RISE News nยบ4 - Spring Quarter 2019
BEST OF NASHVILLE
Read what our RISE Nashville keynotes had to say at our biggest conference yet.
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NEWS THE LATEST RISE recommended reading: The promise and pitfalls of Medicare Advantage encounter data
Why women must be strategic about their personal and professional image
Agent fraud alert: Beware of potential genetic test scams
Affordable Care Act news roundup— Department of Justice now supports full repeal; House Democrats make moves to strengthen law
7 business gems from Starbucks marketing guru John Moore
4 things to know about the latest changes to the CMS HCC 2019 Risk Adjustment Model 3 health plan executives to join CEO roundtable on Medicaid Social determinants of health: 5 takeaways from the 2nd annual RISE Symposium Improve the member experience through value-based enrollment
Bloom Analytics toolkit + techno-functional SMEs = HEDISÂŽ & Star success
Cognizant
A Year of Collaboration
Wunderman
CMS releases RADV auditor guidance
The latest on Medicaid Work requirements Medicare Advantage achieves costeffective care and better outcomes for beneficiaries with chronic conditions relative to fee-for-service Medicare
Avalere Converting commercial members to Medicare members: Barriers and opportunities
Deft Research Health Value - based payment: A 5-step makeover for health plans
SS&C DST Health National survey reveals greater risk of seniors switching Medicare Advantage plans in 2019
Welltok
WA N T TO K N O W MOR E?
Click to see our entire collection of Insights & Articles 2
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The Best of RISE Nashville
Hear about our fearless keynote speaker Aron Ralston, who inspired attendees with his tale of survival and life lessons learned after he was trapped by an 800-pound boulder in a remote canyon for five days.
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SUMMARY 3
The Latest News
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Note From the Director
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Letter From the Editor
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The Best of RISE Nashville
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And The Winner Is....
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6 Trends in 2019 Medicare Shopping and Switching
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Leadership Lessons from Dr. Tiffany A. Love
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Upcoming Events
And the winner is....
Dr. Mark Dambro is this year’s winner of the Martin L. Block Award for Clinical Excellence and Innovation. His wife and daughter surprised him at RISE Nashville and were there for the presentation of RISE’s most prestigious award.
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6 trends in 2019 Medicare shopping and switching Senior citizens typically don’t want to shop for insurance products...
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Kevin Mowll Executive Director, The RISE Association
Note from the Director:
REFLECTING ON HOPEFUL MESSAGES FROM NASHVILLE
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resh from Nashville, I am excited to report that our big annual summit was a huge success. Thank you to all who came and participated. This newsletter contains some terrific articles that dip back down into the rich and insightful content from the conference, providing you an extension of the terrific experience and learning that occurred.
We had some amazing keynote speakers who provided inspiration, insights, and hopeful messages that applied to all of us. Additionally, our executive committee members served as a panel to open the event with their expectations for the conference, and to close the program with a recap and reflections. It was clear that, while there are several emerging and notable issues in our regulatory and compliance environment, there is still a lot of basic “blocking and tackling” required daily to 4
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run the business. With the growth of the industry overall, there is a constant influx of new employees needing introduction and orientation. There are new plans, new service vendors, mergers and acquisitions, and rebranding, which combine to make a dynamic and exciting context for our event.
of interest in the attached newsletter. We look forward to hearing from you with opinions, reactions, and recommendations. Our second quarterly newsletter sets us on course for the annual CMS bid filing season, RADV audits, ACA marketplace settlements, and more to come.
RISE also revealed the four major facets of our organization, showing how we strive to meet the needs of our customers on a 24/7 basis:
As always, we wish you all the best in your busy endeavors.
