Interview with Dr. Leelee Thames
This week, Dr. Leelee Thames, the Chief Value Officer at Novant Health, is our guest. She is the third University of Tennessee physician executive MBA graduate to join us. During our interview, she will explain why she loves her job.
Leelee completed her medical degree at Texas A& M College of Medicine and her anesthesiology residency at the University of Oregon Health and Science University.
During her residency, she also completed an NIH-funded research fellowship in systematic and comparative effectiveness reviews for the development of evidence-based guidelines. She completed the UT PEMBA in 2015.
Our Sponsor
We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.
The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.
By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.
Dr. Thames’s career has progressed rapidly. Over a relatively short time, she advanced from practicing anesthesiologist to medical director, chief medical officer, and VP for quality, to her current role as CVO. She explains what attracted her to those roles, and how she demonstrated her competence as she progressed.
Being A Health System Chief Value Officer
Dr. Thames describes the importance of finding appropriate mentors. Leelee obtained her executive MBA seven years ago. She explains why she decided to get the MBA and how it has helped advance her career.
After spending time with health plans, I was really intrigued with this opportunity to work for a health system and really focus on care transformation and moving the organization towards value-based care.
She also outlines what she does as CVO, and why she prefers working in a health system. She closes by giving her advice for other physicians hoping to move into a health plan or health system leadership role.
Summary
Physicians can accelerate their career progress by actively pursuing more challenging roles. It may also require a willingness to relocate. If you'd like like to contact Dr. Thames, the best option is to find her on LinkedIn.
NOTE: Look below for a transcript of today's episode that you can download or read.
Links for Today's Episode:
- Dr. Leelee Thames LinkedIn Profile
- Novant Health
- New Hanover Health Advantage
- University of Tennessee Physician Executive MBA Program
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Transcription PNC Episode 201
Why Being Health System Chief Value Officer is More Fun Than Being CMO
John: Today, I'm very happy to have another alumnus from the UT physician executive MBA program. She's going to be telling us how her career evolved from practicing anesthesiologists to chief value officer for a large health system. So, I want to welcome to the podcast Dr. Leelee Thames. Nice to see you.
Dr. Leelee Thames: Nice to see you too, John. Thank you for having me.
John: I'm really happy you're here. I was talking with Kate actually at the UT Pemba and I said, I would really love to talk to some of your graduates. For some reason, she thought of you right away and we were able to connect. Well, I'm really interested in careers, especially physicians who are doing leadership positions whether it's in a health system or an insurance company, something like that. So, this is going to be really interesting today.
Dr. Leelee Thames: Thank you. I'm looking forward to the conversation.
John: All right. So, what we'll usually do is we go back ways. We don't have to go back to your childhood, but your education, maybe the undergrad, and medical school. Just take us through that process briefly, and then we'll go from there.
Dr. Leelee Thames: Well, I first want to start by sharing that I'm coming from an immigrant family. It was actually ingrained in me to get a good education, to create a future worthy of the sacrifices that my family made in coming to America. And so, I knew I had to get a college education because my father who didn't know much English got one as well. And so, I went to Baylor University, I got a bachelor's in biology. I attended medical school at Texas A&M college of medicine. And from there, I went to Oregon Health & Science for anesthesiology training, where I also completed a clinical research fellowship in evidence-based medicine for clinical practice guidelines.
John: So, now, can you explain that? Because I saw that, it was a fellowship at the NIH, I believe, and that was sort of integrated into your residency.
Dr. Leelee Thames: That's right. It extended my residency for a year, but it was an integrative program and a wonderful opportunity where I could both practice my anesthesia as well as overlap it with clinical research. And so, I worked at the Oregon Evidence Practice Center there and it was such a wonderful opportunity and that's what led to my evolution in my career in leadership.
John: Okay. But it has the word "research" in it there. So, was that something that you thought initially you were going to be doing, clinical research? I want you to fill us in on that because that sounds a little interesting.
Dr. Leelee Thames: Yeah. I thought my whole career, being a physician meant ongoing learning, lifelong learning. And I just thought being able to contribute to the sciences was something that would be really valuable. And so, that's why I thought doing a clinical research fellowship was going to not only advance anesthesia but just medicine as a whole and me as a physician.
John: And I bet too. I mean, so much of what we do when we start out in practice is trying to understand new drugs, new treatments, and really understanding how research is done and how to analyze and interpret. It can be a huge help not to mention actually doing your own studies if you get to that point. So, it sounds like fun.
Dr. Leelee Thames: Yeah, it was. I worked with Dr. Roger Chou at OHSU and we really focused on comparative effectiveness reviews and systematic reviews to provide the best clinical guidelines and recommendations for various different positions.
John: Clinical guidelines. Now that seems to be a real tie-in to what you did later, I'm thinking, so we'll have to circle back to that. But then you began practicing as an anesthesiologist, correct?
Dr. Leelee Thames: Yes. I practiced in Portland, Oregon. For the first five years, I was part of a large anesthesia group. And then a year after that, I actually started my own anesthesia business called The Anesthesia Northwest. And that was fun learning the business side of standing up your own anesthesia company and all the financials and things like that. And I really think that really propelled me to make a decision on whether I like that business aspect of healthcare or did I want to just focus primarily on that clinical care?
John: What prompted you to start your own business?
