We gathered questions from Carolyn’s network to share her thoughts on her tenure with The Action Group, plans for the future, and hopes for her successor
What was your primary aspiration when you took over as president and CEO of The Action Group 20 years ago?
Before I became a Board member and eventually Board chair, I’d spent a couple of years attending what was then Buyers Health Care Action Group (BHCAG) meetings when the whole concept of group health was new to me. Although I sat in the outer-ring chairs, waiting to be called to the “Big Kids’ Table,” I was listening and learning — and incredibly impressed by the passion of high-profile HR and benefits thought leaders who were willing to take risks to improve the health care system and address the stunning and unchecked variation in health care quality and cost. My fresh perspective back then allowed me to fully appreciate that existing programs were not rational, and that recommended Action Group course corrections were directionally smart. The radically different, employer-managed, consumer-driven model embodied the principles of managed competition. I couldn’t think of anything more fun and challenging than to become firmly committed to transforming health care through the work of The Action Group.
How did your aspiration evolve over the years?
I’ve seen an incredible amount of change. We’ve gone from being an organization that was basically offering an employee health benefit program called Choice Plus to one that tried to inculcate all that it thought was right into the program. We put a lot of effort into identifying like-minded vendors and service providers to help employers understand the value of collaborating across the health care supply chain to better manage costs and improve care. The employer voice is powerful, and when we make our shared expectations known, vendors hold themselves to a higher standard and understand that incentives and rewards will be geared toward reform-oriented activities. We were learning as we were building Choice Plus, quietly infusing important concepts into the way we did business.
Then came the National Data Cooperative which helped us understand cost-saving and quality improvement goals. Minnesota Bridges to Excellence was about quality improvement that was agnostic to plan or network. We had deep and abiding commitments from a diverse set of stakeholders to work together to improve care on behalf of the people of Minnesota. We’ve also used — and are using again to improve mental health care in Minnesota — the eValue8™ tool that enables us to educate employers about identifying and buying quality. Learning networks on a variety of high-cost, high-variability conditions revealed further quality and cost chasms and led to real solutions that are now in play. Today, multi-stakeholder groups come together through The Action Group to fix a health care system that was never built.
That’s a very long answer to say I started out thinking the great people around the “Big Kids’ Table” would solve for health care chaos. Now I say, involve everybody! It can make life better for all. It was once about employer members only, now we know we have to take off our “corporate hats” and create higher value for all Minnesotans. The Action Group now focuses on a leadership, not a transactional, position. What I’ve learned in my journey is that we must take our work out broadly so Minnesotans are more vibrant, well, healthy. We create thriving organizations and communities when we are all able to access needed health care and services.
What I’ve learned in my journey is that we must take
our work out broadly so Minnesotans are more vibrant, well, healthy.
What is the most gratifying initiative you worked on during your time with The Action Group?
Of course, being part of the Choice Plus chapter was very gratifying. It was breakthrough thinking for the largest Minnesota employers to join forces and develop a direct-contracting model to reward health providers that were efficient, made good business decisions, and kept costs in check. We forget how revolutionary that was and how it has informed sustainable, positive change throughout the health care system in Minnesota and beyond.
Minnesota Bridges to Excellence holds a very special place in my heart, though. It was a start-to-finish program and it was particularly rewarding to nurture it every step of the way. I’m really, really proud of how the entire community came together to change care. We helped amplify the voice of purchasers, sending a clear message to the marketplace about expectations for high achievement and continuous improvement. Resulting infrastructure changes are impressive. We set goals for the entire state in improving care in diabetes, vascular conditions, and depression, then set about to accomplish them.
We have always had a knack for creating a safe place for candid, open, honest, real conversations — even among sworn competitors. There’s a bit of magic in convening competitors and opening conversations in true collaboration with shared goals in mind.
What are the top books, podcasts, people or resources that have informed your leadership in recent years?
There’s no single person, place or thing that informed my direction and approach. A lot of what I’ve assimilated has been through learning a little something from everyone I meet. Admiring adversaries, picking up points about how I can be more effective at my job…basically, going into every situation with my eyes and ears open. Most important, I’ve learned to adopt practices I admire and to be completely authentic.
I am who I am and, while speaking my mind honestly hasn’t always worked to my best advantage, I’ve been true to my beliefs and my expectations that people do what serves the greatest good.
Can you share your favorite “it wasn’t funny at the time…” story about a challenging situation that you now laugh about?
