view from the top

Interview with Scott Storrer, CEO, MEDecision

Creating a high-performance culture positions a leading health information technology company for growth

When mid-sized companies are preparing for major growth, it sometimes takes a significant culture shift to move nimbly to the next level without excessive growing pains. This was the case at health information technology company MEDecision when Scott Storrer was brought in 2008 to succeed the founder and CEO.

Scott Storrer was brought in by company founder and CEO David St. Clair as his successor as he prepared to retire at the end of 2009 after 21 years. The company had been bought by Health Care Service Corporation and was at the threshold of significant core growth and expansion into emerging collaborative health information technology (HIT) solutions.

St. Clair built his company into the market leader in its industry, providing state-of-the-art technology platforms for patient care, disease management and utilization management and a health care information exchange. He had nurtured a family-oriented culture, but it had become clear that the culture needed to change to move MEDecision to the next level of performance and growth.

A health care industry veteran, Storrer's challenge was to build a high-performance culture that retained the best attributes of the family culture, such as its work-life balance, flexible work schedules and the relaxed, creative feel that works so well in a software development environment.

In this view from the top interview, Storrer says that he came to MEDecision having learned some important lessons about shaping a culture during his years at Cardinal Health, where he was group president of the pharmaceutical segment, and CIGNA Corporation, where he was executive vice president of service and information technology.

He knew that for a culture to be successfully shifted across an entire organization, it must be led by the CEO, rather than by leaders of divisions or departments. He also experienced the need for senior team alignment. Storrer believed that for change at MEDecision to be widely embraced and adopted, a strong cultural foundation should be created first in order to support a new strategy and structure.

It was the right time to do this because the company had yet not set its strategy and there was openness to changing the structure, he notes in the following interview. So, within a few months of his appointment, Storrer brought Senn Delaney in to help address several challenges and create a healthy, high-performance culture.

During the last year, Storrer has led the company to milestones that have set the stage for the company's meaningful growth, including:

• growing MEDecision's business in 2009 in a down economy

• assembling a highly credentialed team of senior executives and managers from such organizations as Capital One, CIGNA, Deloitte, GE Healthcare, Horizon Blue Cross Blue Shield of New Jersey, IBM, Landacorp, Siemens Medical and UnitedHealth Group

• acquiring HxTechnologies, a health information exchange company that specializes in enabling the seamless and secure flow of clinical data among health care stakeholders

• extending the functionality of MEDecision technologies through in-house development and strategic partnerships

• receiving ranking as one of the “Best Places to Work in Healthcare” by Modern Healthcare Magazine and one of the “Best Places to Work in Pennsylvania” by the Central Pennsylvania Business Journal

Storrer believes the culture-shaping work built the foundation to create greater alignment and focus around the vision, mission and goals, build trust and accountability and enable people across the organization to think differently and embrace change.

As a result, MEDecision is better positioned to grow exponentially and better serve the needs of its customers.

Download the article or continue reading the interview below.


When did you join the company and what drew you to the role?

I came to MEDecision in December 2008. It was appealing to me personally and professionally for several reasons. From a personal standpoint, I have a strong passion for health care, especially for the value that technology can bring to improving health outcomes.

It was also an opportunity to do something very different in my career. We're a mid-size company. It was an opportunity to prove myself as a leader of a smaller, growing organization, and work in a founder-led organization that is highly entrepreneurial.

During the election, there was a strong potential for health care reform, and using technology is a big part of the solution. As a health information technology company, MEDecision is well positioned to be a powerful puzzle piece in improving health care. That was very appealing.

The other thing that really drew me was how well the company was positioned. It is a 21-year-old company. MEDecision had just been taken private by a large health care service corporation, which provides a lot of stability. We have the capital and backing to grow our business in this emerging space of health information technology.

What were the cultural strengths and challenges when you arrived?

We are the market leader in our core business for utilization management, case management and disease management. One in six insured Americans — about 45 million individuals — is managed on our collaborative health care management platforms.

But technologies change, and technology and software development in particular demand high-execution discipline. When I went through the interview process, David was absolutely open with me about challenges and things we needed to focus on around execution. It was clear that the company could do better.

The culture was more family-like. Some of the good aspects are very important and have to be maintained, such as work-life balance and flexible hours. We are a software development house, so free sodas and wearing jeans and having the flexibility to really be creative and do innovative things are part of that.

The whole key here is how do we maintain the good aspects of a family-like culture and at the same time transition it into a healthy, high-performing culture? For example, one of the attributes that was okay for 21 years was a not-for-profit type of mentality. There wasn't a strong focus on pricing the market to make sure that we're optimizing fair profit.

Coming from a large company, I made the wrong assumption that I would have fewer resources with which to work. What I found was that the company is very resource rich. Our branding and marketing communications, for example, was far more developed than I have experienced at other large corporations .