Dr. Leelee Thames: There was a great opportunity there locally with an ambulatory surgical center. And so, I thought everything kind of lined up and I thought it
would be fun to be a business owner. I've always had that spirit of innovation and enjoying business and just thought I should go ahead with it and see how I landed.
John: Well, most business owners that I've talked to that have started something and didn't learn about it beforehand in terms of their education were like, "Well, there's a lot of different responsibilities in there that I wasn't aware of initially".
Dr. Leelee Thames: Right, right. It has a totally different level of managing the business itself even beyond that clinical space. So, it was a great experience and I really, really value that opportunity.
John: Now, if I understand your background and some of the other work you were doing, that wasn't the only thing you were doing, you were working as a medical director as well.
Dr. Leelee Thames: Yeah. So, based on my clinical research fellowship in that work in clinical guidelines, I actually started advising insurance companies on how to incorporate evidence-based medicine into quality and utilization management programs using the highest level of evidence.
Actually, my whole career has always been in conjunction with not only my clinical practice but also working with payers. And so, I really valued these opportunities because it provided me with a global perspective on healthcare. And during that time frame was when the affordable care act was starting to take the lead in healthcare. And so, I knew that there was a great opportunity to be one of the problem-solvers as we move towards transformation in healthcare. And I really wanted to be one of those people who made a contribution.
John: So, that's when the ACOs were starting and trying to survive. And the "population health" so to speak was becoming one of the catchwords.
Dr. Leelee Thames: That's right. That's right. So, moving towards greater value, ensuring high-quality care and cost-effective care to reduce that ongoing projection of increasing GDP on health care. And so, with the healthcare landscape being so dynamic and all the shifts in payment reform it's been an exciting journey just because there are so many changes, so many regulations, and being involved in this space has really given me an opportunity to be innovative in a different way.
John: All right. So, I'm trying to mesh these two. So, you're practicing. You're trying to apply really good medicine frontline with patients. You're probably putting in place those kinds of protocols and things to ensure quality, but at the same time you're working with basically what was like a health plan or that was delivering. Well, it was kind of managing the delivery of care. It didn't really employ physicians. Right?
Dr. Leelee Thames: Right. Yeah. So, it was very interesting. I would have conversations with my colleagues and they would ask me questions, "Well, why is this a part of the clinical criteria?" and things like that. And it was valuable because I was able to incorporate those clinical conversations into some of those policies we would develop. And so, it was a wonderful experience to really mesh that business side with clinical care.
John: And then at some point you started to get involved. You shifted more towards working for, I think, explain this to me, if you can, was it like a health system that also had an integrated, maybe not its own insurance company, but it was either acting like an ACO. Tell me that process. What did you get into next?
Dr. Leelee Thames: Sure. So, after my time practicing clinically and then being involved with an insurance company in Oregon, I really was at a crossroads of trying to figure out how to move forward in my career. Because as you can imagine having a couple of full-time jobs and then getting an MBA was a lot of juggling happening.
And so, I really had to make a personal decision-career decision on which of these both incredibly fulfilling careers I was going to take. Because as you can imagine, I knew it was not going to be sustainable long-term if I kept on this path.
And so, after spending time at that first insurance company, I actually moved on to another insurance company and became the national CMO there. And then as part of that, there was an MSO that I helped with managing the shared services with the ACO. And so, there's a lot of parallels between what's happening in the ACO space and health plan space, as you mentioned, related to population health, managing total cost of care, because all of us at the end of the day want to achieve the quadruple aim.
And so, I'm getting to leverage my health plan background supporting these MSO services. I felt it would be a great opportunity to further expand my experiences and share that experience with a broader group of healthcare programs.
John: All right, now we're going to digress for a minute here for two reasons. Number one is going to be "Describe what the term MSO or the acronym stands for". And my experience is that the term is used in a lot of different ways from just somebody doing some services for an insurer or a hospital to sort of running and the claims processing and all that kind of thing. So, what is an MSO exactly in your experience?
Dr. Leelee Thames: MSO stands for Managed Service Organization. And so, a lot of health systems, you might have health plans or other products and things like that. They basically are able to gain economies of scale by centralizing shared services. And so, in that MSO if you can apply some of those operations across multiple businesses, you will gain not only cost savings but efficiencies.
John: Okay. You're talking about an MSO that's owned by a health system as opposed to a third-party MSOs that will come in and support somebody else?
Dr. Leelee Thames: Correct. Yeah. It's a way to describe the infrastructure where you housed the shared and support services.
John: Okay. Then the other digression is, you mentioned the MBA. And that is one of the reasons I have you on the podcast. So, tell me why you decided to pursue the MBA? Why did you choose UT Pemba? That's not my most critical question. I don't want to be just harping for my sponsor, but how did you make that decision? What kind of thought process did you go through in trying to decide which one to go to? Because there are so many different types of MBA programs, from what I know.
Dr. Leelee Thames: Right. Yeah. Well, I had the fortune of, again, having some of these business experiences and it really intrigued me because it opened my mind to additional possibilities as a physician, I never thought was possible. Because most of the time, a lot of physicians, including myself had thought, "Oh, I finished medical school, finished my training, and now I'm going to be a practicing provider. And that was the end of it".
But I saw this as an opportunity to do health care a little bit differently and how I could be part of the solution. And so, as you mentioned, there are so many MBAs out there, some physician executive MBAs and or just straight MBAs. And so, I did a lot of research online and I actually talked with a couple of physician executive MBAs in my local community and got insight on how they landed, where they were, and their insights.
