new collaborations, boundless possibilities

For Melinda S. Hancock, FHFMA, CPA, the state of health care today, and its evolution tomorrow, might be aptly summarized in the words of Sir Arthur C. Clarke: "The limits of the possible can only be defined by going beyond them into the impossible."

As Hancock assumes the role of HFMA Chair this month during HFMA's National Institute in Orlando, June 22-25, she will lead the Association in a time of fundamental change and innovation for the industry. Her theme, "Go Beyond," is focused on helping HFMA members and other healthcare leaders transcend the status quo to help improve care delivery and outcomes. She wants to motivate members to move beyond their current job descriptions to help health care in this transformation, and to better grasp the financial possibilities and realities associated with changing payment models, collaborations, and partnerships.

Finance executives will need to take the extra step to better understand clinical medicine and appropriately evaluate related business and financial needs, Hancock says. New payment models are changing the fundamental financial structure of health care and affecting how health systems deliver care, she says. "Quality initiatives have financial repercussions. That's how you go beyond. We need to think differently about partnerships, about education, and about the team."

Hancock's term as HFMA Chair comes at a time when policy makers, payers, and health systems are instituting measures to improve outcomes for the approximately 35 million admissions to U.S. hospitals that take place each year and require an estimated $859 billion in hospitalrelated expenses.3 Against this backdrop, in January, the U.S. Department of Health & Human Services accelerated the timeline for the transition to value-based payments.

"The stakes associated with reinventing health care are enormous for patients and providers," Hancock says. Meanwhile, the industry's focus on price transparency, emerging payment models, and consumer satisfaction is making healthcare finance that much more complex.

Consider the recent release by the Centers for Medicare & Medicaid Services of its star ratings of hospitals based on patient evaluations. A recent story from Kaiser Health News notes the rating system is being launched as a way to openly disclose aggregate satisfaction scores. Medicare officials report plans to expand the star ratings to include clinical outcomes and safety in 2016. Transparency is an important trend for health care. The results of ratings, positive or negative, exert even more pressure on health care to improve its delivery and bend the cost curve, Hancock says. True transformation, however, will be driven by both patients and providers, she explains. "It starts with greater accountability, but it includes access to information that will help patients make better decisions, which means both price and quality information," Hancock says.

Opportunity in the Throes of Change

Clinical transformation has been part of Hancock's career path since 2007, when she led related transformational initiatives first as vice president of strategic finance and then as CFO and senior vice president in the Virginia market at Bon Secours Health System, a $3.3 billion, 14-hospital system headquartered in Marriottsville, Md. And clinical transformation, along with associated strategic and operational issues, continues to be a primary interest for Hancock in her current role as a consulting partner at DHG Healthcare, the national healthcare practice of Dixon Hughes Goodman LLP. one of the top 20 accounting firms in the United States.

Hancock's executive leadership at DHG Healthcare includes responsibility for development of services pointed to the mandatory elements of payment reform (value-based purchasing, réadmissions, hospital-acquired conditions), shared savings models, governmental and commercial bundled payments, and Medicare innovation models. She leads DHG Healthcare team members who are addressing some of the most pressing business issues facing U.S. healthcare organizations, including the provider journey to risk capability and implementation of advanced payment models that advance crucial institutional Triple Aim objectives.

The mandatory coverage components of healthcare reform, Hancock says, are spreading across the continuum. And they are the building blocks for emerging advanced payment models. "How do we help providers accept more risk without jeopardizing their organizations' financial health?"

All this change is helping clinical and finance departments to better integrate and collaborate on new solutions to improve care deliveiy. "How do you think differently about care delivery when you're working across episodes of care, and not just those that take place in the hospital? For example, if you are a hospital participating in bundled payments, you are also managing patients for 90 days postdischarge," Hancock says.

Interoperability of electronic health records (EHRs) also plays a critical role. "If you are discharging to a home health unit in a skilled nursing facility [SNF] that you don't own or that isn't on your EHR, how are you communicating that care plan so that there is a full picture of the health of the patient and you're not duplicating tests?" Hancock asks. "How do you keep that patient from getting readmitted? Better care management requires more integration and communication of health information."

Hancock understands and empathizes with the challenges facing most health system finance executives. "As executives in health care, we are responsible for quality and profitability today, and simultaneously for continuing to move our organizations forward into new models."

That includes thinking differently about health care, as will be required to sustain success, Hancock says. "It's not a nicety anymore; it's a requirement to understand the continuum and how you play in it."

Recognizing that their organizations can't own the continuum, health system leaders also understand that they need to partner. For example, about 22 percent of SNFs applied for the non-risk phase of bundled payments.

"This is not just a hospital program," Hancock says. "A large number of postacute providers and physician groups applied and are actively pursuing bundled payments this time, and it underscores the influence multiple new payment models will have on health care." The challenge for finance professionals will be to manage fee-for-service revenue in "both the volume and value camps."

These realities sum up Hancock's key message as HFMA's new Chair. The new healthcare economy will demand greater collaboration and cooperation among health systems, physicians, and health plans. "With the growth of bundled payments and shared savings models, we must be prepared and willing to work with new partners," she says.

"Especially today, you've got to go beyond your traditional responsibilities and comfort zones. If you don't, you are going to lose sight of all the opportunities in front of you. And if you do only what you've done in the past, you're not going to get where you need to be."

Healthcare finance professionals should expand their skill sets and knowledge base, Hancock advises: "Don't just say, 'It's not my job.' ''

The Art and Science of Leadership

Hancock took on leadership roles early in her career, including management of teams.