The key thing I would say about the culture is that we had a lot of resources, but there was a lack of alignment across the groups. We were well positioned for the next stage of growth to take advantage of the current market opportunities that are presenting. However, if we are going to scale the company and go big, we have to focus on integration of how we work together across the silos to bring the best value and service to our customers.

Why did you decide to work on the culture right away?

Although I was in the president and COO role, David allowed me to run all aspects of the company. I was adamant when I took this job that the thing I was going to focus on first was culture. I would make sure that it was done from the top down, and that the CEO would embrace it and push it throughout the organization.

Call it luck or being in the right place at the right time, but here was a company that David had hired me to take big, and it had not yet set its strategy and David was very open to changing the structure. It was the opportune time to sequence things in the manner that we did.

I knew that sooner or later we had to get around to strategy, and we would have to address the structural issues to get back to the basics to best serve the customer. But my learnings from CIGNA and Cardinal were that before you can work on structure and strategy, you need to make material movement on the culture.

Within my first month here, that is where I began. I started in December. In January, we started discussions about bringing in Senn Delaney. David was skeptical but saw how strongly I believed in this and said he would support me, and he did.

You believe in aligning the culture with the strategy and structure. What have you done at MEDecision?

If I didn't have the experiences of Cardinal and CIGNA, I probably would have done it differently. I would have focused on structure first, gotten some people in on the leadership team, done strategy and, at the same time, start to muddle through culture. But I would recommend to anyone to focus on the culture first.

We didn't begin working on strategy and structure until we were a good few months in to the cultural transformation. Once I started to see the lead team buying in and some momentum building , that is when we started to tweak the structure and hire additional A-level talent. We came together to work on our multi-year business strategy in the summer of 2009.

How has working on the culture first helped support your strategy?

We did the first culture-shaping session in February with my team of leaders who were here at the time. By the first half of the year, a good portion of the company went through the process.

The culture-shaping process has helped employees understand where we are very strong as a company and our weaknesses. This was helpful when we started to get into discussing structural change.

As we began strategy discussions for growing big in health information technology, we talked about the need to diversify into other areas of health care technology that have not been associated with the company.

The Senn Delaney concepts they learned in the sessions really enabled them to look at things differently. People really got it. They didn't fight it. They embraced it.

As we began to build the strategy, for the first time in my career, I was heartened to find that we did not have pockets of the organization resisting the new directions in which we are headed. I think that a lot of that is because culture has to link to structure and to strategy. All three need to be in alignment. If you have to pick one to start with and to get real traction on, it is the cultural piece. If you do not get that right, the culture will not endorse the structure and people certainly won't embrace a longer-term strategy.

Did the culture shift have a positive impact on the process of creating the long-term strategy?

It has really paid dividends. We believe that strategy is invented from within. For a 90-day period, we got about a third of our company involved with our multi-year strategy. We took that group offsite for three days at the end of a 90-day sprint to pull the strategy together.

Several Senn Delaney leadership and teamwork concepts around the role of thought and healthy state of mind, helped us to have difficult discussions about where the company was heading in a more productive, trusting, open and collaborative way.

We were able to see perspectives we might have missed if we were working within a dysfunctional culture where people are afraid to express different points of view or ideas.

As we started to lock in to where we are going strategically, we had a lot of discussions about structure. We talked about how we had to reorganize, how people would have to give up piece of their square, so to speak, to really contribute to make sure we could be successful in delivery of our strategy.

We then brought the strategy to a company meeting where everyone had an opportunity to offer opinions and ask questions. Going through that strategic process as employees was very powerful.

By having invested in the culture, the strategic process was just a great success, including how we worked through it and how broadly it has been accepted by the company.

You have made dramatic change to the culture in a short period of time. Can you provide some examples of improvement?

This past year, we have had new leadership, we have gone through a different type of business planning, and we have shifted the strategy. And while we continue to lead our core business to stronger growth, we are starting to branch out in other areas. About 30 percent of our employee base is new, which changes the cultural makeup.

Through all this change, we were able to grow the business and improve our customer satisfaction despite the weak economy. We also acquired a company during the first quarter of last year. Because the cultural work provided us with a more enterprise-wide leadership perspective, my lead team has an appreciation of the new thinking that the founder of that company brings to the table. That understanding helped the team to accept and bring the leader of that company strongly on board into our company. It's been great.

I feel good that there are clearly elements of the family culture that we have maintained, but that we have coupled that with elements of becoming a high-performance culture. It is a healthy, high performance culture and that shows up clearly in employee surveys.

One of the positive aspects of the culture is that the company and employees all have a desire to succeed. People are very resilient and open to change because they believe in the company. They just didn't have the kind of leadership and strategic focus that they have now.

What are you doing to get the high-performance values you have identified from being in place to in use?

