“My early career was in Mental Health. I believe the fact that mental health is treated differently is a historical accident brought about from Dorothea Dix and her important and successful campaign for mental institutions. We will never control health care costs until we include mental health.”
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Will Ferniany, Ph.D., a senior leader in health care since 1975, is the Chief Executive Officer of the UAB Health System — a $3.4 billion, six-hospital, academic health system which includes a wholly-owned insurance plan. Prior to coming to the University of Alabama at Birmingham in 2008, Ferniany was Associate Vice Chancellor and Chief Executive Officer of University of Mississippi Health Care. He also spent 14 years at the University of Pennsylvania where he held several senior leadership positions, including Senior Vice President of all physician services and Chief Administrative Officer.
Ferniany holds a Ph.D. in Administration-Health Services and a Master’s of Science in Health Service Administration from UAB. His undergraduate degree is from the University of Alabama. Ferniany has been a Senior Fellow in the Leonard Davis Institute, an adjunct faculty member of the Wharton School and the School of Health Related Professions at the University of Mississippi; and an instructor in the University of Pennsylvania’s School of Medicine. He currently teaches in UAB’s School of Medicine. Ferniany has served on many regional national health administration boards, including the Alabama Hospital Association (past Chair), Association of American Medical Centers, University Health Consortium, Council of Teaching Hospitals (past Chair), Vizient, and the University of Miami Health System.
Ferniany believes he has developed a practical and politically feasible approach to U.S. health care reform, which can be read in its entirety here.
Thank you so much for doing this with us Dr. Ferniany! Can you tell us a story about what brought you to this specific career path?
So many things in life happen randomly, and it was a combination of random events that led me to hospital administration as a career. I was a student in pre-dentistry at the University of Alabama, and in my first semester, I decided I did not want to be a dentist. I went to the University Career Counselor and they gave me the Strong Vocational Career Test — it said I would be best as a priest, Army officer, or manager. I decided manager looked the most interesting.
At the time I was volunteering at Bryce State Hospital for the Mentally ill — I had also volunteered at hospitals in high school — and the father of one of my friends was a hospital administrator. I decided to go into Mental Health Administration, and that was my field for the early part of my career until I was hired to run the Psychiatric programs at the University of Alabama at Birmingham. Then, my career moved from mental health to academic medicine.
Can you share the most interesting story that happened to you since you began leading your company?
You know, the thing that is the most interesting is really the caliber of people we have in our health system and at our institution who are working daily to improve the health of the people of Alabama and around the world. Their work has created a cascade of interesting stories and medical successes. Our UAB Kidney Chain is the nation’s longest, ongoing, single-center paired kidney transplant chain, with 112 people transplanted since Dec. 2013. Our lead surgeon for the chain, Dr. Jayme Locke, has traveled to South Africa three times to help that country re-write its organ donation policy and take the same techniques that have been applied to the UAB Kidney Chain and help them execute similar strategies. Our robotic surgery program regularly sets new surgical standards.
We perform almost 1,000 robotic surgeries a year, which is the largest surgical volume in the country. And because of the expertise of our team, we attract hundreds of surgeons from around the world for observation and educational sessions. In fact, we are recognized as the U.S. leader in robotic surgery teaching.
Other academic medical centers come to us to ask for guidance on developing their curriculums in the field. UAB Hospital is only the 12th hospital in the world to receive four consecutive Magnet designations by The American Nurses Credentialing Center. We have an unbelievable opportunity in the area of precision medicine, led by Bruce Korf and Matt Might (who was appointed to the White House Precision Medicine Initiative by former President Barack Obama) in our Hugh Kaul Precision Medicine Institute. They are reshaping the way we think about human health, diagnosis and treatment of disease. It really focuses on individual patients to understand how their lifestyles, behavior, environment and genetics interact to affect their health. And this enables a systematic approach to integrate these factors into the prevention, diagnosis and treatment of disease tailored to the individual patient.
There are so many other stories and examples. Truly. And the reason we are seeing these successes is because the leadership in our organization at every level is committed to finding, bringing in and supporting the most talented and cutting-edge thinking doctors, nurses and researchers we can to solve the challenging health care needs we face. We’re determined to do it.
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?
