Editor's note: This is the second in a series of stories called "Profiles in Health" - a look at how health care leaders experience the American health care system as consumers and patients. The series is part of the Healthy States project, American Public Media's focus on information, insight and experiences in health.
By Jennifer Vogel
When Mary Brainerd, CEO and president of HealthPartners, was first diagnosed with breast cancer in 2000, she was flabbergasted. "I think anybody who hears 'cancer' and them in the same sentence is shocked, and shocked at a fundamental level," she said from her 10th floor office in Bloomington, overlooking the Minnesota River. "All the way from fear to guilt, you wonder, what did I do that I would have brought this on myself?"
At 59, Brainerd looks the picture of health. She is an avid biker, hiker and bird watcher with bright blue eyes and a genuine laugh. Given that there is no history of breast cancer in her immediate family, she didn't expect a routine mammogram to turn up a lump. "I was pretty stunned."
The cancer was found early and treated in just over four months with a lumpectomy and radiation. "I didn't have to have chemotherapy," said Brainerd, who was HealthPartners' chief operating officer at the time. "I was really lucky. But that didn't change the emotional and psychological part of not sleeping and anxiety and worrying about my kids and my family." Brainerd and her husband Dick, who serves on the city council in Mahtomedi, have a daughter and son, now grown.
She vividly recalls the fear of being a patient, but she also remembers looking on as a manager. "I think we did, from the standpoint of the care itself, we did a good job," she said. The cancer is gone and has not returned. But when it came to some of the less tangible aspects of treatment, "I could see where there was a missed opportunity. I think, I'm here fearing for my life, and if you would welcome me as if it wasn't a routine thing, I could really see the difference that a warm welcome and eye contact could make."
"You don't know when you first get that word ('cancer') whether it's terrible or not so bad," she said. "And so the sleepless nights and the fear just made me understand personally something I had not understood before, which was how much of illness is living with illness. We treat the body and we have so many opportunities to do more for people emotionally." Brainerd, who is formally trained in transcendental meditation, said, "Positive human connection helps with resilience. It helps with hopefulness."
These insights inform how Brainerd does her job, which is to run a company that both insures and provides health and dental care to 1.4 million people. A recent merger with Park Nicollet Health Services means the expanded HealthPartners now operates seven hospitals and more than 50 clinics in Minnesota and Wisconsin and employs more than 22,000 people.
Brainerd has pushed for high-quality care, urging staff to be more empathetic, proactive, and coordinated in their approaches. As a cancer patient, she noticed how small inconsistencies in what doctors recommended for follow-up care shook her confidence and made her wonder who to trust. She built new facilities at HealthPartners' Regions Hospital in St. Paul focused on breast health and mental health that promise not only state-of-the-art technology but compassion and comfort. She launched new management protocols for diabetes patients that keep them out of emergency departments and brought in programs that enrich the "whole person," such as one that distributes books to kids in waiting rooms. The non-profit National Committee for Quality Assurance has ranked HealthPartners the top private health plan in Minnesota for nine years straight. Last year, Modern Healthcare magazine named Brainerd one of the most influential people in the field.
You don't know when you first get that word (cancer) whether it's terrible or not so bad ... The fear just made me understand personally something I had not understood before, which was how much of illness is living with illness.Mary Brainerd
Brainerd was raised Catholic in St. Paul. Her father was a stockbroker and her mother a librarian at the University of St. Thomas--it was her mom, whom Brainerd calls "a very advanced thinker," who pushed her to learn meditation. She attended the Convent of the Visitation high school, built around Salesian spirituality, or spirituality in the everyday world. St. Francis de Sales is credited with the adage, "Bloom where you are planted." Of the experience, Brainerd said, "I appreciate the values of the school and the sisters, and the huge advantage of seeing women lead an institution."
Kathy Cooney, HealthPartners' chief administrative officer, who considers Brainerd a friend, describes her as insightful, smart, and curious. She recalls a conversation with the CEO not long after her mom, also named Mary, died. "She said, 'My mother was the most wonderful, warm person. She came into a room and was always warm. Anyone she ever talked to always felt respected, because she gave them her full attention.' I said, 'Mary, you just described yourself.'"
It was while attending the University of Minnesota as a philosophy student that Brainerd got her first taste of health care. She took an internship at the Minnesota Department of Health, where she helped organize a public health conference. "By the time the summer was over, I was kind of hooked on health care but with a totally unrelated undergraduate degree," Brainerd said. She cured that by taking night classes at St. Thomas, where she earned a master's in business administration. She was working at Blue Cross and Blue Shield of Minnesota when she was recruited in 1992 to come to HealthPartners. She became CEO ten years later.
