Health systems have to evolve as the industry does.
But in order for those changes to work, health systems have to be strategic about considering the geographic and community dynamics at play around them.
Those are the nuances Peggy Sanborn, vice president for strategic growth and diversified services at Dignity Health, helps navigate—regardless of whether she's working on a partnership with a local urgent care center or a massive deal like Dignity’s merger with Catholic Health Initiatives.
“It requires my team and myself to be well-versed in all of the different types of structures and understand the rules and regulations under which we can do certain things," Sanborn told FierceHealthcare in a recent interview about how she and her team are helping to develop and grow Dignity’s footprint across the care continuum.
Here’s more of what she had to say about how the health system's broad reach into so many different states and sites of care requires so many unique approaches to make it work.
FierceHealthcare: Dignity Health’s merger with Catholic Health Initiatives is expected to close by the end of the year. What are some lessons you’ve learned while navigating that process?
Peggy Sanborn: It's always infinitely more complicated than you’d ever anticipate it would be. Even though we both run large, hospital-based health systems—if you’ve done one, you’ve done one. Everybody’s a little bit different, and I think the more work we do to define how we’ll function once we come together, the more we understand how many layers there are to making that successful. As complex as it is to construct a relationship like this from negotiating and putting it all together, that might be the easiest part, when you think about how hard it is to put together two very large organizations and have them come out strong.
FH: What are the strengths and challenges of that deal?
PS: I think our shared mission and values of a well-aligned culture that we identified early on—people with their hearts and minds in the right place—is going to help us be successful. But it is never going to be, “OK, we’re done, so we can just sit back and it’s all going to work from here.” It does require a tremendous amount of work to put two large organizations together, but I think we’ve got really good leadership and a really strong vision behind what we do, and very committed people who want to see it be successful. Those ingredients will take you a long way in trying to work through all the challenges that are sure to come.
FH: What challenges do you run into when it comes to expansion when Dignity Health already has such a wide geographic footprint?
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PS: Not every good idea fits in every geography. We can have very strong partners who we’ve built great relationships for novel care or innovative care or an ability to expand. But what may work in Phoenix may not work in Bakersfield. What may work in the coast of California may not work in Las Vegas, Nevada. So, it’s nuanced by the particulars of the market that we want to work in.
It’s also somewhat driven by the partner’s model for care. Some of them are built to work very well in concentrated urban environments, others in more suburban or even more rural environments. So, the solutions, unfortunately, are not like books on a shelf—well, I need one of those so I can use this. They require adjustment and adaptation, and sometimes they require more than one partner that works in that space.
FH: A lot of talk right now is focused on consolidation or mergers, but you also focus a lot on partnerships or joint ventures. Why is that important?
PS: The complexity of a merger or an acquisition is on every facet of your organization to be able to be effective at it. We could probably spend the entire time talking about all the complexities. There’re 28 different work streams working on integration, and it’s requiring hundreds of people from our organization, who also have day jobs, to work on that. We don’t even want to go into how many advisers you need to help you do that.
That’s one massive undertaking, and it can be transformative. … But when you talk about partnerships and joint ventures, it’s looking at a best-in-class provider, who can do something with you, that the two of you can bring together that is greater than the sum of its parts.
If I partner with a surgical operator, they’re really focused on that very efficient model of surgical care. What I bring is a whole system of care that says I can bring together the physicians and the payer contracts and the primary care and the post-acute component that may be required for these patients. I can bring all of that as part of a system of care, and I can partner with you effectively on upping our game in the [ambulatory surgical center] by connecting the dots and by helping you to be more successful at what you do.
FH: You clearly have plenty on your plate at the moment. But looking forward into 2019 and beyond, what are some of your goals and things you really want to accomplish?
PS: I’d like to see us continue our path to diversify what we do as a health system, to begin to push even more into meeting patients where they want to receive care. So my goal in 2019 would be to have a high degree of energy and focus on that as a combined organization to continue to diversify our services, and reach out to deliver care where patients want to have their care delivered.