Why You Need to Know Him:
Because James Hinton is the first outsider to lead Baylor Scott & White Health, the largest nonprofit health system in Texas, stretching back more than half a century before the Dallas-based healthcare juggernaut merged with Temple’s Scott & White. Hinton is a lifer from New Mexico’s largest health system, Presbyterian Healthcare Services, and didn’t come up under Baylor royalty like previous CEO Joel Allison did.
Allison was the understudy of Boone Powell Jr., who led what was then known as the Baylor Health Care System from 1980 through 2000. Powell Sr. ran the show for three decades before his son. Speaking to Hinton, it seems as if he’s followed this same lineage even though he hasn’t—he says all the right things and can back up his philosophy with experience. There are visible parallels with Allison’s clear-eyed assessment that healthcare needs to start paying for outcomes rather than procedures.
In New Mexico, Hinton was early to the managed-care trend, deciding in 1985 to launch Presbyterian’s own health plan. He instituted a triage program for the emergency room, suspecting as many as 30 percent of its patients could be seen in settings that didn’t cost as much. So those folks who ambled in with sinusitis got seen within 24 hours by a primary care doctor instead of an emergency physician. Another program allowed patients with chronic diseases to be seen by doctors in their own homes—and the hospital supplied the technology. Presbyterian was also one of the federal government’s so-called “Pioneer” plans, which meant that the hospital system would either be penalized or rewarded for its outcomes.
“He’s got incredible vision in terms of understanding where the world is going, and understanding that if we’re going to try to make healthcare more affordable and … better, that we needed to develop new models,” says Rick Pollack, American Hospital Association president and CEO. “That’s a vision that so many of us have come to join him in.”
In some ways, that vision was born out of competition. Hinton doesn’t speak of epiphany moments—he chose a graduate degree in healthcare administration over law school simply because law didn’t sound as interesting. He would rather discuss challenging times that required him to implement something that would give the system a competitive edge. He speaks of the first time Presbyterian’s executives met with Intel. “They said, ‘You know, if our chips had as many flaws in them as your health system, we’d have been out of business a long time ago,’” Hinton remembered. “These big, sophisticated corporations can hire the best consultants that can mine the data just like we can mine the data. They know where the gaps are.”
In some ways, that’s freeing for him. There is nowhere to hide, and if the system is not successful in driving down costs for employers, they will simply go to the competition. In New Mexico, that was Lovelace, the nimble, physician-owned health system and medical group that rose to national prominence after hosting the health assessments for the Mercury astronauts, who were immortalized in the 1983 movie “The Right Stuff.”
The formation of the health plan was in response to losing patients to Lovelace, Hinton said. Here in Texas, he’ll have to deal with the challenges that come with a broader geography, a much larger system, and more competitors. Presbyterian was an eight-hospital system with 10,000 employees and an affiliated physician group of 850 or so providers. Baylor Scott & White includes 47 hospitals and more than 1,000 clinics and outpatient centers spread across 250 miles. And, healthcare is trending away from inpatient services and toward outpatient centers located in communities. It’s been years since inpatient revenue increased in Texas, which puts forth a problem that doesn’t just affect Baylor—how are those huge hospitals best used?
Hinton tells a story of arriving at Presbyterian to find a 60-bed inpatient unit for elderly patients having cataract surgery. They’d arrive overnight, be given strong general anesthesia in the morning, have the hour-long procedure, and be unable to wake up—so they’d stay another night. He noticed how wasteful that process is. Today, he notes, you can “almost get that cataract surgery done in a drive-in window.”
“Everything about how we take care of people is so different today,” he says. “We just have to make sure these big inpatient centers are adapting to that.”
That’s a message he’s carried for years on his way up to board chair of the American Hospital Association. He recalls one particular meeting in Washington, D.C. The room was pretty buttoned-up. In his address, Hinton brought up the ’90s country song “Bubba Shot the Jukebox,” by Mark Chesnutt. “The story is that Bubba goes into this bar, right, and there’s a song that makes him cry. So he goes out to get his gun, and he comes back in and shoots it,” he says. “Healthcare is going through a lot of change; we can’t be like Bubba and shoot the jukebox.”
Saving money and quoting country songs–sounds like all the new Texan needs now is a pair of Lucchese boots.