• Events, such as RISE Nashville, RISE West, Risk Adjustment Forum, the “Qualipalooza,” as well as webinars throughout the year • Articles & insights, including our website news and our quarterly newsletter • The RISE Association • The RISE Institute Even if you weren’t among the more than 1,400 people who attend RISE Nashville, I trust you will find articles
@RISEhlth
Sign up for our Medicare Marketing and Sales newsletter Ilene MacDonald Editor, RISE
Letter From the Editor:
CROSS-COUNTRY CONTENT It’s been a busy few months at RISE. Just weeks after we returned from our annual Medicare Marketing & Sales Summit in Las Vegas, we headed to Nashville, where we hosted more than 1,400 attendees who represented 587 organizations across 46 states in the United States! Whew! Yes, the team was tired but left both events recharged and ready to act on all we learned. In this spring issue of our quarterly newsletter, you’ll find coverage of RISE Nashville, including excerpts from our keynote presentations and hot topic discussions (Spoiler Alert: social determinants of health was one of them). You’ll also read about Mark Dambro, M.D., this year’s recipient of the Martin L. Block Award for Clinical Excellence and Innovation, RISE’s most prestigious award. These two articles will give you a sense of what attendees learned at the event, and I’ll be writing more articles based on conference sessions in the upcoming weeks. This issue features surprising research findings from Deft Research’s 2019 Medicare Shopping and Switching Study, which analyzed the responses of more than 3,500 seniors who either had a 2018 Medicare Advantage plan, a 2018 MedSupp plan, or an original Medicare only plan for 2018. George Dippel, senior vice president of client services, gave an overview of the findings at this year’s Medicare Marketing & Sales Summit and the trends uncovered may help your sales and marketing teams prepare for next year’s Annual Election Period. You’ll also read my interview with Dr. Tiffany A. Love, who will be a featured speaker at our upcoming RISE National Women in Health Care Leadership Summit, April 29-30, in San Diego. Dr. Love, regional chief nursing officer for Coastal Health Care Alliance, is refreshingly honest about her rocky journey to the C-suite and offers thoughts on leadership development, diversity, and the need for women to support one another. We hope you enjoy the spring quarterly newsletter and we welcome your feedback. Please let me know what you think about the stories in this issue and ideas for other topics you’d like to see covered in our fall 2019 publication.
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oin RISE June 27 - 28th, 2019 in Orlando, FL for the 4th Annual RISE Quality Leadership Summit at the Waldorf Astoria Orlando!
Qualipalooza is the only ‘TEAMCENTRIC’ conference focusing on four key areas in quality of care and improving performance for a wellrounded team learning experience. Bringing all seniority levels from high level execs to managers for two days of in-depth content curated to sync all team members’ mindsets to the ultimate goal—maintain or improve quality rating. At Qualipalooza, we take things a step further with more focused discussions on: Star Ratings, HEDIS scores, CAPHS and HOS, plus pharmacy measures to maximize efficiency and revenue within your plan than any other conference. You asked and we listened– we’ve moved to Florida! With so many amusement parks within driving distance, bringing your family is a must!
To contact the editor, please email IMacDonald@risehealth.org
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THE BEST OF RISE NASHVILLE 1,400 executives 587 organizations 112 speakers 46 states This is what made RISE Nashville bigger and better than ever before.
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Keynotes made us laugh, cry
ASHVILLE, Tenn.— More than 1,400 executives and senior leaders from hundreds of health plans, provider groups, integrated health systems and service providers across the country came together last week in Nashville to share strategies to address regulatory challenges, the latest trends and developments in the industry, member engagement strategies, and care outcomes.
The 13th annual RISE Nashville Summit was our biggest event yet, drawing representatives from 587 organizations across 46 states. Attendees came from various backgrounds, including risk adjustment, quality improvement, business development, data and analytics, operations, product management, marketing, and actuarial. The three-day conference, which included a pre-conference day with five workshops, featured roundtable discussions with exhibitors and eight learning tracks with more than 40 sessions that addressed top issues facing health plans today, including risk revenue management, quality improvement, member engagement and care management, payer-provider collaboration, new technologies and advanced analytics, and policy updates. Speakers also tackled emerging issues, including opioid addiction and abuse, and cybersecurity.