And what I thought was really intriguing was that the UT physician executive MBA provided you with a network of physician leaders who you could draw on, even in your later years, post-graduation. And we as physicians and especially those who are in leadership positions or in managed care, really have a different vision and a different way of thinking of things. And it's been so valuable to me to be able to call up some colleagues and get their input on different ideas or how they did something at their health plans.
I really thought that network and getting that comradery with my fellow MBA students would be a great lifelong opportunity to draw on. And so, that's one of the main reasons why I chose UT Pemba. But also, just looking at the physicians and the staff who make up UT Pemba I thought were an incredible group. And definitely, that experience really ingrained upon me. That helped really form my decision on why I chose the path of moving into more physician leadership.
John: One of the things I've heard people talk about is whether to do an executive MBA, that's just physicians or not? And I've heard arguments on both sides. So, I don't know. What do you think about it? You obviously decided to go with the physician executive MBA, but did you feel like there were certain distinct advantages of that? Were there things you thought maybe the nonphysician might've had a slight edge in certain aspects? Or how did you decide about that?
Dr. Leelee Thames: Yeah, that's a great question. As I mentioned, I met with some physicians who had MBA experiences and I think from what they were experiencing, just having that physician experience is a bit different. And knowing that I wanted to stay in healthcare and make an impact in healthcare, it was important to, again, have that network. I also had a lot of friends who had MBAs who were not physicians. And it was hard for me to sort out how it would directly impact healthcare. That's really what drew me to UT's MBA program.
John: One thing I would imagine having not been through any of those programs though is that the healthcare finances is really a whole lot different from sort of your typical corporate financing. And so, I found that interesting as I was learning at the hospital I worked at as CMO. It was a different world that healthcare lives in.
Dr. Leelee Thames: Right. Right.
John: All right. So, that was about five years ago. And you did mention you still been in touch with some of the people you came to know. I know there are projects that can be done during the MBA. So, you probably developed some pretty long-term relationships, I would guess.
Dr. Leelee Thames: Yeah. Some great friendships. And again, folks I can pulse check and say, "Hey, what do you think about this? What are you doing at your organization related to this?" And so, it's always been fun. It's always collaborative and great to share best practices across the country.
John: Now, I haven't asked you about this before we got on the call, but have you participated at all with the APL, The American Association for Physician Leadership?
Dr. Leelee Thames: No. No, I have not.
John: Because there's a lot of overlap there. A lot of people that I've talked to in the past and it has some of that networking, but obviously it's not the same as being actually in some kind of program together for a year. It's just a professional society.
Okay. Well now I really want to know what this job is called - Chief value officer. Tell us about the latest, what you've been up to for the last two or three years at your latest position.
Dr. Leelee Thames: Yeah. So, after spending time with health plans, I was really intrigued with this opportunity to work for a health system and really focus on care transformation and moving the organization towards value-based care.
With my background in healthcare finance, health plan space, the intent, and the goal were to really achieve that quadruple aim. And one of those key components, as you may recall, is ensuring physician readiness. And so, I really felt that I could be a contributor in helping bring along additional physicians in moving towards value, that high-quality care that's cost-effective and enables us to better manage populations.
And so, it's also a building job. It's almost as if I'm doing some startup work. I helped start our Medicare advantage products and lead our ACOs and help with our employee health plan. It's been a lot of collaboration with folks on the hospital side and providers. And that was one of the missing pieces, moving away from practicing medicine to being on the health insurance side. I always longed to continue to have those colleagues.
This opportunity really allows me to take a holistic approach in connecting with my colleagues again in the provider space. And so, it's been a journey and it's been very wonderful to see how we are really trying to transform healthcare locally. And hopefully, this translates into more long-term success for our organization as a whole.
John: So, it seemed like there'd be two things going on here, at least, from probably hundreds of things. But you're trying to get physicians to think differently. Especially the longer they've been in practice, the less likely they're going to be aware of or embracing certain changes to how health care is provided.
And then the other piece that most organizations seem to have in my opinion is the lack of physician leadership. There are always physician leaders like yourself, but it always seems like they need more leaders. It's hard to take physicians out of the practice side to teach them to be managers and leaders. But I would think in this environment you would need to have more involvement.
So, how are you addressing both of those things in terms of just getting physicians to understand population health and managing differently? And then also maybe pulling along some of them to become more involved in leading the charge?
Dr. Leelee Thames: Well, we have a great group of physicians here, and so they've been wonderful to work with. And as we come to the table and talk about what our shared goals are, I think that's the best place to start with. Recognizing that we may diverge on what that future state is, but as long as we come together saying, "You know what? We all are working towards population health, improving outcomes, managing total cost of care, ensuring it's safe for patients".
I think with that starting point, understanding our intent at the end of the day is the same. That's really been the best catalyst to help move forward the conversations that can be quite challenging as you can imagine when we're talking about payment transformation or we're talking about how to mitigate risk and who bears that risk.
So, it's a journey. We're still on that journey, but I'm really confident that as we continue to have these conversations, we're going to get there. And the whole country is moving and working to get there. It's an exciting time in healthcare. A great time for innovation as it relates to not just research itself, but innovation in how we do healthcare better as a whole so that we can sustain this in the future.
