November 17, 2022
This episode is part of our Excellence in Leadership Series, presented by Citi. Carladenise Edwards, Ph.D. is a healthcare strategy expert.
This episode was made possible by our partnership with Citi.
[00:00:00] Gary Bisbee, Ph.D.: Well, good afternoon, Carladenise, , and welcome.
[00:00:04] Carladenise Edwards, Ph.D.: Thank you.
[00:00:05] Gary Bisbee, Ph.D.: Why don’t we get to know you a little bit better and let me just ask about your early life. What was life like growing up for you, Carladenise? .
[00:00:15] Carladenise Edwards, Ph.D.: Oh my goodness. Well, I’m a military brat a proud daughter of a US Marine, and so we moved around Gary every two or three years. My family was packing up, going somewhere new. It was when we got to San Diego and I went to high school and my parents bought a house for the first time in the neighborhood, in the community, and everybody had lived there their whole life. All the kids had gone to the same elementary school, the same middle school, and now we’re at the same high school. And at that time there was what they called busing, voluntary ethnic enrollment program. Veep and all of the minority kids were bused into the neighborhood. Yet we lived in the neighborhood and so this was probably the most transformational experience for me is learning a, that not everybody moved every two or three years and people actually lived in homes for the majority of their life and didn’t move from their neighborhood, but also that. I was for the first time recognizing that for most of my childhood and life, we had always been the only black family because other kids were coming into the community to go to our school. And I was creating relationships with people of different cultures and communities I’d never done before. My childhood was pretty happy, pretty go lucky. And fortunate, I think I was very privileged. I think I was very privileged.
[00:01:39] Gary Bisbee, Ph.D.: Well, as you know, Carladenise, this show is about leadership. Would you say that your leadership style at all is drawn from your parents?
[00:01:50] Carladenise Edwards, Ph.D.: Ha. Yes, my father is a marine , so anybody who’s worked with me or for me knows that cuz it just bleeds through my bark and my stature and my, I’m just gonna say incredible. Respect for people who have high integrity and, courage. And so I absolutely am the daughter of a US Marine. I also inherited from my dad, Gary, this comfort and actually joy from being number two, from being second, from being the person who’s the wind beneath the leaders wings and have done that with a lot of joy and a lot of pride. And my superpower or secret power is helping individuals and organizations achieve their goals. That’s just what we do.
[00:02:44] Gary Bisbee, Ph.D.: well, what did the young Carladenise think about leadership?
[00:02:48] Carladenise Edwards, Ph.D.: You know, I really thought about it in terms of change and being impactful and as I prepared for this interview, I was really thinking deeply about that. You know, my daughter is applying to college right now and she was writing one of her college essays in a question, the prompt, Gary, was name the historical event or something that’s happened in history that’s inspired you. And she started to write the story of my great grandfather, her great grandfather who was a minister, and he was run out of the country by the Klan for preaching racially equality and solidarity. And an Episcopal priest found him hanging from a tree in Miami, rescued him, and they ran off to The Bahamas. And so my stories of leadership and my vision of leadership is a grandfather and a father who exemplified incredible courage. And who are in essence fearless about executing on their values and their core value as equity.
[00:03:57] Gary Bisbee, Ph.D.: Terrific. Background. Thank you for sharing that with us. When did healthcare enter your life or your interest, I should say, Carladenise?
[00:04:06] Carladenise Edwards, Ph.D.: So when I was growing up, there were very few I would say role models that I could identify with. And I knew I was not gonna be a Marine like my father and I definitely did not wanna be a teacher like my mother. And so I had glammed on to Louis Sullivan, don’t know why, but he was the one person that I would see out publicly doing things that at some level reflected me. I also had a girlfriend whose father was a CFO at Kaiser Permanente when I was. And he was another African American who I said, okay, he’s not in the military and he’s not a teacher. So this healthcare thing, it was like, well, I guess maybe I need to be a doctor. And of course at that time they, everybody said, you need to be a nurse. But I was pretty convinced that I was gonna be a leader in healthcare, went to Penn, thinking I was gonna study medicine and go to medical school and ended up studying the study of medicine. The history of medicine. And then for me, the rest is history. I call myself an epidemiologist by training Gary because I studied the patterns and transitions of disease, the social, political, environmental impacts on how people age, right? And then I wanted my work to be in improving that, improving how you and I. Improving the quality of our life as we age. That’s been my work from a healthcare perspective.
[00:05:35] Gary Bisbee, Ph.D.: Well, thinking about your career, gosh what a marvelous career. You’ve been a large health system executive. You’ve been an entrepreneur, an advisor, you’re a director. You’ve been both at the federal government, the state government level. What’s driven you to be broad in how you view positions your role in healthcare?
