Care for All, From a Different Angle

Through her work at the Catholic nonprofit system Trinity Health, Shelby Decosta is using her own tools of policy and strategy to heal

“When I was studying pharmacy as an undergraduate, I had no idea it was possible to influence the quality of patient care without being in a clinical position. However, once I discovered the importance of healthcare management, policy, and strategy, my focus changed dramatically.

Although I am not Catholic, I found that I was drawn to the values of Catholic healthcare services, which have a long history of caring for underserved populations. At Trinity Health, where I became SVP of mergers, acquisitions, and partnership development in 2013, this commitment had been upheld for more than 100 years in some communities.

Shelby Decosta, SVP, Mergers, Acquisitions, and Partnership Development, Trinity Health

When I arrived, Trinity was in the process of integrating with Catholic Healthcare East after a merger that same year. I had two key goals at that time: to strengthen the new organization on a regional and national level, and to promote Trinity Health as a leading partner in acute and non-acute affiliations. To reach those milestones, I established a multi-disciplinary growth leadership team that included finance, legal, quality, and strategy to augment the M&A team.

With options to create partnerships, mergers, joint ventures, and agreements to provide management or consulting services, we profiled every hospital and health system in the country and ranked them according to criteria developed by the new CEO, board, and leadership team. We also aligned the work closely with our organizational strategic plan.

This proactive approach ultimately resulted in nearly two dozen transactions within two years, compared to the typical two or three annual transactions for most organizations. There are approximately sixty opportunities still being pursued from that initial ranking for possible action.

One partnership that grew out of this process was with Saint FrancisCare. The organization is part of an effort to increase Trinity’s presence in the Northeast and to broaden its continuum of community care, which was already supported by an existing hospital in Springfield, Massachusetts, and a continuing-care ministry [or nursing home] in Hartford, Connecticut. As is often the case, there were mutual benefits for both parties in such transactions. Saint FrancisCare reduces administrative costs and integrates its acute and non-acute care with a national system with significant best-practice sharing and efficiencies.

“When I was studying pharmacy as an undergraduate, I had no idea it was possible to influence the quality of patient care without being in a clinical position. However, once I discovered the importance of healthcare management, policy, and strategy, my focus changed dramatically.”

At the same time, Trinity gains a clinically-integrated network of approximately 1,000 physicians and a collaborative approach to sharing information. This newly formed New England network will serve as the foundation for Trinity’s population-health infrastructure in the region.

National retail collaborations were also among the successful initiatives implemented as part of the prioritized transactions. We created a 340B partnership with Walgreens that increases access to care and lowers costs by enabling patients to receive 20–25 percent prescription discounts at pharmacies close to their homes. Trinity was further able to increase engagement and reduce readmissions by collaborating with Walgreens on medication reconciliation. The program ensures that patients understand instructions for proper dosage and guards against adverse drug interactions.

SHELBY DECOSTA’S Career milestones

Dignity Health Nevada’s first CSO

Established academic affiliation for Dignity Health that brought specialized neurosurgery and transplant care to southern Nevada

Developed nearly $2B in new revenue while leading M&A and partnership development for Trinity Health

Increased Trinity’s capabilities for managing risk through a national population-health joint venture

We also strengthened care provided by existing Trinity services, such as senior emergency departments, with geriatric-care specialists and customized amenities for older patients, and our Program of All-Inclusive Care For the Elderly (PACE). Trinity operates the largest PACE program in the country with 2.5 million annual patient visits that integrate medical and long-term care management, keeping patients independent as long as possible.

I recently took on a set of new challenges when I became chief strategy officer for UCSF Health. Although many of the goals are similar—such as maintaining excellence in specialty medicine and promoting a high-value system of care—the environment in which these goals are to be accomplished is very different. I now focus on the San Francisco Bay Area, where there are fewer potential partners in the geographic area, as it’s rather small. So while the strategies for success may be the same, there is a more competitive, pressured environment and a faster pace required to form alliances with other organizations before competitors do.

My first order of business is to leverage existing relationships and pursue new partnerships in order to accelerate the creation of additional care access points for UCSF patients. The ultimate goal is to increase accountable-care organization (ACO) capacity from approximately 50,000 patients annually to 500,000.

Although the specific goals may have changed, my commitment to find new ways in which to expand accessibility to quality specialized care has greatly increased because of recent events in my own life. Both my mother, who was diagnosed with a rare auto-immune disorder, and a close family friend were referred to California for treatment unavailable to them in Hawaii. (My friend was referred to UCSF Health.) Each of them received exceptional care, which, in some populations, is not always possible. This realization reinforced my passion to keep working to make the best possible healthcare available to everyone.”

Photo by Kathryn MacDonald Photography