John: It seemed like one of the things that was slowing some of the smaller hospitals around Chicago is being able to measure your outcomes in a way that you could actually take action and implement different approaches or changing the model of care. So, you feel like, at this point, most systems now have pretty good tools for measuring or get the information, whether it's directly from Medicare or some other way to be able to say, "Okay, we're going to put this in place and we're going to monitor what happens. We're going to measure the cost of care and the quality at the same time?"
Dr. Leelee Thames: Well, I would say it runs the gamut across the country from what I've heard, especially the smaller hospitals and smaller practices. I'm sure it's absolutely challenging just because funding the resources necessary to get those types of analytics in place is really challenging.
But as you're more involved in things like ACOs where CMS provides the information, or if you're self-funded, and you have that data straight from the payers or whoever's managing your claims, that's when it becomes a little bit easier because then you can move forward and manipulate that data.
But right now, I think there's a lot of wonderful resources out there. But again, it's a challenge and a barrier across the board. And we really need the payers to share as much information as possible to help with that complete picture in managing that total cost of care as well as quality for providers.
John: So, you sound like you're pretty challenged in your job, but tell us a little bit about how satisfying it is to work in this environment? I mean, you're not seeing patients, you're a doctor, you kind of thought, well, I'm going to start and see patients, but you're not doing that. And you're working in a completely different way, but of course, what you're doing is greatly affecting patient care. So, tell me your satisfaction level and how exciting it is to work where you're working right now.
Dr. Leelee Thames: Yeah, that's a really great question, John, because I think that was really pivotal in my decision-making - What did I want at the end of the day? As an anesthesiologist, you take care of patients one at a time. And I wonder what would happen if I actually had the opportunity that would make an impact on hundreds or thousands of patients at a time?
And so that is really what drives me. The ability to make a positive and lasting impact on populations. Because at the end of the day, as a physician yourself, we really just want to ensure patients get the best possible care and you want to make sure it's cost-effective for them so that they can manage their health outcomes.
And this is really one of the most fun jobs I've ever had. It's not without its challenges and it's not without a lot of barriers to getting us to where we need to be, but that's what's exciting about it. How do we overcome, how do we succeed when there are new regulations that are putting pressure on the organization and putting pressure on providers as a whole? And so, being able to navigate that, for me, I think that's what's fun about the job of being a problem solver.
John: Yeah. It sounds like it would really, especially depending on your personality and how long you've been in medicine, it could really be something that's fun and challenging. Yes, it can be fun and challenging even though there might be some long days and some seemingly overwhelming challenges at times.
But let me shift gears now. Let's say I'm out of my residency, I'm an internist at one of your hospitals, or anesthesiologist, or a family doctor. I say, Dr. Thames, I really like what you're doing. It sounds pretty cool. How do I get from where I am here now, looking back the way you did it? What advice would you have for me? I'm a physician, I'm practicing. I like one-on-one care, but I would like to have a bigger impact, that I'd like to get involved in leadership in a hospital or a health system. What kind of advice would you have?
Dr. Leelee Thames: So, I would not be where I am today without other physician leaders who brought me along the way. So, I would recommend asking folks you see in positions where you might want to be, or you might want to learn more about. Just ask them, "Hey, could I spend some time with you learning about what you do?" I doubt anyone would say "no" because it's such a pleasure sharing with others your own journey.
And for me, how I've been able to transition and again, it's always been people along the way who really shared their life with me, that allowed me to get a better picture or get more insight to figure out where I want it to be. There are so many people out there who are ready and willing to help. And so, feel free to reach out to me as well if there's interest in learning. I think that's what we should do as physician colleagues to teach each other and learn from each other.
John: Do you think that there'll be a continuing need for pulling physicians into management and leadership jobs in this kind of environment?
Dr. Leelee Thames: Oh, absolutely. I think physicians are in a unique position because we have such a close bond with patients and we know what the patients not only need, but we know how they might respond just because we've interacted with them so closely. And we are in alignment with the overall goal of trying to help improve their health. I think we're in such a great position to really be an advocate for them. And that's what I see myself as really. Now part of my role is to be an advocate for patients. Be an advocate for my physician colleagues and ensure that we make this sustainable for our organization.
John: Yeah. I think the people that lead hospitals and health systems are dedicated, but I think the CFO needs a physician explaining to him or her what patient care really is when they've never experienced it first hand and how all these decisions aren't necessarily just financial decisions. There are important considerations for patients. And I agree with you definitely that physicians are in the best position to do that. A chief nursing officer can help a lot too, but I'll stand behind the chief medical officer any day.
And just before we close, the chief value officer, it's not a common term. From organization to organization have different terms, but you are chief value officer and president there. So, it's just a leadership position that really helps pull everything together, to try and improve patient care.
Dr. Leelee Thames: Yeah, yeah. And I think one of the key things is about care transformation because we know that we cannot stay in a fee-for-service world, and that is not what CMS will allow, that's not what employers want. Because it's really about outcomes at the end of the day. And really about ensuring that we can create a health system that's sustainable long-term.
And so that's what's exciting about my job. I try to see it as I'm the person who helps bridge that gap and try to think of ways for us to do things differently. And so, that's why the job is so fun. I'm almost a builder and get to think outside the box and try different things and use what's happening in leading industries to apply and hopefully, again, build upon so that we can improve and drive out outcomes.
John: It sounds like that so-called change management is a big piece of it. That's always something that's talked about in leadership training. All right. Well, this has been fun. This is very exciting. We'll have to touch base with you again in a few years and see what's happening. Any last bits of advice before I let you go for the listeners today?
