Making the Case for Complex Care: Partnering with Finance


Lauran Hardin, MSN, CNL, FNAP, FAAN, Senior Advisor and Mark Humowiecki, JD, Senior Director, Camden Coalition’s National Center for Complex Health and Social Needs

Interprofessional collaboration is a common characteristic in complex care programs. Extending this practice to include an organizational financial leader as a team member can have powerful results for your program and the people you serve. With support from The Commonwealth Fund, we interviewed more than 100 leaders of successful complex care programs about how to make the value case for complex care. Across the board, leaders emphasized the importance of the relationship with the chief financial officer (CFO).

Following are five principles to consider in building a strong partnership with finance leaders to improve complex care programs.

1. Motivate with Non-Monetary Values

Finance leaders are inspired and motivated by more than just dollars and cents. One of the most underrated principles in building a strong partnership is to understand how many financial professionals are inspired by and committed to the mission of the organization. While they have a responsibility to ensure that the organization can sustain itself financially, they are also driven by the goals of improving health, particularly for communities that have been marginalized.

"To me, even as a finance person, the term return on investment (ROI) is almost too simplistic. Other things are just as important to the holistic picture.”

Rick Wagers, Emeritus Executive Vice President and Chief Financial Officer, Regional One Health.

“Our Board absolutely wants it. They say, 'the finance stuff is great, but tell us about what you're doing to meet the mission. What are you doing to care for the community and the poor and vulnerable? You really have to connect it back to why we're here.”

Ben Carter, Chief Operating Officer, Trinity Health

2. Partner to Choose Measures

Interviewing your CFO or a finance staff member to discover what matters most to the organization will help you to target your measures and approach to advocate for your program.

Regional One Health in Memphis, Tennessee has a successful complex care program called ONEHealth serving people who are uninsured. Regional One Health included the CFO as a partner in the design of their initiative from the very beginning. They defined measures of success together, which has paid off in support for the program for the long term.

 “Our CFO opened the door for us to make the case that investing in these programs creates return on investment, not just in bending the cost curve of utilization. He has spoken very eloquently about our primary goal being to improve the health of the folks that we’re taking care of. If we do that, the measures of health are important. Our quality metrics became important, the benefit to the community matters, there’s a benefit to individuals achieving self-sufficiency. These measures broadened the definition of return on investment in our value case.”

Susan Cooper MSN, Senior Vice President & Chief Clinical Integration Officer, Regional One Health

3. Learn the Language

If you want to advocate for your population, you need to learn the language of finance to help articulate what you want to accomplish. Understanding key concepts like fixed and variable costs, operating and contribution margin, and economic priorities for your organization will help you link the clinical imperative to a financial rationale. Building the Value Case for Complex Care toolkit provides resources and links to help you build this competency.

“Leaders like chief nurses need to be translators. They need to understand other languages in order to translate the story to people who have never been in a clinical setting and don’t know this world. Other people grew up with a different mental model. Physicians, nurses, finance – you have to understand all of them enough to understand their framework”.

Gay Landstrom, SVP and Chief Nursing Officer, Trinity Health

“You have to start marrying the clinical rationale with the financial imperative. It’s really about communicating that in a way that stays true to the mission and is savvy enough to generate the resources to actually address the problem. “

Dave A. Chokshi, Health Commissioner of New York City

4. Do Your Homework

Bringing a proposal to the table where you’ve worked out as much as you can regarding the finances will advance your mission and help your financial officer see the connection between the clinical reality and desired outcomes. Providing the data and analysis you have access to builds credibility and shows respect for the partnership with finance.

“As a nurse-led organization, whenever a new program is being developed, the first thing we do is figure out what will make sense to meet the need. We look at the volume and how many clients this will serve. We sit down and look at our model and identify the level of service we need. We start working on a budget. Then we say to our CFO, 'Here's how many FTEs we need. Here's the volume. Here’s the value equation. Now you plug in the numbers and make it work.'"

Pooja Bhalla, DNP, RN, Executive Director of Healthcare Services, Illumination Foundation

"You've got to be able to tell the story, no matter how hard or incomplete it is. A lot of people need that perspective for validity. It may not be the tightest ROI, but at least you've struggled through it. Then they’ll be willing to listen to the rest of it.”

Gay Landstrom, SVP and Chief Nursing Officer, Trinity Health

5. Recognize that CFOs Value Collaboration

Many of the CFOs we interviewed spoke about the desire to be part of something bigger than numbers. Ron Yee, MD, MBA, former Chief Medical Officer for the National Association of Community Health Centers, shared that he wanted to engage in solutions and transformation, and sought out opportunities where he could bring his best skills to the table to make things happen in partnership with others in his organization. Others we spoke to echoed this sentiment.

“If you’re a financial's really hard for you to connect to the people at the end of that because you're dealing just with numbers and you're not seeing patients. You're very rarely talking to're so removed from the conversation. If analysts understand the objective, they engage because it's very rare that people include them in decision-making.”

Torrie Fields, Chief Executive Officer, Votive Health

“As a CFO you can often be in an ivory tower and it's easy to say no. Being in the trenches close to where the action is, and seeing and feeling these things and being close to the people that are trying to do good things -- you want to be supportive of them. You’re part of the story of success.”

Rick Wagers, Emeritus Executive Vice President and Chief Financial Officer at Regional One Health

 “That's the exciting part, helping clinicians do their passion and finding that kind of partnership across other community services. It's not that people don't want to do it, it's just hard to see it. In the end, you all benefit from it. Patients really benefit. We're looking across this bigger community and we can all do something better."

Dan Green, Vice President of Finance, Mercy Health Saint Mary’s

Susan Cooper MSN, SVP & Chief Clinical Integration Officer, Regional One Health summed it up best:

“It's kind of like joining the head and the heart in a way that can create a full picture of the program as opposed to these little pieces and parts. Together we're able to connect all the pieces of the puzzle to create this overview of something that's really beautiful and wonderful for the people who need it most.”

That’s a powerful partnership to make the value case for sustainable change.