Patricia Maryland: Finding opportunity in crisis
In 2007, Patricia Maryland received what she could only describe as a calling. She was tapped for a new two-pronged position
at Ascension Health, as Market Leader for Michigan and President and CEO of St. John Providence Health System (SJPHS). SJPHS
is a member of Ascension Health, accounting for 25% of its patients across five hospitals and more than 125 medical facilities
in southeast Michigan. It spends significant resources caring for people living in poverty.
Maryland knew it would be a difficult road ahead. Detroit was facing the most economically challenging time in its history
since the Great Depression. By 2009, Michigan had the highest unemployment rate in the country; GM and Chrysler had declared
bankruptcy, with nearly one million jobs lost across the state. The idea that workers' insurance could pay the healthcare
tab for SJPHS was no longer viable.
Great leaders can do more with less, and it was up to Maryland to ensure the health system survived and could continue to
meet the needs of the community. This was not a job for the faint of heart. She had to act quickly to slash $70 million in
operating expenses while maintaining the mission to serve people in need.
"There was no way to make the cuts and preserve the current operating structure," says Maryland. "We had to do something new
for Detroit and for the future...In Detroit, you can get stifled because of the challenges, but instead we looked it as a
bold way to extend our creativity. We blossomed in the face of adversity."
Amidst one of the worst economic crises in US history, Maryland, who has a doctorate in public health administration, proceeded
to execute a broad vision based on a preventative, patient-centric approach to care. Patricia believed there was a chance
to scale up healthcare services so that patients would have a better outcome while saving the system money—all by distributing
health care services differently. It centered on providing an earlier, more interventionist and more holistic approach to
care—as Maryland explains, "Our job is to connect the dots and coordinate other services so patients are treated earlier and
correctly and thus able to have a better outcome."
It's the type of healthcare Maryland had wished for while growing up, as she watched her mother struggle with diabetes. "My
mother had all the complications that follow with diabetes—problems with eyes, nerves, congestive heart failure, and then
renal failure, which she died from," she remembers. "We were frustrated when we used the health system; it was always focused
on what we needed to do today. We took on each health problem as it surfaced. Care was provided in a silo way. What my mother
really needed was a team of physicians to sit with us and review all the things we needed to be thinking about when it comes
Wellness and preventive care attract significant attention, but because it calls on distracted service providers to invest
today to obtain results tomorrow, few organizations want to risk leadership in this area for the possible negative short-term
impact on budgets. But Maryland knew it was an important element to reducing the overall cost of care. She also saw it as
an important shift away from the current unsustainable business model, which is based on a disjointed fee-for-service reimbursement
system, which incentivizes physicians and hospitals to treat sick patients rather than performing services designed to keep
The fruits of Maryland's labor is a program called Partners in Care involving St. John's Providence and the Physician Alliance,
a network of more than 2,300 physicians in southeast Michigan. Working together, the two groups cut the overall cost of care
by shifting treatments away from the hospital emergency room to primary care physicians, who could intervene early on and
thus avoid admissions to acute care facilities. The hallmark of the new model is the "medical home"—which is a designated
primary physician who meets the patient regularly and focuses on wellness and understanding the needs of the entire family
to connect them to the right care.
It was through this hospital-physician organization that SJPHS secured the first commitment on an outcome-based hospital payment
model from the large insurer, Blue Cross Blue Shield of Michigan. Under the agreement, St. John's Providence receives higher
reimbursement for successful patient outcomes. The agreement sets a new standard of pay-for-performance by encouraging high
quality of care rather than high volumes of services, measured by the successful treatment of patients.
Maryland was part of the decision to roll out this model and sell it to Ascension's employees. Over the past five years, her
team has proved its mettle with metrics that show the overall cost of healthcare for the Ascension workforce has dropped significantly.
The company has now taken the model national with some 150,000 associates now enrolled—all based on a risky pilot launched
in a Detroit on the ropes during the worst recession since the Great Depression.
The lesson for fellow women in the management hot seat? Hard times are often the best time—to think big.