Volume 29

The True Grit Issue



Turning Risk into an Asset Reaps Huge Rewards


Join Us for Stop Competing, Start Collaborating


50 Rural Hospital CEOs to Know 2018


Good Luck to John Henderson TORCH’s New CEO


Big News! HealthSure Has a New Team Member



We’ve said it before and we’ll keep saying it because not only is it true, it is increasingly essential in the delivery of healthcare to rural Americans: When it comes to grit, true grit, the women and men managing and working in rural hospitals have it in spades!

In this, our fourth annual True Grit issue of HealthSure Headlines, we take a behind-the-scenes look at the type of grit it takes to become recognized as one of the very best rural hospitals in the country.

Our feature article is adapted from one of the monthly webinars HealthSure hosts in our role as manager of the Rural Hospital Insurance of America program (RHIA). RHIA is an exciting program that comes at a time when our hospitals need it most. If you are looking to leverage your buying power and collaborate with other rural hospitals, join the RHIA conversation and your voice will be heard.

Each webinar features expert panelists who share how their work is keeping rural healthcare strong in America. Earlier this year, two members of the senior management at Hill Country Memorial (HCM), in Fredericksburg, Texas were our guests in a webinar called: TRUE GRIT: The 3 Keys to Becoming the Best of the Best. A recording of the webinar is available on the RHIA website: www.rhiaprogram.com

True Grit: Turning Risk into an Asset Reaps Huge Rewards

By Barry Couch, CIC, ARM

Change never comes to the party alone; risk is its constant companion. Turning risk into an asset starts with embracing change by summoning enough grit to override the natural desire to stay within your comfort zone.

While the people behind the success of Hill Country Memorial (HCM), in Fredericksburg, Texas would be the last to brag about how much grit they have – and they have it by the truckload – embracing change has brought huge rewards along with national recognition.

Here is just some of the recognition HCM has garnered:

  • The Malcolm Baldrige National Quality Award in 2014
  • A top 10% national NIST National Institute of Standards and Technology ranking for employee and physician satisfaction and engagement
  • Recognition as a top 100 US hospital by Watson Health (Formerly Truven Health Analytics) for six years in a row
  • A #1 rating by CMS of its value-based purchasing program

These awards are just the tip of the iceberg according to HCM’s Chief Executive Officer, Jayne Pope who says the recognition is nice but, “… we’re the first to say we are not there yet. It’s not about the awards; it’s about the achievement for the patient. What counts the most is how we continue our journey towards even more remarkable results. It’s a journey that will never end.”

Building a Foundation for Success

The HCM team has been on this journey for many years and what’s most impressive is how they have engaged every employee and manager – plus the other stake holders in the community – in the achievement of what they call Strategic Breakthrough Initiatives (SBIs). Their progress has been driven by three powerful elements the HCM team put into place at the outset: HCM’s mission, vision, and core competencies.

Here is how Jayne describes them, “Our mission is to be Remarkable Always. One of the things a former board member said is the more complex it gets, the simpler we need to get. So, we created mission and vision statements that are memorable, aspirational, and measurable, because we want our team to focus on their work and serving others rather than on memorizing difficult missions and visions. You may be thinking to yourself right now, ‘How is remarkable measurable?’ It’s because we’ve defined remarkable as performing in the top decile of the country in every single measure, and so that’s what we strive for.”

HCM’s vision is to Empower Others and Create Healthy. They have instituted many practices to prevent harm, which creates healthy in their community. That vision is applicable to all of the services HCM offers. Jayne explains, “We want our community to be empowered… our patients to be empowered, and I absolutely need for those people who are next to the bedside, who understand the needs of those they serve, to be empowered.” Healthcare is very complicated and HCM keeps it simple. It is about healthcare, not about sickness care.

Jayne recalls the first time she entered HCM, “I knew there was something special about the hospital. I repeatedly heard that throughout the organization.” The first step was for the executive team to ask themselves, “What is it that’s special?” Identifying the hospital’s greatest strengths helped them identify the three core competencies.

The first one is Relationship Building. HCM builds relationships with their community, patients, and team. Hosting a variety of community events provides the team the opportunity to listen to their community. The team meets with the patients to ensure they are meeting their needs. HCM builds relationships with their team through a very structured process.

The second one is Values-Driven Culture. Every day the team asks, “How does that fit with our values?” HCM has five values and everyone on the team know what they are: Others First, Compassion, Innovation, Accountability, and Stewardship. The values are used to select new team members, physicians, and providers. At the board level, candidates go through an intensive process of values screening first to see if they are a good fit. The HR staff value screens every team member, and the volunteer coordinator value screens every volunteer. Jayne explains, “We believe this hospital was created by coins in a jar, people going door-to-door to collect coins… the founders who created the bedrock of this organization, we want to be true to those values for generations to come.”

Execution is HCM’s third core competency. Jayne addresses the challenges hospitals face in community healthcare delivery. “It is a tough climb in healthcare. We know that the work gets harder and harder and that we have to be together with our team and with our community in order to execute. Those awards… are the result of building the relationship, having those values hardwired, and then building accountability models that enable us to execute.”

