In a report released April 10, consulting firm Kaufman Hall indicated that M&A activity among hospitals and health systems continues to increase. During 2013, there were 98 mergers and acquisitions, up three percent over 2012, but up 51% compared to 2010. In their analysis, Kaufman Hall stated, “The level of activity shows consolidation continuing to occur among not-for-profit hospitals and health systems as they position themselves for value-based payment and population health management.”

The numbers are even more substantial when taking into consideration other healthcare entities such as physician groups, labs, MRI, dialysis, home health, behavioral health and hospice. The most recent figures available indicate that there were 267 mergers and acquisitions during the third quarter of 2013 alone. That was an increase of 16% over the second quarter of 2013, and a 35% increase compared to the third quarter of 2012. Those numbers were reported by Irving Levin Associates, a business intelligence firm that specializes in healthcare finance.

Commenting on the data released by Irving Levin, Lisa Phillips, editor of Health Care M&A News, said, “Health systems that have made strategic acquisitions such as physician medical groups will now turn their attention to long-term care, home health care and rehabilitation to fill out their care continuum requirements. We still expect a fluid market in physician medical groups and continued consolidation among hospitals.”

Ernst & Young’s senior managing director for U.S. healthcare mergers and acquisitions, Gregory Park, indicated last month that the Affordable Care Act was causing a “tectonic shift” in hospital operations. Michael Finnerty, Managing Director at Kaufman Hall, commented, “Our analysis confirms that hospitals and health systems are continuing to pursue partnership arrangements as one approach to accessing the enhanced infrastructure necessary to provide care successfully in the changing environment.”

This changing landscape in our industry presents unique opportunities for healthcare executives to differentiate themselves among their peers. There’s no better time than now to evaluate how you can position your leadership skills and accomplishments to take advantage of the transformation that’s occurring in the healthcare industry.
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Tagged in: healthcare industry
Numerous firms are in the business of ranking hospitals (U.S. News & World Report, Healthgrades, Truven Health Analytics, LeapFrog Group, American Nurses Credentialing Center, etc.). Recently, Becker’s Hospital Review analyzed all of these sources and other data to develop its annual list of “100 Great Hospitals in America.”

Becker’s data isn’t a ranking – it presents a list of 100 hospitals in alphabetical order. The value of this list is that it identifies key trends and activities that executives can use to improve the position of their hospitals in today’s rapidly changing landscape. If you’re in a career transition phase, you can use this information to acquire valuable knowledge and help differentiate yourself among your peers.

The information is an “easy read” – just three paragraphs per hospital – so you can scan through the list, review some of the data, and perhaps gain some inspiration about how you can evolve your hospital’s clinical and business practices to increase performance in one or more areas.

Becker’s report also serves as a reminder of the importance of communicating the accomplishments of your hospital. No matter how great a job you’re doing, if you don’t get the word out there – both to your community and to your internal personnel – you increase the risk of placing your hospital at a competitive disadvantage. If you haven’t yet implemented or strengthened your hospital’s strategic communication plan, it’s important to begin to evaluate how proactive communications can:

(1) Improve the perception of your hospital by industry analysts and the board
(2) Improve awareness of the value and quality of your hospital within the community
(3) Improve the alignment of your staff with clinical and business goals

To view Becker’s data on “100 Great Hospitals” and discover how they’re differentiating themselves, you can access the report at:
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Tagged in: healthcare industry
In a recent study conducted by L.E.K. Consulting, approximately 150 hospital CEOs and other senior decision makers were asked how they expected to respond to the Affordable Care Act. Their answers indicated they were planning to implement the following strategies:

69 percent – Increase process efficiency
51 percent – Reduce costs by renegotiating with suppliers
45 percent – Reduce redundant procedures in care
45 percent – Delay capital expenditures
35 percent – Increase utilization
30 percent – Lower costs at care centers
18 percent – Delay acquisitions
05 percent – Do nothing

Other findings noted in the four-page “Executive Insights” report (link below) include:

"Typical suburban hospital’s margins are currently approximately 4% but this is expected to decline to 0%, primarily due to payer-mix shifts.”

"The top 100 hospital systems in the U.S. will account for more than 60% of hospital spending, up from 40% in 2008.”

“While most hospitals still operate as standalone institutions, the majority will likely eventually move towards joining large, consolidated, and increasingly strategically integrated systems.”

The concise report also includes data on the percentage of respondents indicating their interest in specific medical technology solutions to address issues such as disease management, hospital management, clinical analytics, etc.

