Fact: The US spends much more on healthcare than other rich countries but has fewer hospital beds and doctors. That’s hurting us now as we battle COVID-19. In this podcast, Carecentrix CEO John Driscoll and I explain what’s going on and what we can do about it.
Massachusetts General Hospital and the Brigham and Women’s Hospital joined together as Partners HealthCare 25 years ago. Now they’re changing the name to Mass General Brigham, spending up to $100 million in the process. I’m quoted on the subject in a recent front page Boston Globe article (In major rebranding, Partners HealthCare to change name to Mass General Brigham).
What’s in a name, you may ask? In this case it’s worth parsing the change and exploring the history.
What does Partners mean anyway?
Partners HealthCare never had much brand equity. The word “partners” really described the decision of the two hospitals to partner with one another to offset the power of managed care organizations to play them off against one another. All HMOs needed one of those hospitals in their network, but not both. With Partners it was all or nothing. Partners had no problem playing “take it or leave it” right from the get go, nearly bringing Tufts Health Plan to its knees in the late 90s.
So unlike your typical business combination, which relies on elimination of duplication and other efficiencies to be successful, Partners succeeded right away by virtue of its enhanced market power and high pricing. Duplication remained –and remains to this day. MGH and the Brigham continued to move forward on their own while a new Partners overhead was introduced. No one –not patients, not doctors, not nurses– developed any attachment to Partners as an entity.
Why keep General?
Massachusetts General Hospital has kept the same name since its charter was granted by the Commonwealth of Massachusetts in 1811. It’s a proud name, and maybe sometimes a little too proud. (Some say MGH stands for Man’s Greatest Hospital.)
“Massachusetts” is shortened and “Hospital” is omitted from the new name. Of all the words to keep, why was “General” left intact? It seems so… generic. But it also reminds us of the grand era of American industry. General Motors. General Electric. General Atomics. (Remember that one.) The idea was that the one General company could dominate the industry and we’d all be the better for it.
Outside of this state, errr… Commonwealth, “Mass” doesn’t necessarily mean Massachusetts. It could mean a Catholic Mass or a big pile of something. But MGH is so often referred to here and abroad as Mass General that it must have seemed safe to trim it down officially, since the whole name is long anyway.
Where did the Women go?
How did Brigham and Women’s Hospital (BWH) get its name? Unlike MGH, BWH went through some name changes, although none recently. The Boston Lying in Hospital was founded in 1832 and the Free Hospital for Women came about in 1875. They merged in 1966 to become the Boston Hospital for Women. (Apparently that name didn’t stick right away, since I was always told I was born in the Lying in Hospital –even though I was born after the merger.)
In 1980, the Peter Bent Brigham Hospital, Robert Breck Brigham Hospital and Boston Hospital for Women merged (not partnered) to become BWH.
If they had called it the Women’s and Brigham the Women’s name might have survived the latest consolidation rather than being unceremoniously lopped off.
GSK not G SK
Back in the 1980s and 1990s a lot of big pharmaceutical companies merged. It was typical for them to drop the last name of their multiword names when they did. For example, SmithKline & French became SmithKline Beckman after merging with Beckman and then SmithKline Beecham after merging with Beecham.
When Glaxo Wellcome and SmithKline Beecham came together they followed a similar path. But you may notice they went with GlaxoSmithKline rather than Glaxo SmithKline, because the SmithKline people thought that would make it harder to get rid of their name later on. That’s a true story. I was there.
The stratagem has worked so far.
I wonder whether the BWH folks lobbied for MassGeneralBrigham to avoid a similar fate down the road.
When did Hospital become a bad word?
Remember when there were doctors and hospitals? Now it’s providers, medical centers and health systems. Hospitals still dominate economically and politically, but there is a general (and welcome) shift to lower acuity settings of care. Meanwhile Partners has vacuumed up so many other hospitals, physicians and other players that “hospital” no longer belongs in the name.
An interesting marker of the new company’s brand equity and name recognition is that unlike virtually every other new healthcare organization or company, it omits the word “health” from its name. People already understand it’s a healthcare organization.
What about Harvard?
MGH and BWH are both Harvard hospitals. So why not just call it the Harvard Hospital System or Harvard Health System? The use of the Harvard name could be a topic for its own post (Harvard Pilgrim –originally Harvard Community Health Plan and soon to merge with Tufts but with no name announced yet– is a great example) but the simple answer is that while MGH and BWH are Harvard hospitals, there are others like Beth Israel Deaconess and Boston Children’s that are also affiliated with the University.
