The American Hospital Association’s incoming president and CEO says that successful advocacy isn’t just about lobbying on Capitol Hill. Performance improvement in the field and advancing better care for patients and communities also make hospitals strong advocates.
Rick Pollack has been on the front lines of nearly every major political health care battle for the past three decades. Those years of studying, understanding and debating the complexities of the nation’s health care system have given Pollack a unique perspective, one that observers say should serve him well as he prepares to take over as CEO and president of the American Hospital Association. Pollack takes the reins of the nation’s largest hospital trade association on Sept. 1, replacing Rich Umbdenstock who will retire at the end of the year.
What are the AHA’s biggest strengths?
Pollack: Our strength comes from our membership. We represent members that are cornerstones of society and pillars of their communities. They provide essential public services.
Other fundamental strengths are our advocacy and representation capabilities. Our members are in every state and every congressional district. But when I say advocacy and representation, I also mean it in broad terms; it’s not just lobbying on Capitol Hill. It is about having a multilateral impact in influencing regulatory agencies, the media, the courts, accreditation agencies, academia and think tanks.
When I think of advocacy as a strength, I also think about the ways we help the field to self-regulate and use guidelines and codes of conduct to promote high standards that often can avoid unnecessary government regulation.
When I talk about advocacy, I also look at what we do in social media both as an organization and as part of the Coalition to Protect America’s Health Care.
Advocacy is also performance improvement in quality, patient safety, addressing diversity and disparities, and protecting patient privacy. It is working to increase the public’s confidence and trust in our field because that makes us stronger advocates and gives us increased credibility.
A lot of people tend to think that advocacy only takes place in Washington, D.C., and not in the AHA’s Chicago office. Well, it takes place in Chicago as well.
Another key strength is our ability to be thought leaders and offer solutions to the challenges that we face as a nation. We have a proven track record of doing this with such road maps as Health for Life and Ensuring a Healthier Tomorrow to improve health and health care in America. We’ve also put forth reports and recommendations addressing key issues, including caring for vulnerable populations, managing an intergenerational workforce and advance illness management.
A third area of strength is in knowledge transfer and being a facilitator and distribution channel to our members so that they are able to learn from each other.
Lastly, our relationship with the allied hospital associations is a big strength since they are partners in everything we do.
Would you consider such efforts as the Hospital Engagement Network and Hospitals in Pursuit of Excellence — which both have elements of knowledge transfer and performance improvement — as part of advocacy?
Pollack: Absolutely. I go back to the construct that whatever we do to increase public confidence and trust will make us more influential. Of course, these initiatives also help our members do their jobs more effectively, which is another important role of the association.
What do you see as the AHA’s biggest gaps or organizational challenges?
Pollack: Health care is changing and that means our members are changing. We need to be responsive to their evolving needs. We have to understand what services members consider to be of the highest value and make sure that we focus on their priorities. In some cases, that may mean exploring new strategic alliances to ensure that members get what they need to do their jobs better.
Another organizational challenge is finding more creative and innovative ways to engage our members. We need to broaden the feedback loop by using technology and other mechanisms so that we can engage more people and hear more voices as we develop our strategies on various issues.
Thinking about those strengths and opportunities, are there organizational issues that you plan to focus on as you take the helm of the association?
Pollack: There are a couple of things that aren’t going to change. The AHA vision is of a society of healthy communities, where all individuals reach their highest potential for health. That doesn’t need to change.
We have a mission to advance the health of individuals and communities. We want to lead, represent and serve organizations that are accountable to the community and committed to health improvement. That doesn’t need to change.
Thanks to Rich Umbdenstock’s great leadership, we have a solid foundation that we can build on. There are two things, however, that we need to focus on. One we call “Redefining the H” that involves a series of initiatives to prepare the field for the future.
Your question, though, is focused on the association. That’s what we call “Redefining the A.” We know that advocacy in multiple locations and across multiple arenas is something that the members value. We know that they also value thought leadership, knowledge transfer and learning from each other. But, as I mentioned, as the field changes, we have to make sure we are providing the right mix of other services that they also value.
In regard to new strategic alliances, a growing number of health systems now have health plans. We also see more physicians moving into leadership. Are those areas where you envision the AHA broadening its reach?
Pollack: As it relates to physicians, in 2011 we launched the Physician Leadership Forum as a way to involve these leaders and get their perspectives and insights. We also established a committee on clinical leadership, which has been very valuable in providing advice on clinical issues.
Looking at members with their own health plans, we need to be responsive to the trend and the issues they face. We’ve taken some steps in that direction, which I am committed to building on. For example, we’ve created an executive roundtable for hospitals that have plans. The forum is co-chaired by Rich Umbdenstock and Jim Hinton, president and CEO of Presbyterian Healthcare Services and immediate past AHA chairman. This is where we’ve been discussing issues and potential programming to be responsive to this segment of the membership.
