“Surround yourself with people who make your weaknesses irrelevant.”
Dr Robert Groves is the Executive Vice President and Chief Medical Officer of Banner | Aetna, a new insurance company in Arizona formed by a joint venture that leverages the strengths of the number one healthcare delivery organization in Arizona (Banner Health) along with the National insurance brand (Aetna). Prior to his current role, Dr Groves also led a highly successful private practice for nearly thirty years before stepping into a larger leadership role as the Vice President of Health Management at Banner Health.
You were running a successful private practice prior to leadership at Banner and now Banner|Aetna – what led you to a larger leadership role?
The way I describe my progress to the role that I’m in now is that a lot of it was somewhat accidental. I tell folks that are interested in making progress on a leadership track to stay alert and stay curious. Stay open to opportunities that come along because that’s really all I did.
I was in private practice in Greeley, Colorado and minding my own business, and my partner said, “Banner is looking at a project up in Chicago called eICU.” And I thought, “Well, that’s interesting,” because I’d always been interested in the intersection of health care and technology. I even tried my hand at a startup business a long time ago.
But I said, “Okay, I’ll go up and evaluate it.” I was fortunate enough to meet leadership within Banner, and we hit it off. They called me and said, “Hey, we want you to interview for the eICU medical director role. We’d like you to help us roll this out across Banner.” For the audience’s benefit, this is the application of tele-technology and computer algorithms to manage intensive care unit patients. So I went up and looked at it, met these people, and interviewed for the role.
The other piece of advice that I give people is to try to be yourself because I remember during the interview, one of the gentlemen who was there—it was a panel interview, you’ve got nine people, and I hadn’t interviewed for a job in a long time—asked me, “Are you committed to staying and seeing this thing through? We want to make sure you’re going to stay at Banner.” And I said “Well, I love to start things. I love to get them up and going, but I’m not crazy about running them. So my guess is I’ll be here a couple of years and that’s probably about it, and I’ll go back to what I was doing.”
The one who had asked the question said, “Well, I don’t think that’s what we’re looking for.” And to his credit, my mentor, a gentleman named Dr. John Hensing, stood up, and he said, “I think that’s exactly what we’re looking for. Right now, we need somebody to roll this thing out.” That changed the tone of the interview completely. Ultimately, I ended up getting it.
Tell us about Banner|Aetna – How did you get involved and what’s the mission of the organization?
In my position in health management, I had worked with Aetna as one of the many payers that I worked with in that role at Banner and we had a very special relationship. We seemed to be philosophically aligned and had the same goals in mind. Sometimes teams just click, and we seemed to click with Aetna very well. When I heard that, above my pay grade, they were talking about a joint venture, I was really excited about that. We know that incentives drive behavior, and we know that the traditional relationship between providers and payers has been adversarial. One’s trying to get the price down, the other’s trying to get the price up to pay the bills, and it’s not a great way to fix health care.
And so when I heard that this was happening, I thought, “Wow, there is an opportunity there to align incentives with two great organizations, and I really want to be a part of that.” So we were really formed as the insurance play for Banner Health in Arizona and in the other markets in which we operate. The primary goal is to work on that very big, thorny problem - How do we change the way health care is delivered in Arizona? How do we make progress toward that goal of aligned incentives on every angle and making this work for patients so that we can really focus our efforts around their needs?
I’m getting up into that age where there’s no doubt at some point I’m going to need services, so there’s a selfish motive here as well as a legacy motive. I’ve been in health care a long time. In part, I feel responsible for the mess that we have, so I really wanted to be part of fixing it, and Banner|Aetna I saw as a great opportunity to do that.
Affordable health care is talked about a lot but we don’t normally get to the root of the issue. Is the root of the issue the incentive piece that you mentioned? Incentives are not aligned properly?
I’ll tell you the way I think about it. When I was younger, I used to know that I could figure out how to fix health care, just me, all on my own. If they just give me the range, let me make all the policies, and set it up, then I know how to fix it. I no longer kid myself that that’s true. It is a highly complex system. The stakes are incredibly high. It is the economic engine in many towns. These are the jobs. So fixing it is not as easy as turning off the spigot because when you do that, that’s somebody’s job that you’ve turned off too.
But what I do believe is this: incentives drive behavior. I don’t think there are any evil players in health care. I learned that it’s not the payers. I work with really good people that are trying to do the right thing. It’s not Big Pharma. Everybody’s following the incentives. If we want the system to change, then we have to change the way that we reward performance in health care. So yes, I think it’s the incentives. By the way, I personally can’t fix it, but I do believe if we get the incentives right, there are so many bright people out there that will drive us toward that goal of fixing health care.
You’re going after a really big problem in affordable healthcare. A lot of great entrepreneurs are trying to attack really complex, hard problems. Where do you start with a really hard problem?
A huge piece of it is incentives: making sure that we get the metrics right, that we’re measuring the right things so that we don’t have unintended consequences. We set those measures as enough of a stretch so that it actually forces people to work outside their comfort zones a little bit to get there but not so high that it’s impossible to reach and they give up. I mean, that’s an art in and of itself. So incentives are a big piece of it.
