The odds are not in his favor.
Dr. David Carmouche has spent his entire career trying to provide world class healthcare for a state with some pretty sick people. In fact, he has a vision for an entirely new and better healthcare system for the people of Louisiana. The challenge is as daunting as you can imagine, and then some. The state is near the bottom in terms of health status in the U.S. and folks are paying dearly for health. The average Louisiana household spends 40% of its income on healthcare.
As a physician, Dr. Carmouche treated patients directly. Later, he worked with physicians across the state and influenced how patients were treated. Eventually it became clear that if he wanted a world class healthcare system in Louisiana, he would need to address how patients buy and pay for healthcare. He would need to address the payment model.
So Dr. Carmouche joined one of the few organizations in the state with the role, scope and influence to break the cycle of too much money paid for not enough benefit. Today, he is the Chief Medical Officer and EVP of External Affairs at Blue Cross Blue Shield of Louisiana. Well, that’s what his business card says. By the end of our conversation I saw him as “Bold Leader, Audacious Challenge Division.”
Like nearly every one of the bold leaders I’ve met, Dr. Carmouche came to the conversation with humbleness and an initial surprise at my observation about him. Changing healthcare for the people of Louisiana is a challenge bigger than one leader. It’s bigger than what one company can do. There are so many kinds of inertia working against rewarding and meaningful change. So what struck me, as I listened to his story, were the things he does to beat the odds.
Work outside your box: Shortly after arriving at Blue Cross, Dr. Carmouche learned that the plan was decreasing reimbursement to physical and occupational therapists throughout its network. When he asked why, the answer was that it was to keep BCBS competitive with other commercial carriers who were paying less. Dr. Carmouche was concerned about the “commoditization” of these professional services. So instead, the health plan created a first of its kind value-based therapy reimbursement by segmenting providers on measures of efficiency and effectiveness. Therapy providers who agreed to measure functional outcomes on a standardized, validated, office-based tool were eligible for enhanced reimbursement if their patients were achieving better-than-expected outcomes at fewer-than-expected visits. Rather than a trade off of traditional needs, this thinking aligned the needs of BCBS members (patients), the finances of the health plan, and outstanding providers. It’s a much better outcome than arbitrary fee schedule reductions for providers, and only possible by thinking outside the organization’s traditional box.
Commit to a cause: I don’t think there is anyone who would argue that the healthcare system works well. Dr. Carmouche uses this to ask people to pick a side: for a meaningful change to healthcare or against it. Recently, he met Dr. Paul Grundy, Global Director of Healthcare Transformation at IBM, and a man often considered the “godfather” of the Patient Centered Medical Home movement. Talking over dinner, Dr. Grundy leaned over and asked, “Do you think you have the stomach to sustain the effort that will be required to change healthcare in Louisiana?” The question highlighted the opportunity to paint this black or white. “If you agree the system is broken, and you are part of the system, you have to choose: Are you part of the problem or part of the solution? Those of us in healthcare have to reframe ourselves to be part of the solution. It’s a conscious decision. And once you’ve made the decision and commitment to create change, you’ll need to enlist others.”
Share the vision and coach people to do work differently: “I have a great appreciation for my role as communicator vs. being operational.” As you might expect, Dr. Carmouche speaks. He writes, and presents to internal and external groups of all kinds. Yet, his favorite kind of communication role is when he gets 45 minutes with just one or two people. Sure, he communicates the vision: why, where, what success looks like. In an intimate setting he also gets to listen, and talk with leaders about how they’ll work differently. “It’s personal,” he says. “And, it’s sound-bite-proof.” This is a brilliant and bold leadership strategy for enrolling stakeholders. (For more insight on this topic, read: 9 Leadership Competencies to Drive Change: a Bold Leader Conversation with John Geisler.)
Build an activist organization: Blue Cross Blue Shield of Louisiana is an incredibly strong, stable, long-standing brand in the eyes of Louisianians. The company has a terrific performance history. Yet, to create a truly amazing healthcare system in Louisiana, Dr. Carmouche wants an “activist” organization. Financial incentives now encourage healthcare players NOT to change. He believes an organization should use its position, its ability, and have the proactive guts to question everything. This includes how doctors are paid, customer usage and who pays what. He is proud to stand on, but is not content with, tradition or traditional capabilities.
I left our conversation feeling the odds shifting in the favor of the people of Louisiana. I’m staying tuned because one doctor is working outside his box, is committed to a cause, and is building an activist organization.
What are you facing where the odds are not in your favor? Where along the journey are you?
You might also be interested in:
How Bold Leaders in Healthcare Are Overcoming Uncertainty
About the Bold Leader blog series: The posts in this series are written from the ongoing conversations we have with Bold Leaders. Bold isn’t meant to indicate big egos, but behavior such as taking bold actions and being willing to step into big challenges. We seek to meet more of them, help them in their work, learn more about their needs and interest and share the interesting and helpful tidbits.