L.E.K. Consulting is a 30-year-old management consulting firm with clients in the private and public sectors. You can access their report at: http://www.lek.com/sites/default/files/LEK_HospitalSurveyEI0214_Final%28v4%29.pdf
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Tagged in: affordable care act
At the ACHE “Congress on Healthcare Leadership” this week, a key presentation discussed the issues surrounding increased scrutiny of executive compensation. The presenters, F. Kenneth Ackerman Jr. and David A. Bjork, chairman and senior vice president at Integrated Health Strategies, stressed the growing importance of establishing a compensation committee to improve governance. The speakers referred to a report (link below), issued by the Alliance for Advancing Nonprofit Health Care, which helps healthcare executives answer a simple question: “Among all of the 50–100 ‘best practices’ that permeate the literature, which are the ones that are likely to make the most difference in achieving excellence in governance?”

In the concise report, titled “Great Governance,” the authors provide recommendations on how to establish and improve compensation committees and other governance practices. Seven benchmarks are listed in the report, along with “key action steps” to consider when addressing the benchmarks.

Appendices in the report provide checklists to evaluate board meeting practices and other governance activities. It’s a great document that will help CEOs and other executives address hospital compensation plans. The proactive planning discussed in the report will also help executives respond to challenges from board members as well as from the media regarding executive compensation.

The bottom line is that it’s important to educate board members before questions arise—and by strengthening the compensation committee, the board will help protect the hospital, the CEO and the board itself.

You can access the “Great Governance” report at http://www.integratedhealthcarestrategies.com/documents/articles/378.pdf
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According to a 2013 survey co-sponsored by the American Society for Healthcare Human Resources Administration, CEOs of independent health systems earned a median salary of $750,000, while CEOs at subsidiary health systems earned a median figure of $539,000. CFOs at hospitals and health systems earned median compensation that ranged from about $200,000 at subsidiary hospitals to about $400,000 at independent systems. Median salaries for COOs at health systems ranged from approximately $350,000 to $450,000 depending on the type of ownership. At independent and subsidiary hospitals, COO compensation averaged about $300,000.

This data and additional details are found in an article published by Becker’s Hospital Review (link below). The article also discusses five trends in hospital executive compensation to watch in 2014:

1. Expect modest increases, generally between two percent and four percent.

2. Nonprofit hospital executives need to address the public perception that compensation is not tied to healthcare quality.

3. Compensation plans will be more closely linked to value-based outcomes and physician engagement and alignment.

4. Advocacy groups are pushing hospitals to align compensation with attaining goals.

5. Hospital executives who are physicians are in high demand and receiving greater pay increases.

The bottom line is that there are new factors coming into play with hospital executive compensation – and the more you know, the better you will be able to navigate the changing landscape. To see the article in Becker's Hospital Review, visit
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Tagged in: healthcare industry
In a March 10 press release, ACHE reported that CEO turnover occurred at one out of every five hospitals in the US during 2013. The 20% figure is the highest turnover rate recorded by ACHE since they started reporting the annual data in 1981. For 2013, ACHE reported 4,546 total hospitals in the US, which included general medical, short-term and non-federal hospitals.

President and CEO of ACHE, Deborah J. Bowen, said, “The increase in the turnover rate may be indicative of a combination of factors, including an increased number of baby boomers seeking retirement, the emerging trend toward consolidation in our industry and the complexity and amount of change going on in healthcare today.”

On its website (link below), ACHE provides a state-by-state list showing the percent of CEO turnover. States are ranked by high-turnover, medium turnover, and low-turnover. Among states with the highest turnover rates are Oklahoma (33%), Arkansas (30%), Virginia (29%), Florida (27%) and Louisiana (27%). States with the lowest rates include New Jersey (10%), Oregon (13%), Pennsylvania (14%), Wisconsin (14%) and Minnesota (15%).

In 2013, Black Book Market Research reported that the average tenure of a hospital CEO is less than 3.5 years, and that involuntary termination accounted for 56% of that turnover. Other findings reported by Black Book include the following:

A) 87% of Chief Medical Officers are replaced within two months after a change in CEO.

B) 94% of new CEOs who come into their position without extensive hospital experience say they don’t think healthcare expertise is needed when replacing other senior executives during an overhaul of management staff.

C) 89% of board members involved in hiring an “outsider” indicate that “broad business operational expertise and singular vision pays off with fresh perspectives on efficiencies, value, cost savings, and the goodwill to the community.”

Commenting on the accelerated rate of hospital CEO turnover, Ms. Bowen remarked, “The increase in the rate reinforces the need for healthcare leaders to work with their boards to ensure appropriate succession plans are in place.”

The complete list of state-by-state CEO turnover rates is available at:
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I'd like to share a valuable article with you titled “Healthcare Executives in Job Transition.” The author, Dr. Laura Canter, is a Licensed Performance Psychologist. She has worked with professional and elite amateur athletes in a variety of sports, including in the NFL, MLB, tennis and other fields. After completing her graduate studies at the University of Queensland in Brisbane, Australia, Laura switched her focus to concentrate on the mental aspects of performance, sharing her philosophy with business executives, high performance athletes and other top performers. In the article, she addresses key questions such as:

1) What do executives in transition need to work on to be successful?