Dr. Leelee Thames: Yeah. I would just suggest that if anyone's interested in a physician leadership position, healthcare leadership position, really take the time to investigate it and don't shrink back and don't be held back by fear. Because once you step out of that realm and get an opportunity to see the bigger picture in healthcare, I think you might be quite intrigued to figure out how you might fit in. And so, any way that I can support or help, I would love to do that for anyone.
John: Well, thank you very much. It has been very interesting and helpful. I'm going to put the links to your LinkedIn profile. It's easy to find. They can just look up your name, but I'll put that in the show notes if anybody wants to get in touch and ask you questions directly or recommend some other mentors and so forth. And so, with that, I really appreciate the time you spent with us today Leelee. It's been great. And I'll say goodbye at this point.
Dr. Leelee Thames: John, it's been a pleasure. Thank you so much.
John: You're welcome. Take care.
Dr. Leelee Thames: Bye-bye.
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Transcription PNC Episode 201
Why Being Health System Chief Value Officer is More Fun Than Being CMO
John: Today, I'm very happy to have another alumnus from the UT physician executive MBA program. She's going to be telling us how her career evolved from practicing anesthesiologists to chief value officer for a large health system. So, I want to welcome to the podcast Dr. Leelee Thames. Nice to see you.
Dr. Leelee Thames: Nice to see you too, John. Thank you for having me.
John: I'm really happy you're here. I was talking with Kate actually at the UT Pemba and I said, I would really love to talk to some of your graduates. For some reason, she thought of you right away and we were able to connect. Well, I'm really interested in careers, especially physicians who are doing leadership positions whether it's in a health system or an insurance company, something like that. So, this is going to be really interesting today.
Dr. Leelee Thames: Thank you. I'm looking forward to the conversation.
John: All right. So, what we'll usually do is we go back ways. We don't have to go back to your childhood, but your education, maybe the undergrad, and medical school. Just take us through that process briefly, and then we'll go from there.
Dr. Leelee Thames: Well, I first want to start by sharing that I'm coming from an immigrant family. It was actually ingrained in me to get a good education, to create a future worthy of the sacrifices that my family made in coming to America. And so, I knew I had to get a college education because my father who didn't know much English got one as well. And so, I went to Baylor University, I got a bachelor's in biology. I attended medical school at Texas A&M college of medicine. And from there, I went to Oregon Health & Science for anesthesiology training, where I also completed a clinical research fellowship in evidence-based medicine for clinical practice guidelines.
John: So, now, can you explain that? Because I saw that, it was a fellowship at the NIH, I believe, and that was sort of integrated into your residency.
Dr. Leelee Thames: That's right. It extended my residency for a year, but it was an integrative program and a wonderful opportunity where I could both practice my anesthesia as well as overlap it with clinical research. And so, I worked at the Oregon Evidence Practice Center there and it was such a wonderful opportunity and that's what led to my evolution in my career in leadership.
John: Okay. But it has the word "research" in it there. So, was that something that you thought initially you were going to be doing, clinical research? I want you to fill us in on that because that sounds a little interesting.
Dr. Leelee Thames: Yeah. I thought my whole career, being a physician meant ongoing learning, lifelong learning. And I just thought being able to contribute to the sciences was something that would be really valuable. And so, that's why I thought doing a clinical research fellowship was going to not only advance anesthesia but just medicine as a whole and me as a physician.
John: And I bet too. I mean, so much of what we do when we start out in practice is trying to understand new drugs, new treatments, and really understanding how research is done and how to analyze and interpret. It can be a huge help not to mention actually doing your own studies if you get to that point. So, it sounds like fun.
Dr. Leelee Thames: Yeah, it was. I worked with Dr. Roger Chou at OHSU and we really focused on comparative effectiveness reviews and systematic reviews to provide the best clinical guidelines and recommendations for various different positions.
John: Clinical guidelines. Now that seems to be a real tie-in to what you did later, I'm thinking, so we'll have to circle back to that. But then you began practicing as an anesthesiologist, correct?
Dr. Leelee Thames: Yes. I practiced in Portland, Oregon. For the first five years, I was part of a large anesthesia group. And then a year after that, I actually started my own anesthesia business called The Anesthesia Northwest. And that was fun learning the business side of standing up your own anesthesia company and all the financials and things like that. And I really think that really propelled me to make a decision on whether I like that business aspect of healthcare or did I want to just focus primarily on that clinical care?
John: What prompted you to start your own business?
Dr. Leelee Thames: There was a great opportunity there locally with an ambulatory surgical center. And so, I thought everything kind of lined up and I thought it
would be fun to be a business owner. I've always had that spirit of innovation and enjoying business and just thought I should go ahead with it and see how I landed.
John: Well, most business owners that I've talked to that have started something and didn't learn about it beforehand in terms of their education were like, "Well, there's a lot of different responsibilities in there that I wasn't aware of initially".
Dr. Leelee Thames: Right, right. It has a totally different level of managing the business itself even beyond that clinical space. So, it was a great experience and I really, really value that opportunity.
John: Now, if I understand your background and some of the other work you were doing, that wasn't the only thing you were doing, you were working as a medical director as well.
Dr. Leelee Thames: Yeah. So, based on my clinical research fellowship in that work in clinical guidelines, I actually started advising insurance companies on how to incorporate evidence-based medicine into quality and utilization management programs using the highest level of evidence.
