leading by example

HFMA Chair Kari Cornicelli believes finance leaders have the right set of financial and leadership skills to lead change within their organizations-and to teach future finance leaders to do the same.

As the healthcare industry undergoes a profound transformation that will ultimately affect everyone who delivers, accesses, or pays for care, healthcare finance professionals will be "absolutely pivotal" in leading the changes required for their organizations to be successful, HFMA Chair Kari Cornicelli says.

The challenges facing the industry are daunting as we move away from a fee-for-service delivery system to value-based models of care: The basis for payment will be fundamentally different, the quality bar will be set even higher, and consumers and payers will expect more value in return for their dollars spent on health care. These changes will require strong, innovative leadership from all finance professionals, says Cornicelli, FHFMA, CPA.

"Just think about the power of what one healthcare finance leader can accomplish: developing data that supports new care protocols that improve quality of life while reducing costs or engaging patients at the time of preregistration to ensure they understand their insurance coverage and payment options, thereby reducing their stress. Who better than finance professionals to lead the changes needed to guide our organizations into the future?" Cornicelli says.

As 2014-15 HFMA Chair, Cornicelli's theme is "Leading the Change"-encouraging healthcare finance professionals at all levels to take a lead role in making a difference in their organizations and keeping hospitals and health systems strong.

"I believe healthcare finance professionals are in the best position to lead the changes needed within our industry," Cornicelli told volunteers who gathered at HFMA's Leadership Training Conference in April. "We understand the payment methodologies, the utilization data, and the cost structures. We can use this knowledge to work collaboratively with other healthcare leaders to create and implement strategic imperatives that support the communities we serve, experiment with different payment models, improve quality and efficiency within our organizations, reduce costs by decreasing overutilization, and support initiatives that promote a positive experience for patients, physicians, and clinicians.

"The work ahead of us is challenging work, requiring bold new ideas and innovations-and changes that may not be popular. It will stretch us beyond our limits and compel us to rethink the tools, methods, and systems we have developed over the past years, if not decades. But if we stay committed to making a difference, we can and will accomplish truly remarkable things in the years to come."

Leading the Charge for Change

In her role as vice president and CFO for Sharp Grossmont Hospital in La Mesa, Calif., Cornicelli is known for her passion for using financial and clinical data to drive change within the organization. She's proud that she's been part of a team that has produced strong year-over-year financial results and market-share growth, which has transformed the hospital from a facility that once treated fewer than 200 inpatients a day to one with a daily census of more than 345 inpatients.

She has found it rewarding to lead the advancement of new programs and services that benefit the community Sharp Grossmont serves, including an affiliation with Rady Children's Hospital to lease a hospital pediatric care unit; the development of a physician joint venture for outpatient imaging services; implementation of new technologies, such as da Vinci robotic surgery and TomoTherapy (a radiation treatment system that treats hard-to-reach tumors and reduces exposure to healthy tissue), that have expanded service lines and optimized revenue; and development of a master site plan for the expansion of diagnostic, surgical, emergency, and critical care services. Her leadership was instrumental in passing Proposition G, a $254 million public bond to fund strategic hospital building projects, which was approved with the highest passage rate in California history.

"I work with outstanding financial colleagues at Sharp HealthCare-and together, we work with our clinical peers to continually improve Sharp," Cornicelli says.

Throughout Sharp HealthCare, Cornicelli is known as a strong leader who effectively pulls teams of people together from throughout the system to lead innovations and tackle challenges.

"She's known for being committed and focused and for doing the right thing, no matter what," says Ann Pumpian, system senior vice president of finance for Sharp HealthCare. "She is a relationship builder who connects with all of the participants in the organization to drive change. She's also an extraordinary mentor, having worked with and developed a number of our key leaders today."

One leadership initiative in particular has drawn the respect and admiration of fellow leaders and staff: her work as co-chair of Sharp HealthCare's system ICD-10 committee, through which she has spearheaded efforts to improve clinical documentation and analyze product lines to determine ways to improve efficiency, reduce costs, and promote higher-quality outcomes. As her team has worked to engage physicians in more accurately capturing information related to the care they provide, the health system has experienced improved risk-adjusted severity of illness and mortality rates and significant improvements in case mix index.

"Her role in directing and driving our ICD-io project has really expanded Kari's influence from a financial focus to operational outcomes," Pumpian says. "She has led that effort with our chief information officer, and it has crossed so many components of our organization, from communicating and educating the medical staff at each of our hospitals to defining the leadership role that we needed to undertake, working with our billing partners to ensure that our information would be accepted and that they were prepared to send ICD-io information as well, and collaborating with each of the executive leadership teams within our integrated delivery network to drive that new model and process. What is extraordinary about her leadership of this initiative is that as we continue to refocus and redefine and develop appropriate budgets for the implementation, Kari is always one step ahead. Our work in preparing for ICD-10, particularly in enhancing medical record documentation, serves us well in spite of the delay of implementation to October 2015."

