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Discussion with Mary Brainerd, President and CEO, HealthPartners
Civic Caucus, 8301
Creekside Circle, Bloomington, MN 55437
Verne Johnson (Chair); David Broden, Janis Clay, Jan Hively (phone), Ted
Kolderie (phone), Tim McDonald, John Mooty, Bob White, Donna Zimmerman
Context of the meeting—There
has been growing sentiment among the Caucus’s core and digital membership
that Minnesota is slipping. How do we make it the state we want it to be?
This is a question the Caucus is working on, presently. As President and
CEO of one of the largest non-profit health care organizations in the
country, a native Minnesotan, and a founding CEO of the Itasca project, we
hope Mary Brainerd may provide some useful insights on the question.
Welcome and introductions—
Those present shared a moment of silence and reflection on the eighth
anniversary of the September 11 attacks in New York, Washington, and
Mary Brainerd is
president and chief executive officer for HealthPartners, a “family of
nonprofit Minnesota health care organizations” headquartered in
Minneapolis. She has been with the organization since 1992. Prior to
joining HealthPartners, Ms. Brainerd held senior level positions with Blue
Cross and Blue Shield of Minnesota.
A graduate of the
University of Minnesota and the University of St. Thomas, Mary grew up in
St. Paul and has been actively involved in the Twin Cities community for
several years. She is one of the founding CEOs of the Itasca Project.
Comments and discussion—During
Brainerd's comments and in discussion, the following points were raised:
1. Business leadership via The Itasca Project--Brainerd
opened discussion by describing the origins of the Itasca project, a group
of 40 current and retired business and civic leaders formed in 2004 to
address issues that affect the long-term economic vitality and quality of
life of the state.
became a CEO,” she said, “I understood that was in a position to make a
difference. We were getting too much politics focused in the short-term,
and not enough long-term thinking.” Her special concerns are disparities
in socioeconomic status which threaten the vitality of the region,
including income, education and health.
of Itasca has become integrated into HealthPartner’s mission. The entire
Itasca group—all 40-50 members—meet four times a year, she said. A smaller
‘working team’ of ten meets every Friday morning, and this is a committed
team of individuals who get more directly involved with Itasca’s
strategies and tactics. McKinsey provides basic staffing for the group.
asked what kind of vote would be needed to adopt a plan, within the Itasca
group? “We haven’t had to take many hard ones,” Brainerd considered,
because they operate generally on consensus. “The harder questions come
really in deciding how political we want to become.”
speaker was asked about the Metro v. statewide linkage in Itasca, and
representation from rural business. Involvement is concentrated within the
Cities. The Itasca group recognizes that many of the issues they have
championed, such as early childhood education, transportation, disparities
and now job growth impact the entire state. “The challenge is getting
people involved” who reside out-state, she said. “Friday morning meetings
just are not feasible for those outside of the Metro area.
asked about Itasca’s procedures: Do they have a process, like the Civic
Caucus, for bringing people in front of the group, for a visit? And, for
educational purposes, circulate notes? “We have people come in often,”
Brainerd said, “but we haven’t sent around notes. That’s an interesting
idea, and we have used our working group meetings to generate discussion
and plans for the initiatives, as well as communications with the larger
Itasca group.” She thought on it some.
2. The problem of structural governance in
has been working with the Minnesota Business Partnership, and McKinsey, a
consultant firm, in support of the Minneapolis Public Schools strategic
plan. That commenced development this past year, presently in the
implementation stage. From the process, Brainerd drew some lessons.
a problem in the structural governance of districts,” she argued.
Separately-elected board members, especially rooted in constituencies,
create a dynamic of factionalism. Adults are putting their interests
first, whether they see it or not.
for the kids?” she asked, rhetorically. “It’s hard to identify who the
real advocates are for kids. Itasca and the Business Partnership are not
in a position to do so as a sustained voice of advocacy. It needs to be in
the system itself.”
outgoing Minneapolis superintendent (Green; tenure up at the end of
‘09/10) will tell you, it’s very difficult to run a district with all the
competing constituencies.” Brainerd cited cities where mayors have taken
control of districts, or appoint board members, as interesting models.
role of technology in schools, a member observed that we need a
‘productivity increase’ in schools, and electronics offers the most
cost-effective approach as in business.
Itasca has wanted to see more of an effect than they have in school
district results. “We’re frustrated at our ability to have an impact on
performance,” she said, frankly.
prodded, with some gentle teasing: Is it a problem with Minnesota’s
structure, or your own inadequacy? “Maybe our own inadequacy,” she
grinned…but there are structural problems that the business community
can’t solve from the outside. The system is very resistant to change.