Our focus in 2009 was on reinforcing the values of trust, coaching, feedback and accountability. We have focused on using the Senn Delaney Accountability Ladder, on how you build trust and on giving coaching and feedback.

One of the things we have used quite effectively here with employees is a culture placemat.

Our vision and mission statement have not changed in 21 years, which is something very unique for company, and a tribute to David St. Clair. The vision and mission will not change either to support where we need to go with our core business and emerging markets.

The culture placemat is very helpful to visually demonstrate how this hangs together. It helps us understand how all department strategies line up and support the strategy. It allows us to focus on how we want to lead. It is a visual roadmap to that enables employees to understand the enterprise goals in the calendar year and the non-negotiable cultural elements that we are going to focus on.

We have backstopped the culture work with top-shelf communications. We do monthly town halls. I am very transparent in sharing our senior team meeting communications information throughout the entire company. We worked hard this year to immerse our employees in information on how our business works, our customer issues and what is happening in the market. We do that through town halls, and on our intranet site's leadership corner with new articles from any senior leaders who want to address the entire company on a topic or situation.

At the end of every town hall, we do a survey to ask people where they are on the Mood Elevator, another Senn Delaney concept that connects people to healthier mood states. The vast majority of employees are halfway to the top of the Mood Elevator and grateful.

I understand that you just finished culture-shaping sessions for the remainder of the company. What is next?

Now that individuals are strongly living the values of accountability and trust, in 2010, we will continue to reinforce those attributes but also strongly focus on creating greater degrees of teamwork and clarity and alignment of goals.

We will be thinking about how we can use this greater degree of energy and positive behavior to bring everyone together across the enterprise to create value for our customers. We will remain steadfast in our work to transform into a truly market-driven culture company.

Where are you headed as a company?

The company has all the right ingredients, the right people and the right technical assets to play really big in health information technology. My goal is to grow the company at levels of five to 10 times its current size in the next five years. We are now much better positioned to realize that amount of growth on a controlled basis.

The goal is to have well over 50-percent market share in our core business within three years. We have about a 30-percent market share today.

In our emerging health information technology areas of electronic health records, telehealth and clinical trial recruitment, we want to have a 25- to 30-percent market share over that same period.

I would categorize 2009 as a foundational year — the first year of a two-year turnaround. We were able to get back to the basics in each of the functional disciplines to best service our customers. Now that the functions are back on solid footing, in 2010, we are beginning to integrate across the functions, breaking down silos to truly maximize customer satisfaction and customer value.

The cultural profile of our strengths and challenges from when we first measured the senior leadership team and then six months later were radically different. It's hard to draw definitive conclusions about the shift since half of those leaders have since changed over. However, the most recent survey had no red at all (challenges) and had moved into green (strengths) on virtually every measure. Most notably, there is greater accountability, clarity about the vision, mission and goals, openness to change, higher trust and openness, and greater alignment and focus of leadership at the top.

We have not yet measured the culture shift of the company as a whole, but we do know from two significant ratings that are based on employee surveys of pretty much the same measures used by Senn Delaney that our cultural health and employee satisfaction has greatly improved.

Modern Healthcare ranked MEDecision 21st out of 100 est places to work in all of health care in the U.S. To provide context, GE Healthcare ranked 88th on that scale. I am an ex-GE guy, and I thought they had the best culture in the world. We did this survey when about three quarters of the company had gone through the Senn Delaney culture-shaping process. It's pretty impressive that we were ranked 21st out of 100 in all of health care. We had never ranked in previous years.

In the state of Pennsylvania, we were ranked 33rd best place to work, across all companies and industries. We have never ranked at all in previous years.

What cultural challenges do you see during this growth period?

Maintaining the culture we have been creating is going to be the trick as we grow. As you grow, you're bringing in new people. This year, we grew our employee base 30 percent, and you can feel it. When you bring in top talent from other organizations, everyone brings along their own cultural elements. All of a sudden, you have an influx of 30 percent of new employees who may not value those family-like values we have here.

The challenge is how to find the best of those elements and carry them on and shape the new people who come on board to embrace the family elements of the culture.

How do you define success in terms of executing your strategy?

What I keep telling the company is that success for us is not seeing major changes or swings year over year. There needs to be continuity. As I look out over the next couple of years, I see keeping the mission and vision we have had for 21 years intact for the most part in our core and emerging business. We look to see slight change in the enterprise goals each year and slight change in the department strategies that support all this.

As long as you have the right strategy, the right structure and the right cultural norm, employees should expect almost minimal, planned and fluid change as we move forward.

The culture placemat has been really helping to demonstrate that. We had our placemat for 2009 and our company meeting for 2010. When we put that up on the board, everyone was looking for big change; the reality is that there is little change.

To me that's just a measure of success and one more example of how we have used the techniques to educate the company and move everyone forward.