Actually, my whole career has always been in conjunction with not only my clinical practice but also working with payers. And so, I really valued these opportunities because it provided me with a global perspective on healthcare. And during that time frame was when the affordable care act was starting to take the lead in healthcare. And so, I knew that there was a great opportunity to be one of the problem-solvers as we move towards transformation in healthcare. And I really wanted to be one of those people who made a contribution.
John: So, that's when the ACOs were starting and trying to survive. And the "population health" so to speak was becoming one of the catchwords.
Dr. Leelee Thames: That's right. That's right. So, moving towards greater value, ensuring high-quality care and cost-effective care to reduce that ongoing projection of increasing GDP on health care. And so, with the healthcare landscape being so dynamic and all the shifts in payment reform it's been an exciting journey just because there are so many changes, so many regulations, and being involved in this space has really given me an opportunity to be innovative in a different way.
John: All right. So, I'm trying to mesh these two. So, you're practicing. You're trying to apply really good medicine frontline with patients. You're probably putting in place those kinds of protocols and things to ensure quality, but at the same time you're working with basically what was like a health plan or that was delivering. Well, it was kind of managing the delivery of care. It didn't really employ physicians. Right?
Dr. Leelee Thames: Right. Yeah. So, it was very interesting. I would have conversations with my colleagues and they would ask me questions, "Well, why is this a part of the clinical criteria?" and things like that. And it was valuable because I was able to incorporate those clinical conversations into some of those policies we would develop. And so, it was a wonderful experience to really mesh that business side with clinical care.
John: And then at some point you started to get involved. You shifted more towards working for, I think, explain this to me, if you can, was it like a health system that also had an integrated, maybe not its own insurance company, but it was either acting like an ACO. Tell me that process. What did you get into next?
Dr. Leelee Thames: Sure. So, after my time practicing clinically and then being involved with an insurance company in Oregon, I really was at a crossroads of trying to figure out how to move forward in my career. Because as you can imagine having a couple of full-time jobs and then getting an MBA was a lot of juggling happening.
And so, I really had to make a personal decision-career decision on which of these both incredibly fulfilling careers I was going to take. Because as you can imagine, I knew it was not going to be sustainable long-term if I kept on this path.
And so, after spending time at that first insurance company, I actually moved on to another insurance company and became the national CMO there. And then as part of that, there was an MSO that I helped with managing the shared services with the ACO. And so, there's a lot of parallels between what's happening in the ACO space and health plan space, as you mentioned, related to population health, managing total cost of care, because all of us at the end of the day want to achieve the quadruple aim.
And so, I'm getting to leverage my health plan background supporting these MSO services. I felt it would be a great opportunity to further expand my experiences and share that experience with a broader group of healthcare programs.
John: All right, now we're going to digress for a minute here for two reasons. Number one is going to be "Describe what the term MSO or the acronym stands for". And my experience is that the term is used in a lot of different ways from just somebody doing some services for an insurer or a hospital to sort of running and the claims processing and all that kind of thing. So, what is an MSO exactly in your experience?
Dr. Leelee Thames: MSO stands for Managed Service Organization. And so, a lot of health systems, you might have health plans or other products and things like that. They basically are able to gain economies of scale by centralizing shared services. And so, in that MSO if you can apply some of those operations across multiple businesses, you will gain not only cost savings but efficiencies.
John: Okay. You're talking about an MSO that's owned by a health system as opposed to a third-party MSOs that will come in and support somebody else?
Dr. Leelee Thames: Correct. Yeah. It's a way to describe the infrastructure where you housed the shared and support services.
John: Okay. Then the other digression is, you mentioned the MBA. And that is one of the reasons I have you on the podcast. So, tell me why you decided to pursue the MBA? Why did you choose UT Pemba? That's not my most critical question. I don't want to be just harping for my sponsor, but how did you make that decision? What kind of thought process did you go through in trying to decide which one to go to? Because there are so many different types of MBA programs, from what I know.
Dr. Leelee Thames: Right. Yeah. Well, I had the fortune of, again, having some of these business experiences and it really intrigued me because it opened my mind to additional possibilities as a physician, I never thought was possible. Because most of the time, a lot of physicians, including myself had thought, "Oh, I finished medical school, finished my training, and now I'm going to be a practicing provider. And that was the end of it".
But I saw this as an opportunity to do health care a little bit differently and how I could be part of the solution. And so, as you mentioned, there are so many MBAs out there, some physician executive MBAs and or just straight MBAs. And so, I did a lot of research online and I actually talked with a couple of physician executive MBAs in my local community and got insight on how they landed, where they were, and their insights.
And what I thought was really intriguing was that the UT physician executive MBA provided you with a network of physician leaders who you could draw on, even in your later years, post-graduation. And we as physicians and especially those who are in leadership positions or in managed care, really have a different vision and a different way of thinking of things. And it's been so valuable to me to be able to call up some colleagues and get their input on different ideas or how they did something at their health plans.
I really thought that network and getting that comradery with my fellow MBA students would be a great lifelong opportunity to draw on. And so, that's one of the main reasons why I chose UT Pemba. But also, just looking at the physicians and the staff who make up UT Pemba I thought were an incredible group. And definitely, that experience really ingrained upon me. That helped really form my decision on why I chose the path of moving into more physician leadership.
John: One of the things I've heard people talk about is whether to do an executive MBA, that's just physicians or not? And I've heard arguments on both sides. So, I don't know. What do you think about it? You obviously decided to go with the physician executive MBA, but did you feel like there were certain distinct advantages of that? Were there things you thought maybe the nonphysician might've had a slight edge in certain aspects? Or how did you decide about that?
