New AHA chairs calling for health care has deep roots
A chance moment kick-started Eugene Woods’ career as a health care leader more than 25 years ago, and a simple health care–related accident that took his aunt Carmen’s life years ago continues to fuel his passion for the field decades later. Now, Woods, 52, is embracing some significant new beginnings. In April, he took the helm as president and CEO of Carolinas HealthCare System in Charlotte, N.C. Last month, he began his yearlong role as chair of the American Hospital Association’s board of trustees. Woods recently sat down with Marty Stempniak to talk about the AHA’s new strategic plan, his fluency in Spanish and his love of singing and writing music.
Starting out
My introduction to the health care field was an accident, but my calling was not. I was an undergraduate, and the day of a career fair, by mistake, I went to a presentation in which a local hospital administrator was talking about how in health care you can change lives and communities. He sort of had me at "hello." After listening to that CEO, I decided the next day to major in health policy and administration at Penn State.
Making a difference
When I was a kid growing up in Spain, my father was in the military, and one of my favorite aunts, Carmen, went to the hospital there for headaches. She died from a medication error, leaving three young kids at home. She is the aunt who gave me my first music album, and I always remember who she was and what she meant to me when I was a kid. Once I decided to pursue a career in health policy and administration, that became my source of inspiration — realizing that health care is a field in which you can actually make a difference in people’s lives in any community. My first job in health care was director of quality, and it's still in my DNA today.
New beginnings
I can't think of a more exciting time to make a difference in the health care field. We have a new president in the White House. We have a new president of the American Hospital Association, Rick Pollack, and we have a new strategic plan for the AHA. So, yes, it’s a time of new beginnings in many ways. It’s a privilege for me to lead one of the most important and historically relevant professional organizations in the country. Since 1899, the association has helped to shape health care in America. We’re at a time of reinvention now, so to work with such a talented field to reinvent health care yet again is exciting.
Plotting strategy
In 2017, we’re launching the new strategic plan called Advancing Health in America, led by Pollack and endorsed by the AHA board. The focus will be implementing that plan from 2017 to 2020, and there are a number of driving forces that I think are important.
One is the topic of affordability. It is top of mind for politicians, for employers and for the general public, and it’s multifactorial. A year ago, we had a 12 percent increase in drug spending, the highest in more than a decade. We’ve seen 3,500 generic drugs that, in a relatively short period, doubled in price; 400 of those drugs increased 1,000 percent. We’re entering an era of labor shortages for both nurses and physicians, which also has an impact. And so, the affordability agenda is something that the field will continue to focus on. What I’m proud of is that the AHA, through its Hospital Engagement Network, has really contributed to affordability. We’ve saved nearly $300 million by preventing 34,000 incidents of harm. Part of affordability is continuing to improve the standard of care in clinical practice so that we can continue to improve quality while decreasing costs.
The other aspect of the strategic plan is looking at the concept of metrics that matter. There are hundreds of different metrics and methodologies that we are trying to interpret, and we’ve narrowed them down to 11. They include some population health statistics, such as obesity and diabetes, so that we can convene different stakeholders, such as government, payers, etc., around what’s been an overwhelming onslaught of metrics, many of which aren’t really meaningful.
And there are two other things that I would highlight. One is the proliferation of regulations, some of which are outdated, conflicting and impede or thwart our transformation efforts. Last year alone, almost 15,000 pages of new regulations had been written at one point — almost a final rule every week. And so, a key focus is to make sure that regulations aren’t overly burdensome on the field.
The committee on research, which I chair, is also looking at what we’re calling the next generation of community health. We’re at a point where we have to rethink how we engage with communities, especially as more people are becoming insured. Carolinas HealthCare System serves Anson County, where a quarter of the 26,000 residents are below the poverty line. The county ranks 87th out of 100 counties in North Carolina based on such factors as smoking, obesity rates and use of primary care physicians. The 52-bed hospital there had an average daily census of three to five patients and really wasn't going to serve the community well long term.
So, we built a new 15-bed acute care hospital and colocated medical homes and primary care facilities, which is in line with the community’s needs, specifically around chronic conditions. Primary care visits increased 250 percent, and we're already seeing decreases in chronic conditions like obesity and diabetes. This was one way to rethink how we provide for the needs of communities going forward, and we need to continue to explore that on a larger scale.
Local priorities
At Carolinas, we hot-spotted the area we serve and found six ZIP codes in which the emergency department use is three times the national average, and there are not only some access issues to primary care but also some food deserts. So we’re forming a coalition called One Charlotte to figure out how to engage differently with the business and faith communities and with politicians to bring services specifically to those communities in need. There are many nonprofits in the Charlotte area that are focused on trying to help those who are most vulnerable. The coalition can bring more deliberate planning to those areas.
We’re the largest provider of health care in the Carolinas, and we have a tremendous opportunity to redefine how it is delivered in the states we serve and beyond. One of the key priorities is developing partnerships with other like-minded organizations that are hoping to change health care delivery in the state, including research, technology and educational organizations. As states move into a value-based world and clinically integrated networks form, together with analytics and care management, these partnerships are important so that we can serve more populations and communities better.