A Strategic Map for The World to See

One of the remarkable aspects of HCM’s success has been its ability to engage the community and all other stakeholders. There is an ongoing conversation that drives the creation of HCM’s strategic plan. HCM publishes its strategic map for all the world to see. It’s is not a dusty old document but a living entity built on listening.

Jayne says, “We listen to many stakeholders to ensure that we have diverse inputs: donors, schools, providers, senior leaders, key consultants (like HealthSure), et cetera. We must understand what is happening in our community, what’s happening federally, what’s happening in our state, and it’s been instrumental in building a relationship and working from our values, and then being able to execute.”

HCM refers to this as TOWS, SWOT reversed. They evaluate the hospital’s strengths, weaknesses, opportunities, and threats. Jayne describes the process, “We do it with all the folks in the picture with the ear. We start with the HealthSure folks because we get a really good view of what the risks are in the state, they know what the risks are federally, and it enables us to then focus the rest of those TOWS sessions.”

Jayne explains, “Last year HealthSure identified that cybersecurity is a major priority and that we needed to evaluate our readiness and insurance. I wish I could say that was wasted money. However, it was not. We had the opportunity to use that insurance.” Every year HealthSure looks beyond insurance policies. “They know the pressures rural hospitals are facing and bring ideas to the table to address our unique issues. It enables us to focus our hospital Board TOWS.”

HCM takes what they learn from the community and puts it into action as the foundation for their strategy. HCM posts that strategy in their organization, in every meeting room, on their website. They make this strategy transparent, because HCM cannot accomplish this strategy alone. Jayne explains, “We need for our team to walk beside us with executing on the strategy.”

Execution Essential to the Success Equation

HCM took what they learned from listening to identify the hospital’s Strategic Breakthrough Initiatives (SBIs) which make up the strategic plan. Emily Padula, HCM’s Chief Strategy Officer explains, “We have a strategy map, which is our big picture and tells us our measures of success for the year. Then, coming out of that, we have action plans, very specific, where we say, ‘How are we going to get to our measurable goals this year?’ Before the year even starts we assign those SBIs to operational scope or strategic scope. Generally, something is considered strategic if it requires executive level involvement.” A few examples are: HCM building a care navigation program, opioid stewardship program, and looking at cost reduction across the system.

The executive team selects four to six projects every quarter and determines who’s going to lead the SBI. The leader could be a department director, a frontline team member, or a volunteer. It depends on who the stakeholders are in the process. Over half of HCM’s team members have participated on an SBI team.

Once that leader has been selected, Emily meets with them to work on their charter. That charter defines who’s going to be on their team, their measures of success, their deliverables, and the work they will accomplish. Together they determine the metrics to define a successful quarter.

Emily describes that all of this takes place in what they call the war room with war room accountability and coaching. “There are no battles involved.”

Got Rhythm?

Execution takes focus, focus drives consistency, and consistency demands a significant level of accountability. Emily says there is an “operational rhythm” that keeps HCM humming along and staying in tune. “We have set meetings and times and places and reports, where we review our progress toward our strategic goals. That happens quarterly, monthly, and weekly. For example, all executives go offsite for a quarterly business review to review of all of the measures and sub-measures of our strategic goals.”

Strategic goals are measured quarterly to make sure the team is on track. There are some sub-measures to help prioritize the actions for the next quarter. HCM ensures they are on top of reaching their goals for the year. During the quarterly meetings the SBIs get selected and sometimes changed. Emily explains, “We list out all the SBIs we’re going to do for the year at the beginning, but they get modified every quarter as new priorities arrive or things change.”

Monthly: HCM reviews their progress and checks that all the appropriate action is being taken. For example, every executive meets with each of their directors every month to review progress on their 90-day plan.

Weekly: HCM conducts a Tuesday extended huddle, to review the dashboards of all of their key measures of the strategy. Emily brings quality and safety reports to review during the huddle. The Chief Nursing Officer brings the patient experience survey results report every week. The Chief Operating Officer looks at productivity and volumes reports. HCM frequently checks on their performance, therefore rarely are they surprised by an outcome.

The Road Ahead

Healthcare pioneers like Jayne Pope and her team are taking a different path. They recognize that change brings opportunity by accepting some level of risk. The pay back is continuous improvement, significant cost control, an increased ability to control what their future will be, and the successful achievement of their mission.

Please Note: If you would like any of Hill Country’s SBI tools, contact HealthSure and we will help you get them.



Join Us for Stop Competing, Start Collaborating

What if you knew your rural or critical access hospital could become obsolete in the near future?

Would your job be to keep your hospital open no matter what? Would you fight tooth and nail to make sure your hospital was the proverbial “last man standing”? Or, would you find new ways to deliver the best possible healthcare to your region?

Questions like these have been answered by a group of rural hospital leaders who decided to stop competing and start collaborating to ensure a future for their hospital in rural healthcare delivery.