Hot topic discussions Conference Chair Nathan Goldstein, chief product officer, Signify Health moderated an audience-driven panel discussion on challenges within the industry, including proposed changes by the Centers for Medicare & Medicaid Services (CMS) to RADV audits, as well as final changes to the Medicare Advantage HCC risk adjustment model, and the ongoing issue of inconsistent documentation in electronic health records and the need for improved provider and coding education. CMS
deputy
directors
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Social determinants of health was also the underlying theme of Dr. John Medina’s keynote, who noted that one of the biggest culprits of a deteriorating memory and physical health is loneliness.
Matrix Medical Network shared its Mobile Health Clinic with RISE Nashville attendees.
representatives from the Office of Inspector General were also on hand to provide regulatory updates. Although those sessions were closed to press, attendees had the opportunity to ask regulatory officials about new policies, audits and other changes coming down the pike. Traditional health care services only address 10 percent of health determinants and health plans need to work with providers and community partners to tackle the other factors, including social circumstances and behaviors. Indeed, Goldstein said at the top of the conference that there is growing recognition within the industry that if we don’t address the issues surrounding social determinants of health that are outside the health care system, then it is too late by the time it arrives within the health care system.
Medina, a developmental molecular biologist and author of the New York times bestseller, “Brain Rules: 12 Principles for Surviving at Work, Home and School,” kicked off the summit with an entertaining but poignant look at the aging brain, providing strategies to keep our brains sharp throughout our lifespans, and ultimately changing behaviors to reduce future health care costs. Fortunately, he said, there are actions we can take to stay mentally alert as we age, including the usual suspects like diet (plant-based diets are the best) and exercise (but not too much, brisk walks that add up to 150 minutes a week will do). There are other ways to improve working or short-term memory, he said, like learning to play a new musical instrument as well as the music theory behind it, mastering a foreign language over the course of a year (a year of Mandarin is ideal for native English speakers), and read a book (paper, not digital) at least three-anda-half hours a week. But one of the best ways people over the age of 65 can mentally stay at the top of their game: Teach young children. Research shows that those who teach preschool-age children have a decreased incidence of depression, anxiety and stress, and they lower their mortality risk. It also benefits the children. Seniors are more patient than a 30-year-old teacher and preschoolers show an increase in problem-solving ability, language and emotional development, and have greater social skills than their peers who didn’t receive the intergenerational teaching experience. Social interaction is also vital. Globally, 7
Everyone will encounter a boulder in their lives and with it a feeling of crisis, as if their world is turning upside down”
Medina said, cognitive decline is 70 percent less in seniors who remain socially active, whether it’s through frequent contact with family, neighbors or friends. Indeed, memory studies conducted over a 12-year period found memory declines in lonely seniors at twice the rate of socially active seniors. Loneliness not only impacts cognitive function, he said, but also erodes their immune function, elevates stress hormone levels, and increases risk for heart disease. Indeed, the probability of death is 45 percent greater for lonely seniors, he said. “Loneliness really hurts this population. It makes them sicker and kills them, in fact,” Medina said. “Socialization cures that.” Aron Ralston, an experienced hiker and climber and author of the New York Times bestseller, “Between a Rock and a Hard Place,” inspired on the second day of the conference with the life lessons he learned after he became trapped by an 8
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800-pound boulder in a remote location for more than five days, ultimately freeing himself by severing his own arm with a pocketknife. It was difficult to listen to the retelling of his ordeal, but his message was not about what he lost. Instead it was about what he gained from the experience. Everyone will encounter a boulder in their lives and with it a feeling of crisis, as if their world is turning upside down, he said. For Ralston, it was the knowledge of his certain death as his food and water supply dwindled and the fact that there was no one within miles to find and rescue him. As he stood in what he was sure to be his grave, Ralston said he experienced a revelation about what was most important in his life. It wasn’t about accomplishments, it was his relationships. “It’s not what you do, it’s about who you are and who you love,” he said. And when you can’t confront those obstacles on your own, you turn to those
relationships, Ralston said. His survival is a miracle, and Ralston said he looks back at the experience not in horror, but in gratitude and he continues to thank the boulder for that lesson. “When the boulder comes to you, do you push it away or do you open your arms and welcome it,” said Ralston, urging attendees to think about why that boulder has come into their lives and what they can do to turn those obstacles into blessings.