2) What seems to be the most common challenge going into a transition period?

3) What characteristics mark the difference between those who seem to be most successful in transition versus those who seem to struggle with the journey?

People going through transition always seem to struggle with Controllable vs. Uncontrollables, and Dr. Canter has important advice to share with you on how to approach these factors. Key takeaways from the article include:

1) How to understand and be clear about what you can control and what you cannot control.

2) Internal motivation is critical – you have to discover what inspires you. What do you like about your job? Why do you do it?

3) With every job transition, there are “Seven Elements of Excellence,” which will help guide you throughout your transition.

After you read this informative article, please share it with others who may benefit. The article, “Healthcare Executives in Job Transition,” is available by copying the link below into your web browser:
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Historically, hospitals have experienced difficulties managing physicians. But with the new healthcare reform initiatives, employing physicians is seen as critical to reaping new revenue streams tied to greater coordination of healthcare. As a result, health systems have been acquiring physician groups at an accelerating pace.

In the article linked below, “Making Physicians Pay Off,” Beth Kutscher of Modern Healthcare does a great job explaining the cost-benefit factors that hospitals are reviewing when trying to balance the “current costs” versus “future benefits” of employing physicians.

Here’s a key takeaway offered in the article: “Given a median loss of $176,463 for employing a doctor, some analysts are predicting a pullback on physician buys this year.”

However, many hospital executives continue to say that these acquisitions are critical because their current balance sheet numbers don’t reflect the future reality: capitalizing on new revenue opportunities will require much greater coordination of healthcare for patient populations, and having doctors and hospitals tightly integrated is essential in that regard.

Dr. Alan Kaplan, president and CEO of a 12-hospital system based in Iowa, is quoted in the article, saying, “You have to bring them in—and then you have to bring them in as efficiently as you can. It's really a strategic asset that requires investment.”

To learn more about the pros and cons of acquiring physician groups, you can read the article in its entirety by copying this link into your web browser:
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Key trends for 2014 have been identified by PricewaterhouseCoopers (PwC) as well as Premier, which is a healthcare improvement alliance of 2,800 hospitals and health systems and more than 93,000 non-acute care sites. Both firms analyzed data during late 2013 and have recently announced their findings.

“Top 10” List from PwC:
1. Companies are rethinking their roles in the new health economy
2. Corporate funds are invading the healthcare venture capital space
3. Employers are exploring the use of private exchanges
4. Healthcare industry accelerates the pace of price transparency
5. Social, mobile, analytics and cloud are converging
6. Technology is the new workforce multiplier
7. Advances in scientific tools are transforming clinical trials
8. To truly innovate, be ready to fail fast, frequently and frugally
9. States are pursuing Medicaid managed long-term care
10. New rules are combating the counterfeit drugs

Premier’s “Big 8” List:

1. Chronic Care—more healthcare providers will get involved in ambulatory care to improve management of chronic conditions.

2. Health Coaches—the key to managing chronic conditions is having health coaches who know patients on a one-on-one basis.

3. Home-Based Care—technology improvements are increasing opportunities for patients to receive medical treatments outside of the hospital.

4. Employer Health Incentives—employers are increasingly motivating employees to remain healthy through the use of free online tools and financial incentives.

5. Private Health Insurance Exchanges—employers are increasingly using these exchanges, which allow people to have more options and customize their insurance coverage.

6. CMS Policy Changes—more healthcare policy changes from CMS will address the growth rate in Medicare and Medicaid.

7. Open-Source Software for Big Data—to help drive innovation, healthcare providers will push for “big data” applications that allow more customization by independent, third-party software vendors.

8. Expanding Healthcare Partnerships—these partnerships will increasingly expand to include social service agencies and other non-healthcare service providers such as community-based groups and even fitness centers.

Also noteworthy is news out of CMS… The number of Americans age 85 and older is accelerating and will increase by 300% to 18 million by 2050. As a result, according to an analysis conducted by Truven Health Analytics for CMS, the expansion of long-term care support programs offered by Medicaid is accelerating. The number of states with these programs grew on average by one per year between 2004 and 2012 (from 8 to 16), but the pace is now five per year (growing from 16 states to 26 states in the last two years alone.
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Even though it's later in December it's not too late to make the right impression. December is always the month that I focus on my established, new relationships and potential relationships. Take time to thank those that have helped you and that can potentially help you. Be creative in your communications and find ways to differentiate yourself. Whatever you do, personalize it and make sure the receiver feels like this was made just for them. Get outside your comfort zone and always be sincere in what you say. Try to focus on the personal side, don't have an agenda.

