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Featured topic and speakers
What does health care leadership do? Is health care leadership a good career? What are the rural health priorities? What are the challenges in rural health care accessibility?
Our guest is the interim CEO of Marshfield Clinic Health System, Brian Hoerneman, MD. Dr. Hoerneman talks about his path to leadership, the unique perspective he has as a leader who grew up in Marshfield, the challenges facing Marshfield Clinic and rural health care, and the health system’s merger with Sanford Health. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Brian Hoerneman, MD, interim CEO, Marshfield Clinic Health System
Transcript
Unger: Hello, and welcome to the AMA Update video and podcast. Today, we're talking with the interim CEO of Marshfield Clinic Health system, Dr. Brian Hoerneman in Marshfield, Wisconsin, about what it's like to be a health system leader in his own hometown and why he continues to practice in his hospital's emergency department. I've been assured that he will not be called away during this particular conversation.
I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Hoerneman, welcome.
Dr. Hoerneman: Hi, Todd. Thanks for having me today.
Unger: Well, a lot of times, executives transfer into towns to lead a health system. And you, on the other hand, were raised in Marshfield. That's got to be kind of an interesting feeling. How does having that history in Marshfield help you to lead now as an interim CEO?
Dr. Hoerneman: Yeah, it's terrific to have been back with the health system. And I've been back with the health system now for almost 20 years. So, as you mentioned, I'm an emergency medicine physician and then have been involved in a variety of leadership roles over the last 15 years or so, and most recently, serving as the interim CEO for the health system.
So our health system's mission, vision, and values really is around that affordable, accessible, high-quality care in a rural environment. So growing up in a rural environment and understanding our community some has really given me a good perspective on what our communities need and how we can meet the needs of patients and continue to improve on that over the years.
So it's been a terrific privilege to be back with the health system, and it's been a great place to have a career. But yeah, having that experience with the rural geography and now having the privilege of leading this rural health system, that has given me a really nice perspective.
Unger: I should have asked you to start with. But is that something you ever thought would happen to you when you were young?
Dr. Hoerneman: That's a super question, Todd. And no, that had not been on the top of my list. I always have had an interest in how things work, and including in health care. And being a leader, having that curiosity and that interest, I think that does help you be a successful leader and working on solving problems.
So had I expected that 20 years ago when I joined the system? No, but I did have an interest in joining leadership and have been really pleased to be able to be part of the organization where that's been encouraged to grow and be part of leadership over time.
Unger: Well, if you're a person that likes to see things work or make them work, you certainly have work cut out for you in health because there's a lot of change and a lot that needs fixing. What do you think patients in Marshfield need most right now?
Dr. Hoerneman: Yeah. No, that's a super question. So we have seen changes in our rural communities over the last decade plus. And like many rural communities, we have seen some of that same trends in our population, where we've had an older population over time, and then that population has a higher degree of chronic illnesses. We've also seen that this is a rural geography that has some economic challenges, even more so than some of their urban counterparts.
And those things combined together with limited access to primary care and specialty care, all of those compound issues and make it really challenging for those patients that are living in a rural geography to get the care that they need. And so if I had to point to one thing that I thought patients in our region need, it really is around that accessibility of care. And that's where we've been focusing a lot of our work is to make sure that patients can get in to see their physicians when they need to get seen, and making sure that we're doing that in a manner close to home.
There are spots in our health system where patients have to drive over an hour to get to any clinic or hospital. So we're trying to, as much as we can, provide that care in their community and close to home, so looking at the creative ways to do that.
So if you look at telemedicine—how are we doing that? At the home or in the close-by clinic? Or how are we going to end up doing that through outreach, where we get a specialist to travel? So trying to be really creative on doing that in a rural geography. We do have to think differently to meet those patient needs that way. But if I had to point to one thing on what the patients in our rural geography need, it is that accessibility to care.
Unger: Absolutely. And as interim CEO—this is very interesting—you have continued to work in the emergency department. So I want you to tell us more about why you did that, and how it influences you as a leader?
Dr. Hoerneman: Yeah. No, I've enjoyed to be able to continue to work in the emergency department. I enjoy seeing patients and appreciate the ability to still provide the care right there in the ER. It gives a great perspective. It allows you to understand what patients are coming in with and what they're encountering when they're first entering our health system.
It also is a good opportunity for me to interact with my colleagues. And so to get a little bit better picture of their practices, see their day-to-day, understand some of the challenges that they might have. And then how are we going to address the organizational resources to be able to support those practices as effectively as we can, and make sure their practices are as rewarding as they can be, and they can get to the outcomes that they want to receive.
