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Common Culture – A source of strength for integrated delivery systems 

By Cathy Eddy, Health Plan Alliance, July 25, 2016

On July 20, I had the opportunity to be part of a discussion that American Hospital Association and Sharp Healthcare hosted in San Diego for integrated delivery systems with health plans. I was asked to facilitate an exchange on key trends in product innovation.

During the day the discussion hit on many of the national trends we are seeing in our work with health plans around the country:

  • Strategic Value
  • Growth
  • Changes in Ownership
  • Alignment and Intersection
  • Government Oversight

During my session, we went into depth about the need for alignment between payers and providers and the key intersection points where health systems and their provider-sponsored health plans need to work in tandem to be successful. These areas are:

  • Governance
  • Customer experience
  • Contracting strategy
  • Risk adjustment
  • Quality metrics
  • Clinical integration
  • Informatics and analytics
  • Technology assessment and IT infrastructure

Jim Hinton, President & CEO, Presbyterian Healthcare Services who chaired the meeting, suggested I add a slide about Culture, another area that is a key to success. He shared that his team will call out when the word “side” is mentioned. I’ve been on the Presbyterian Health Plan board for 10 years and the organization does a great job of looking at its challenges and opportunities from a system point of view. We have an annual planning retreat with the system and health plan boards that contribute to a common culture at the governance level.  Jim’s comment reminded us that words matter.  So does culture.

Mike Murphy, CEO of Sharp Healthcare, led a discussion with a team of his executives including Melissa Hayden Cook, the CEO of Sharp Health Plan. They did a great overview about how they work as an integrated health system. This organization has built the “Sharp Experience” that drives a common culture. For the past 15 years, Sharp has held annual all-employee meetings  – three sessions where 17,000 employees, 2,600 physicians and 2,000 volunteers are invited to take a bus trip to the convention center and recommit to Sharp Healthcare and their role with the system. Their vision: To be the best health care system in the universe!

Integrated Delivery Systems often include several business models and that can result in different cultures. The language of a health plan is different than the one used by providers. The meaning given to the same words can be different – for instance, revenue. In a health plan, revenue comes from premium dollars, but payers see provider revenue as a cost. Roles can have the same title, but different responsibilities  -- care manager is just one example. It is a challenge for our integrated delivery systems to develop a common culture.  Kudos to Sharp and Presbyterian for the work they have done in this arena.

Value-based payments will drive the need for collaboration. Population health focuses on the care continuum. The customer experience is often a reflection of the system’s culture…positive when everyone is working with a common set of values and negative when the hand-offs are confusing and disjointed. As we strive to successfully integrate providers and payers, the value of a common culture can be an important key to success.

So how healthy is your culture? Listen carefully to see the words that are a part of conversations in your health system to see if you are thinking like an integrated system.

This post originally apperared on the Health Plan Alliance Blog on June 28th, 2016. You can see the original at and see all the Health Plan Alliance Blog posts at

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