TWEETING THE NASHVILLE TIMELINE
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AND THE WINNER IS....
RISE recognizes Dr. Mark Dambro with Martin L. Block Award
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ark Dambro, M.D., senior vice president of health informatics for Signify Health, was awarded the Martin L. Block Award for Clinical Excellence and Innovation at the 13th Annual RISE Nashville Summit.
The Dr. Martin L. Block Award is a prestigious accolade presented annually at RISE Nashville that acknowledges an individual’s effort to enhance the lives of America’s seniors through clinical leadership, policy vision, and by superior example.
Dr. Dambro was selected largely in part for... his unwavering dedication to improving patient experience and care by utilizing data and technology” 10
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Chosen out of four finalists, Dr. Dambro was selected largely in part for his career spent enriching the lives of his patients, fellow physicians, and colleagues through his unwavering dedication to improving patient experience and care by utilizing data and technology. “We are extremely pleased to present Dr. Mark Dambro with our Martin L. Block Award,” said Kevin Mowll, executive director of the RISE Association. “Dr. Dambro has a long and distinguished career that included many years of private practice where he directly provided for patients and expressed his deep commitment and dedication to the well-being of those under his care. That sensibility expressed itself continuously throughout his career and is readily
(right) RISE Nashville Conference Chair Ana Handshuh looks on as Dr. Mark Dambro learns he is this year’s winner of the ML Block Award.
apparent in any presentation he makes to conference audiences.” A graduate of Washington University School of Medicine in St. Louis, Dr. Dambro began his career as senior vice president for a large hospital corporation in 1987. Several years later, he decided to pursue his dream of opening a private family medicine practice where he saw thousands of patients–many of whom were Medicare patients–and ran a paperless office well ahead of his time. In the 1990s, Dr. Dambro authored, and coedited with Dr. Winter Griffith, the 5-Minute Clinical Consult, fulfilling his longtime dream of bringing a handheld clinical reference to the practicing physician. Dr. Dambro was then recruited to a consulting position to help build a Medicare risk adjustment company known as Censeo Health. He joined as chief medical officer (CMO) and in his role, he continued to teach the art of bedside diagnosis while helping the company develop 1,000+ clinical and practice-related questions for in-home health assessments. Dr. Dambro helped health plans and medical groups align risk adjustment with care management, interfacing with CMS, the health plan, Censeo Health, and the practicing clinician. 11
In his current role at Signify Health (formerly Censeo Health), Dr. Dambro uses his clinical and technology background to transform the quality and delivery of care via the organization’s intelligent technology platform to create a better care experience through Signify’s national network of clinicians. Nathan Goldstein, chief product officer, Signify Health and conference chair of RISE Nashville, presented the award to Dr. Dambro, whom he described as a close friend, colleague and partner in Signify’s mission to improve quality of life by providing comprehensive care where and when it’s needed most.
Dr. Dambro said that it was an honor to receive the award but described his work as a team effort that began when he
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was in private practice with a nurse and front office staff who helped him deliver good medicine to his patients that has continued today with his team at Signify Health. “I am so humbled,” Dr, Dambro said, equating the moment of receiving the award to one of the most memorable of his life, including his marriage, graduation, and birth of his first child. “It is particularly poignant to be honored by my peers and standing here to accept this award.”
About the Martin L. Block Award for Clinical Excellence and Innovation The Dr. Martin Block award is given annually to an individual who has made a significant impact in the lives of America’s seniors through clinical leadership, policy vision or through superior example of RISE’s mission to promote continuous
improvement in the health care system. The main criteria for this award, in memory of Dr. Martin L. Block of Arizona. Includes the following: Nominee may work within the clinical field as an MD, NP, RN, PA, DO or otherwise clinically credentialed.