Dr. Leelee Thames: Yeah, that's a great question. As I mentioned, I met with some physicians who had MBA experiences and I think from what they were experiencing, just having that physician experience is a bit different. And knowing that I wanted to stay in healthcare and make an impact in healthcare, it was important to, again, have that network. I also had a lot of friends who had MBAs who were not physicians. And it was hard for me to sort out how it would directly impact healthcare. That's really what drew me to UT's MBA program.
John: One thing I would imagine having not been through any of those programs though is that the healthcare finances is really a whole lot different from sort of your typical corporate financing. And so, I found that interesting as I was learning at the hospital I worked at as CMO. It was a different world that healthcare lives in.
Dr. Leelee Thames: Right. Right.
John: All right. So, that was about five years ago. And you did mention you still been in touch with some of the people you came to know. I know there are projects that can be done during the MBA. So, you probably developed some pretty long-term relationships, I would guess.
Dr. Leelee Thames: Yeah. Some great friendships. And again, folks I can pulse check and say, "Hey, what do you think about this? What are you doing at your organization related to this?" And so, it's always been fun. It's always collaborative and great to share best practices across the country.
John: Now, I haven't asked you about this before we got on the call, but have you participated at all with the APL, The American Association for Physician Leadership?
Dr. Leelee Thames: No. No, I have not.
John: Because there's a lot of overlap there. A lot of people that I've talked to in the past and it has some of that networking, but obviously it's not the same as being actually in some kind of program together for a year. It's just a professional society.
Okay. Well now I really want to know what this job is called - Chief value officer. Tell us about the latest, what you've been up to for the last two or three years at your latest position.
Dr. Leelee Thames: Yeah. So, after spending time with health plans, I was really intrigued with this opportunity to work for a health system and really focus on care transformation and moving the organization towards value-based care.
With my background in healthcare finance, health plan space, the intent, and the goal were to really achieve that quadruple aim. And one of those key components, as you may recall, is ensuring physician readiness. And so, I really felt that I could be a contributor in helping bring along additional physicians in moving towards value, that high-quality care that's cost-effective and enables us to better manage populations.
And so, it's also a building job. It's almost as if I'm doing some startup work. I helped start our Medicare advantage products and lead our ACOs and help with our employee health plan. It's been a lot of collaboration with folks on the hospital side and providers. And that was one of the missing pieces, moving away from practicing medicine to being on the health insurance side. I always longed to continue to have those colleagues.
This opportunity really allows me to take a holistic approach in connecting with my colleagues again in the provider space. And so, it's been a journey and it's been very wonderful to see how we are really trying to transform healthcare locally. And hopefully, this translates into more long-term success for our organization as a whole.
John: So, it seemed like there'd be two things going on here, at least, from probably hundreds of things. But you're trying to get physicians to think differently. Especially the longer they've been in practice, the less likely they're going to be aware of or embracing certain changes to how health care is provided.
And then the other piece that most organizations seem to have in my opinion is the lack of physician leadership. There are always physician leaders like yourself, but it always seems like they need more leaders. It's hard to take physicians out of the practice side to teach them to be managers and leaders. But I would think in this environment you would need to have more involvement.
So, how are you addressing both of those things in terms of just getting physicians to understand population health and managing differently? And then also maybe pulling along some of them to become more involved in leading the charge?
Dr. Leelee Thames: Well, we have a great group of physicians here, and so they've been wonderful to work with. And as we come to the table and talk about what our shared goals are, I think that's the best place to start with. Recognizing that we may diverge on what that future state is, but as long as we come together saying, "You know what? We all are working towards population health, improving outcomes, managing total cost of care, ensuring it's safe for patients".
I think with that starting point, understanding our intent at the end of the day is the same. That's really been the best catalyst to help move forward the conversations that can be quite challenging as you can imagine when we're talking about payment transformation or we're talking about how to mitigate risk and who bears that risk.
So, it's a journey. We're still on that journey, but I'm really confident that as we continue to have these conversations, we're going to get there. And the whole country is moving and working to get there. It's an exciting time in healthcare. A great time for innovation as it relates to not just research itself, but innovation in how we do healthcare better as a whole so that we can sustain this in the future.
John: It seemed like one of the things that was slowing some of the smaller hospitals around Chicago is being able to measure your outcomes in a way that you could actually take action and implement different approaches or changing the model of care. So, you feel like, at this point, most systems now have pretty good tools for measuring or get the information, whether it's directly from Medicare or some other way to be able to say, "Okay, we're going to put this in place and we're going to monitor what happens. We're going to measure the cost of care and the quality at the same time?"
Dr. Leelee Thames: Well, I would say it runs the gamut across the country from what I've heard, especially the smaller hospitals and smaller practices. I'm sure it's absolutely challenging just because funding the resources necessary to get those types of analytics in place is really challenging.
But as you're more involved in things like ACOs where CMS provides the information, or if you're self-funded, and you have that data straight from the payers or whoever's managing your claims, that's when it becomes a little bit easier because then you can move forward and manipulate that data.
But right now, I think there's a lot of wonderful resources out there. But again, it's a challenge and a barrier across the board. And we really need the payers to share as much information as possible to help with that complete picture in managing that total cost of care as well as quality for providers.