The lesson learned was to ask “why?” In the mid-1970s, as a young administrator at Bryce, I wanted the grounds staff to “bush hog” the woods behind the hospital. These men kept telling me, “You don’t want to do this.” As a good student, I did what I was taught and explained why this was important. I never took the time to ask “why not cut it?” Finally, I got frustrated and said “just cut it.” Well, they did, and they found several skeletons identified as patients who had eloped years earlier but were never found. The workers must have known there was a good chance those former patients would be out there. You can imagine the rest — news coverage, very upset boss, etc. I learned my lesson to not only listen but ask questions until I fully understand.
What do you think makes your company stand out? Can you share a story?
UAB Medicine, which is the academic component of the UAB Health System, is one of the great academic medical centers in the world. The reason for this is the close alignment between the research, clinical and educational mission. We are 23rd in the United States with almost $300 million in National Institutes of Health research funding. Our patient satisfaction scores are strong, which is a testament to our outstanding care teams. And our innovative care options are important, especially considering the complex care we provide patients. Again, our people and their commitment to the patient is what makes our academic medical center such a special place.
What advice would you give to other healthcare leaders to help their team to thrive?
Communicate, communicate, communicate. Never stop the communication with your team, and as much as possible, be as transparent as you can be. What many leaders don’t realize — but what their marketers understand — is that your staff has to hear something at least six times before they even know you are trying to tell them something and another six before they understand. A single email just does not do it.
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?
1. Cost of inputs are higher. The US does not allow — by law — Medicare to negotiate drug or medical device prices. As a result, our pharmacy and medical device prices are many times higher than the rest of the world. We pay staff more than other developed countries, as patients we want private rooms, we have considerably more regulations, and a fragmented billing system.
2. Not enough is spent on public health and social determinants of health. We spend about 17 percent of our GDP on health care, which is very high compared to other developed countries. However, we don’t spend much on public health and the social safety net compared to those same countries. If you compare both health care and social safety net expenses, the spending is much closer. It would be much more effective for the US to spend more on education, public health, housing, etc., than to cure people once they get sick. This is especially true of education. There is a direct correlation between education and improved health.
3. We spend too much on Administrative Costs. Because of our fragmented and over regulated system, health providers employee “armies” of people to do billing and argue with the same number of people the insurers employ to do billing. Providers must employ people to do coding and reporting on a myriad of different reporting requirements, most just a little different between Medicare and each insurance company. It is estimated that almost 25 percent of our health care cost is in administrative expenses.
4. Our culture. A large part of our expenditures are in the last year of life — after facing cancer or experiencing heart attacks or other ailments. These expenditures are not just on the elderly but for traumas, too. If you take the US murder rate, for example, our mortality is much closer to the rest of the world. A lot of this is cultural. Think about the famous quote from Joseph Stalin, “If you kill a million people it is a statistic, but if you kill one it is a tragedy.” That is true of health care. I can discuss that we should not do heart surgery on a patient over a certain age or engage in cancer surgery/chemo/radiation treatments for a person who will only live 3 to 6 months more, but when it is one of my loved ones, my feeling is different.
5. Fee for Service payment for care. We need to move from fee for service to payment of the total cost of bringing the patient back to as high of a level of life functioning as possible — a type of global payment. Right now if a patient comes into a hospital with throat cancer, if they survived and are discharged, the hospital sees it as a success. But the patient has much farther to go before they are back to the highest level of life functioning. Hospitals should be paid — not on what is done in the hospital and 30 days after — but on a bundled fee of the total cost of care to get the patient to the highest level of life functioning. It should be the total cost of the care, not just the inpatient component.
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.
The Affordable Care Act helped get more people insurance, but it did not really control health care costs. In addition, Medicare for All is too far of a reach. Our health system is just too fragmented in its approaches, and it makes policy implementation difficult (VA, private insurance, Medicare, Medicaid etc.). I believe we need to provide a uniform platform that encourages competition, improves health, lowers cost, and provides options. For this we need a new health care plan, Universal Health Choice, A Health Plan for America.
Ok, it’s 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 I do to help?
I have been advocating a new Health Plan for America (Universal Health Choice) locally, in Washington, D.C., and with my colleagues around the country that I believe will address these issues. You can read the plan in its entirety here. If lawmakers do not start fresh and build a system for America’s future, everyone’s best efforts and intentions will fall flat. We must improve the efficacy of the system to benefit patients, as well as make health care financially sustainable.
