Inside Track: No stranger to change
Paul Brand, the new executive vice president of Alliance for Health, knows the U.S. health care system must be transformed.
Paul Brand’s first years were spent in the midst of some of the most profound change a major American city has endured.
Getting used to change, and planning for more, would behoove anyone like Brand, whose career has been spent in the rapidly changing health care industry.
This summer, Brand was named executive vice president of Alliance for Health, and long-time president Lody Zwarensteyn said it is his hope and expectation that the board will name Brand to head AFH next year when Zwarensteyn retires.
Brand was executive director of the Rockford, Ill.-based Employers’ Coalition on Health. He led the employer-based health care purchasing model that was aligned with the Patient Protection and Affordable Care Act.
PAUL W. BRAND
Brand says there are “no strong incentives now to drive quality up and cost down” in the hospital industry, but changing that is what supporters say is the whole point of the Affordable Care Act.
Millions of American workers and their families who had health insurance lost it as industrial plants were closed and the capital invested in Mexican and Asian factories. As the proportion of insured Americans kept shrinking, hospitals kept raising their prices, so those who had insurance were, in reality, paying surcharges to cover the cost of those not able to pay.
Social change was taking place in Detroit when Paul Brand was growing up there. A store near his home, where the 12-year-old often bought candy, was torched in the 1967 Detroit riots. “We watched it burn down from our dining room windows,” he said.
He recalls lying in bed and hearing 50-caliber machine gun fire from a National Guard armored personal carrier. “People called that a race riot — it wasn’t. It was an economic riot, about economic inequality,” he said.
In 1955, when Brand was born, he said, his neighborhood was probably 95 percent white. “We were among the last white families to move out, in 1969.”
His father was a white-collar employee at Chevrolet Gear & Axle in Highland Park who had “worked his way up from the shop floor.” Brand said everybody’s father was in the auto industry on his street. His mother was a high school chemistry teacher with a master’s in education.
“My life as a child was colorblind,” said Brand, saying the neighborhood kids played together regardless of skin color. If there was tension, “it was never black and white — it was always public school versus Catholic school,” he said.
The subsequent “white flight” to the suburbs left many inner cities with seriously depressed real estate values, rising crime and drug addiction, and unemployment.
When Brand earned a degree in urban economics at Michigan State University’s College of Urban Development, his professors’ discussions were often about the changes in Detroit “and I had lived it.”
When he graduated in 1976, a professor urged him to attend graduate school and he did, but he also needed a job. His professor found a solution that started Brand on his career: a job at the community mental health center at St. Lawrence Hospital in Lansing, now part of the Sparrow Health System. Brand worked part time on a project studying the potential for mental health services at nursing homes and also as a psychological technician — in essence, an orderly.
Michigan was moving people from mental health care facilities to nursing homes, where there typically was no staff trained to care for mental patients. Soon Brand was helping train nursing home staffs in five states how to care for geriatric patients with mental problems.
“I was a 22-year-old gerontologist,” joked Brand.
In 1979, the state got a grant to expand community mental health services and hired Brand to work on the part dealing with mental health issues among the elderly. “By that time, I knew what I was doing. I was a 25-year-old gerontologist,” he quipped.
Then he served on the small staff of a governor’s task force on mental health and aging and came to the attention of the Area Agency on Aging, which recruited him to serve as executive director of the Area Agency on Aging in Wayne County (with the exception of Detroit).
In 1985, Brand was recruited by Port Huron Hospital to be COO of its for-profit subsidiary, Willow Enterprises, where he developed expanded services for older adults.
He moved to Grand Rapids in 1991 when he was recruited by Saint Mary’s Hospital, where he started work as director of community care, charged with coordinating all hospital- affiliated home and long-term care services and developing senior services.
Ultimately, Brand was named director of clinical resource management at Saint Mary’s, working to redesign clinical processes to be more efficient, higher quality and lower cost. The first project was the process for joint replacement surgery. One of the solutions was simple: Nurses often had difficulty getting patients out of bed soon after surgery, necessary for quicker recovery. The patients and families would object, but Brand found that educating them in advance led to better cooperation with the nurses.
“We took the stay from about seven days down to under four,” he said.
One doctor suggested that knee surgery for a common sports injury of young athletes could be an outpatient procedure, eliminating a three-day-stay. But not everyone was happy about that change. One of the hospital’s executives called Brand on the carpet, complaining he was causing the hospital to lose bed days, thus cutting into hospital revenue. Over the next four months, all of his staff was laid off, so Brand resigned.
“That’s when I decided employers (who were paying for their employees’ health insurance) had to know what was going on,” he said. He started working on the purchasing side of the health care equation.
In 1994, he founded Continuum LLC and worked under a management services agreement with three employer coalitions on health care services: Health Partners in Holland, Healthcare 2000 in Grand Rapids, and The Muskegon Area Alliance. Those organizations merged to create the REAL Health Association, with Brand as chief executive.
The REAL Health Association was a purchasing plan with comprehensive contracts with hospitals, physicians and ancillary health care providers in its 13-county market. He said it became known as the first in the nation to develop partnership approaches with physician groups, using its hospital and physician performance measurement data to work toward quality improvement.
As the economy deteriorated in the first decade of the 2000s, the big insurance carriers in Michigan were able to lower their prices in order to “buy business,” causing declining membership in REAL Health. The remaining employers like Meijer, Gentex and Padnos could no longer make the association’s business model work, so the board chose to cease operations in 2006.
“Today, every health plan in the business touts its provider performance measures,” said Brand. “None were doing so at the time.”
Many employers want to know why health care costs keep rising so fast, but Brand said inefficiency in the system, perhaps as much as 20 percent, and a lack of incentives to improve quality while reducing costs are not the only problems. Much of it is demographic: People over 50 are a larger portion of the U.S. population than at any time in history. At the same time, there are not enough primary care doctors in the pipeline. Most new doctors want to specialize because it pays more than primary care.
Then there is the American way of life in the 21st century.
“If you eat the average American diet, you will get sick before your time,” said Brand, citing one estimate that 60 percent of Americans’ diets, coupled with lack of exercise, put them on track to become diabetic.