• Nominee can work for a health plan, accountable care organization or vendor/supplier to the health care marketplace. • Nominee must have fulfilled one of the following criteria: • Contributed to significant process improvement in the care of seniors • Dedicated more than 10 years to exemplary work in this industry • For more information and details please visit: http://risehealth.org/ martin-l-block-award
...equating the moment of receiving the award to one of the most memorable of his life, including his marriage, graduation, and the birth of his first child
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6 TRENDS IN 2019 MEDICARE SHOPPING & SWITCHING Senior citizens typically don’t want to shop for insurance products. But this year 1 out of 3 seniors either switched health plans or are compelled to at least look at other options... 14
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enior citizens typically don’t want to shop for insurance products. But this year 1 out of 3 seniors either switched health plans or felt compelled to at least look at other options, according to George Dippel, senior vice president of client services, Deft Research, LLC. And about half of those who switched plans did so even though they were happy with the coverage they had in 2018.
Dippel, a featured speaker at the 12th Annual Medicare Marketing & Sales Summit, discussed the trends in Medicare shopping and switching during this year’s Annual Election Period and what the findings mean for health plans. The findings are based on the market research firm’s 2019 Medicare Shopping and Switching Study, which analyzed the responses of 3,554 seniors who either had a 2018 Medicare Advantage plan (MA), a 2018 MedSupp plan, or an original Medicare only plan for 2018. The survey was administered from Dec. 10 to Dec. 31, 2018. Below we summarize the highlights of the study.
The national MA market was relatively stable—except in these four regions. Dippel said that MA members in Minnesota, Northern California, Illinois, and Maryland were disproportionately forced to switch their coverage. Minnesota experienced the most significant plan disruption with 400,000 members forced to switch plans because of a federal competition requirement that eliminated Medicare Cost plans in most counties of the state.
MA plans that increased premiums for 2019 saw drops in memberships. Dippel said that each 1 percent increase in a premium was associated with a 0.1 percent membership drop on average. The average premium increase for 2019 was 6 percent. 16
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Roughly 10 percent of Medicare members switched plans or insurers during the 2019 AEP. Seniors spent time looking at new coverage options if their current plan had a negative change in either access or cost-sharing: • Seven percent of those surveyed switched insurers; three percent switched plans but kept their insurers. • Nearly 58 percent of all switchers moved from one MA plan to another. • Twenty-eight percent of all switchers moved from a MedSupp plan to another MedSupp plan. • Seven percent of all switchers moved from a MedSupp plan to an MA plan.
MA members were twice as likely to switch plans or insurers during the AEP than those with MedSupp. Dippel said that is likely because MA members face fewer barriers to switching plans (no medical underwriting, for example) and MedSupp members can change plans at any point throughout the year.
Half of switchers were satisfied with their 2018 coverage but shopped around anyway and found a better 2019 option. Why did they shop around? Most said they wanted to conduct “due diligence” to make sure the coverage they had in 2018 was still the best option in 2019. This means insurers could lose members to competitors that have even more appealing coverage options. Therefore, Dippel said, plans should add or increase benefits and benefit levels next year to keep existing members and attract new ones.
Why did they shop around? Most said they wanted to conduct “due diligence... This means insurers could lose members to competitors” Most popular supplemental benefits: Eyewear and overthe-counter (OTC) pharmacy allowances. Nearly half of MA members surveyed said they would be more likely to switch to a different MA plan if it offered annual eyewear coverage. Close to two-thirds of MA members also said transportation benefits would influence to some degree their likelihood to switch plans. But the most popular combination of potential supplemental benefits that would entice the largest proportion of MA seniors to switch plans is a three-benefit package that included an eyewear allowance, gym benefit, and OTC pharmacy allowance.
Most Common Reasons for Shopping Medicare Plans Conduct “due diligence� to make sure 2018 coverage was still the best option for 2019 Annual Notice of Change (ANOC) letter 2018 coverage was changing Someone recommended to look at other options 17
LESSONS IN LEADERSHIP
Dr. Tiffany A. Love on leadership development, diversity, and the need for women to support one another
Dr. Tiffany A. Love on how to overcome setbacks and help develop diverse health care executives
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t’s common to hear positive stories about how leaders rose in the ranks to the executive suite. But not all leadership journeys are easy. Tiffany A. Love, Ph.D., regional chief nursing officer for Coastal Health Care Alliance, will discuss her own bumpy road to the C-suite at The 3rd Annual RISE National Women in Health Care Leadership Summit , April 29-30, in San Diego. RISE talked to Love ahead of the conference about her thoughts on leadership development, diversity, and the need for women to support one another.