I believe there is a practical and politically feasible approach to U.S. health care reform.
The keys to this solution are vouchers (for choice) and allowing everyone an option to purchase a Medicare solution. The proposal provides freedom of choice for people purchasing insurance; addresses concerns regarding pre-existing conditions; provides competition, thereby reducing the cost and increasing benefits; stabilizes the small and individual markets; ensures fairness by having large risk pools; and eliminates the Medicaid stigma barrier.
We already have a proven example of how a voucher system could operate with Medicare Advantage, where beneficiaries can stay with traditional Medicare or elect private insurance. The private insurance companies compete to offer the best benefits for the “voucher.”
This proposal does not provide for universal insurance, but it does offer a foundation for such in the event that the federal and/or state government(s) wished to extend benefits to all, through tax credits or subsidies.
As a mental health professional myself, I am 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?
As I noted, my early career was in Mental Health. I believe the fact that mental health is treated differently is a historical accident brought about from Dorothea Dix and her important and successful campaign for mental institutions. We will never control health care costs until we include mental health. Part of the problem is that we are paid fee for service, and as such, the provider is not concerned about the total cost of the person’s care. You can see this where population health or capitated payments are made. Once the provider is financially responsible for the cost overall cost of care, attention is given to mental health and other social determinants of health.
How would you define an “excellent healthcare provider”?
One that puts the patient first. This sounds like mother hood and apple pie, but it rarely happens. We make decisions to save costs, meet regulations, attract MDs, retain nurses, etc. Rarely do we make a decision with the criteria being, “what will improve the provider patient interaction.” The philosophical underpinning of the modern hospital is the industrial revolution (Michel Foucault, The Birth of A Clinic). The hospital has the same underpinnings as a prison — to take the patient (or prisoner) and put them into our “machine.” It’s designed for the patient to bend to the needs of the organization and not the other way around. The patient becomes a “widget” in our complicated system. Look at the similarities in prisons and hospitals. They take your clothes and make you use theirs — and prison clothes are better than hospitals. Both feed you when they want to feed you. An ICU and maximum-security prison are similar in design. Hospital’s wake you for a test. Clinics are not open at convenient times. You have to wait in waiting rooms. I could go on. The bottom line: the patient is not first.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
People do what you inspect not what you expect. This quote is a principle of my management and has served me very well. I do not know the origin, but a boss I had many years ago taught me this.
Are you working on any exciting new projects now? How do you think that will help people?
We are working on two that I am very excited about.
The first is re-imagining the primary care visit. The primary care visit — outside of the medicine practiced — and the electronic health record have not changed one bit since I was a child. You call and make an appointment, wait in the waiting room, get called back, and sit on a table with white paper. There, a nurse takes your vitals, a doctor comes in, etc. UAB Medicine is working to design the primary care practice of the future. We’re setting up a beta site in Birmingham with focus groups and we will conduct extensive research. We plan to open a practice and use it as a test bin to find out what millennials need and want in a primary care physician and a primary care appointment visit. We’re doing that research now. We’re going to try a lot of different things, and those things that work, we’re going to export it into our practices. We are also working to conceptualize the role of primary care in medicine. As medicine moves more towards population health and value-based payment, what is the role of primary care? That’s a broad question overall and there’s no simple answer.
Our second project focuses on a medical app. There are currently some 60,000 medical apps available. But physicians and patients either are not aware of most of them, or don’t know which ones are good. Many don’t even know how to use them. UAB Medicine is starting a new service similar to the Apple Store Genius Bar where our doctors can write an “app script,” and the patient can come to the bar, receive help downloading it and then taught how to use it so it benefits them and their specific needs.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Frederic Reichheld, the Loyalty Effect. Satisfaction is not what is important, it is loyalty to the service or product.
Patrick Lencioni The Five Dysfunctions of a Team. This book helps you build a strong team. You can’t manage alone.
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. 🙂
To redesign the health care system so that it is fair to every American. I really believe I have a plan to do it. I firmly believe it is possible to balance compassion with good business sense and fiscal responsibility in health care reform. With the right amount of good-faith debate and insight from other experts, I think it could lead to that very outcome.
How can our readers follow you on social media?
I don’t use social media personally, but people can follow UAB Medicine on Twitter @uabmedicine.
Thank you so much for these insights! This was so inspiring!
About the Author:
Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.
Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.
After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.
In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.
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