Brainerd sought the position because she likes the company's philosophy of making decisions from the patient's point of view; the board of directors is elected by HealthPartners' membership. "I love that because it gives real clarity to me about what I should be considering first and last when we make important decisions," she said.
According to Cooney, who has worked at HealthPartners for nearly three decades, Brainerd is a "very balanced individual. She values her family. She values her workout time. The fact that she is a well-rounded leader only makes her a better leader." Her background in philosophy and meditation is in keeping with those qualities, she said. "A lot of us have benefited from that. We are dealing with difficult issues sometimes, but we don't feel flustered or frenzied."
That calm was on display when Brainerd was contending with cancer. Most of those she worked with had no idea. "I can vividly remember when she got her diagnosis," Cooney said. "She was sitting in her office with her husband. She handled it with class. She modeled resiliency for all of us."
After Brainerd finished what she describes as, "four and a half months of anxiety and fear and cancer treatment," she turned to meditation. "I went to a seminar that Jon Kabat-Zinn, who is really the founder of mindfulness meditation, did. I'm not a zealot meditator, but I do believe that we still are not connecting with whole people and therein lines another opportunity. To be able to be resilient, because of some of the ways our lives in general take so much out of us, you need to replenish."
Brainerd doesn't talk readily about her private life, but she occasionally speaks of her fight with cancer in the belief that real, human stories can connect people and motivate them. When she first took over as CEO, she commissioned a play called "Fire in the Bones," which explored different health care scenarios for a character with cancer. It was repeatedly performed for HealthPartners employees in order to spur discussion around what changes might allow front line workers to better do their jobs. "We heard hard things," Brainerd said.
Stories about "being on the other side of the bed" can be powerful tools and "a reminder of shared humanity," said David Abelson, an internist, who was CEO of Park Nicollet before the merger and now is HealthPartners senior executive vice president and president of the combined care group. Abelson speaks openly about a recent mini-stroke that landed him at Methodist Hospital, where he has worked for years. "I was not a stranger," he said. "I have all of this training. I know a lot of medicine. But when that event occurred and I couldn't stand, I was in a strange land. I was afraid. The biggest symbol to me was the ceiling moving as I was on a cart being wheeled to radiology. When else in your life do you watch the ceiling move?" It was an aspect of the patient experience he hadn't previously considered. "People are creating these lifelong stories, which you as a caregiver also have," he said.
Abelson has known Brainerd since just after she joined HealthPartners. "She has an incredibly, huge heart," he said. "That heart drives the work that she does and the work of the organization. She's also incredibly intelligent and very straightforward." Like most of those around her, he didn't know about Brainerd's cancer, but he says talking about it "makes her come across as a leader who is amazing and genuine."
In 2012, HealthPartners opened the new mental health center at Regions. It was designed with the help of a family and patient advisory council. "What they had to say was, start from scratch," Brainerd said. "Look at what facilities are healing and hopeful for people with mental illness, as opposed to a step up from a jail. It's so much more about what does it feel like when you're admitted. How can it be a warm welcome. How could you still feel like you have dignity. How quickly can we get your belongings back to you, not lock them away. How quickly can you dress in regular clothes."
HealthPartners also has been part of a campaign called "Make it OK," designed to lessen the stigma of mental illness. Asked what prompted the focus on mental health, Brainerd said, "A story, actually."
She remembers being at Regions one Christmas Eve, on her way home to a party. "And there was a woman on the elevator with me who clearly was experiencing or had experienced mental illness. So I just said something casual to her like, 'I hope you are going to have a good holiday.' And she said, 'I am going to have a great holiday.' And so I said, 'Terrific, what's up.' She said, 'I'm celebrating. The first year I have ever lived on my own independently was this year. I live in an apartment and I made it a year.' I am like, 'That is awesome.'"
"Then she said, 'And I'm here to spend Christmas Eve with the reception staff in the Emergency Department.' And that is just what broke my heart. That was her relationship. And it was like, we have to be able to do better than that."
Brainerd ties HealthPartners' mental health initiatives back to her own experience as a patient. "We've been on a big journey with big results, simply trying to recognize that our work some days might feel routine, but for our patients we never know," she said. "It may be the best day or the worst day."
"The medical care and the technology are one thing, but the human contact and a healing relationship is for our patients absolutely essential."
Jennifer Vogel is a freelance journalist living in Minneapolis and a contributor to MPR News.