Hospitals are at varying degrees of shifting from volume to value. How can the AHA help them manage that transition?
Pollack: Members are moving down multiple paths from different starting points, at different speeds and on different schedules tailored to the needs of their individual communities. As an association, one of the things we need to continue to do is lay out the various options that organizations may consider and provide tools for assessing which pathway might be the most appropriate for them to take.
It is not our job to tell people which pathway to take; it is our job to lay out the options, to help them assess what the best option is and, in some cases, provide the tools to help them move down the strategy that they choose. It’s also our job to facilitate member learning from each other. Another key to this shift is alignment between hospitals and physicians. That’s why we need to continue working to break down regulatory barriers to clinical integration, so that hospitals and physicians can work together more effectively to deliver better care.
How concerned are you about field unity as the health care landscape continues to shift?
Pollack: Maintaining field unity is absolutely critical. I’ve been executive vice president for 25 years and field unity is something I have always focused on. With just a couple of exceptions, I think we’ve hung together very well. But, there are always challenges.
Whether we were navigating our way through the sustainable growth rate formula fix or making sure there weren’t cuts in the most recent trade bill, or avoiding cuts in the 21st Century Cures Act, there has been total unity. We have an agenda where there are a lot of things on which we can agree.
It may be a cliché, but there’s a lot more that unites us than divides us. No matter what pathway you take to the future, everybody wants to make sure that there aren’t any more budget reductions in Medicare and Medicaid. Everybody has an interest in expanding coverage. Everybody has an interest in expanding opportunities for telemedicine and achieving better IT interoperability. Everybody has an interest in breaking down barriers to clinical integration. Everybody has an interest in pushing back on the overreaching behavior of the recovery audit contractors. Everybody has an interest in performance improvement on quality, safety, diversity and disparities.
In other interviews, you’ve alluded to an emerging policy issue: addressing financing for what you deemed essential services — emergency preparedness, graduate medical education and more. How do you see that playing out?
Pollack: We are moving into a new era of economics in health care. In this new world, purchasers of health services are generally focused on one, and only one, thing and that is the lowest price. Of course, they are concerned about value and quality, but ultimately they seem to be concerned about getting the lowest price.
If everyone is just concerned about getting the lowest price, how can we pay for the social goods, many of which are services that the public depends upon? How do we finance emergency preparedness? How do we finance GME beyond Medicare’s contribution? How do we finance research?
When community members are facing a traumatic situation, whether it is an accident or an epidemic, they don’t run to their insurance company, minute clinic or an imaging center, they end up coming to the hospital because we are the ultimate safety net in society. If everybody is just paying the lowest amount, the question becomes, how do we sustain the social goods?
In this new environment, the public needs to understand the challenge, and we need to be thoughtful about how we finance these services.
Will this be one of the main issues you take up as president and CEO?
Pollack: Yes. We have to give voice to it.
You brought up the word “consumer.” We are hearing about consumerism in health care now. How big a shift is it for hospitals to think about consumers vs. patients?
Pollack: It is going to be really important that our field makes some adjustments. The hospital experience typically comes from episodic interactions with patients and consumers, encountering them when they walk through the doors of our facilities.
As we move toward value-based payment, bundling and population health for attributable populations, we have to engage our patients on a more continuous basis, not only to improve their care, but to ensure loyalty and to manage their health and wellness. Digital strategies provide a key platform for addressing this challenge. While providing clinically competent care is key, ensuring a great patient care experience in every interaction will be more important than ever before.
Matthew Weinstock is assistant managing editor of Hospitals & Health Networks magazine, Chicago.
Who is Rick Pollack?
Which mentor influenced you the most?
Dick Davidson (former AHA president and CEO)
After nearly 25 years of heading the AHA’s lobbying efforts, what stands out as one of your proudest moments or achievements?
Helping to create the Coalition to Protect America’s Health Care, providing leadership in several efforts to expand coverage for the uninsured and building an advocacy team that is recognized as one of the best in America.
What book is on your nightstand?
Thomas Jefferson: The Art of Power by Jon Meacham
What are your hobbies?
I enjoy playing with my grandson, taking pictures — photography has been a lifelong hobby — working out and following various sports.
Background: Pollack began his career in 1976 as a legislative assistant to Congressman David Obey of Wisconsin. In 1980, he left Capitol Hill to become a lobbyist with the American Nurses Association. Then, in 1982, he joined the AHA’s advocacy team. Pollack was named executive vice president for advocacy and public policy in 1991.
Editor’s Note: Pollack is the third consecutive Richard J. to be named AHA president and CEO — Richard J. Davidson, Richard J. Umbdenstock, Richard J. Pollack. — M.W.