Join the TORCH Insurance program manager and a panel of hospital executives as they explore how a growing number of rural hospital CEOs have been collaborating to make sure there is healthcare on the ground in their communities three to five years down the road.

Based on the premise that rural healthcare will look different whether we like it or not, and that hospital CEOs can choose between having a hand in it or sit back and let it happen, the panel will explore:

  • Who to include in a regional collaboration conversation
  • Collaborative group operating principles
  • Who needs education and what they need to learn (hint: it starts with the Board)
  • Dangers to avoid
  • The positive outcomes possible (and already achieved)
  • A road map for the future

Join us at the TORCH Conference, Wednesday, April 11th at 11:00 am, you will learn how hospital leaders just like you are looking beyond individual survival and discovering how they can have more strength in all areas as a group.


Fran McCown, CEO at Haskell County Hospital District for 9 years. HCHD includes a CAH, a primary care clinic and walk in clinic. Prior to that, Fran was the CFO for 23 years at rural facilities with 14 of those years at Rolling Plains Memorial Hospital in Sweetwater. She holds a Bachelors of Business Administration in Accounting from Texas Tech University in Lubbock. And, she has been a member of the board at the Texas Organization of Rural and Community Hospitals (TORCH) for 4 years.

David C. Ashworth, LFACHE, founding member of LRC Advisors. David is a seasoned health system executive whose career has been focused on system strategy and development. Most recently, he served as president of a national health care real estate development company. LRC Advisors was formed specifically to partner with rural health care providers and community leaders in visualizing and planning realistic and sustainable paths forward.

Bill Haire, founding member of LRC Advisors. Bill has decades of experience as a hospital executive, health system COO, and physician group practice executive throughout the south central United States. In his role as an LRC member, Bill assesses the strategic, market and operational situations facing rural healthcare providers, with the goal of helping them visualize a realistic and sustainable future along with a road map for navigating that future.


Brant Couch, CPA, CIC is the president of HealthSure, the TORCH Insurance Program manager. Brant is known for his precise understanding of hospital finance and ability to see beyond traditional, worn-out strategies. He is directly involved in the design and implementation of risk and insurance management solutions that are keeping rural and critical access hospitals safely ahead of the game.




50 Rural Hospital CEOs to Know 2018

Congratulations to Jayne Pope as CEO of Hill Country Memorial Hospital and John Henderson, as CEO of Childress Regional Medical Center, on being on Becker’s Healthcare 50 Rural Hospital CEOs to Know 2018 list.

Becker’s Healthcare recognized 50 rural hospital CEOs to know in 2018.

The CEOs featured on this list have overcome significant challenges operating rural community and critical access hospitals to lead sustainable and thriving organizations. Many CEOs have served their institutions for decades, recruiting physicians, expanding services and implementing technology platforms to ensure the best care possible for their communities.

Becker’s Healthcare accepted nominations for this list and considered leaders making a positive impact on their organizations. The CEOs featured lead hospitals consistently recognized by the National Rural Health Association, American Hospital Association and HIMSS as top institutions; others sit on local chamber of commerce boards and serve state hospital associations.




Good Luck John Henderson!

HealthSure would like to congratulate and wish the best of luck to John Henderson in his new role as TORCH CEO. Earlier this year the TORCH Board of Directors announced, “The TORCH Board is extremely excited to have John join the organization and look forward to his leadership as the future unfolds. We congratulate and welcome John into this new role and offer him our support as he directs our organization.” John started his new role April 2nd.

As the TORCH Insurance Program Manager, HealthSure’s team has had the pleasure of working with John in his previous role as CEO of Childress Regional Medical Center. We would like to wish John the best of luck for his first week. We look forward to working with him in the future.



Big News! HealthSure Has a New Team Member

We are delighted to announce Eric Boudinet has joined HealthSure as a member of our Employee Benefits team.

As a trusted advisor, Eric is not afraid to get in the weeds with his clients and act as a team player, not just a consultant. He knows his client’s wear many hats and look to him as the expert in the field of risk management. Eric’s number one goal is ensuring his clients have the best plans and strategies for their specific needs and achieve the best possible results on a consistent basis.

Eric brings over 6 years of experience in the executive consulting and human resources/benefits arena. Prior to joining HealthSure, he worked as an HRIS and benefits technology consultant, helping clients achieve maximum ROI and create programs to ensure best practices. He believes forming true partnerships with his clients is essential to ensuring they get the best value and returns possible.





Small but important print
This communication is designed to provide a summary of significant developments to our clients. Information presented is based on known provisions. Additional facts and information or future developments may affect the subjects addressed. It is intended to be informational and does not constitute legal advice regarding any specific situation. Plan sponsors should consult and rely on their attorneys for legal advice.
What Happens Next? This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

©2018 HealthSure. All Rights Reserved.
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Take the Community Hospital Insurance Coalition (CHIC) for example. With our expert support and management, more than 30 rural hospitals who have come together to own this medical stop-loss reinsurance company. They are paying less for their insurance, improving benefits program performance, and receiving their share of a significant annual surplus cash distribution (~$2.5 million since inception in 2018).