[00:05:58] Carladenise Edwards, Ph.D.: You know, I think I’m a student at heart and so I absolutely follow opportunities that enable me to continue learning. And the data points I’ve been looking for have been to fulfill this thesis that I have around how this country and how this nation can actually create a system of care that actually enables health to be achieved and for people to be rewarded for that, for individuals to actually make money to achieve some level of profitability and productivity off of. As opposed to sickness. And so part of my transitions has been, ooh, that’s an opportunity for a new data point. The other part of my transitions, Gary, and this is full transparency, in candor, is I have a really hard time when people call me saying no. When someone asks me to do something that I think is compelling and has an irresistible value proposition. I struggle right to say no even when it’s in the fire. Because I think when you’re called sometimes people see your skill sets and talents in ways that you don’t see them yourself. And I have been really fortunate that leaders like a Rod Hawkman and a Right Laster and a Jeb Bush and Rhonda Meadows and others have said to me, Carl , you could help us.
[00:07:30] Gary Bisbee, Ph.D.: You make the point about not, you know, not saying no even in the face of fire, and yet I’m wondering in your case, Carladenise if the fire maybe. Is an attraction to you. Do you you’ve had some really interesting challenges during your time.
[00:07:45] Carladenise Edwards, Ph.D.: It goes back to my great-great-grandfather who was in the heat of the Civil Rights Movement, preaching racially equality and solidarity. Even in the face of the kkk, in the face of adversity goes to my father going to Vietnam, a war that was not highly regarded or respected, but knowing that a joining the Marines was gonna change the economic trajectory of his family. Right, giving him an opportunity to have a standard of living that no one else in our family had ever achieved, and B, he really thought he was serving his country. Back to your question, what did I inherit from my family? I inherited that fearlessness and that courage.
[00:08:31] Gary Bisbee, Ph.D.: what would you say over the course of your 20 years of experiences in healthcare, what are the major lessons that you’ve learned?
[00:08:41] Carladenise Edwards, Ph.D.: Oh, wow. That’s a great question. One is not to take yourself too seriously, and I really mean that. I remember a leader saying to me, don’t believe the headlines. And at the time they were saying it because, you know, negative press. But I also think it’s true when there’s good press, don’t always believe the headlines. Don’t take yourself so seriously. The second one is work is actually really hard if you actually are working. , you’re trying to use energy to produce something that has value and work is not, vacation work is hard, and the energy that it takes to do that in solo or in partnership and collaboration means that you’re pushing uphill to produce something that has value and you have to keep work in context because it is not vacation. So one, don’t take yourself too seriously. Two, work is really hard and it should produce value. And then I think number three, what I’ve learned is that we collectively can do great things if we work together as community.
[00:10:06] Gary Bisbee, Ph.D.: Great lessons for sure. Why don’t we move to your executive role in large health systems? Some of that time has been spent as a chief strategy officer. At three large health systems, Alameda, Providence, and Henry Ford. What would you say, Carladenise, what are the main challenges that large health systems are facing today, all of which you’ve dealt with during the time that that you’ve been there?
[00:10:35] Carladenise Edwards, Ph.D.: Today, it’s very different than what it was probably when I started this journey as a Chief Strategy officer in non-profit Healthcare 10 years ago. I’ll go back 10 years. 10 years ago it was trying to figure out how to create a value based care engine, meaning creating ways in which you could collect money, make money that was predicated on quality and outcomes. And that was really important 10 years ago, right? This journey to what we call population health, but we really didn’t mean it, it was really financing of healthcare, managing the health of the population. Now what health systems are really struggling with is the workforce. And to be candid, figuring out what business they’re. And then what is the value proposition for those who fund that business so that you can win in it? And I say that really intentionally because health systems over the past 10 years have been trying to be all things to all people. I think we have inadvertently undermined our ability to do anything. And I think we’re at a pivotal juncture, Gary, where health systems really need to hone in on the business that they’re in, the value that they bring, right? The work that’s being done, what productive instrument is being used to get to something that has value. And so then we can figure out how to sustain that. And so I do think right now the big dilemma for health systems is workforce. But what the workforce is saying is we can’t keep doing this anymore. And that this is trying to be all things to all people all. and health systems need to figure out what it is they are going to be for the community and do that exceptionally well.
[00:12:42] Gary Bisbee, Ph.D.: The last 20 years has been characterized by increasing baby boomers, you know, turning 65. So we had a lot more Medicare patients now than we used to have. Probably if we’ve got 60, 65 million of them now, we probably had 35 million of them 20 years ago or less. So the government payments to, to health systems. Most of our health systems have 50%, 60% of our revenues come from governments these days. And how do you, I’m following through on your thought about the value. Get let’s figure out what we want to do for the community and do that well, how can you do that when you’re really being paid at such a low rate for a good part of your patient?
