When Mary Jo Cagle, MD, stepped into the role of president and CEO at Cone Health, she became the first woman and first physician to lead the Greensboro, N.C.-based health system.
Now, four years after taking the helm and 14 years after joining the system, Dr. Cagle will step down as president and CEO due to a serious family health matter. Her last day with the organization will be May 31. Bernard "Bernie" Sherry, who has served as interim COO since December, has been named interim CEO.
In a conversation with Becker's, Dr. Cagle reflected on the leadership practices and cultural changes that most significantly improved access to care and patient outcomes during her tenure.
Dr. Cagle noted that Cone Health -- a nonprofit system with approximately 13,000 employees and more than 150 locations, including five hospitals -- has been intentional about collaborating with community members and ensuring its leadership team reflects the demographics of the area it serves.
"And that's not just ethnically," Dr. Cagle said. "That is, that there's female representation. Part of our market share is rural, so we want rural leadership represented. And, of course, there is the ethnic element as well. We feel like we represent our community best when the leadership, [including the board], is representative of our community."
She said during her tenure, Cone Health has also been intentional about including the voices of the community and front-line workers as the system develops its strategies.
"Not just consultants and administration sitting in a room developing strategies, but really being collaborative in developing those strategies, and in doing so, we have created an organization that has deep support of the communities that we serve," Dr. Cagle said.
One example of this is Cone Health's pursuit of health equity. Dr. Cagle said the community has supported this pursuit, which centers around a broad definition that addresses equity among various geographic, demographic and socioeconomic populations.
"This is not a political statement here," she said. "This is a health statement, because if we look at our data here, we know that we are a historically and nationally unhealthy community, and our goal is to increase the health of our entire community. So, in our northern area of service, it's a very rural community with average age being much higher, and so we got an elderly rural community that had a problem with access.
"Our strategies there have to be very different. In Guilford County, where our Moses Cone Hospital is, it's a very ethnically diverse community, and so the strategies of building trust in those underserved communities need to be different than the rural community. We've tried to say, let's understand the challenges of inequities in care and all the ways that that occurs, and listen to our community members and their perceptions about where we've fallen short and how we can improve that, and partnering with them. That's led to great partnerships with businesses, with school boards, and with the cities and counties that we serve."
During her tenure, Dr. Cagle has also played a significant role in key decisions, including Cone Health becoming part of Washington, D.C.-based Risant Health, a nonprofit organization that is part of Oakland, Calif.-based Kaiser Permanente. Risant members have access to its value-based platform, which can help provide resources to advance health-focused care in multipayer, multiprovider environments.
When it comes to navigating decisions related to evaluating and potentially entering a partnership or merger, she pointed to a structured due diligence process, as well as physician involvement and a calculated evaluation approach.
"One of the big, important things we learned -- and that was very important to our board -- was to sit down and clearly delineate what we must have in any partnership," Dr. Cagle said. "And we talked about values and culture, but deeper than that, what were the characteristics in the culture that had to be honored? Nobody's going to match your culture or your values exactly, but what were the things we were going to look for? We [considered] the must-haves that would tell us we could move forward, and what were the things that, if we saw them, would be a red flag or even a stop sign? We delineated those things -- the things we were going to be looking for during our due diligence."
She also noted the importance of physicians being part of the due diligence process. She said physicians were key to helping make the Risant decision and encouraged leaders at other systems to ensure their perspectives are part of significant decisions.
Outside of these decisions, she emphasized the importance of innovations in proactive wellness care or data-driven care in the next five years. Specifically, initiatives to move toward value-based care and lowering the cost of care.
"If we're really going to get to value-based care and lowering the cost of care, we're all going to have to move much further upstream, keeping populations healthy, and I think we're going to have to look at food as medicine," Dr. Cagle said. "For instance, how to choose food, how to prepare food and what a healthy diet looks like. Helping people -- certainly with certain disease states -- to choose and know what diets to eat, yes, but even earlier than that, how to help a healthy family stay healthy choosing. It's surprising how many people don't know how to choose and cook a healthy diet using fruits and vegetables and not using processed food. So I think the whole program of food as medicine, and how to cook here and do healthy food -- I think we're going to have to say, 'This is how you do that.'"
As Dr. Cagle discussed the future of the industry, she highlighted the need for health systems to also build robust workforce pipelines. She said this means partnering with educators to ensure young people learn about healthcare careers earlier in their lives.
She said she also is optimistic about opportunities for artificial intelligence and robotics to alleviate administrative burden in the workforce. "Let fantastic nurses get at the bedside and do what they're passionate about doing," she said. "I think we're just beginning to see some of that innovation, and there's a lot more to come."
Ultimately, her sentiments returned to the importance of partnering with communities, listening to community leaders and opportunities for collaboration. Dr. Cagle believes leading with this in mind has significantly shaped her tenure at Cone Health.
"It has been an honor," she said, reflecting on her role as the first woman and physician to lead the health system. "It's been an opportunity to show other women in the organization, in our state, what's possible."