The other piece of it that I personally work on is the policies that come out of federal regulation because oftentimes, it’s whatever Medicare does that many of the private insurers will follow suit on, and not all of those policies make sense. In fact, there’s a huge number of them that don’t make any sense. Part of what I do is try to educate the public so that they’re more savvy on what’s going on and understand the sleight of hand that can happen both in health plans and in the delivery system so that they get a much more concrete feel for how this works and can be their own best advocates.
Part of what I’m doing is trying to cut through the complexity, looking for those strategies that will allow, for example, a patient with a behavioral-health issue to have a site that they can go to and to some extent self-serve. A big part of what I see as our role is to act as an innovation laboratory for our larger parent organizations. It’s very difficult to turn CVS-Aetna on a dime. It’s very difficult to turn Banner on a dime. It’s a ten-billion-dollar, highly integrated, complex system, and because we are smaller than those behemoths, we have the opportunity to trial things, and even to fail sometimes, so that we can find those things that really work and then determine if they can scale to our population of three hundred and fifty thousand covered lives. If it works there, we know that we’ve got something that we can recommend to the larger organizations. So that’s a big piece of it is the innovation engine.
What would you say in your career that you did really well that got you working on really interesting, complicated problems? What were the things that you look back on like “I did that really well to put myself in this position”?
There are a couple of things, probably three that I can think of right off the top of my head.
One is coach training, training to be a certified coach. In that process, they asked us to come up with two words that would describe how we think about leadership and how we think about improving the system and how we think about coaching others. For me, those were curious and connected, so I am constantly thinking, especially when times get hard, “Stay curious. That may feel like a barrier, but stay curious, dig a little bit deeper, find out what’s really going on. Find out what’s going on with the people around you that may have caused them to put up barriers, then stay connected.” Human relationships are still at the bottom of what makes the world go round. Treat people well. Be reliable. Show up when you say you’re going to show up. And that staying curious and staying connected is certainly a big part of what I think I’ve done well.
Another piece of it is, as I was told early on in my career—I read it somewhere, and I wish I could remember where because it’s been phenomenal advice—to focus on those areas where you can really excel, that come naturally to you, that are part of your DNA, and get as good as you can at those things. Then surround yourself with people who make your weaknesses irrelevant. So many leaders I see are trying to become a jack-of-all-trades, and that’s really tough. Ultimately, it is my belief that if I had chosen that path, I would be mediocre at everything, including those things that I love to do. So that was really good advice: find out what your niche is and then just polish that as much as you can until it shines.
The third thing is to be prepared for opportunities when they arise—and they will—and don’t be afraid when they do arise to stretch yourself. In order to grow, we have to become uncomfortable. You don’t grow muscles by being a couch potato. You have to push a little bit, and it has to hurt a little bit. But wow—the results that you can get! The same thing is true in a career. Many times I’ve stepped out and into areas that I wasn’t quite ready for. It’s been an incredible journey. I still feel like we have a lot of work yet to do. And we (Banner|Aetna) continue to work on that with novel strategies and novel solutions that we bring in for diabetes, behavioral health, premature births . . . we’re working hard on all of those things every day.
Is there a book that made a huge impact in your career or that’s a favorite?
I think one of the things that has made it possible for me to function in some pretty high-stress positions and some pretty high-stress situations for a lot of years has been mediation - and it is self-inquiry, understanding my own mind, understanding that my thoughts are not necessarily me and that the chatter that goes on in my head is not reality.
There are several books along those lines that I really appreciated and enjoyed. This is in a purely self-examination sense: the Tao Te Ching Stephen Mitchell translation I thought was so brief but so pithy. Then recently, one of the books that really inspired me was a book called Thinking Fast and Slow by Daniel Kahneman, the Nobel laureate who discovered behavioral economics, because one of my beliefs is that the next frontier in health care, after we’ve gotten all the analytics down so that we can predict where the problems are going to be, becomes how to help people to do the things that bend the curve toward health. What can we learn from behavioral psychology and behavioral science that will help us help him meet their own health goals?
Richard Thaler, along those same lines, recently came out with a book called Nudge: The Final Edition. Those books were really transformational for me in the way I think.
Do you have a favorite quote or a phrase you keep front of mind?
“Stay connected and stay curious.”
What is the best advice that you have gotten in your career, and what would your parting advice be as well?
Of those things that I have not already covered is - failure is not final. I dropped out of high school. I was a Pizza Hut manager of the year, then a few days later I was fired. I’ve had so many times in my life where the initial thought is “This is over. Oh my gosh, what am I going to do? I’m a failure. Those naysayers were right: I wasn’t living up to my potential in high school,” and all of those things that you hear and then you start to tell yourself. And each and every time that has happened, new doors have opened up, and it has forced me into those uncomfortable positions where I had to make decisions that I didn’t want to make. I wanted to sit back and be comfortable—maybe a little too comfortable. But failure is a true opportunity to learn. Get prepared to have people tell you no and to fail because it’s only through repeated failure that we learn what works. It’s like a famous Thomas Edison quote that says he discovered a thousand ways not to invent the light bulb before he got there.
Take it in stride. Look for opportunities when that happens.