[00:13:29] Carladenise Edwards, Ph.D.: This goes back to, I was sharing with you, I think off camera. One of the things that I’m working on in my free time now is really thinking about how do we create a sustainable healthcare economy. and it has to be within the geopolitics of capitalism and in this capitalist society we have for profit businesses, not for profit businesses. Tax exempt businesses, you know the whole gamut. Phil, philanthropic right? Businesses. We really do. Going back to the point I made about a hospital needs to be a hospital and a pharmacy might need to be a pharmacy and all these things in between, need to figure out what they do in the value chain of healthcare. I really do believe that there needs to be a public health infrastructure. I think we need to have the infrastructure that enables everyone, regardless of their ability to pay to get the fundamental things that enable us to be healthy and secure, the lack of health and the lack of access is a security threat. It’s a global economic threat. So folks need to be able to get vaccines. Folks need to be able to get preventive. Folks need to understand the nutrition pyramid and how to access the food that’s required in order for them to sustain healthy lives, right? And then if you need transportation to get to that appointment so that you can actually get the surgery or the treatment that you need, we need to make sure those basics are accounted for. And unfortunately, that doesn’t necessarily address the question that you asked about the inability for us to fund that, right? Because the government dollars are becoming much more scarce. But what it does address is what are we funding right now? That funding that you talk about that comes into the health system is our insurance payments to people who are acutely. Who needed an intervention for sickness? I really think if we took that 60 cents and if we spent 30 of it trying to keep people from not needing those services, we would be better off.
[00:15:51] Gary Bisbee, Ph.D.: Let’s get back to your point about the workforce and particularly. Physicians for a moment, and then we can cover the nurses. But in terms of physicians if we have a million active practicing physicians in the country, some estimates are 500,000 of them, or 400,000 of them are employed by health systems, we probably got another now couple hundred thousand employed by. Optums and CVSs and Walgreens of the world. How do you think that’s changing the practice of medicine where our physicians are increasingly employed by these large entities?
[00:16:31] Carladenise Edwards, Ph.D.: What it’s doing, it’s changing the landscape in a couple ways. One, I think there’s some good in this and it’s particularly when I talk to and I’ll bring this up and it might sound awkward. Hopefully it doesn’t come off poorly for the audience. Women who practice medicine, who have struggled to try to be all things to all people in their. you know, being employed and having some predictability in your paycheck, your income and your schedule has actually enabled some women to make that transition into medicine and manage a lifestyle that’s a lot more reasonable than in the past where you were trying to run your practice, manage your practice medicine, and then when you’re not running a business, Go home and manage your family. The other way I think that it’s been interesting and transformative is from the health system perspective. Health systems and hospitals have to be on their A game. Now. We have to create the irresistible value prop for those practices to wanna be affiliated with us. If I use the collective, we as somebody who’s been a part of health systems for a long time is not an automatic.
[00:17:42] Gary Bisbee, Ph.D.: Following up on that we’re talking about these large, well capitalized. The Walgreens, Optums now Amazon. So on. You make the point about the employed physician. How else do you think these large companies that are elbowing their way into primary care particularly, but somewhat ambulatory care, how is that going to change the practice, the delivery medicine, do you think?
[00:18:09] Carladenise Edwards, Ph.D.: From the practic. And point they’re gonna force an improvement in the patient’s experience that raises the bar. So if these, what we call disruptors are successful and create a platform or a product or service that is more patient centric. With higher scores, right? Then the health systems are gonna have to figure out how to compete with that. The other way to answer that question is the entities that are not traditional healthcare businesses, but are retail commercial ventures that provide services outside of healthcare that are now entering the space. I think they’re the ones who will actually help us rewrite the way in which healthcare is funded and accessed, because I don’t believe that can happen from the inside. Going back to my three times as Chief Strategy Officer for health systems, one of the things that I learned, it’s really hard to lead change at a transformational. From the inside because no one fundamentally wants to change the business that they’re in.
[00:19:32] Gary Bisbee, Ph.D.: Unfortunately, we’re gonna have to land here Carladenise I hope you’ll come back. What advice do you have for young? Up and coming leaders in healthcare.
[00:19:46] Carladenise Edwards, Ph.D.: Be brave, be fearless, and actually recognize its work. , but it’s absolutely the right work and do it for the right reason, which is you wanna have an impact, you wanna improve the actual health of this community, that we are all accountable for. So we can leave something good behind. Yeah. Be brave, be fearless.
[00:20:14] Gary Bisbee, Ph.D.: Well done Carladenise. Thank you so much for being with us.
[00:20:18] Carladenise Edwards, Ph.D.: Thank you for having me.
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