So I think if you had to pick an example of that, the electronic medical record would be a good one. You can go to meetings. You can round on providers. You can get a pretty good sense of how the program works from those sort of activities. But until you've used it firsthand, it is difficult to get really a full sense of it and understand where some of the opportunities are.
So that's just one example. But I think that actually applies to any number of different scenarios where we're trying to support the provider practices. And I've appreciated still being able to practice and still understand, then, how we can best support our providers.
Unger: EHR is just one of many burdens that physicians face, and obviously, lead to high levels of physician burnout. And it's really interesting that you're there on the front lines and you know exactly what they're facing.
You became the interim CEO after Dr. Susan Turney. We had a chance to talk to Dr. Turney a number of times, especially during the pandemic, before she retired last year. Since then, one of the biggest developments has been the merger with Sanford Health, which was announced back in July. Can you tell us a little bit more about that?
Dr. Hoerneman: Yeah, I'd be happy to. Yeah, Dr. Turney really led the organization through some really challenging times with COVID. And then right over the last year, we've seen some exciting developments, and it's certainly been a busy time in the health care. But yeah, happy to give a little background on the partnership with Sanford Health.
We are really excited about the partnership. And a lot of that comes down to the fact that we've just been excited to find a partner that is so closely aligned with what we're trying to accomplish as a health system. So if you look at what we're trying to accomplish—meeting patients where they're at, giving high-quality care in that rural geography—Sanford very much does that.
And by the two organizations coming together, I really think we have the opportunity to innovatively lead that rural health care push and address the things like access, quality. And then how do we do that in a really sustainable manner? So how do we make sure that we are here as health systems for patients for the next generation to come in the face of all the different challenges that we have in health care in general right now?
We both have an integrated approach to care. So we have our health plans, and we've got our primary care, specialty care, hospital practices. And both have a focus on graduate medical education.
Recruitment and retention of providers in our rural geography is a big deal. And so for us to both have that as an area of focus and start to prepare that next generation of caregivers and providers, that's really, I think, key to the success going forward.
And then yeah, other synergies. So we've got—both systems have a robust research program right now. And by coming together, patients in our regions will have access to over 1,000 clinical trials. And those type of synergies are top to bottom as you go through the different organizations—or through the organizations, really opportunities that I see for us to be able to advance care for patients.
Things are going along well. And actually, we anticipate that we're going to be able to close by the end of the year here still. So we're just thrilled to have that potential partnership with Sanford Health. They've been terrific to work with. Really a nice alignment for both organizations.
Unger: Well, it's clearly an exciting time for Marshfield Health and for Sanford, and you have big plans for the future. When you think of health care more broadly, what's one change you'd like to see happen over the next few years?
Dr. Hoerneman: Yeah, if we had to pick just one change—health care I think right now is at a bit of a crossroads. And health care is not easy, particularly in that rural geography.
So if you take a look at some of the demographic challenges that I spoke to before, and you combine that with the fact that we've seen increasing costs—so rise of cost of labor and pharmaceuticals. You've seen the impact of declining or stagnant reimbursement. All of those make it more challenging to have a margin in health care.
And the old adage is that "no margin, no mission", that still remains true today. For us to be able to be successful and invest back into our practices, there has to be some level of margin.
And we've seen impact in our region. In fact, within the last year here, earlier this year in 2024, we did see two hospitals in Western Wisconsin close—two HS hospitals close in the Chippewa Valley. And so yeah, I do have concerns about the sustainability of rural health care given those challenges.
So what can you do about that? How can you end up doing things differently than maybe some of for-profit systems that focus on the higher payer mix or the procedures and still be able to provide that full spectrum of care?
And really, I think some of that starts at our ability to continue to advocate at both that state and national level, to be able to put ourselves forward as supporters of initiatives that ensure that patients in rural geographies are going to have access to care for years to come. So that's certainly one of those.
And the other way that we can do that is, how do we provide care more effectively? How can we do that innovatively? And we have a number of things going on in the system right now on that from technology and AI perspective.
Our providers are using AI as part of their clinical documentation. That's saving them time. It's helping reduce their burnout. They're getting home more reasonable time. They have more time in the evening.
So as those aspects, that technology continues to advance and we innovate and get more creative on how we're doing those things, I really do think that is going to be exciting in the next couple of years going forward. So yeah, I'm very optimistic about the next steps for our organization and what things look like in the future. And yeah.
Unger: Well, those would definitely be wins for both your patients and your physicians. Thank you so much, Dr. Hoerneman, for joining us today. And we're going to look forward to hearing what's next for Marshfield Health. And we'll talk to you again soon.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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