It doesn't have to be about business at this time of year.

Please don't hesitate to share some of your creative ideas with me.


What should you do when an opportunity goes away?

The opportunity represents the short term; we now need to focus on the long-term.

How to do this:

FOCUS on the recruiter you worked with, how will you stay in touch; the employers you connected with, how will you stay in touch; the other contacts you reached out to for information about this opportunity, how will you stay in touch?

You now need to think through:

  • How will you stay in touch, what will the process look like?
  • How did you react to the news, demonstrate your professionalism?
  • People feel guilty when they deliver bad news, how will you take advantage of it?
  • How can you ensure getting some honest feedback from the people in the process so that you can improve your process?

Dear Network, We have our next webinar scheduled for 11a.m., Wednesday, July 24, Eastern Time (adjust for your own time zone). The same organization, AchieveIt, is hosting the webinar with the following organizations presenting: Aspirion Health Resources (Barry Mathias) and BrightWhistle (Jason Hopper). Please utilize the following link to register for this free webinar

As healthcare leaders continue to struggle with healthcare reform, many organizations are evaluating what is working within their organizations and looking to best practice solutions to achieve their goals and objectives. There are many niche companies in the market today that are experts in a very specific area, offering products, services and expertise that are not often found within an organization. These niche companies excel in the work that they do because of their more narrow focus and level of expertise and experience that they bring to an organization. This webinar will focus on two companies that you probably have not heard of, but are having a significant impact on the performance of their current and growing companies. In my daily discussions with healthcare executives, I realize that they do not have the time to scan the market to identify best practice solutions, so I thought that this is a service that I can provide to Wiederhold network. I think that you will find these two companies very intriguing and potentially a solution to some of your current challenges and opportunities. My hope is that bringing companies like Aspirion Health Resources and BrightWhistle to your attention will assist you in your work and hopefully save you time in looking for solutions. Please feel free to invite other members of your team to attend this special webinar. I look forward to having you join me on this webinar.

Best regards, Jim Wiederhold President Wiederhold & Associates

Tagged in: seminar

Michael French is an expert in interim work, both nationally and internationally. We have found that most of our clients have an interest in learning more about these particular areas. Michael will be part of our program and will spend time with our clients on both sides of these important opportunity areas. You will find a short bio on Michael French below reflecting on his expertise.

About Michael French

Michael French has more than 35 years of experience as an effective and communicative leader of for-profit and not-for-profit healthcare delivery systems as a CEO, COO and Hospital Administrator. He has achieved results through building trusting relationships with Boards, physicians, senior leadership and staff and actively engaging them in developing and executing strategic and operational plans. He has completed operational, quality and financial improvements in a variety of organizations ranging from a 100 bed acute care hospital to multi-facility integrated systems. For the past five years, Michael has been providing both domestic and international Hospital Interim CEO, turnaround and consulting services, specifically in California, the Middle East and Turkey. In addition to Interim CEO engagements, Michael has led operational turnarounds, performance improvement and due diligent projects.

Tagged in: interim

Chief Information Officer - Opportunity

GCI has been retained for a CIO search for a Mid West based Healthcare System. The healthcare system includes ten hospitals, ambulatory surgery centers, imaging centers, an employed primary care physician network, assisted living facilities, commercial and Medicaid HMOs, home health care and hospice, durable medical equipment, retail pharmacy services, and a wholly-owned medical malpractice insurance company. The System has 17,400 employees and more than 20,000 network physicians.

The CIO will be a member of its President's cabinet, and reporting into the President & CEO.

Interested candidates please contact Kelly Goerlich, This email address is being protected from spambots. You need JavaScript enabled to view it. . Please note: we are NOT recruiters, but are assisting a recruiting firm in finding a viable candidate.

Tagged in: career opportunity

As promised, we are introducing another new program we have talked about for months. We believe that transition is more than just finding another job, it's learning new skills along the way. With the arrival of healthcare reform, we have developed the concept of the three-legged stool. Each one of these legs is extremely important for any healthcare executive to be successful in their careers. These are: quality, strategy and finance.

Our second program is focused on finance.
The process will work as follows. Each individual that we work with at the appropriate level will be assessed by our expert. Once the assessment is completed and reviewed by our expert, he will meet with that individual by telephone one-on-one. During that meeting he will review their results and make suggestions that may include additional training in the area of finance. If any additional training is needed, this individual can create an agreement with our expert. The assessment part will fall under the Wiederhold & Associates program. Any additional training will be handled by the individual and our expert.

I do not think anyone can disagree that finance will be a major focus of healthcare reform and that anyone who lacks in that area will have his/her challenges. We are very fortunate that we have located an expert in this area who brings a long history of success in healthcare. Let me introduce you to Jim Morell  Please review the short bio below.