Cornicelli has been invigorated by the work she's done at Sharp Grossmont, part of a fully integrated delivery system. Sharp HealthCare, that has managed population health through capitated contracts for more than 3o years. She credits Pumpian with motivating her and other leaders to exceed expectations and meet the challenges of healthcare reform with new ideas. "Time and again, Ann has shown me the importance of being a leader and an innovator; the importance of being ready to try something new," Cornicelli says.

Cornicelli's employees respect her knowledge of health care, which finance director Daniel Kindron describes as "far beyond that of a typical CFO," as well as her ability to bring out the best in her staff and others whom she mentors.

"She really pushes us to be more than what our true titles tell us to be," Kindron says. "She places an emphasis on all of us to be value-added-to not just pull data, but also to engage clinicians and other leaders in using data to continually drive improved outcomes. She has a passion for the work she does and for our organization's mission, and she brings meaning to her role at Sharp HealthCare.

"For me, she has been a true mentor, but at the same time, she has also been a really good friend," Kindron says. 'Tve really grown under her leadership. She sets a really high bar for the performance she wants her departments and leaders to attain, but she's not unrealistic. She's the driver of change, leading our organization into the future."

Foundation for Leadership

Cornicelli began her career in finance at a savings and loan while working on her accounting degree at Weber State University in Ogden, Utah, in the 1980s. Just a few months before graduation, her employer's director of human resources approached her about applying for an accountant position at the local hospital, St. Benedict's Health System in Ogden, Utah. That position became her entiyway into healthcare finance.

"When I look back at the beginning of my healthcare career in the mid 1980s, I realize that I joined the industiy during a time of sweeping change," Cornicelli says. "Back then, health care was experiencing changes very similar to the ones we face today. Many providers were experiencing program downsizing, hospital closures, and mergers. Yet despite these challenges, I remember how excited I was to be working for a hospital during that period and how proud I was of the mission we had to serve our community."

Just a few years out of college, Cornicelli found herself in the role of interim CFO at Holy Cross Hospital in Salt Lake City, Utah, in the midst of desperate times. "The hospital was losing money, and we all knew that some major cuts were going to be necessaiy-and soon," she says. "At the time, we were losing about $1.8 million a year-a lot of money back then."

What happened next taught Cornicelli a great deal about the power of a committed leadership team. As she and other leaders worked to lead the hospital through a clinical transformation that would help ensure its financial viability, they knew that some degree of restructuring also would be necessary. Three vice presidents volunteered to leave, a move that ultimately helped swing the hospital's financial position from a $1.8 million loss to a $a million gain the following year. It was a formative time for Cornicelli, who was still new in her role as a healthcare finance leader. "I was really impacted by the examples of leadership that this team set," she says.

It's an example of the ways in which healthcare leaders-and healthcare finance leaders in particular-can make a difference in their organizations through their leadership, optimism, and innovation, Cornicelli says.

"In finance, we tend to focus on the numbers, but we should never forget that health care goes way beyond the numbers," she says. "Finance is at the heart of any healthcare organization's transformation. Our knowledge of our organizations' structure, processes, payment methodologies, and resource utilization puts us in a unique position to partner with clinicians and physicians to guide this transformation and make sure our organizations continue to meet the needs of the communities we serve into the future. We can use our knowledge to help lower costs, improve care coordination, reward value, and make the healthcare experience better for patients and their families."

It isn't enough to want to make a difference, Cornicelli says. There also has to be the will to work hard and in collaboration with others to achieve lasting change-and the willingness to make sacrifices, if needed, to make change happen.

"Because I've been through so many scenarios in my career where we have had to make tough decisions related to programs and people, I'm a different kind of leader today than I was when I first began my career in health care," Cornicelli says. "The knowledge and experience I've gained over time have pushed me to continually find ways to enhance value, improve care, and help my colleagues deliver an outstanding patient experience."

Cornicelli also is firmly committed to the effort of mentoring the next generation of financial leaders. With many smart, talented financial officers expected to retire in the next 10 years, she believes it is vital to make sure every member of an organization's healthcare finance team is welltrained and given the opportunity to gain the knowledge and experience needed to lead change in their organizations.

"We need to make sure that they truly understand not only the financial and operational aspects of our business, but also how important it is to develop relationships with clinicians and physicians. It's through these relationships that they will ultimately transform our industry," she says.

