Dr. Kristy Fassler, ND, Co-Founder, North Coast Family Health

Today’s guest is Dr. Kristy Fassler, ND, co-founder of North Coast Family Health Integrative Medicine Clinic, a naturopathic practice in Portsmouth, New Hampshire. In this podcast Dr. Fassler and I discuss the training naturopathic doctors take, the philosophy behind naturopathy, and how naturopathic doctors work with patients to identify underlying dysfunction within the body and mind and correct it to promote healing from the inside out.

We also discuss how Dr. Fassler worked with her husband, other naturopaths, and the community to get the state of New Hampshire to recognize and license naturopathic doctors in the mid-1990s, and as a result she and her husband hold license numbers 2 and 3 in the state. 

This podcast was eye-opening for me because prior to talking with Dr. Fassler I had never spoken with a naturopathic doctor. I learned a lot about the field, and found many parallels between the naturopathic approach and the current movement in mainstream medicine toward a focus on wellness and patient centeredness – beliefs that naturopaths hold central to their practice. 

Links to the Podcast:

Soundcloud: 
https://soundcloud.com/healthleaderforge/dr-kristy-fassler-nd-co-founder-of-the-north-coast-family-health-integrative-medicine-clinic

Stitcher: http://www.stitcher.com/podcast/the-health-leader-forge

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

Podcast Outline

Time		Topic
0:01:50		undergraduate education and discovering naturopathy
0:05:03		Naturopathic Doctor training at Bastyr University
0:11:45		founding North Coast Family Health Integrative Medicine Clinic
0:14:59		lobbying to get state licensure for NDs
0:21:25		the practice of Naturopathic Medicine at North Coast, tick borne illnesses
0:29:20		what is being a new patient at North Coast like?
0:33:55		promoting healing from the inside out
0:36:02		homeopathic medicine
0:44:30		therapies offered at North Coast
0:48:31		challenges of practice - managing a business, the health care system
0:51:20		doctor as teacher
0:55:20		practice management
1:00:30		reflections on a career so far
1:03:10		advice for those interested in a career as an ND
1:04:16		Addendum and a correction

Links to Topics Discussed:

North Coast Family Health Integrative Medicine Clinic

Adelle Davis, Let's Eat Right to Keep Fit

Bastyr University

Lyme Disease

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Karen F. Clements, RN, FACHE, Associate Chief Nursing Officer, Dartmouth-Hitchcock Medical Center

Today’s guest is Karen Clements, the Associate Chief Nurse for Ambulatory and Primary Care Nursing, Emergency and Patient Placement Services, and Care Management and Psychiatric Services for the Dartmouth-Hitchcock Health System, or as her staff prefers, she is the Associate Chief Nurse for Team Awesome.

Despite its rural location, Dartmouth-Hitchcock Medical Center is the largest hospital in New Hampshire, taking referrals from over forty other hospitals in New England. It is also a major teaching hospital associated with Dartmouth College’s Geisel School of Medicine.

Karen is also the President of the Northern New England Association of Healthcare Executives, one of the sponsors of this podcast.

Karen is a nurse-executive whose roots are in emergency and trauma nursing. Her career began with an active duty tour in the Army’s Nurse Corps, then she returned home to Bangor, Maine where she progressed through the nursing ranks to become the Chief Nursing Officer of Acadia Hospital, a 100 bed freestanding psychiatric hospital. After 23 years with the Eastern Maine Healthcare System, she followed professional and personal opportunity to Dartmouth-Hitchcock, where her leadership skills quickly led her to the Associate Chief Nurse position.

In this podcast we talk about Karen’s career leading up to her current position at Dartmouth-Hitchcock, how Dartmouth-Hitchcock is changing to meet the challenges of an evolving health system, and how nursing is playing a role in that transition. We then talk about leadership, and Karen’s role in the Northern New England Association of Healthcare Executives and conclude with Karen’s recommendations for early careerists.

Links to the Podcast:

Soundcloud: https://soundcloud.com/healthleaderforge/karen-f-clements-rn-fache-associate-chief-nursing-officer-dartmouth-hitchcock-health-system

Stitcher: http://www.stitcher.com/podcast/the-health-leader-forge

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

Transcript of the interview available here. 