Jim Morellis an acknowledged industry leader with over thirty-five years’ experience as a consultant, administrator and patient care provider.  His knowledge, integrity, and objectivity are reassuring for organizations seeking to develop and implement winning strategies, improve operational performance, and plan for the most appropriate healthcare facilities and sites.

JCM Advisors, LLC (JCMA) and its predecessor firm Morell & Associates (MA)
JCMA is the preferred source for healthcare providers seeking a strategic advantage in today’s unsettling environment.  Jim integrates years of experience in strategy formation, operations improvement, facilities development, and financial feasibility to effectively formulate viable solutions for the toughest management challenges facing today’s healthcare organizations.  This experience is also helpful to vendors to the healthcare industry as well as the courts in the areas of bankruptcy and medical malpractice. Jim also applies these years of experience in his coaching of boards and management teams.

Ernst & Young, Chicago, Illinois
Jim was an up through the ranks Partner in the Healthcare Management Consulting Practice. Early in his career he worked in the finance practice performing financial feasibility studies primarily for hospital bond offerings. He eventually assumed responsibility for the review and sign-off on all of the demand note sections of each financial feasibility study issued by the firm. During this period of default risk every organization successfully met their debt obligations, much to Jim’s and the firm’s relief.

Following these assignments Jim assisted healthcare provider and vendor organizations in the development of their business strategies for a number of years. With this background Jim shifted his focus to the development and leadership of the firm’s operationally focused facility development practice. This consultancy looked at the site and facility needs of healthcare providers through the perspective of strategy formation, operations improvement, and financial performance. Throughout Jim’s tenure at E&Y he worked with both audit and non-audit client organizations ranging from academic medical centers to small rural hospitals, stand-alone hospitals to healthcare systems, faculty practice plans to small physician group practices, and for-profit as well as tax exempt providers located throughout the country.

In addition to his own consultancies and his tenure in public accounting, Jim has also provided management consulting services with two boutique healthcare firms.

Signature Leadership Qualifications
Jim serves as an Adjunct Faculty member at DePaul University, Chicago. He teaches the capstone Strategic Analysis course for both MBA and undergrad business majors at the Driehaus College of Business. As the capstone name implies, this is the final class for each student before graduation at both the MBA and undergrad levels. The curriculum is designed to bring the real world into the classroom with a curriculum that includes the following activities.

  • Classroom presentations and discussion focused on the text, the research project, the simulation, and career development
  • Text study and related quizzes
  • Research project designed to prepare the students for interviews through a comparative study of targeted firms of their choosing in the same industry. The analytics address each company’s strategy, operations, management reports, and financial statements looking for alignment or dissonance. Depending on the size of the class, students are required to make one or more presentations relative to their research.
  • Capsim computer simulation team competition. The students form teams to operate a high tech company. Each team competes against other teams in the class as well as against an equal number of computer operated teams. This exercise is designed to have the students work together to apply what they have learned in class, through their respective research projects, and the body of knowledge and experience they have developed to date in their careers. Each team makes a presentation discussing their performance at the end of the competition.

Jim is a former federal auditor having served as an Inspector General – Audit for the U.S. Army. During is active military service Jim conducted financial audits of hundreds of military units through the Office of the Inspector General, 2d Armored Division.

Jim is a frequent speaker at the ACHE’s Annual Congress on Administration, the AAHC’s Fall Conference as well as various national, state and local professional associations. Jim has published articles on a variety of healthcare management issues.

Prior to making the commitment to management consulting Jim served as an administrative resident and administrator at The Ohio State University Hospital & Clinics, now The Ohio State University Medical Center. Jim also worked as a certified nursing assistance at the University of Minnesota Hospital & Clinics, now the University of Minnesota Medical Center.

Education and Certifications

  • Jim holds a Bachelor of Arts in Economics and Psychology (with a focus in Organization Design) from Case Western Reserve University, Cleveland, Ohio and a Master of Science in Hospital and Health Services Administration from The Ohio State University, Columbus.
  • He is a Fellow of both the American College of Healthcare Executives (ACHE or the College) and the American Association of Healthcare Consultants (AAHC or the Association). He is a Past Chair of the Association’s Board and has chaired many of the Association’s committees. He is also a Past Chair of the College’s Consulting Special Interest Area, now the ACHE’s Healthcare Consultants Forum.
  • The program Jim has prepared for those individuals needing additional assistance in the development of their financial acumen is multi-disciplinary and based in part upon results of the 2012 WA Financial Acumen Survey, his experience across a broad range of healthcare organizations, and his work at DePaul University. Elements of the Financial Acumen program include an assessment process, a customized skills development plan, associated learning modules, as well as individual coaching and consultation.
  • This program is designed to be customized to best meet the needs and goals of the individual executive. The goals of the program are to (1) assist each executive in their preparation for their upcoming interviews and (2) provide the financial acumen tools necessary to more effectively lead their new organization through these turbulent times.
  • If you have any questions or comments. Please do not hesitate to reach out to me. On an additional note, we will offer Jim Morell's services beyond just those individuals involved in the Wiederhold & Associates transition/career development program.