When I read ‘Fear of Falling’: How Hospitals Do Even More Harm By Keeping Patients in Bed I was reminded of the old adage, ‘What gets measured gets done.’
In this video I lay out three solutions to the problem of overzealous pursuit of fall reduction:
- Keep the measure but change the target so we’re not aiming for zero falls
- Add a new measure of how much patients are getting up and walking
- Reduce the penalties for excessive falls
What do you think?
Question: How do you know when a non-profit healthcare organization is getting too big?
Answer: When it’s considering spending over $100 million to change its name.
Partners HealthCare was founded in 1994 when Massachusetts General Hospital and the Brigham and Women’s Hospital decided to team up (“partner”) to defend themselves against Blue Cross and Harvard Pilgrim, which for a brief moment had gained the upper hand as managed care caught on. As a new MBA at the Boston Consulting Group, I remember seeing the projections: MGH and the Brigham were going to be in trouble as Massachusetts copied California and drove down hospital utilization.
Insurance companies didn’t need to include both MGH and the Brigham in their networks–so they tried to play them off against one another to get better rates. That’s why Partners was created.
The two hospitals never wanted to merge and in the end they didn’t have to. The healthcare economy boomed, no one could exclude Partners from their network, and Partners was able to use its muscle to do very well in managed care contracting.
Partners got its act together and executed well, especially compared to its local academic and community-based competitors.
A quarter century later, the original partners have acquired several other hospitals and physician organizations. It’s the biggest private employer in Massachusetts by far, and rivals the state government itself in terms of workforce size.
Lately the company has had to deal with its success. Healthcare costs are a big issue in Massachusetts –as they are elsewhere– and Partners is in the crosshairs. The company is built for market power and clinical excellence, which does not lead to the lowest cost approach. And leaders within the Partners hospitals have been reluctant to cede authority to the central organization.
Something has to change. In particular Partners has to do a better job of integrating its various components –or so goes the conventional wisdom.
New CEO, Dr. Anne Klibanski was mostly recently the head of research for Partners. She’s touted as a great listener, and good at getting people to collaborate. But as I told the Boston Globe (New Partners Chief no stranger to role of uniter)
As a good listener, Klibanski could successfully unite the various factions at Partners. “On the other hand,” [Williams] said, “listening might not be the issue. Partners might need someone to bang people’s heads together.”
Now comes word that Partners is thinking of investing $100 million in changing its name to something more alluring like Mass General Brigham Health. It could be worth it to Partners by bringing the different factions together and for marketing and fundraising purposes. (For sure it will be great for branding and marketing agencies!) But what does that say about the state of healthcare in Massachusetts?
An expert quoted in the Globe (As Partners HealthCare rethinks its strategy, it’s considering whether to change its name) said it best:
“I don’t think those names matter to ordinary human beings who get health care in our state,” said Alan Sager, a professor at the Boston University School of Public Health. “The underlying fights about decentralized versus centralized power are internal matters for Partners. I don’t think they should plague the public with their own organizational anxieties.”
Partners has great hospitals and great people that make it the pride of Massachusetts. It does make business sense for Partners to consider rebranding. But that doesn’t mean it’s good news for the finances of those footing the bill.
Looks like Rhode Island would rather create a health system monopoly than allow in a competitor from Big Bad Massachusetts. Partners HealthCare has been trying to acquire the second largest hospital system in RI, but now the governor has pulled together the three biggest systems to see if they can come together instead.
Partners is staging a tactical retreat (see Partners pulls out of talks for Rhode Island health system) in the Boston Globe.
Thankfully, I am not privy to the details of how things operate in Rhode Island and I don’t know how hard these three systems’ heads are being banged together to get them to team up. But my guess is there’s a good chance the parties will fail to coalesce and that Partners will be back.
Here’s what I told the Globe:
“It was clear that some of the powers that be in Rhode Island want to maintain a Rhode Island-dominated health care system,” said David E. Williams, president of Health Business Group, a Boston consulting firm.
“I don’t think it’s actually going to solve any of their economic problems,” Williams said, “and I think it’s reasonably likely that Partners will be back at the table in three to six months after Rhode Island determines that going it alone is not viable.”