Podcast Outline

Time Topic
0:02:36 background, Army Nurse Corps
0:08:08 working up through the ranks, Eastern Maine Medical Center
0:18:49 Chief Nursing Officer, Acadia Hospital
0:25:34 coming to Dartmouth-Hitchcock Medical Center
0:30:52 Associate Chief Nursing Officer, Dartmouth-Hitchcock
0:33:55 role of Chief Nursing Officer and practice of nursing
0:37:44 use of advanced practice nurses (APRNs) at Dartmouth-Hitchcock
0:39:22 structure of nurses in the facility
0:40:18 Karen's professional growth at Dartmouth-Hitchcock
0:43:38 strategy
0:47:25 the future of health care and Dartmouth's approach
0:50:00 leadership
0:53:57 mentorship
1:00:32 women in leadership
1:05:30 ACHE/NNEAHE
1:10:36 advice to early careerists

Links to Topics Discussed:

Dartmouth-Hitchcock Health System

Dartmouth-Hitchcock Nursing

we joke about Karen following her husband Peter, a previous guest, to Dartmouth-Hitchcock. 

Eastern Maine Medical Center

Acadia Hospital

Army Nurse Corps - see also my interview with the Chief of the Army Nurse Corps 

Northern New England Association of Healthcare Executives (NNEAHE)

American College of Healthcare Executives (ACHE)

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Betsey Rhynhart, Executive Director, New Hampshire Accountable Care Partners

Today’s guest is Betsey Rhynhart, the Executive Director of New Hampshire Accountable Care Partners, an Accountable Care Organization or ACO headquartered at Concord Hospital in Concord New Hampshire. New Hampshire Accountable Care Partners was formed as a partnership between four community health systems in Southern New Hampshire: Concord Hospital, The Elliot Health System, Southern New Hampshire Health System, and Wentworth-Douglas Health System. In this podcast Betsey talks about her career, and how her education in public health and her background in insurance and strategy merge in her current role leading the ACO’s efforts. She talks about how the ACO is a learning organization that is helping the participating partners move toward a strategy of providing value-based care, a recurring theme we have been hearing from a number of leaders in recent interviews. Betsey provides an inside view of how the ACO was formed, how it operates, what the organization’s goals and objectives are, and what the participating organizations hope to gain from their collaboration. Betsey’s career and current role are great examples of how public health and direct care are beginning to merge as direct care delivery systems become more involved in population health models.

Links to the Podcast:

Soundcloud

        Unabridged: https://soundcloud.com/healthleaderforge/betsey-rhynhart-executive-director-new-hampshire-accountable-care-partners

        Abrdiged: https://soundcloud.com/healthleaderforge/abridged-betsey-rhynhart-executive-director-new-hampshire-accountable-care-partners

Stitcher: http://www.stitcher.com/podcast/the-health-leader-forge

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

Podcast Outline

Time		Topic
0:02:00		Education and early career
0:17:50		Concord Hospital
0:21:02		Executive Director of Accountable Care
0:24:28		About the ACA, the Triple Aim, and the Triple Problem
0:37:04		New Hampshire Accountable Care Partners
0:41:15		Establishing the ACO
0:45:25		The broad strategy of moving to value
0:53:07		Medicare and CHIP Reauthorization (MACRA) Act of 2015
0:57:16		How are beneficiaries assigned to an ACO?
1:01:31		Primary Care in an ACO Medical Home
1:04:15		Generating shared savings
1:14:05		Listening to the data - the importance of analytics
1:22:17		Shared learning, sharing best practices
1:25:24		Sharing the shared savings, evolving to achieve success
1:30:44		Leadership, mentorship, and advice to early careerists

Links to Topics Discussed:

Concord Hospital

New Hampshire Accountable Care Partners

CMS on Accountable Care Organizations

Medicare and CHIP Re-authorization Act (MACRA)

County Health Rankings and Roadmaps

Boston University's Masters of Public Health

Being Mortal: Medicine and What Matters in the End

American's Association of Health Plans (AHIP)

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Dr. Michael Sherman, MD, MBA, Chief Medical Officer, Harvard Pilgrim Health Care

Today's guest is Dr. Michael Sherman, the Chief Medical Officer and Senior Vice President for Health Services at Harvard Pilgrim Health Care. Harvard Pilgrim is a New England-based regional health plan with 1.25 million members. It has been ranked #1 by NCQA for the past ten years. Michael holds Bachelor’s and Master’s degrees from the University of Pennsylvania in Medical Anthropology, he attended Yale Medical School, and is a board certified anesthesiologist. In the mid-1990's he made the decision to pursue an MBA at Harvard Business School with the thought that he would seek to blend together his clinical expertise with a business education, but he was sure of one thing: that he would never work for an insurance plan. In this podcast he tells the story of his career, about becoming a physician, making the transition to executive leadership, and how he ultimately worked for three health insurers (ironically, the payers he said he would not work for). Michael's career involves a great deal of serendipity, but it also shows his deliberateness as he worked to develop the skills he knew he needed to progress as an executive by gaining exposure and experience in a wide array of organizations. He is also quite candid about his successes and challenges, which shows that the road to senior leadership is never smooth sailing.