Navigating Your Career Path

Over the past 20 years, we have all witnessed significant change in the healthcare industry, as well as the advent of the flavor of the month/week mentality. We react quickly to changes in thought without truly exploring the consequences of the change or reflecting on our current course. What’s more, we often don’t give that current course the time it needs to develop in order for us to know whether or not it will be successful. It has, at times, seemed as if so many found themselves looking and acting like a deer in the headlights or the boat floating wherever the wind or current would take it. Why? Are people trying to keep up with the changes/reform? Are they struggling to figure out how to comply? Regardless of how you view healthcare reform, the boats have found a sense of direction and the deer have scattered.

Read the full article as published by the Healthcare Executive.


Wiederhold and Associates will from time to time be presenting articles on subjects of interest and importance from our clients, past clients and most active network members. Mark Phelps will address the very hot topic of insurance exchanges under the affordable care act. Mark looks forward to your comments on his article.

Insurance Exchanges and the Affordable Care Act

With President Obama's reelection a part of history, the movement to implement the Patient Protection and Affordable Care Act (ACA) has been ensured. When the ACA was heard by the Supreme Court, one case under consideration was filed by the National Federation of Independent Businesses. 1 The arguments in that case concerned the issue of whether Congress exceeded its power by requiring most Americans to buy health insurance or pay a fine. This provision was known as the individual mandate. 2

That mandate, along with four other major approaches, was the reason the ACA was drafted to attack the problem of the uninsured in our society. 3 The other approaches to combat un-insurance in the ACA were: 1) guaranteed coverage in plans provided by insurance companies; 2) the mandate to individuals to obtain health insurance; 3) state-run health insurance markets, called “exchanges,” where individuals and small employers’ workers can shop for insurance packages; and 4) expansion of the federal-state Medicaid program of care for the poor and the disabled. 4

The theory of insurance exchanges in the ACA was to offer "one stop shopping" for individuals and small businesses with affordable coverage. 5 It would also be the only place for Members of Congress to obtain their health insurance. 6

Insurance exchanges offer individuals and small businesses the ability to pool risk and purchasing power and therefore pay lower rates. 7 Affordable Insurance Exchanges are also modeled to provide users with the ability to determine if tax credits are applicable or if the user can enroll in programs such as the Children's Health Insurance Program (CHIP). 8

Rules were published by the Department of Health and Human Services (HHS) on March 12, 2012 regarding Affordable Health Insurance Exchanges. 9 The operational date for the Exchanges is January 2014. The rules published in March 2012 included standards for the following:

  • The establishment and operation of an Exchange
  • Health insurance plans that participate in an Exchange
  • Determinations of an individual’s eligibility to enroll in Exchange health plans and in insurance affordability programs
  • Enrollment in health plans through Exchanges
  • Employer eligibility for and participation in the Small Business Health Options Program (SHOP) 10
  • Those rules also specified that exchanges will perform certain functions listed below:
  • Certifying health plans as “qualified health plans” to be offered in the Exchange
  • Operating a website to facilitate comparisons among qualified health plans for consumers
  • Operating a toll-free hotline for consumer support, providing grant funding to entities called “Navigators” for consumer assistance, and conducting outreach and education to consumers regarding Exchanges
  • Determining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs (premium tax credits, Medicaid, CHIP and the Basic Health Plan)
  • Facilitating enrollment of consumers in qualified health plans 11

Going into the Presidential election of 2012, individual states had a looming deadline of November 16, 2012 to notify the Department of Health and Human Services if they intended to set up their own insurance exchanges or enter into a state-federal partnership.12 At the request of state governors, HHS granted an extension until December 14, 2012 to respond to this deadline. 13 HHS clarified that there would be no further extensions of deadlines regarding the implementation of Exchanges in a Memorandum of Frequently Asked Questions (Memorandum) dated December 10, 2012. 14 This additional time gave state officials who were trying to determine whether there was enough political will, technical knowledge and time in their respective states to organize their own new health benefit marketplaces. 15