Behavioral health
For a long time, nobody talked about behavioral health and, in many ways, there was a stigma associated with it. However, it can no longer be ignored. One out of four people in the U.S. deals with a behavioral health issue; 40,000 people commit suicide every year; and about 5.5 million people with behavioral health issues go to emergency departments every year.
There’s reason for optimism because a couple of years ago the Excellence in Mental Health Act was passed, the first federal regulation in a long time that looked to increase mental health resources. Specifically, 24 states received grants, North Carolina being one of them. About 29 counties do not have a single psychiatrist, and this grant provides some funding to help analyze this shortage. Also, the Helping Families in Mental Health Crisis Act was passed by the House in July, which will reorganize federal agencies that oversee mental health policy, direct funding to combat serious mental illness and provide additional payments through Medicaid to deal with illnesses like schizophrenia. I’m encouraged by that.
At Carolinas, we are proud that we are one of the national leaders in co-locating behavioral health into primary care offices. So, when behavioral health patients come to their primary care offices, we have the resources to take care of those patients virtually through coaching and specialists, and can administer behavioral health medications right there. Not only did depression and anxiety scores go down for patients who visit their primary care physicians with previously undiagnosed behavioral health issues, but their A1C blood sugar levels also improved. We’ve found that telepsychiatry is also effective in emergency departments, and we’ve decreased our wait times in the ED significantly because of that. We do about 500 virtual ED consults for behavioral health monthly, which also has improved care delivery.
Effective behavioral health programs require a partnership of legislators, the health care field, churches, educators and the community because so many folks are affected. In 2016, we trained more than 3,500 community mental health first aid responders in early detection of suicidal tendencies, how to have the conversation in the communities, how to help folks when they’re in need, and what resources are available in the health system. We found that to be very effective, because sometimes it’s difficult to know when people are suffering.
Not long ago, we learned about a man who was suicidal, and one of the mental health first aid responders not only helped him get the resources he needed but also continued to follow up with him. Eventually, the man was able to get a job and was named employee of the year at his workplace.
Hospitals Against Violence
Across the country, we’ve seen violence erupt in way too many communities, and whenever it happens, it deeply affects so many folks. But one of the things that is most important, from the AHA’s perspective, is that the victims of violence typically wind up on hospitals’ doorsteps. Every day, hospitals are asked to respond to the trauma caused by violence.
A few years ago, the Centers for Disease Control and Prevention reported that health care systems treated more than 2 million people in EDs and outpatient centers every year as a result of violence. Another study recently pointed out that treatment costs about $30 billion for those patients, not including the social and psychological costs. So, the AHA has launched a Hospitals Against Violence initiative that focuses on addressing violence within our four walls and in the communities we serve. It is about fostering hospital efforts to combat violence in the communities and health facilities, facilitating conversations, sharing best practices, and highlighting the collaborative efforts that hospitals have with nonprofit community organizations, including the police departments. It’s something that is another major focus for us here at Carolinas, and certainly for the association.
After the recent demonstrations in Charlotte, I visited our emergency department that treated police officers and protesters alike. It’s evidence that we’re there for everyone no matter what, 24/7, 365 days a year. But it really references what I said earlier: We’re focusing on working with the community in new ways, including supporting law enforcement in how police officers connect with individuals, bringing primary care and other services into communities in need, and fundamentally looking at how we create jobs. These are all systemic issues that lead to disenfranchisement and are root causes of violence, and we’re working with other organizations to help address them.
Cloning what works
I’m a big believer in an approach to leadership called the "appreciative inquiry." It’s highlighted in one of my favorite books, Switch: How to Change When Change is Hard.
The point of the book is that, so often as leaders, we ask the question: What's broken and how do we fix it? How I’ve tried to approach leadership is that sometimes you can be more effective by saying, ‘What’s working and how do you clone it?’ If I think about that leadership style, one of the most exciting things about being at the American Hospital Association is that I’ve been able to speak with and see leaders from all around the country and learned about so many incredible innovations that I continue to be amazed at the field’s commitment to community. There are many bright spots in the health care system right now.
So, while a lot of times we are focused on what’s broken and what needs to be fixed, I think if we would just clone what’s working well in any one of the systems that we have in the country — from rural to urban to regional and national systems — that it would be transformative. We’ve seen that already in how we’ve approached the [Hospital Engagement Network] work. As I mentioned, $300 million saved, 34,000 instances of harm averted — and this is accomplished simply by working together on best practices. Part of the excitement and part of the leadership that I hope to bring as chair is continuing to highlight those bright spots, because I think we can all learn a lot from them.
Remembering my Aunt Carmen, it is a privilege to make a difference in somebody else’s life and to help improve the health of communities. It’s an opportunity to serve as a leader in the health system. I’m sure there are many other fields in which folks feel the same, but making a gadget or a widget is not something that I’m made out to do. I have a goal of really shaping the health of communities for generations to come. And I know it may sound highbrow, but I am still inspired by the original reasons that motivated me to serve this field.
Marty Stempniak is senior writer at Trustee.
