New hospital head takes on ‘aspirational’ goals for value-based care

Dec. 21--CEDAR RAPIDS -- As the incoming president and CEO of UnityPoint Health-Cedar Rapids, Michelle Niermann has what she describes as an aspirational goal of "transforming what health care looks like."

Niermann, who will take over Jan. 1 -- making her the first female leader in the hospital's more than 130-year history -- said in an interview with The Gazette on Monday that she aims to change the way the health system is reimbursed to provide better health outcomes for patients.

"If those payment systems can transform, we think that we can deliver better health care and we think we can actually lower costs," Niermann said.

Niermann currently holds the role of executive vice president and chief operating officer of UnityPoint Health-Cedar Rapids, a positions she's had since early 2016.

"It's been a great place to work. I've been very fortunate to have lots of good mentors," Niermann said.

She will succeed Ted Townsend, who held the role as president and CEO at the Cedar Rapids health system for 16 years. He also has served as interim head of the UnityPoint Health hospital in Dubuque since May.

Townsend will retire at the end of this year after 39 years in the health care industry.

"I think we are leaving UnityPoint Health-Cedar Rapids in great hands and I think you should continue to look forward to good things," Townsend said. "I feel comfortable and confident and happy she's here and ready to take the reins."

UnityPoint Health-Cedar Rapids includes the 532-bed St. Luke's Hospital and several clinics and offices in the Cedar Rapids area that staffs nearly 4,000 employees. In 2017, the hospital had nearly 18,000 inpatient admissions, about 53,000 emergency room visits and performed around 30,000 surgeries.

As she prepares to take on the role, Niermann said she has "the goal of (UnityPoint Health-Cedar Rapids) being the pre-eminent health care system in the Midwest," she told The Gazette.

And she hopes to achieve that goal by "transforming what health care looks like" -- particularly when it comes to how health care is paid for.

"We think the way that physicians, hospitals, health systems are paid is unsustainable, really for everyone," Niermann said. "That includes not only us as an organization, but really our larger economy, the employers and people within it."

Payers -- such as employer-based insurance companies, private insurance or government-supported programs such as Medicaid, Medicare and the Affordable Care Act -- reimburse health systems for every service, "regardless as to whether it's improving health or not."

Payers know this system doesn't work, Niermann said, and the easiest solution from their point of view is to reduce reimbursements for individual services.

"That's not very helpful to anyone," she said. "It's a constant downward pressure when our costs are not dropping -- our inputs, our supplies, pharmaceuticals, wages."

Reinvention is necessary, Niermann said. UnityPoint Health-Cedar Rapids should "more responsibility for the health of the people in the communities that we serve" by taking more risk and flexibility on delivery of health care.

Niermann pointed to mental health as an example. Her proposal is that UnityPoint Health-Cedar Rapids -- which is inclusive of AbbeHealth, the Cedar Rapids mental health provider -- would find more ways to make more touches with individuals that the hospital comes into contact with and prevent more emergency room visits.

"It's pretty aspirational, I would say," she said. "And not everyone's aligned. Payers aren't necessarily enthusiastic about making those transformations."

Hospital officials declined to disclose Niermann's salary as president and CEO. According to a 2016 executive compensation report from UnityPoint Health, Townsend's base salary was $510,000.

Opportunities kept appearing

Niermann spent most of her professional life at St. Luke's. Some of her key accomplishments during her time include implementing performance assessment tools and facilitating increased patient and physician satisfaction.

Niermann earned her undergraduate degree from Bradley University in Peoria, Ill.

After obtaining a master's in hospital and health administration at the University of Iowa, she started in 1994 as an administrative fellow at St. Luke's Hospital -- which was not yet part of the UnityPoint Health system.

"I came into the field, honestly, because I wanted to be in health care, but not as a clinician. I wanted the opportunity to have some influence in a field that I think does important and pretty amazing work," she said.

"I came in with all those kind of aspirations, that kind of mind-set, but it's probably only been in the last handful of years where I started to think (being CEO) might be something I could do."

Niermann said she never expected she and her husband, both from central Illinois and who attended graduate school at the University of Iowa, would end up long-term in the region.

"So I came here after I finished my masters and never had any expectation that, you know, 24 years later I'd still be here," she said.

But the opportunities kept appearing, she said.

She went on to obtain various leadership roles at the hospital. She also was appointed as the interim CEO of Jones Regional Medical Center in Anamosa from 1999 to 2001, "during which time the hospital transitioned from a management agreement to a wholly owned subsidiary of UnityPoint Health-St. Luke's," according to Niermann's resume.

Starting in 2013, Niermann held a dual role as regional senior vice president and chief operating officer, as well as regional vice president of clinical operations overseeing UnityPoint Health-Cedar Rapids' clinics.

"But that was a little bit unusual," she said. "At the time, I was the only person in the system who had both the hospital operations role and the clinic operations role.

"Why we had kind of that dual role in the first place is because there is or should be integration between all in those settings of care. While your encounters with our hospital hopefully will be short, that's a little more clinically intense moment in your life and we need to make a smooth handover back to your physician's office, and physician's office needs to make a smooth handover to the hospital."

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