His discussion of the work he is doing with value-based payment and bundling at Harvard Pilgrim is particularly useful and timely. It is very popular to demonize health insurers, but Michael’s efforts to create win-win arrangements between Harvard Pilgrim and its partners in the provider community shows what is actually possible. It is interesting to see how his passion for developing these agreements meshes with a recurring theme of negotiations from different points in his career leading up to his current role. The podcast concludes with a discussion about Michael's leadership style, and his recommendations for physicians who are looking to make the transition from clinical leadership to executive leadership.

The interview is available in its entirety at the unabridged link below. The podcast outline corresponds with the unabridged version. There is also an abridged version of the interview that focuses primarily on Michael's work immediately leading up to his current role. 

Links to the Podcast:

Anchor:

   Unabridged: https://anchor.fm/healthleaderforge/episodes/Dr--Michael-Sherman--Chief-Medical-Officer--Harvard-Pilgrim-Health-Care-egra8g

             Abridged: https://anchor.fm/healthleaderforge/episodes/Abridged-Dr--Michael-Sherman--Chief-Medical-Officer--Harvard-Pilgrim-Health-Care-egra7r

Stitcher: https://listen.stitcher.com/yvap/?af_dp=stitcher://episode/41445563&af_web_dp=https://www.stitcher.com/episode/41445563

iTunes: https://itunes.apple.com/us/podcast/healthleaderforge/id981989377

YouTube: https://youtu.be/nxkYEFZWuKU

Podcast Outline (these times apply to the full length version)

Time	Topic
0:02:56	background education, becoming a physician
0:13:11	decision to go to business school
0:23:06	the importance of establishing self as a physician before going into business/leadership role
0:25:21	DaVita, Inc.: Director of Corporate Development, DaVita, Inc.
0:30:57	HealthAllies: Vice President, Provider Business Development and Product Management
0:36:37	IMMUSOL: Vice President, Medical Affairs
0:43:08	Thomson Reuters: Vice President & General Manager, Health Plan Solutions
0:54:27	Transition to the payer world: United Health Group
1:00:38	Humana: Corporate Medical Director, Physician Strategies
1:12:43	about Harvard Pilgrim Health Care
1:17:09	Harvard Pilgrim Institute/Harvard Medical School Department of Population Health
1:18:55	Chief Medical Officer and Senior Vice President, Health Services
1:21:52	Paying for value, one size doesn't fit all
1:34:45	Consolidation of Health Insurers
1:36:27	Thoughts on leadership, hiring the right talent, and being an executive
1:51:02	Mentorship
1:52:51	Professional Organizaitons
1:54:26	Advice to clinicians who want to make the transition to clinician executives

Topics Discussed:

Harvard Pilgrim Health Care

Harvard Business School

DaVita

HealthAllies (Optum HealthAllies)

Thomson Reuters

UnitedHealth Group

Humana

America’s Health Insurance Plans (AHIP)



Articles by Dr. Sherman:

              Paying for Value: What's Next?

              How to Design a Bundled Payment Around Value

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Daniel L. Andrus, Fire Chief for the City of Concord, New Hampshire

Are you a leader? How much do you trust your subordinates? Enough to let them strap you to a litter and let them lower you on a rope over the side of a 30 story sky scraper? Daniel Andrus, the Fire Chief for the City of Concord, New Hampshire, let his subordinates do exactly that. In today’s podcast, Dan tells the story of his 37 year career as a firefighter. Dan has a long list of credentials including master’s degrees in public administration and economics. He is, as he puts it, a continual learner. In addition to his role as fire chief, he serves on the boards of a number of non-profit organizations. This was one of the most educational podcasts for me that I have done so far because I knew very little about the organization and operations of the fire service. The fire service is a critical community resource that every health care executive should have an understanding of, so I was very pleased Dan took the time to share his story and I hope it is useful to health care executives as they think about emergency preparedness.

Links to the Podcast:

Anchor: 

        Unabridged: https://anchor.fm/healthleaderforge/episodes/Daniel-L--Andrus--Fire-Chief-for-the-City-of-Concord--NH-egraa1

        Abrdiged: https://anchor.fm/healthleaderforge/episodes/Abridged-Daniel-Andrus--Fire-Chief--City-of-Concord--NH-egra5e

Stitcher: https://listen.stitcher.com/yvap/?af_dp=stitcher://episode/41266021&af_web_dp=https://www.stitcher.com/episode/41266021

iTunes: https://podcasts.apple.com/us/podcast/daniel-l-andrus-fire-chief-for-the-city-of-concord-nh/id981989377?i=1000357158632