Every component of it. A morass. “The rigidity of seniority and bumping,
the governance structures.” They all present a challenge.
was brought up about McKinsey’s staffing of Itasca meetings, and a
curiosity: Consultancies tend to work with systems, as they are. In the
case of Minneapolis Public Schools they worked with the challenges of the
institution of the District. But the problems—the ultimate causes—may lie
even further up, at political and policy levels. Would Itasca be missing a
piece of the picture?
said that the policy-level of K-12, and the design of the K-12 system, is
also on their mind. Itasca and the Business Partnership were supportive
this past legislative session on the site-governed schools legislation
that is now being applied in Minneapolis.
3. Health care reform--“Minnesota
has done a good job in health care,” she said, “when you look at the
product we get for its cost—though it still costs too much.”
Mayo, we still have many small and efficient practices, and we have been
using technology far ahead of other states. We’ve had clinics and
hospitals incorporating health information technology for ten years, while
many states are just now beginning.”
And, it is
important that Minnesota has the not-for-profit model of health insurance.
asked: How do we get to resolving the question of cost control? “We have
been operating on the notion,” Brainerd began, “that more is better. I
have a mantra: More is not always better. Sometimes, more is worse.”
needs to be a compensation system that pays for things other than volume.
She emphasized that much of the talk today does not include the notion of
personal responsibility—for co-pays, for living a healthy lifestyle.
4. Importance of healthy living--And
prevention through healthy living is one of the areas with greatest raw
potential for cost savings. When looking at information on HealthPartners
members as to how they answered questions on healthy behaviors—(healthy
nutrition fruits/vegetables, exercise, no tobacco, no to moderate alcohol
use) only 3 percent responded that they engaged in all of the healthy
common chronic illness, such as heart disease or diabetes, could have
their onset delayed if not fully prevented, if we lived healthier.”
asked if price incentives worked into insurance plans, such as a credit
for visiting a gym regularly, is a proper mechanism. The topic of personal
responsibility is nowhere to be found in the health care bill presently
being considered in Washington, she said.
reminded a member about something: “I’ve been conscious lately,” he said,
“because of the coverage of health care of the importance of understanding
how these systems work. How do you fix a system without understanding it
first? Baseball writers know how the player contracts work; we’re trying
to restructure this large system while we learn about it.”
very good point,” she agreed.
5. Opposition to public option--What
is the speaker’s view on the public option being discussed in the national
health care debate? “It would be a disaster in Minnesota because it would
collapse Minnesota physician practices and hospitals if based on Medicare
payment rates.” “The dynamic is reversed in other states. Because we cost
less to deliver care here in Minnesota, the government has decided to
reimburse us less than other states. This has been engrained since the
1960s,” and is an example of the potential for perverse incentives, and
unfair competition. “We need to equal out things nationally first.”
6. Concern over malpractice--On the
question of doctors over-ordering tests, to cover themselves against
malpractice, Brainerd said, “We do have some requirements in our law that
help mitigate malpractice concerns in Minnesota” procedures that minimize
the risk of meritless lawsuits.” But she feels that this focus on
malpractice costs as the major driver is a “red herring, at least in
7. Leadership in Public Affairs--A
member wants to know, Where is leadership coming from today—the business
or political realms?
happening on the political side,” she said. Mary Carlson Nelson had a good
observation. There used to be a time, she said, thinking of Governor
Perpich, when government and the civic community were active in leading a
progressive agenda for our state’s growth and future. “It hasn’t been like
that in recent years. And its time for that to change,” Brainerd lamented.
8. Common objectives in the political parties--"This
is what I’d like to see from both political parties…and I’ve thought about
it since hearing Dave Durenberger quote Ted Mitau at a recent event.
Despite occasional differences in degree and method of approach, the
platforms of the two parties, …stress the necessity for stimulating
economic growth and business development, for initiating action to protect
consumers, for reorganizing state government, for safeguarding human
rights, for assuring racial justice, for conserving natural resources, for
controlling air and water pollution, for assuring greater highway safety,
for improving and advancing education, for strengthening health and
welfare, for easing the impact of the property tax on the elderly, for
providing tax incentives to corporations willing to train the unskilled
and economically handicapped, and for improving public transportation.”
9. Preserve what is working well--The
chair asked the speaker if she had any closing thoughts, anything she’d
like to leave the meeting on. “In health care,” Brainerd advised, “as we
talk about reforms, let’s preserve two things that have worked well in
Minnesota: group practice, and the non-profit model. With federal reform,
“We want to maintain local controls; local exceptionalisms.”
She agreed with the
Caucus’ hypothesis that Minnesota is slipping. She cited a study that
showed a slide in the business climate of Minneapolis/St. Paul from a
position of 20—nationally, in 2003—to 71st in 2008. This is a
problem of the civic sector as much as government.
challenge, and others, the Caucus will continue to work. Stay tuned.
Thanks all around.