finally, the fact that substantive discussions have not
been held to formalize how the Foundation will be the system-wide clinical integrator suggests a
strong disconnect between culture and strategies.

15. Page 15
The system-wide strategies do not conform to its culture. This is often the
case, especially with market adaptors who employ copycat strategies. More-
over, this is frequently the case with hospitals and health systems that acquire
physician organizations. The system and physicians have different objectives. In System must
this case, at the macro level, it appears that both are on the same page. How-
ever, it is easier to rally around a concept such as “clinical integration,” or change its
“ACO” than to actually meticulously describe and agree upon mutual goals and culture or put
objectives, especially with copycat strategies in turbulent environments. In-
stead of ensuring its strategies match culture, this organization spent a rela- strategies and
tively inordinate amount of time on identifying and describing desired leader- leadership at
ship characteristics and skill set of the Foundation CEO. Again, this is consis-
tent with organizations employing copycat strategies. Unless the culture em- risk of failure
powers leadership to execute transactional or transformational tactics to im-
prove departmental and enterprise-wide process improvement, achievement of
clinical integration and ACO strategies will partially or fully fail expectation.

16. Joseph Mack & Associates
Joseph Mack & Associates specializes in health care strategy, mergers and
acquisitions, physician operations, and creation of risk bearing and accountable
care organizations. Our expertise is in strategic planning, finance, change
management, operations, process improvement, managed care, risk
management and business intelligence within highly competitive market places.
P.O. Box 23
Joseph Mack has served in executive roles at hospitals, medical groups, the
Dana Point, CA 92629 second largest insurance brokerage and employee benefits consulting company
in the nation, the management consulting practices of two Big 5 accounting
Phone: 949-481-0602 firms, as well as the nation’s preeminent medical group trade association. This
Mobile: 949-697-9476 seasoning enables Mr. Mack to take a hands-on, results oriented approach
E-mail: towards creating and reorganizing physician, hospital and health systems into
Joseph.Mack@jmahealthcare.com
integrated collaborative provider organizations with aligned strategic, financial,
operational and cultural objectives.
Integrated Delivery Systems Qualifications and Experience
 Worked with MemorialCare Medical Foundation within MemorialCare
Health System to integrate leadership and operations of the former Bristol
www.jmahealthcare.com Park Medical Group and Nautilus Health Management Company/Greater
Newport Physicians, and on strategies to develop and implement clinical
integration system-wide.
 Served as financial, strategic and restructuring advisor for a free-standing
medical center’s integrated delivery system initiatives, including conducting
situational analyses, financial modeling, appraisals and due diligence on
several potential strategies, models, corporate structures, and organizations.
Clients for which we provided  Evaluated and made recommendations for a hospital to create a hospital/
integrated delivery system
consulting services include physician joint venture and acquire a Limited Knox-Keene HMO License
(aka risk bearing organization) to increase business.
 MemorialCare Medical
Foundation. Long Beach, CA.  Directed the financial and operational due diligence for Tenet of Mullikin
 Geisenger Health System. Medical Centers (later MedPartners), a $367 million integrated delivery
Danville, PA.
 Winchester Hospital. system including a hospital, physician group and IPA network throughout
Winchester, MA the State of California that was over 90% capitated representing in excess of
 Good Samaritan Hospital. 300,000 commercial and senior HMO members.
Cincinnati, OH
 Catholic Healthcare West. San  Created first Limited License Knox-Keene HMO organization in the State of
Francisco, CA California for Mullikin Medical Centers, calculating the organization’s
 Sharp Health System, San
Diego, CA
tangible net equity. Projections were accurate through the first eight
 St. Joseph Health System. quarters of operations.
Orange, CA
 Sutter Health System,  Created process adopted firm wide within Ernst & Young that used
Sacramento, CA organizational change management techniques to overcome resistance to
 UniHealth Burbank, CA
change, and to create or reorganize integrated delivery systems.
 Wrote the strategic/operational plan for Catholic Healthcare West's
Physician strategy, which included a medical foundation, IPAs, MSOs, and a
decentralized local involvement of hospitals in each region.