She is convinced she wouldn't be where she is today if she hadn't been mentored by strong financial leaders such as Pumpian. "I was given opportunities to learn and grow from everyone I have ever worked for, and I feel very strongly that it's my responsibility to give back," she says. "I believe we should be mentoring young professionals so that they are prepared to assume leadership roles to further advance our healthcare industry. I had unbelievable leaders-bosses who were mentors; great CFOs. They taught me the fundamentals of health care and how it works. I do the same for my employees-and I want them to learn to do the same for others as well."

Cornicelli also values the experiences she's gained through her involvement with HFMA, both as a member and as a volunteer leader. Since joining the Association, Cornicelli has taken on increasing levels of responsibility within her chapter and with HFMA National. As a member of the San Diego Imperial Chapter, she served as director, treasurer, secretary, vice president, presidentelect, and president. On a national level, she's served on HFMA's Board of Directors and as secretary/treasurer and chair-elect. She has also actively participated on advisory groups for e-learning and healthcare reform, the national task force for revenue cycle key performance indicators, the PATIENT FRIENDLY BILLING? Task Force, and the National Advisory Council. She has earned several awards for her service, including the HFMA Medal of Honor.

"My experiences with HFMA were instrumental in helping me learn the business of health care," she says. "I can't imagine going through the tough changes we were experiencing in the 1980s, with the introduction of DRGs, and the changes we are experiencing today, as we undergo healthcare reform, without the support of HFMA. The role models I've had in HFMA and throughout my career have impressed upon me the importance of setting high standards for myself and our finance team and to hold ourselves and others accountable for attaining those standards, because good financial management is critical for our hospitals."

The Time for Change Is Now

It is clear to everyone in health care that the industry has to change. Cornicelli wants to see finance leaders and executives leading that transformation.

"We need to lead in our communities and in our hospitals. We need to lead on both a state and national level," she says. "We know our industry better than anybody else. We can create the care delivery models and new payment systems that reward value, promote health and wellness, improve quality outcomes, and reduce the cost of health care. And we need to lead the changes in our organizations and in our communities so that we can sustain health care for our country."

Leadership from healthcare finance professionals at every level is needed to enact large-scale, sustainable change.

"We need to lead boldly and experiment with new ideas that will make a difference during a time of challenge and realignment," Cornicelli says. "We need to initiate conversations if they don't exist, we need to use data to explore new ways to do business, and we need to teach our organizations how to use that data. We need to be willing to learn from our clinical partners so that the transformation that takes place in our organizations is not just a financial transition, but also one that produces high-quality clinical outcomes.

"I believe financial leaders should be a positive force during these turbulent times," she says. "We need to rise above the uncertainty and lead with optimism and innovation. We can and we must lead this change."

"If we stay committed to making a difference, we can and will accomplish truly remarkable things in the years to come."

-Kari Cornicelli

Making a Difference in the Industry and in the Community

In addition to her volunteer leadership with HFM A, Chair Kari Cornicelli currently serves as an appointed member of the Centers for Medicare & Medicaid Services' Advisory Panel on Hospital Outpatient Payment and is a member of the board of directors of Grossmont Imaging, LLC. Additionally, she is a past member of the board of trustees for the California Hospital Association; Neighborhood Healthcare, a California federally qualified health center that provides care for those patients most in need; and Ramona Pony Baseball, which helps young people learn how to play baseball and be good citizens.

Getting to Know Kari Cornicelli

Family: The foundation for her passion for leadership started early in life. Her father, who served in the Air Force, and her mother, an entrepreneur, were very active in the communities in which they lived. Together, the family was involved in many volunteer activities. This early commitment to community volunteerism has seen her through a career that spans 28 years, culminating with her new role as HFMA Chair. Leadership, community involvement, and philanthropy have been a guiding force for this mother of two.

Cornicelli and her husband, Joe, have continued her family history of community service through team parenting, coaching, and serving on the board of a youth baseball league. Their sons, Aaron, 28, and Matthew, 21, were athletic, involved in baseball, football, and wrestling. Cornicelli is proud of her sons. Matthew is a U.S. Marine, and Aaron works in the healthcare industry, for VHA. Aaron and his wife, Katelyn, have a daughter, Kynlee, and a son, Weston. Cornicelli loves being a grandmother, her favorite "title" of all.

Favorite pastimes: Cornicelli loves to shop. She also enjoys reading, biking, hiking, camping, and traveling. Although she loves traveling internationally, she is just as happy to get to camp at the beach or in the mountains with family and friends.