Podcast Outline

Time Topic
0:01:46 a family tradition of firefighting, early career with Salt Lake City Fire Department
0:07:55 formal education
0:11:57 firefighter/paramedic
0:15:47 early leadership - promoted to fire lieutenant
0:19:05 public information officer to Fire Chief for Salt Lake City
0:24:28 becoming a manager - fire captain
0:29:02 Battalion Chief, Emergency Management and Technical Services Division, Salt Lake City
0:33:47 Fire Marshal, Salt Lake City - 2002 Winter Olympics
0:38:16 Battalion Chief, Operations Bureau, Salt Lake City
0:40:47 Deputy Fire Chief, Administrative Bureau (including Airport Bureau and EMS)
                   Board of Community Health Center
                   pursuing an MPA, MS Econ
0:53:28 Coming to Concord
0:56:59 the job of Fire Chief, Concord Fire Department
1:05:14 interfacing with the direct health care and public health systems
1:07:33 involvement in community organizations - knowing your customers
1:12:41 innovative health care delivery with EMS assets - Mobile Integrative Health Care
1:15:14 organizational culture
1:17:45 role of women and minorities in firefighting
1:20:27 why do people join and why do people stay?
1:22:44 leadership
1:28:40 advice about pursuing a career in firefighting and EMS

Links to Topics Discussed:

Fire Department, Concord, NH

Fire Department, Salt Lake City, UT

New Hampshire Fire Academy

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Jill Gravink, Founder and Executive Director of Northeast Passage

Today’s guest is Jill Gravink, the Founder and Executive Director of Northeast Passage. Jill founded Northeast Passage in 1990 as a means of bringing Recreational Therapy out of the inpatient setting and into the community. Northeast Passage works with people who have physical and mental disabilities, using sport and leisure activities to improve the quality of the client’s life and to, as they say at Northeast Passage, “Live beyond disability.” Northeast Passage works with everyone from children to combat veterans, treating more than 3,000 clients last year. In this podcast Jill tells the story of how Northeast Passage came to be, and what it took to grow the organization from just her operating out of the trunk of her car to where it is today. We also discuss how organizations like Northeast Passage are well poised to contribute to the future of health care as the industry shifts to outcomes and value-based reimbursement, and conclude with a discussion about leadership.

Links to the Podcast:

Anchor: https://anchor.fm/healthleaderforge/episodes/Jill-Gravink--Founder-and-Executive-Director-of-Northeast-Passage-egraam

Stitcher: https://listen.stitcher.com/yvap/?af_dp=stitcher://episode/41078139&af_web_dp=https://www.stitcher.com/episode/41078139

iTunes: https://podcasts.apple.com/us/podcast/jill-gravink-founder-and-executive-director-of/id981989377?i=1000356065522

Podcast Outline

Time	Topic
0:01:34	Educational background
0:02:47	Defining recreational therapy
0:05:16	Art of recreational therapy, about NEP
0:06:36	History of recreational therapy
0:08:03	Getting certified in recreational therapy
0:08:40	First job after graduation
0:10:45	Use of aquatics in physical therapy
0:11:40	Starting NEP and initial vision
0:14:46	NEP’s first clients
0:17:11	NEP initial funding and sponsors
0:18:00	Coming back to UNH to teach
0:19:57	NEP’s early days, lessons learned, partnerships
0:23:24	Defining “universal design”
0:24:44	Growth of NEP in clients and funding, future NEP sustainability
0:27:52	Beginning to charge clients fees for service, NEP financial difficulties
0:29:58	Development of recreational therapy at NEP, associated grants
0:33:21	Learning to manage an organization
0:36:21	Merging NEP with UNH
0:38:13	Defining and using “strength-based” in therapy
0:39:31	Importance of integrating therapy within the community
0:44:04	Role group dynamics play in therapy
0:45:00	Receiving veterans’ adaptive sports grant, addressing veterans’ therapy needs
0:50:00	Long term relationship with Veterans’ Affairs after grant, current work with VA
0:52:10	Broader healthcare reimbursement trends away from FFS towards outcome and value-based payments
0:54:58	Change in role as executive director with UNH merger
0:56:38	The future of NEP
0:58:55	Changes in strategy and vision of NEP over time
1:00:41	NEP’s current organizational structure, working with UNH students
1:02:27	Changes in personal leadership style over time, lessons learned
1:05:46	How to find the right people for leadership positions
1:06:57	Philosophy on leadership and its challenges and opportunities
1:11:35	Importance of organizational culture
1:13:47	Early career mentors, importance of mentorship
1:16:47	Advice for people who want to address social needs
1:19:05	Advice for people interested in a career in recreational therapy

Topics Discussed:

Northeast Passage

American Thereapeutic Recreation Association

Adaptive Sports

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Thanks to Sameer Panesar for production support.