HHS further clarified in the Memorandum that if "a state plans to operate the Exchange in its state in partnership with the federal government starting in 2014", the state will need to declare "what partnership role they would like to have by February 15, 2013". 16 The deadline of February 15, 2013 has come and gone. We now know that the federal government will run 26 of the state health exchanges. 17 (Maine, New Jersey, Pennsylvania, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Ohio, Indiana, Mississippi, Louisiana, Missouri, Wisconsin, Texas, Oklahoma, Kansas, Nebraska, South Dakota, North Dakota, Montana, Wyoming, Arizona, Alaska) It also will partner with seven states, where state and federal officials take joint responsibility for the marketplace. 18 (New Hampshire, Delaware, West Virginia, Michigan, Illinois, Iowa, Arkansas) Seventeen states and the District of Columbia will take on the task themselves. 19 (Vermont, Massachusetts, Rhode Island, Connecticut, New York, Maryland, District of Columbia, Kentucky, Minnesota, Colorado, New Mexico, Utah, Idaho, Nevada, Washington, Oregon, California, Hawaii)

The legislative intent of the originally filed federal House of Representative bill for Obamacare in which the federal government would operate one large national insurance exchange may come close to reality with the latest actions of many of the states deciding to have HHS operate their exchanges by default. 20 It seems the Executive Branch of the government may ultimately have significant political power over setting up its signature legislative accomplishment. 21 Further, this will allow HHS to use economies of scale in creating a minimal number of template exchanges that many of the 26 states will use. 22

Mark T. Phelps is a healthcare attorney and an Assistant Professor in the Department of Healthcare Administration at Texas Woman’s University in Houston. He currently is working with healthcare clients on a consulting basis. If you have some interest in learning more about Mark, please Wiederhold & Associates know.

1. Kever, J., Only certainty from ruling on health care law is change, Houston Chronicle, 03-25-2012, from http://www.chron.com

2. Id.

3. Denniston, L., Analysis: Health care’s other mandate, December 19th, 2011, from http://www.scotusblog.com/2011/12/analysis-health-cares-other-mandate,

4. Id.

5. Affordable Insurance Exchanges, from http://cciio.coms.gov/proframs/exchanges/index.html

6. Id.

7. Id.

8. Affordable Insurance Exchanges, from http://www.HealthCare.gov

9. Affordable Insurance Exchanges: Choices, Competition and Clout for States, from http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html

10. Id.

11. Id.

12. Adams, www.CQ.com, 11/9/12

13. Alonso-Zaldivar; More States Reveal Exchange Choices As Administration Extends Deadline; http://www.washingtontimes.com/news/2012/nov/16/states-reveal-their- choices-obamas-health-law/; 11-16-2012

14. Frequently Asked Questions on Exchanges, Market Reforms and Medicaid, Department of Health & Human Services, 12/10/12, from http://www.healthlawyers.org/News/Health20Lawyers20Weekly/Documents/12141 2/FAQs.pdf

15. Adams, www.CQ.com, 11/9/12

16. Frequently Asked Questions on Exchanges, Market Reforms and Medicaid, Department of Health & Human Services, 12/10/12, from http://www.healthlawyers.org/News/Health20Lawyers20Weekly/Documents/12141 2/FAQs.pdf

17. Kliff, It’s official: The feds will run most Obamacare exchanges, THE WASHINGTON POST, February 18, 2013

18. id.

19. id.

20. id.

21. id.

22. id.



Message from Jim Wiederhold, president of Wiederhold & Associates

As many of you are aware, we are in the transition business, career development and executive coaching. We believe that transition should be an holistic approach meaning not just getting people through the transition to the next opportunity but adding skills and knowledge that will make them even more productive in the next opportunity. We have been talking up for several months the introduction of three new programs. The first one is ready to launch and we want to make you aware of it. With the arrival of healthcare reform, we have developed the concept of the three-legged stool. Each one of these legs is extremely important for any healthcare executive to be successful in their careers. These are: quality, strategy and finance.

Our first program is focused on quality. The process will work as follows. Each individual that we work with at the appropriate level will be assessed by our expert. Once the assessment is completed and reviewed by our expert, she will meet with that individual by telephone one-on-one. During that meeting she will review their results and make suggestions that may include additional training in the area of quality. If any additional training is needed, this individual can create an agreement with our expert. The assessment part will fall under the Wiederhold & Associates program. Any additional training will be handled by the individual and our expert.

I do not think anyone can disagree that quality will be a major focus of healthcare reform and that anyone who lacks in that area will have his/her challenges. We are very fortunate that we have located an expert in this area who brings a long history of success in healthcare. Let me introduce you to Debra Honey.

Debra HoneyDebra Honey is a visionary Nurse Executive with more than 30 years of progressively responsible and diversified Nursing Leadership experience. She excels at leading healthcare transformational change initiatives and promoting impeccable standards of care within the industry.

Honey Consulting, Inc.
Debra is President of Honey Consulting, Inc., a progressive, hands-on consulting firm offering practical solutions for opportunities and issues facing healthcare organizations today. She provides expertise in nursing services, nursing operations leadership, and operations support to assist and facilitate improvements in performance and outcomes. Debra also provides Chief Nursing Executive coaching and interim Executive Nursing support.