New AHA chair always in tune
I have two boys; the eldest, 21, is a senior in engineering at the University of Illinois. My youngest, 15, is in 10th grade. Both are much smarter than I ever will be. My wife and I have been married for 22 years. I grew up in southern Spain, where my father was stationed in the Navy for seven years as an aeronautics mechanic. My mother is the eldest of 12, so I’ve been blessed with being surrounded by a big family when I was growing up, and that’s how I became fluent in Spanish. My mother was from a town called Jerez de la Frontera, and those years overseas were formative ones for me.
I grew up in a very musical family, and music remains a big part of who I am. In Spain, my father would come home every day with a new blues record or, at the time, reel-to-reel or eight-track that he was playing. And there was never a reunion with my Spanish family that didn’t include singing or dancing flamenco. When I was 10 years old, my uncle taught me my first song on the guitar. That’s when I got hooked. The next Christmas I asked for my first guitar amplifier. Unbeknownst to me until many years later, my parents had forgone a month’s rent to pay for the guitar and the amp. But, I’ve shared with them that the investment was well worth it because when I went to college, I played in bands to pay the bills. The investment in that guitar put a lot of food on my table and paid a lot of months’ rent when I was in college.
I still try to find time for the guitar nowadays. My wife says she always likes it better when I’m playing. So, at least twice a year, I try to spend a weekend either recording, playing or writing music with former band members from around the country.
Actually, when I attended my first American Hospital Association board meeting, there was a phenomenal band playing at the hotel. Not many folks were paying attention to them, so I walked over to the guitar player, and I said, "I’d probably say no if I were you, but I think if I play one song, I can get the rest of the folks here on the dance floor, either to see me make a fool of myself or see if I’m any good." And sure enough, after a couple of songs, we had everybody dancing and having fun. But I only do that sparingly.
Confronting the opioid crisis
Last year, one of my son’s friends died of an overdose. He would have been the last one you would think would be addicted. It was the classic situation in which he had an injury, he was given some opioids, and then he became addicted and was unable to get out of it. Just as in behavioral health, so many folks in the country know of someone who has been affected by this, and that’s another important, galvanizing cry to figure out how we all can work together to solve this epidemic.
I think we’re just starting to appreciate the full breadth of the issue. There’s not a day that goes by that we don't hear how many people have been affected. It’s something that crosses political lines, economic lines and racial lines. This is an important area of focus, and we now have the nation’s attention.
It’s a significant issue in this region, as well. Hickory, N.C., was ranked fifth in the nation in the rate of opioid use, according to a Castlight Health report called “The Opioid Crisis in America's Workforce.” In focusing on this, we have partnered with the state of North Carolina to integrate with its prescription drug monitoring program and put the data front and center so our providers have access to the latest statistics. I’m also excited about the PRIMUM [Prescription Reporting With Immediate Medication Utilization Mapping] project, a decision-support information system intervention that includes a hard stop in our electronic health records across thousands of providers. When they prescribe a controlled substance, including opioids, if there’s a history of positive drug screening or if the data show remaining drugs on a previous control script, then there’s a hard stop. That’s getting national attention, as well. We’ve also participated in the Lazarus project, which uses the drug Narcan to reverse an opiate overdose; this has saved hundreds of lives in North Carolina. Lastly, we’re integrating the use of the virtual care platform to treat behavioral health issues in primary care offices. That allows us to help at the point of intervention sooner.
Woods relishes Charlotte life
My family and I have enjoyed every place in which we’ve lived, but Charlotte is an incredibly beautiful city. The one thing that struck me immediately is how many trees are here. About 50 percent of the streets are covered by tree canopies. My wife and I have family in Pennsylvania, and, with all the green here, this feels very much like home. We also like being a couple of miles from the mountains. Having grown up in southern Spain near the beach, it’s nice to have easy access to such a beautiful part of the country.
It’s also one of the fastest-growing cities in the country. This community is very welcoming, even if you’re not originally from the area. You don’t have to have lived here for generations as long as you're willing to make a contribution to the community.
Eugene Woods CV
Health care career
- April 2016–present: president and CEO, Carolinas HealthCare System, Charlotte, N.C.
- May 2011–March 2016: president and chief operating officer, CHRISTUS Health, Irving, Texas
- April 2005–May 2011: CEO, St. Joseph Health System, and senior vice president, Catholic Health Initiatives division operations, Lexington, Ky.
- 2001–05: chief operating officer, MedStar Washington Hospital Center, Washington, D.C.
Boards and recognition
- 2013 Senior Healthcare Executive of the Year, National Association of Health Services Executives
- National board member of NAHSE and former president of its Washington, D.C., chapter
- Fellow of the American College of Healthcare Executives
- List of 2016's 100 Most Influential People in Healthcare, Modern Healthcare
- List of Top 100 Chief Operating Officers, Becker Professional Education
- Named three times to list of Top 25 Minority Executives in Healthcare, Modern Healthcare
- Alumni of the Year, Pennsylvania State University
Education
Bachelor’s degree in health planning and administration, master's degree in business administration and master's degree in health administration, all from Pennsylvania State University