Dr. Tiffany A. Love is a Ph.D. and holds numerous credentials. She serves as the regional chief nursing officer for Coastal Health Care Alliance and the 18
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chair of the board of directors for the Health Care Diversity Council. But her path to the C-suite was not an easy one and she plans to share her story at the upcoming 3rd Annual RISE National Women in Health Care Leadership Summit to help encourage women not
to let failures hold them back from pursuing leadership roles. “The reason I have decided to talk about this issue is because I have found people will very quickly tell you positive stories about how they’ve risen to the ranks of the executive suite. But often if you have a chance to know these leaders personally you’ll learn many of their experiences were not so great, and there were times in their lives they didn’t think they’d make it to the executive suite,” Love told RISE. Those bumps and challenges often serve as lessons that will help women become great leaders, she says. “It’s really driven my mission and vision for my career to help support and develop diverse healthcare executives. I consult with women trying to get to the next level of leadership and confront the challenges they may have encountered through my own experience of overcoming barriers to get to the executive suite,” Love says. And there are a lot of barriers. Research shows that approximately 87 percent of white males make up the executive suite and many organizations have no racial, ethnic or gender diversity on their leadership teams, according to Love. “Why are women not getting the opportunity to lead? When you look at the statistics, you realize that almost half of the people graduating within graduate-level programs are women. So, you can’t say we don’t have enough educated women in the pipeline. For whatever reason, they aren’t given the opportunity,” she says.
How to overcome barriers to promotions The biggest challenge that women face is that Caucasian men will typically select Caucasian men for promotional opportunities. “They pick someone most like themselves,” Love says. “That is part of the barrier into the executive suite. Research also shows that if there is a pool of candidates with one or two women and the rest are men, there is a low probability that the women will be selected.” Women have a better opportunity to be promoted when they have a male mentor, she says. The #MeToo movement may make some men reluctant to mentor women, but Love says it’s important to change those attitudes because both men and women have something to gain from mentor relationships. “We need to educate men that promoting women or working closely with a woman doesn’t mean you are putting yourself in a vulnerable position for complaints of harassment. It’s more important we educate executive leaders of what is acceptable behavior and what is not. In many organizations there has been a culture where it’s okay to make sexist jokes, or they don’t realize there is not gender equity, or they realize there is a problem and they don’t know where to start to fix it. Part of the solution is to promote women in leadership so it’s not all men and one woman on the board. We need more diversity in the executive suite,” she says. Her advice to help women overcome
Those bumps and challenges often serve as lessons that will help women become great leaders
these barriers: If women are in a management position, Love suggests they ask senior leaders for permission to develop a program to mentor and sponsor women. The number one way to bridge the gender gap is to create a program where women can be mentored and sponsored, she says. She also encourages women to support one another. “Madeleine K. Albright once said ‘there is a special place in hell for women who don’t help other women.’ Back in the day there was the perception that there was room for only one woman at the table. There was a lot of competition to be that one woman at the table. But there is opportunity for more than one woman to have a seat at the table,” she says. Love says women must speak positively about each other and promote each other. “Regardless of how bad things may get, I really think women shouldn’t speak badly of other women. Even if you don’t like someone. When we speak badly of other women, it perpetuates gender inequity and is an excuse for organizations not to promote other women. You rarely hear men talk about other men in this way,” she says. That’s why Love believes it’s so important for women to attend The 3rd Annual RISE National Women in Health Care Leadership Summit, April 29-30, where they can learn from one another. “It’s an opportunity for women to connect with one another, support one another and build relationships. It’s a place we can go to support and lift each other. We need to take advantage anytime there is an opportunity to congratulate women and bring attention to their accomplishments. I do it and I encourage others to do the same,” she says.
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UPCOMING EVENTS
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RISE Newsletter
March 15-17, 2020
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