This early management experience prompted a period of self-discovery and critical selfassessment of her leadership style, and helped her identify ways to improve.

A mistake made by many managers, Hancock says, is to hold information too closely without sharing enough with their team. She learned from experience. "You may think you are helpingyour team by not overburdening them with oftencomplex details, but in reality, the message is far different," she says. "You're sending a message that you don't trust them with the big stuff-that you're not willing to let that go."

"Each leadership survey, each book, each management article really gave me the drive to understand how my unintentional actions were affecting people, and how I could be more intentional," she continues. "It really woke me up."

So what was the lesson? For Hancock, it was that delegation does not have to mean abdicating responsibility. "It's the art of management: Remain actively involved, yet removed enough so team members have room to explore, succeed, and even fail," she says. Allowing staff to learn from action, respecting everyone on the team, and engaging in humble self-reflection are steps that ultimately build leaders.

"I'm very purposeful in my messaging to make sure I'm conveying trust. It's not the mistakes you make; it's what you do with them," Hancock says.

The Need lor New Partnerships-and Connections

Health care is a fast-changing, dynamic industry that requires leaders not only to know themselves and effectively manage their teams, but also to go beyond to reinvent care.

"We are being asked to take on more, to partner with people we've never partnered with before, to do more than we've ever done, and to look beyond our walls,'' Hancock says.

In 1994, Hancock was introduced to HFMA by her former supervisor at Ernst & Young. She joined, volunteered to work the registration desk at a Virginia chapter event, and was "completely hooked on the experience. I had a chance to meet everybody, network, and have a purpose. I just loved it."

Most of her career connections, she says, have come from HFMA.

"It's a safe place-a safe place to learn, a safe place to meet new people, a safe place to network. And you see a lot of good examples of how to lead, delegate and work as a team in HFMA," Hancock says.

Hancock certainly has taken on many roles during her 21-year affiliation with HFMA, from helping to pass out registration packets at conferences to taking a place on the Board of Directors and now leading the Association as she assumes the Chair role at the HFMA National Institute.

"The road ahead is not a straight line," she says. "It's more of an uneven path with all kinds of experiments and multiple models unfolding simultaneously, calling on us to go beyond our current level of creativity and find new ways to lead through the change and the long transition period." Although finance leaders and healthcare providers face many challenges in transforming health care, Hancock adds, the future, with the promise of innovation and technology to save lives, will be nothing short of inspirational.

Melinda Hancock: Career at a Glance

* Partner, DHG Healthcare, Dixon Hughes Goodman LLP, Richmond, Va.

* CFO and Senior Vice President, Bon Secours Virginia Health System, Central and Eastern Virginia

* Vice President of Strategic Finance, Bon Secours Virginia Health System

* Interim CFO, Bon Secours Charity Health System

* Executive Director, Culpeper Regional Hospital Foundation

* Controller, Culpeper Regional Hospital

* Senior Consultant, Ernst & Young

* Staff Auditor, Deloitte & Touche

Education

The College of William and Mary, BBA, Accounting

University of Phoenix, MBA, Health Administration

HFMA National Experience

* National Chair-Elect

* National Advisory Council

* Regional Executives Council

* Board of Directors

* Executive Committee

Virginia-Washington, D.C. Chapter Experience

* President

* President-Elect

* Secretary

* Director

HFMA Awards

* The William G. Follmer Bronze Award

* The Robert H. Reeves Silver Award

* The Frederick T. Muncie Gold Award

* The Founders Medal of Honor

"We are an industry in the midst of a major transition, one that will require all of us to go beyond the status quo and try something very, very new. The fee-for-service payment system, the foundational financing mechanism for American health care, is diminishing. The limits of a healthcare system that pays for volume are evident to us today. It just hasn't delivered value commensurate with the resources we've put into it. To paraphrase Albert Einstein, 'Once we accept our limits, we can begin to go beyond them.' "

-Melinda Hancock

Leadership Training Conference, April 2015

Getting to Know Melinda Hancock

Out of the Office

On the seventh day of a typical week, it's time to recharge. Hancock says that understanding her limits and setting boundaries makes her even more productive in the office. With her busy travel schedule and dizzying pace of meetings, anything by the water and listening to music are ways to relax. Sharing music with her two children, Tyler (19) and Lauren (16), and her husband, Jason, is even better.

Here are a few of her favorites tunes:

* Feeling stressed? George Winston

* Want to dance? 70s or anything with a good beat

* Running/walking uphill on a treadmill: Go for 135 beats per minute. Anything pop or country

* Self-reflection? John Denver or classical

Any musical is fair game too, she says. "Les Miserables," "Sound of Music," "Pitch Perfect," "Hairspray," and "Grease" are all favorites.

And if you really want to talk '70s culture, she will be the first to tell you the music was good, but the fashion was a little, well, Le Freak (Chic).

Hallmarks of a Leader

Leadership is both art and skill, says HFMA Chair Melinda Hancock. You need to know your strengths and weaknesses and also be able to identify them in your team members.

Here are five actions Hancock believes represent strong leadership;

1. Surround yourself with other strong leaders.

2. Celebrate the success of the team, rather than taking credit.

3. Exert passion in your work, not power.

4. Help team members develop and build their unique talents.

5. Break down barriers to improve efficiency and outcomes.

a. American Hospital Association, 'Fast Facts on U.S. Hospitals,' 2014.