John: So, you sound like you're pretty challenged in your job, but tell us a little bit about how satisfying it is to work in this environment? I mean, you're not seeing patients, you're a doctor, you kind of thought, well, I'm going to start and see patients, but you're not doing that. And you're working in a completely different way, but of course, what you're doing is greatly affecting patient care. So, tell me your satisfaction level and how exciting it is to work where you're working right now.
Dr. Leelee Thames: Yeah, that's a really great question, John, because I think that was really pivotal in my decision-making - What did I want at the end of the day? As an anesthesiologist, you take care of patients one at a time. And I wonder what would happen if I actually had the opportunity that would make an impact on hundreds or thousands of patients at a time?
And so that is really what drives me. The ability to make a positive and lasting impact on populations. Because at the end of the day, as a physician yourself, we really just want to ensure patients get the best possible care and you want to make sure it's cost-effective for them so that they can manage their health outcomes.
And this is really one of the most fun jobs I've ever had. It's not without its challenges and it's not without a lot of barriers to getting us to where we need to be, but that's what's exciting about it. How do we overcome, how do we succeed when there are new regulations that are putting pressure on the organization and putting pressure on providers as a whole? And so, being able to navigate that, for me, I think that's what's fun about the job of being a problem solver.
John: Yeah. It sounds like it would really, especially depending on your personality and how long you've been in medicine, it could really be something that's fun and challenging. Yes, it can be fun and challenging even though there might be some long days and some seemingly overwhelming challenges at times.
But let me shift gears now. Let's say I'm out of my residency, I'm an internist at one of your hospitals, or anesthesiologist, or a family doctor. I say, Dr. Thames, I really like what you're doing. It sounds pretty cool. How do I get from where I am here now, looking back the way you did it? What advice would you have for me? I'm a physician, I'm practicing. I like one-on-one care, but I would like to have a bigger impact, that I'd like to get involved in leadership in a hospital or a health system. What kind of advice would you have?
Dr. Leelee Thames: So, I would not be where I am today without other physician leaders who brought me along the way. So, I would recommend asking folks you see in positions where you might want to be, or you might want to learn more about. Just ask them, "Hey, could I spend some time with you learning about what you do?" I doubt anyone would say "no" because it's such a pleasure sharing with others your own journey.
And for me, how I've been able to transition and again, it's always been people along the way who really shared their life with me, that allowed me to get a better picture or get more insight to figure out where I want it to be. There are so many people out there who are ready and willing to help. And so, feel free to reach out to me as well if there's interest in learning. I think that's what we should do as physician colleagues to teach each other and learn from each other.
John: Do you think that there'll be a continuing need for pulling physicians into management and leadership jobs in this kind of environment?
Dr. Leelee Thames: Oh, absolutely. I think physicians are in a unique position because we have such a close bond with patients and we know what the patients not only need, but we know how they might respond just because we've interacted with them so closely. And we are in alignment with the overall goal of trying to help improve their health. I think we're in such a great position to really be an advocate for them. And that's what I see myself as really. Now part of my role is to be an advocate for patients. Be an advocate for my physician colleagues and ensure that we make this sustainable for our organization.
John: Yeah. I think the people that lead hospitals and health systems are dedicated, but I think the CFO needs a physician explaining to him or her what patient care really is when they've never experienced it first hand and how all these decisions aren't necessarily just financial decisions. There are important considerations for patients. And I agree with you definitely that physicians are in the best position to do that. A chief nursing officer can help a lot too, but I'll stand behind the chief medical officer any day.
And just before we close, the chief value officer, it's not a common term. From organization to organization have different terms, but you are chief value officer and president there. So, it's just a leadership position that really helps pull everything together, to try and improve patient care.
Dr. Leelee Thames: Yeah, yeah. And I think one of the key things is about care transformation because we know that we cannot stay in a fee-for-service world, and that is not what CMS will allow, that's not what employers want. Because it's really about outcomes at the end of the day. And really about ensuring that we can create a health system that's sustainable long-term.
And so that's what's exciting about my job. I try to see it as I'm the person who helps bridge that gap and try to think of ways for us to do things differently. And so, that's why the job is so fun. I'm almost a builder and get to think outside the box and try different things and use what's happening in leading industries to apply and hopefully, again, build upon so that we can improve and drive out outcomes.
John: It sounds like that so-called change management is a big piece of it. That's always something that's talked about in leadership training. All right. Well, this has been fun. This is very exciting. We'll have to touch base with you again in a few years and see what's happening. Any last bits of advice before I let you go for the listeners today?
Dr. Leelee Thames: Yeah. I would just suggest that if anyone's interested in a physician leadership position, healthcare leadership position, really take the time to investigate it and don't shrink back and don't be held back by fear. Because once you step out of that realm and get an opportunity to see the bigger picture in healthcare, I think you might be quite intrigued to figure out how you might fit in. And so, any way that I can support or help, I would love to do that for anyone.
John: Well, thank you very much. It has been very interesting and helpful. I'm going to put the links to your LinkedIn profile. It's easy to find. They can just look up your name, but I'll put that in the show notes if anybody wants to get in touch and ask you questions directly or recommend some other mentors and so forth. And so, with that, I really appreciate the time you spent with us today Leelee. It's been great. And I'll say goodbye at this point.
Dr. Leelee Thames: John, it's been a pleasure. Thank you so much.
John: You're welcome. Take care.
Dr. Leelee Thames: Bye-bye.
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