As complex as US healthcare has become, it may have come full-circle—returning to community-based care. The growth and success of Steward Health Care System is a shining example of how this model can control costs while dramatically improving quality. It also helps eliminate care fragmentation and reduces duplication of services.
Joseph Maher, Steward’s general counsel, firmly believes the health system’s approach is making a difference in how people view community care. He says it will go on to play a significant role in shaping healthcare in the near future.
“Our successes have shown the public that community-based care is far more valuable than it has been given credit for,” he says. “By continuing to expand our networks along with evolving accountable care models, we can make community hospitals extraordinarily relevant in the larger healthcare discussion.”
Evolving with the Industry
Maher developed this perspective while he still had his private legal practice. He began to get involved in the business activities of numerous Boston-area healthcare facilities. In fact, at one point in the mid-1990s, he served simultaneously as vice chairman on the boards of both Faulkner Hospital, a community-based provider, and University Hospital, an academic teaching facility associated with Boston University.
The dual perspectives that came from working within the two different environments provided Maher with a number of key insights. He recognized that academic medical centers have more salaried physicians and that those physicians’ research, writing, and teaching responsibilities were effective at convincing insurers that reimbursement for services should be more than what is paid to community-based providers. However, those same academic activities frequently clashed with the productivity and effectiveness of ongoing clinical services.
During this period, Maher also had the opportunity to negotiate, pro bono, the merger of Faulkner Hospital and the Brigham and Women’s system. This created the current incarnation of Brigham and Women’s Faulkner Hospital. After the merger, he saw that the resulting partnership was producing some unexpected benefits.
“Patients who had been historically sent from physician groups to specialists at Brigham were redirected to Faulkner’s community setting, so costs and efficiencies were better managed,” Maher says. “Patients who needed more significant attention were escalated to specialists. This demonstrated that relationships between community and academic organizations can create benefits for everyone involved.”
Maher’s career in healthcare continued to evolve over the next decade. In 2008, he became general counsel at Caritas Christi Health Care, which operated under the Archdiocese of Boston. When Steward acquired Caritas Christi in 2010, Maher helped guide the transition and subsequently assumed his current role.
The transaction highlighted the ripple effect created by community facilities. By acquiring the ailing Caritas Christi system, Steward saved 12,000 jobs, preserved 13,000 pensions, and provided an infusion of capital from its financial sponsor, Cerberus Capital Management, that enabled all six of the existing facilities that Steward acquired to continue operating.
“Not only are community hospitals economic engines in their neighborhoods, they can provide more than 90 percent of needed care to patients. As a result, they don’t have to travel to larger academic medical centers,” he says. “That’s just one of the reasons community centers need to be supported.”
Community-based Care’s Impact
A recent Boston Globe article supported that point of view. It compared clinical outcomes, patient satisfaction, and overall cost of care through community providers to other major medical centers in the Boston area. The community providers were found to be equal in quality, superior in satisfaction, and 20–30 percent less expensive.
Part of Steward’s success in community-based care is founded on strong relationships in its communities. Maher calls it being a good corporate citizen. And, these relationships help create connections with patients before they have to visit the emergency department. This includes outreach events such as wellness screenings, but also requires internal attention and investment. Details such as an emergency department’s physical appearance and efficiency have just as much of an impact on the patient experience as clinical expertise—and patient satisfaction has become an increasingly important factor in payer reimbursement.
“Not only are community hospitals economic engines in their neighborhoods, they can provide more than 90 percent of needed care to patients. as a result, they don’t have to travel to larger academic medical centers.”
Maher takes great pride in the fact that Steward provides care in a large number of underserved communities. He even jokes that for a for-profit organization, it is actually more mission-driven than many nonprofit hospitals.
“Patients with Medicaid coverage don’t have the same choices that patients with commercial insurance or Medicare have,” Maher says. “Our feeling is that everyone deserves equal levels of care. It’s one of the reasons that our Good Samaritan facility is one of our busiest.”
Steward is one of thirty accountable care organizations (ACOs) that were selected to participate in Pioneer ACO, a federal Medicare pilot program that ran from 2012 to 2016 (Steward also began participating in Massachusetts’s Pilot ACO program in 2017.) As part of Pioneer ACO, Steward has distinguished itself by being among the top performers. Through the program, Steward has generated about $30 million in savings and top quality-of-care rankings.
Steward’s experience working within Massachusetts’s universal care system is one of the factors contributing to the success. But Maher also gives credit to Steward’s own management models.
“Our care, case, and disease management are coordinated through primary care physicians,” he says. “Their involvement is critical to developing an ACO model that does a better job of managing all elements of care.”
Now, Steward is participating in Medicare’s Next Generation (NextGen) initiative. The program is a refined and restructured version of the Pioneer program. One of its goals is to investigate the effectiveness of providers sharing risk with payers. Continuing its performance record from the Pioneer pilot, Steward has already partnered with Blue Cross Blue Shield of Massachusetts (BCBS/MA). In this model, BCBS/MA increases payments when Steward reaches benchmarks surrounding areas such as clinical outcomes and patient satisfaction.
These positive results don’t surprise Maher. He also feels gratified when other hospitals and academic medical centers attempt to replicate Steward’s approach to care. He even mentions public relations and advertising campaigns in which he has recognized those providers adapting Steward’s branding. This is meant to highlight the idea of bringing high-quality care to local communities.
“The accomplishments from the pilot programs are the same things we do in our hospitals every day,” Maher says. “It’s about figuring out the good, the bad, and the ugly. Then, embracing change to make improvements so that no one is left behind.”
That philosophy is clearly guiding Steward as it does more to do good—and to do it better—in as many communities as possible.
McDermott Will & Emery is an integrated, international law firm that values integrity, efficiency, and diversity and emphasizes long-term client relationships. As a recognized industry leader, McDermott’s team of legal and regulatory advisors exhibits an unwavering commitment to successfully navigating the rapidly changing healthcare sector. Our dedicated health lawyers draw on the resources and knowledge of our global firm, including colleagues immersed in data privacy, tax, employee benefits, and intellectual property. We create multidisciplinary teams to develop innovative, goal-oriented solutions at the cutting edge of the healthcare industry. Major legal directories have identified McDermott as the undisputed leader in healthcare law.
Jackson Lewis congratulates Joe Maher on his achievements and this well-deserved recognition. We are proud to partner with Joe and his team to provide Steward Health Care System with a wide array of exceptional, value-driven legal services.
Congratulations Joe Maher and Steward Health Care for the well-deserved recognition you are receiving as leaders and innovators in modern healthcare. Bowditch & Dewey is proud of its longstanding relationship with Steward Health Care and looks forward to continuing to provide you valuable, efficient
legal services throughout New England and beyond.
Fisher Phillips is a national labor and employment law firm with 350 attorneys and thirty-three offices committed to providing practical business solutions for employers’ workplace legal problems. The firm serves healthcare organizations across the country, large and small, including hospitals, clinics, physician groups and practices, nursing homes, assisted and independent living centers, and more. We value the opportunity to support Joseph Maher’s strategic leadership in labor and employment matters.
Joe Maher has been a friend to many of us at Donoghue Barrett & Singal for decades. His ability to cut to the chase and identify the root cause of an issue constantly impresses us. He is an exceptional attorney and a “counselor” in the truest sense of the word—one who understands not only the industry but also the strategic and political context of his environment. It has been an honor working with him, and we congratulate him on his well-deserved recognition from American Healthcare Leader.