Catholic Health Initiatives, Denver, CO
Debra was previously Vice President for Clinical Operations and Clinical Leadership Development for Catholic Health Initiatives, a national not-for-profit healthcare organization comprised of 68 U.S. hospitals located in 19 states. In this role, she was responsible for nursing clinical operational support for system initiatives and market based organizations. She served as the Executive responsible for system-wide strategy for and implementation of clinical competency programs including competency assessment and staff development for all hospitals. She was a valuable clinical resource on a diverse set of national work groups and task forces.

Signature Leadership Qualifications
Debra is a member of the prestigious Robert Wood Johnson Executive Nurse Fellow Program, 2008 cohort, and her diverse leadership experience and areas of expertise include:

  • Overall Clinical Operations
  • Medical Staff Operations
  • Performance Improvement
  • Board Communication & Collaboration
  • Quality and Safety Initiatives
  • Accreditation & Regulatory Compliance
  • Patient and Staff Satisfaction
  • Service Line Assessment & Optimization
  • Staff and Leadership Assessment, Development, & Coaching

She earned valuable direct patient care experience working as a clinical nurse in critical care, emergency services, and surgical services. In addition, Debra taught Nursing at the diploma, bachelor, and masters levels.

Education and Certifications
Debra earned a Bachelor of Science in Nursing from the University of Tennessee at Chattanooga and graduated Magna Cum Laude. She holds a Master of Science in Health Administration from the University of Minnesota, Carlson School of Management. She is a Registered Nurse in the states of Tennessee and California.

Debra prestigious healthcare certifications include:

  • CENP - Certified in Executive Nursing Practice, American Organization of Nurse Executives
  • FACHE - Fellow Status, American College of Healthcare Executives
  • CPHQ - Certified Professional in Healthcare Quality, Healthcare Quality Certification Board

The program that Debra Honey has designed for those individuals needing additional training in this area will include the assessment process, an individualized learning plan, the learning modules, individual coaching and consulting, and simulations.

The program is designed to be customizable to best meet the needs and goals of the individual executive. Gaining expanded competencies and quality and safety in healthcare provides a demonstrable competitive advantage to senior executives in the field.

If you have any questions or comments. Please do not hesitate to reach out to us. On an additional note, we will offer Debra's services beyond just those individuals involved in the Wiederhold & Associates transition/career development program.


1-2:30 p.m. EST, Tuesday, March 26

What's more important to your organization than its strategic plan? Probably nothing. Plan and implement well, and you'll drive the organization to unparalleled success. One misstep, though, and it's game over. To help you create a culture of accountability and execution, we've identified the six most common ways your strategic plan will fail. Join AchieveIt Founder & Chief Execution Officer, Scott Regan, for this free webinar that will help you turn vision and goals into real, meaningful, and tangible results.

Register now for this free webinar:

Scott Regan is the founder and chief execution officer of AchieveIt, a technology firm that specializes in strategy development and execution management. AchieveIt provides cloud-based tools and applications that allow their clients to execute smarter, faster, and better. Before launching the firm in March 2010, Scott served as an independent consultant, as well as the executive vice president of the Juran Institute, a global consulting firm that assists organizations with achieving breakthrough improvements in quality.

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In 2013, I will celebrate 20 years of being an entrepreneur. In 1993 when we started our focus was on the recruiting side, but over the years our business has become strictly focused on transition. It was initially only external transition, but now involves internal transition as well as executive coaching. A very wise person once said to me, “since you know so much about why people separate or fail in their careers/jobs, why don't you take that information and also use it to help people stay gainfully employed?” We listened and that's when we started the executive coaching part of the program.

In those years, as I worked with executives and senior managers it became apparent to me why in most cases people separate from their organizations. And when I say separation, I am focusing on individuals that have been on some level asked to leave or left through mutual agreement. Those reasons have little to do with performance and understanding the task at hand or having the technical skills to execute their jobs, but around what I would label “soft skills”. Soft skills would include things such as communication, listening, emotional intelligence, messaging, relationship building, and conflict resolution. In most cases as we tracked back their last 60 to 90 days of employment, it became apparent that, first, this was no surprise and second, it had more to do with key relationships and politics.

My job is all about talking with people and the majority of them, despite rising high in the organization, are very much focused on task. I by no means, am saying that that is not important, but it is only half the equation. The other half is the soft skills. And then the next question becomes: why do we not pay attention? Here are some of my observations over the years; this is by no means a comprehensive list:

  • Do not see it as important
  • Are not comfortable with the soft skills
  • They are difficult to measure
  • They are the first thing to be neglected in a stressful situation

My point is this: life is about balance and one must strike a balance between achievement and mastering the soft skills. If people would do that, they would be in much greater control of their own destiny career-wise. It's time to start paying attention or continue to repeat the past.