Leading a small organization with small resources — and one that was expected to make transformational health care changes statewide — was sometimes very lonely and a bit terrifying. Small “human moments” had a way of keeping things in perspective. I still cringe a bit when I recall being in a very serious meeting with some high-powered executives, not realizing my teen-age daughter thought it would be funny to turn up the volume on my phone and change my ringtone to “PICK UP THE GODDAMN PHONE!” Or when I thought I was rocking a custom maternity outfit, waltzing out of the ladies room, only to be told by a compassionate soul that my skirt was tucked into my ample yellow maternity panties. Things always seem to turn out O.K. It’s important to relax into the journey.
As a health care insider, what do you believe are the top three changes that need to be made to improve the U.S. health care system?
- Change the way we pay for services. The U.S. health care system is completely irrational and it doesn’t work for consumers. Maybe now that the cost of employer-sponsored health care coverage tops $20,000, outrage will reach a tipping point and action will accelerate.
- Take action to force down health care prices. Aligning incentives across the entire supply chain is essential so everyone is working toward the same end point. In the Choice Plus days, we paid providers for delivering evidence-based care at the right cost and encouraged employees to seek care based on how the provider was performing.
- Make transparency the price of admission. People must know what they are paying for and why it is that price, which forces quality expectations. Consumers have largely abdicated cost and quality to health care industry practices that are not in their best interest. Patient protections and patient-centered care are needed for consumers who are being hurt the most by unchecked costs and a dearth of quality information.
How can your successor and members help advance these changes within the sphere of The Action Group’s influence?
Continue offering proof that Action Group members are much stronger together than they are alone. Those employers who are doing things “better” should be expected to play leadership roles within the coalition. We share a moral responsibility to make the system better. That is not a small thing.
“We share a moral responsibility to make the system better.
That is not a small thing.”
What is the greatest piece of advice you have for your successor?
The first thing that comes to mind is to celebrate small victories; don’t get discouraged by the typical glacial pace of change in health care. While disruptive change is gratifying, incremental change that is substantive and quiet ultimately leads to sustainable improvements. Steady tenacity keeps things moving forward. It’s also important to remember that this work is about helping people and doing good for others, otherwise, what’s the point?
What advice would you give a young person entering the wild world of employer-sponsored health care benefits?
See above! Be patient. Celebrate incremental victories. Remember, it’s about people!
Do you plan to stay involved in driving change in the health care marketplace? If so, any concrete plans?
I will remain on the NQF Board and looking for opportunities to stay involved with the California Health Benefits Review Program. My mind is always open to juicy opportunities that arise. In recent years, I’ve been drawn to environmental and women’s rights issues.
What would you like people to say about your Action Group legacy?
Since the announcement of my retirement, I’ve been receiving lovely messages from the many people I’ve had the privilege of working with throughout my career. When people say I made a difference or The Action Group made a difference in their lives or in the lives of others, it means the world to me. “You were fun to hang out with!” is another favorite!
“When people say I’ve made a difference in their lives or in the
lives of others, it means the world to me.”
Please share your favorite inspiring quote and how it has relevance in your life.
Dr. Suess said, “Don’t cry because it’s over, smile because it happened.” We get too caught up in what was instead of celebrating the experience for what it was. Each chapter of each life brings unique life lessons and we have to trust our instincts when it’s time to turn the page.
What will you miss most about serving as The Action Group’s leader?
I’ve had the luxury of meeting and working with so many different kinds of people with exceptional talents and expertise. I’ll miss the intellectual stimulation of frequent interactions that were filled with diversity of thought and lively discussion. It was a rare day when I wasn’t learning something awesome. Many people along the way have become fast friends, so I take comfort in knowing those relationships will continue.
What will you not miss at all?
Begging people to speak for free. Buying eggs and fruit at Target for early morning meetings. Having to be the A/V girl at meetings. This has not been a glamorous job by any means. I could be meeting with an internationally renowned professor or the CEO of a Fortune 50 company in the morning and taking out the garbage in the evening.
Which books are on your nightstand, just waiting for October 1 (retirement date) to roll around?
- Turtles all the way down, by John Green
- Isaac’s Storm: A Man, a Time, and the Deadliest Hurricane in History, by Erik Larson
- A Gentleman in Moscow, by Amor Towles
- And one I reach for often, The Dalai Lama’s Little Book of Wisdom. It’s been called the essential guide to living and dying well.
What are you most looking forward to in retirement?
Not having any “have tos!”
“Leadership is about making others better as a result of your presence and making sure that impact lasts in your absence.”
Sheryl Sandberg, COO, Facebook